Adapt or die: Is EMS ready for change?
EMS stands to win — or lose — a lot as the reimbursement model changes
By Art Hsieh
When the weather interrupted the plans of EMS on the Hill advocates to visit and speak with their congressional representatives Wednesday, NAEMT staff and the lobbying group Holland & Knight quickly put together an education session for the participants.
Over the course of the day, experts provided a background in the Patient Protection and Affordable Care Act (PPACA), also known as ObamaCare, and specific examples of how EMS is evolving to meet the needs of the new healthcare paradigm.
While it might seem tedious and boring, make no mistake: EMS stands to win — or lose — a lot as the reimbursement model changes.
The traditional, fee-for-service model of paying for ambulance transport is likely to disappear, to be possibly replaced by a "bundled care" reimbursement model, where multiple partners providing multiple services to a medical "episode" are paid one lump sum.
The fee will be based upon how each partner can demonstrate its effectiveness in the treatment and management of that episode. Think about it: EMS was built to transport, at great cost, a patient to an emergency department that provides care at great cost. Despite all of the professional care we provide on scene and in transit, none of it is paid for unless the patient is transported.
It doesn't matter whether the patient needed the transport. Because of this, it’s no surprise that EMS agencies would rather have the patient transported than to treat and release on scene.
Here is a more sobering thought: It's been only recently that EMS has been able to demonstrate its effectiveness in managing medical conditions.
There hasn't been any data to support that ambulance transport (as opposed to another method) makes a difference in outcome measures. Now how is that going to play out in the healthcare paradigm? Frankly, it's not going to.
The mainstay of healthcare reform pivots on the so-called Triple-Aim initiative. The three pillars include:
- Improving the patient experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita cost of healthcare
In other words, organizations that promote better care, a higher quality experience and reduce healthcare cost will be rewarded; organizations that cannot demonstrate those attributes are penalized.
This has serious implications for EMS. Existing EMS systems will see reimbursement dollars shrink over time. They must look toward partnering with other healthcare organizations to provide greater integration of services.
Whatever service is provided, there must be proof that it is effective and reduces cost. Herein lies the great opportunity: EMS as a profession has the opportunity to grow and become an accepted member of the healthcare system.
We are well positioned to work with hospital-based care organizations to assist with a variety of interventions and therapeutics that improve the outcome of the patient, without changing scope of practice.
Projects in Texas, Colorado and Minnesota have already demonstrated significant cost savings to the partnering institutions while providing reimbursement back to the system.
What will prevent us from succeeding is ourselves. Matt Zavadsky, Director of Public Affairs at MedStar Mobile Healthcare, indicated that there is a small window — 12 to 18 months — of opportunity to become an integrated part of the changes necessary to compete in the new paradigm.
Are you ready?