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EMS News in Focus
by Arthur Hsieh

Paradigms clarified: The future of EMS under Obamacare

What needs to change is our own perception of services we provide today compared to what we could provide tomorrow

By Arthur Hsieh

Editor's note: Art Hsieh clarifies and responds to questions about his earlier take on the healthcare ruling.

Based on the comments received from last week's SCOTUS ruling on the Affordable Care Act, I'm throwing in a few of my crystal-ball prognostications for thought and debate from fellow EMS colleagues.

The paradigm shift: I believe that as more insurance companies become responsible for more patients, there will be increasing scrutiny on making healthcare more affordable — i.e., more cost-efficient.

I believe allied health professions, including EMS, are poised to fill this void. What needs to change is our own perception of the services we provide today compared to what we could provide tomorrow. Transporting low-urgency patients to a very expensive and inefficient method of care must be replaced with a better trained and equipped workforce that can provide fundamental initial treatment and make accurate transport decisions to appropriate and, at times, alternative levels of care.

Another impending paradigm shift is that we stop working in a silo isolated from the rest of the healthcare continuum.

We need to understand how partnerships with physicians, nurses, allied health and public health can enhance the overall safety net and plug the gaps that currently exist today. A crude example is the transport of a STEMI cardiac patient directly to the cath lab, bypassing the emergency department.

What about following up with patients after they have been discharged from a hospital? Could we help reduce the rate of reentry into the emergency care system? I think so.

Of course, all of this takes education, training and a persistent commitment to change. That, my friends, I am not yet convinced EMS is ready to do. Hopeful, but not convinced.

Change requires advocacy. We also need to be able to look at ourselves and our industry in the mirror and say, "We're not ready for this sea change. Yet. But we can make it happen through a unified, cohesive approach with buy-in from all stakeholders."

That's what I'm rooting for.

About the author

EMS1 Editorial Advisor Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. Since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a textbook author, has presented at conferences nationwide, and continues to provide patient care at an EMS service in Northern California. Contact Art at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Alan Perry Alan Perry Wednesday, September 04, 2013 4:41:19 AM Art, very good summary of current circumstances and the new opportunities they present. I hope the discussion and action by our EMS colleagues steps up so we can steer the policy and legislative processes required to make these concepts reality.

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