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The Ways and Means to ensure resilient emergency medical care

Ed Racht and Matt Zavadsky recount their EMS advocacy testimony to the U.S. House Committee

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In this episode of the EMS One-Stop podcast, Dr. Edward Racht and Matt Zavadsky join Rob Lawrence to discuss their recent attendance at the U.S. House Committee on Ways & Means hearing on “Access to Health Care in America: Ensuring Resilient Emergency Medical Care,” which took place in an off-site hearing in Denton, Texas, on March 18, 2024.

Dr. Racht, chief medical officer of Global Medical Response; and Zavadsky, chief transformation officer for the Metropolitan Area EMS Authority (MedStar Mobile Healthcare) discuss the evidence and the key issues they conveyed to the committee.

Dr. Racht’s testimony included:

  • The significant advancements made in emergency medicine over the past decades, leading to reduced mortality and disability rates for patients.
  • The importance of updating Medicare reimbursement rates for ambulance services, which have not been revised for over 20 years.
  • Advocating for wholesale reform of Medicare’s coverage of emergency medical services to align with contemporary practices, such as covering treatment in place and transportation to alternative healthcare sites.
  • Matt Zavadsky’s testimony included:
  • The impact of CMS payment policies on EMS, which incentivize unnecessary transportation of patients to the emergency room.
  • Innovative programs initiated by EMS agencies to prevent unnecessary 911 calls and navigate patients to appropriate care settings.
  • Legislative changes required to provide EMS with flexibility in patient navigation, including treatment in place and transport to alternate destinations.
  • The challenges faced by ambulance services nationwide, especially in rural areas, exacerbated by the COVID-19 pandemic.

Top quotes from this episode

“We are the front of the frontline in medicine.” — Dr. Ed Racht

“Our coordinated and integrated EMS and healthcare system now gives gravely injured patients ... the opportunity for rapid surgical intervention and a chance at full recovery.” — Dr. Ed Racht

“Emergency healthcare professionals pride ourselves on our ability to dramatically decrease morbidity and mortality from unexpected and sudden illness and injury.” — Dr. Ed Racht

“CMS payment policy is such that we are incentivized to transport every 911 patient to the ER because that is the only time we get paid.” — Matt Zavadsky

“Ambulance services are a vital component of our local and national healthcare and emergency response systems.” — Matt Zavadsky

“Innovative EMS agencies ... have initiated patient-centric programs designed to prevent 911 calls and navigate patients to the most appropriate care setting.” — Matt Zavadsky

“Ambulance services across the nation, especially in rural areas, are facing unprecedented challenges.” — Matt Zavadsky

Episode contents

0:05 – Introduction

0:55 – Guest introduction

1:40 – Explaining the Ways and Means Committee

2:30 – We are being noticed!

3:40 – Preparing for a congressional hearing

5:40 – The impact of having a congressional hearing in an EMS location

5:58 – The genuine interest of the committee members

9:00 – Dr. Ed Racht testimony to the Congressional Ways and Means Committee

14:24 – Matt Zavadsky testimony to the Congressional Ways and Means Committee

20:52 – Dr. Racht and Zavadsky’s reactions to the evidence they gave and the feedback

29:00 – Zavadsky’s key points he wished to reinforce during his evidence session

31:45 – Balanced billing, patient protections and removing the patient from the middle of the process

32:50 – Independent Dispute Resolution (IDR) and its challenges.

38:29 – Questions for Secretary Becerra on Capitol Hill

44:00 – Final thoughts

45:00 – A call to action to become one and present a united front “When we unify, we are unstoppable.”

48:00 – You the listener are the great politician

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.