By Drew Johnson
EMS1 Editor
These days, EMS has a lot going against it.
In the current system, many agencies suffer under huge stressors caused by a range of issues, many of which could be alleviated by a move to a mobile healthcare model of EMS, according to a session led by Chief Dennis Murphy — former EMS Committee Chair at IAFC – at Fire-Rescue Med in Las Vegas.
Chief Murphy says inefficiency caused by dealing with non-emergency calls, a reduction in Medicare and Medicaid reimbursements, budget cuts at the local and national levels, anti-labor laws, and growth in competition are just several of the factors putting terrific strains on some agencies.
His proposed mobile healthcare solution would restructure the way healthcare is delivered, creating a dual model that addresses patients who need to be treated and released separately from those who need transport to the hospital.
“It’s a comprehensive system of healthcare designed to deliver all types of episodic mobile medical care and transport, including EMS, but not chronic care,” Murphy said.
The mobile healthcare model would do everything from providing medical advice all the way up to mobile transport.
The goal model is to provide just the right level of healthcare for each patient, matching the care to their needs, and not “over-triaging,” Murphy said.
He explained that, too often, responders are called out to help patients that could easily have been treated over the phone by their doctor or a registered nurse.
“The classic example is the patient who needs pain medicine,” he said. “They go to bed at level four on the pain scale and wake up at level eight. They want their pain pill and they call 911 so they can go to the emergency room and get their medicine, which is of course a huge waste.”
In the mobile healthcare model, the patient could dial a seven-digit number (instead of 911) and a mobile primary care unit would be dispatched to their home. The dispatcher is still at the heart of the operation (the “nerve center,” Murphy said) so they are able to switch the call over to emergency if the case becomes worse.
The obvious benefit is that the patient gets the care they need, and nothing more, without an unnecessary cost to the hospital or the EMS agency.
The model speaks to a difference in culture between EMS and primary care. Where responders are trained to treat the patients and transport them to the hospital, “registered nurses are trained to treat and release, whenever safe, not treat and transport,” Murphy said.
The system would alleviate a pervasive problem that many agencies now face. Under new Medicare and Medicaid rules, if EMS agencies receive no payment for a patient they treat and don’t take to the hospital, Murphy said. It’s a regulation that has taken many agencies to the brink of closure.
The mobile healthcare model would be paid for on a membership basis, where people within a community pay a monthly fee that guarantees them whatever level of care is necessary. (Murphy pointed to FireMed as a working system.)
The point of the model is not necessarily to move people away from going to the doctor, Murphy said. The point is to simply make sure they’re receiving the appropriate level of care.
“I’m trying to get people to the doctor, not cut them off,” he said. “But only when they need to go, and never when they don’t”
The mobile healthcare model is pretty radical, and some in EMS may balk at the idea that their service will become de facto primary care. To this point, Murphy says, “People are turning EMS into a primary care system anyway. I say, let’s give it to them.”