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What changes in EMS will persist after the national emergency is over?

Funding a system of readiness through telehealth, treatment and alternative destination reimbursement for EMS


FDNY paramedic Elizabeth Bonilla strictly disinfects her ambulance prior to a double shift at EMS Station 3, Wednesday, April 15, 2020, in the Bronx borough of New York.

AP Photo/John Minchillo

COVID-19 has had a significant and likely lasting impact on EMS in the United States. Changes to our industry have ranged from using respiratory and eye protection on every patient call to CMS allowing transport of patients to alternative destinations like urgent care centers. Social distancing has changed the way initial and continuing education are delivered, protocols for cardiac arrest care have been modified in some jurisdictions, and the combination of certified personnel to make a legal ambulance crew has been broadened by emergency rules.

Which of those changes, from minimal to monumental, will stick?

At the conclusion of the COVID-19: Legal and documentation issues for EMS practitioners webinar, I asked the presenters to look beyond the pandemic. When we start returning to normal, what are the things that we are trying now that are going to stick with EMS for years to come? (Watch the free, on-demand Lexipol webinar for the information presented.)

Here are the responses from Matt Zavadsky, president NAEMT, and attorneys Doug Wolfberg and Steve Wirth of the EMS legal firm Page, Wolfberg & Wirth:

Treatment in place, alternative destinations is likely to become permanent

The things we have been fighting for are more likely to happen, such as treatment in place and payment for that treatment and transport to alternative destinations. I think this crisis has shown those services are an essential part of providing care and that is going to be on the front burner more than ever before.

From the standpoint of medical necessity, people are going to be more considerate about using ambulances in the future. We are already seeing across the country reductions of call volumes by 30 to 40% for non-emergency and emergency transport. That is going to be an issue of how to fund and sustain our system of readiness in the face of that call volume reduction.

— Steve Wirth, Esq., EMT-P, Founding Partner, Page, Wolfberg & Wirth

Lasting recognition that EMS is more than just a ride

For a long time, a lot of us have tried to convince the rest of the healthcare system and the payers that we are more than just a ride. I think that the value that we bring as more than just transportation is something that is going to stick

Also, the recognition of the profession. You’re seeing things on the cover of Time Magazine and on all sorts of large national media outlets about what EMS practitioners actually do in the field. I think that’s going to stick, but we have to keep that top of mind so we can continue to transform the profession.

— Matt Zavadsky, MS-HSA, NREMT, Chief Strategic Integration Officer, MedStar Mobile Healthcare; President, NAEMT

Payment must cover the full range of EMS services

I think something that will become more permanent or more prevalent is EMS having a key role in telehealth consultation. That is an opportunity to expand EMS revenue by partnering with telehealth practitioners.

I don’t think we’re going to see much HIPAA change as a result of the pandemic. HHS is sticking to their guns about the HIPAA rules are the HIPAA rules.

I think we are going to see some reimbursement changes with alternative destinations. I hope treatment in place is part of that.

Finally, we are in the first year of a national Medicare ambulance cost data collection program. For the next five years, Medicare is selecting samples of ambulance services each year. It is fortuitous that Medicare started this cost data collection program in January 2020. If Medicare and the federal government want to see what it costs to run EMS, this is a perfect time to show them. Costs are going up, and call volume for many agencies is going down. Just getting paid for a transport doesn’t pay for the cost of readiness, it doesn’t cover the treatment in place, it doesn’t cover the refusals, the non-transports or the standbys.

This is a golden opportunity for our industry and our profession to show the federal government that if they want this EMS safety net and critical services to be available 24/7 in our communities, don’t just pay EMS for the damn ride. You have got to pay for the cost of these systems to be in place. I think that’s something that should and can outlive this pandemic

— Doug Wolfberg, JD, Founding Partner, Page, Wolfberg & Wirth

Greg Friese, MS, NRP, is the Lexipol Editorial Director, leading the efforts of the editorial team on Police1, FireRescue1, Corrections1 and EMS1. Greg served as the EMS1 editor-in-chief for five years. He has a bachelor’s degree from the University of Wisconsin-Madison and a master’s degree from the University of Idaho. He is an educator, author, national registry paramedic since 2005, and a long-distance runner. Greg was a 2010 recipient of the EMS 10 Award for innovation. He is also a three-time Jesse H. Neal award winner, the most prestigious award in specialized journalism, and the 2018 and 2020 Eddie Award winner for best Column/Blog. Connect with Greg on LinkedIn.