How EMS benefits from hospital readmission penalties
Increased economic pressure on hospitals provides the opportunity to reconfigure the role of EMS within an integrated health care system
Editor's note: This piece is adapted from the whitepaper, “The Future of the Ambulance Service Industry: Value-Focused, Consumer-Driven & Mobile-Savvy.”
Last month, hospital readmissions penalties under the Affordable Care Act were extended to include patients readmitted within 30 days of treatment for chronic obstructive pulmonary disease or total hip or knee replacement.
This is in addition to penalties put into place in 2013 for patients readmitted within 30 days for heart attack, heart failure, or pneumonia.
The penalties, which are aimed at financially punishing poor-quality care, are hitting hospitals hard. Nationally, hospital penalties for preventable readmissions are predicted to hit $756 million in 2014, up from the estimated $227 million in 2013.
These penalties are expected to have a trickle down effect in many other health care industries, including ambulance services and EMS.
An opportunity for EMS
Although paramedics and EMS professionals are not the primary drivers of high-cost, low-quality health care, EMS experts, including Glenn Leland, chief strategy officer at Pro-Transport-1, predict that health care reform could be a tremendous opportunity to reconfigure the role of EMS within an integrated health care system.
“If you step back and look at what’s going on with health care reform … much of the focus is on hospitals,” Leland said. “Hospitals are going through the majority of the change to improve the efficiency of our health care delivery system.
“In fact, EMS is attempting to solve some of the economic efficiency of the Medicare program and readmissions. I see the economic pressure on hospitals as a key, driving pain point for EMS in the future.”
Steve Wirth, one of the nation’s leading EMS attorneys, points to mobile integrated health care as a model for keeping patients out of the hospital and lowering hospital readmissions. These models can also offer greater continuity of care and provide patients with easily accessible primary care services and follow-up care.
Data shows home health care can lead to better patient outcomes. One study from North Shore University Hospital in New York found that among more than post-heart surgery 400 patients, those that did not receive home health care post-surgery were three times more likely to die or be readmitted to the hospital.
Heart surgery patients who received home health care after surgery from a nurse practitioner were significantly less likely to end up back in the hospital within the first month post-discharge.
This kind of positive outcomes data is feeding a growing interest and investment in these new models of care. Mobile integrated health care with EMS and/or nursing professionals can offer greater continuity of care, more hands-on help, and cut down on the need for the most expensive form of care: in-patient hospital care.
Another growing trend is the rise of consumerism in health care. Industry experts argue that EMS and the ambulance service industry must meet and exceed consumer demands to thrive in the new health care environment.
Consumers in the ambulance service industry include:
- Health care providers
- Health care organizations, such as skilled-nursing and assisted-living facilities
Consumers today expect:
- Convenience and an easy user experience
- Proven value for a service, especially a paid service
- Personal connection
- Accessibility of services, anywhere, anytime
To fully understand and meet consumer demand, the ambulance service industry has to recognize how consumer needs are shifting due to:
- An aging population
- An epidemic of chronic illness including obesity, heart disease, and diabetes
- A shortage of primary care providers and clinics
“We need to recognize that we’re health care providers, not emergency providers anymore,” said Jerry Overton, chair of the International Academies of Emergency Dispatch. “We have to redesign our systems around who is really calling for help and what kind of help they need. I think that’s the real challenge.”
Why EMS should shift to non-acute care
Increasingly, the ambulance service industry is being asked by patients and industry organizations to provide basic health care. This a fundamental shift for a profession that was created to offer life-saving, acute, on-scene care and transport.
For EMS providers that are willing to embrace and meet changing consumer demands, it is an enormous opportunity. EMS can offer extraordinary added value within an integrated health care system by using innovative non-acute care models to offer these four services.
- Provide greater continuity of care between health care facilities and the patient’s home.
- Offer post-discharge follow-up visits to help patients transition to their homes, maintain their care plan, and avoid hospital readmission.
- Refer patients, when appropriate, to urgent care or primary care facilities.
- Help patients better navigate the health care system, especially those with chronic co-morbidities or complicated medical conditions.
Some forward-thinking ambulance agencies — including REMSA in Reno, Nevada, MedStar in Ft. Worth, Texas, American Medical Response nationally, MetroAtlanta in Atlanta, Acadian Ambulance in the southern region, WakeMed in North Carolina — are embracing the challenge of meeting these demands.
These organizations have created innovative ways to offer non-acute care with EMS teams and health care professionals, including nursing hotlines, community paramedics, homecare follow-up visit programs, and other cutting-edge care models.  
To read more about the health care reform, health care consumerism, and the future of EMS and the ambulance service industry, download the complete whitepaper, “The Future of the Ambulance Service Industry: Value-Focused, Consumer-Driven & Mobile-Savvy,” which includes “8 Ways Better Technology Platforms Can Improve Ambulance Services.”
1. McCallion, T. Report Card From Reno. EMSWorld News. Oct. 12, 2014.
2. Kizer, KW, Shore, K, Moulin, A. Community Paramedicine: A Promising Model for Integrating Emergency and Primary Care. July 2013.
3. Erich, J. A New Face of Improvement. EMSWorld News. Feb. 5, 2014.