Bipartisan effort urges CMS to adopt ‘treat-in-place’ model for W.Va.
New model would improve resource use and reduce patient, hospital costs
By Bill Carey
WASHINGTON — West Virginia Senators Joe Manchin (D) and Shelley Moore Capito (R), along with Representatives Carol Miller (R) and Alex Mooney (R), called on the Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure to consider a “treat-in-place” model to address the workforce challenges faced by West Virginia hospitals and EMS.
“This would be a major step forward in advancing an improved model that better utilizes limited EMS and hospital staff while ensuring quality patient care and saving approximately $3 million in unnecessary emergency room visits," the lawmakers wrote. “Furthermore, this model could be replicated nationwide, especially in rural communities with limited health resources.”
The West Virginia Office of Emergency Medical Services and the West Virginia Hospital Association, along with a small coalition of emergency medicine physicians, EMS providers, and payers sent a proposal urging CMS to support a new “treat-in-place” model to reduce unnecessary emergency room trips by establishing medical triage lines for low-acuity 911 calls.
The treat-in-place option presented is built upon an effort in Pennsylvania that focused on three conditions that can be treated in place following a 911 call and following narrow protocols developed by EMS. The effort in Pennsylvania was unsuccessful because only one payer participated, so different processes were required for patients based on their insurance status. The West Virginia coalition focuses on one model to secure most payers agreeing to participate in the treat-in-place option, giving EMS one statewide protocol and billing process.
After receiving initial support for the treat-in-place option from the coalition and three statewide payers (Highmark, Public Employee Insurance Agency (PEIA), and Medicaid) the West Virginia Office of Emergency Medical Services has started drafting protocols for three conditions:
- Diabetes – Hypoglycemia Evaluation
- Asthma/COPD Evaluation
- Seizure Evaluation
“This demonstration will provide the flexibility necessary for our first responders to care for West Virginians in the appropriate setting and it aligns with the goals of better utilizing EMS and hospital staff while ensuring quality patient care and reducing unnecessary emergency room visits,” West Virginia Hospital Association President and CEO Jim Kaufman said. “Emergency medical services systems, hospitals and their emergency departments are fundamental components of West Virginia’s healthcare delivery network. Together, they provide the state’s safety net and CMS’s approval of this project will go a long way to ensure access to care, especially in our most rural communities.”
If Medicare participates, West Virginia would be able to demonstrate that all EMS providers could participate while having the payers for approximately 75% of the patients that EMS treats included. This plan offers an improved model that utilizes limited EMS and hospital staff while ensuring quality patient care and saving approximately $3 million in unnecessary emergency room visits.