Just to keep things in perspective, one version of the health care reform legislation contained more than 300,000 words on 2,600 pages—and there were a total of four references that could be even remotely interpreted as applicable to EMS. So says Bill Atkinson, CEO of WakeMed Health and Hospitals in Raleigh, N.C., someone who not only gets EMS but who served on the American Hospital Association’s task force on health care reform and studied the legislation carefully. In other words, EMS is just too small a piece of the total health care pie to get much attention. In fact, Atkinson says, for better or worse, policy makers generally view what happens to a patient prior to admittance to an ED as public safety, not health care.
(Side note: At the National EMS and 911 Stakeholders Meeting at the Institute of Medicine on March 17, part of the discussion centered on this perceived identity crisis of EMS—is it health care or public safety? Even the term “emergency medical services” was bemoaned as being so broad as to be detrimental when trying to describe to others what EMTs and paramedics actually do in the prehospital setting. See John Becknell’s April Ruminations column for more on this topic.)
But that’s not to say that health care reform won’t eventually impact EMS, whether intentionally or not. “What health care reform really means is reduced reimbursement,” says Atkinson. “It’s about cost reform—all the other components are secondary to that.” While there will be an increased number of citizens who are covered (as many as 98 percent), he predicts that reimbursement levels will on average be lower.
One aspect of reform will affect EMS services that provide interfacility transfers, he adds. Once a patient has been delivered to a hospital, everything that happens to that patient, including interfacility transfers, will be considered part of a single incident, which is paid for as part of a fee schedule. That means some as-yet-to-be-determined party will decide what that transfer is worth.
Another area of emphasis in the reform package is the use of health information technology. “It’s a clear want of the federal government,” says Atkinson. Technologies such as electronic patient records and payment systems are seen as key to controlling costs. Organizations that aren’t using accepted technology will have incentives—and later, penalties—to encourage the use of systems that are “certified” under standards that are still being defined. (The law was a little ahead of technology, Atkinson explains, but that should be fixed by 2011.)
How do you stay in front of changes that could impact you? Your best resource is at your local hospital. If you don’t know the chief operating officer of your hospital or health care system, if you don’t have the kind of relationship where you can call that person and ask questions, that’s your first assignment, Atkinson says. Otherwise you’re going to be reading about these changes long after they happen.
Jay Fitch, of the EMS consulting firm Fitch & Associates, says there is a lot of uncertainty around the impact of health care reform but reminds EMS managers that one thing won’t change: “EMS services will be fighting even harder for their fair share of revenues and subsidies. A focus on understanding internal processes and cost containment will be even more important.”
Real health care reform for EMS may come someday if Medicare reimbursement rules allow for payment when a patient isn’t transported. But don’t count on it any time soon—there are simply bigger fish to fry at the moment.
Keith Griffiths can be reached at publisher@emergencybestpractices.com.
