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  • 21 Sep 2018 11:30 AM | AIMHI Admin (Administrator)

    Source Article | Article Suggested by Kristofer Schleicher | Comments Courtesy of Matt Zavadsky

    We know that some EMS agencies participate in the filming of TV shows, but you need to be very careful – the Office of Civil Rights takes these issues very seriously.

    Tip of the hat to Kristofer Schleicher, MedStar’s general counsel, for this article.

    Boston Hospitals Cough Up $1M for ‘Boston Med’ HIPAA Violations

    OCR announced Sept. 20 that it has fined three Boston-area hospitals close to $1 million for HIPAA violations involving the filming of ABC’s TV series “Boston Med.”

    By Fred Donovan

    September 20, 2018 - OCR announced Sept. 20 that it has fined three Boston-area hospitals close to $1 million for HIPAA violations involving the filming of ABC’s TV series “Boston Med.”

    OCR reached HIPAA settlements with Boston Medical Center (BMC), Brigham and Women's Hospital (BWH), and Massachusetts General Hospital (MGH) for compromising patients’ PHI when they invited the “Boston Med” film crews on premises without first obtaining authorization from patients.

    “Patients in hospitals expect to encounter doctors and nurses when getting treatment, not film crews recording them at their most private and vulnerable moments,” said OCR Director Roger Severino. “Hospitals must get authorization from patients before allowing strangers to have access to patients and their medical information.

    Of the total fines, BMC paid $100,000, BWH paid $384,000, and MGH ponied up a hefty $515,000. Each hospital has agreed to provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media.

    According to the OCR guidance: “Health care providers cannot invite or allow media personnel, including film crews, into treatment or other areas of their facilities where patients’ PHI will be accessible in written, electronic, oral, or other visual or audio form, or otherwise make PHI accessible to the media, without prior written authorization from each individual who is or will be in the area or whose PHI otherwise will be accessible to the media. Only in very limited circumstances ... does the HIPAA Privacy Rule permit health care providers to disclose protected health information to members of the media without a prior authorization signed by the individual.”

    Surprisingly, these are not the first HIPAA fines resulting from the filming of a TV series in a hospital. In 2016, New York Presbyterian Hospital (NYP) agreed to pay $2.2 million to OCR for HIPAA violations in filming “NY Med.”

    The New York hospital faced an OCR probe after it allowed film crews and staff to capture two patients on screen without getting the necessary authorization.

    In addition to the settlement fines, NYP agreed to a substantive corrective action plan. As part of the plan, OCR monitored the hospital for two years to ensure that it complied with HIPAA rules.

    “In particular, OCR found that NYP allowed the ABC crew to film someone who was dying and another person in significant distress, even after a medical professional urged the crew to stop,” OCR said at the time. 

    By allowing the media crew to film the patients, NYP allegedly disclosed PHI, including images of patients, OCR pointed out.

    “This case sends an important message that OCR will not permit covered entities to compromise their patients’ privacy by allowing news or television crews to film the patients without their authorization,” said then OCR Director Jocelyn Samuels.  “We take seriously all complaints filed by individuals, and will seek the necessary remedies to ensure that patients’ privacy is fully protected.”

    The OCR investigation also revealed that NYP allegedly did not safeguard patient information per HIPAA obligations. While filming, the ABC media crew could have accessed most of the healthcare facility, including areas where PHI was stored.

    That was not the first time that NYP ran afoul of HIPAA. Back in 2010, the hospital and Columbia University paid $4.8 million in HIPAA settlement fines after an alleged healthcare data breach.

    An OCR investigation found a data network that was shared by both facilities inadvertently allowed ePHI to be accessible on web-based search engines.

    The hospital paid $3.3 million out of the total settlement. OCR also developed a corrective action plan for the hospital, which included developing a risk analysis, implementing a risk management plan, reviewing policies, educating staff, and providing progress reports.


  • 21 Sep 2018 10:18 AM | AIMHI Admin (Administrator)

    Source Article | Comments Courtesy of Matt Zavadsky

    Not necessarily a ‘new’ approach, but an interesting way to position a solution to the high balance-billing issue… 

    Alacura has also contacted area ground ambulance providers (MedStar in 2016) promoting similar contracting proposals.

    FYI, Dr. Gamber is also the Medical Director for Plano Fire Department…

    A Dallas Company Is Going After Exorbitant Air Ambulance Bills

    09/20/2018by Shawn Shinneman 

    While some lawmakers at the federal level push for oversight to curb the enormous air ambulance bills that have grabbed headlines over the last few years, a Dallas company says it has a regulation-free solution.

    Founded three years ago, Alacura has inserted itself as a middle man between providers—which typically have no financial skin in the game—and commercial insurance companies, which have caught flack for their willingness to pay for only a relatively small portion of transport-related bills, leaving patients with balances that sail into the tens of thousands of dollars.

    Alacura has been able to cut deals with transport companies by promising a volume of “missions,” and by talking with insurers to figure out a price they’ll reimburse. Its contracts ensure that the payer covers the entire cost.

    “It’s the patients that get stuck in the middle,” says David Boone, who founded Alacura in 2015, “and that’s ultimately what we’re trying to fix.”

    Stories about high medical bills associated with airplane medical transports have not been hard to come by in recent years. The business model for major medical transport providers, says Alacura Medical Director Mark Gamber, has generally been to re-coop high overhead—related in-part to having highly trained personnel on call at all times—and transports of patients who don’t have insurance by charging commercially insured patients lots and lots of money.

    Reporting from outlets like the Los Angeles Times and New York Times and St. Louis Post-Dispatch, among others, have exposed patient bills as high as $40,000 to $50,000 for in-state trips. Boone says some of the out-of-state trips run much higher, estimating that a large air transport provider would price a trip from Los Angeles to Chicago at somewhere around $600,000. He can do it for between $55,000 and $60,000, he says, at a tab the insurer picks up in full.

    While some decisions have to be made very quickly, many of the patients who travel from one hospital to another via fixed-wing transports aren’t split-second decisions. There’s time for providers to call insurance companies, verify that the patients are in fact insured, and then make a call to put the transport teams into motion.

    Gamber, an ER doctor, can see the issue from the provider’s perspective. Hospitals and physicians are time-strapped and have no financial incentive to bargain hunt on behalf of their patients. So the way Alacura has set it up, when an insurer gets a call from a provider to verify a patient’s insurance coverage, the insurer will tell them to call Alacura to set up the transport, Gamber says.

    From there, Alacura chooses the appropriate transport company from within its network, and acts as the point man for communication should anything go wrong.

    The company has contracts set up with Blue Cross Blue Shield in Texas, Illinois New Mexico, Arizona, and Michigan, and is completing about 30 missions a month and growing, Boone says.

    So far, Alacura has been able to build its transport company network by targeting smaller and mid-sized companies, who seek the added volume. They credential the companies themselves to make sure they’re up to snuff, Gamber says. But both Gamber and Boone recognize that their model is in direct opposition to the business models at the largest transport companies in the country, one of which—Air Medical Group Holdings—is based right up Interstate 35E in Lewisville.

    Those companies are so far reluctant to give up their position. If things go right for Boone and Gamber, Alacura might force their hand.

    “There will be some bumps in the road, but ultimately where I think this will end is with partnering with more of them,” Gamber says. “There are some national-scope transport companies that will probably not appreciate what we’re doing and push back.

    Hopefully we’ll be able to partner with one of those, because right now we have a lot of regional relationships. Ideally, we can develop a national relationship.”


  • 18 Sep 2018 2:27 PM | AIMHI Admin (Administrator)

    Comments Courtesy of Matt Zavadsky

    Congratulations to Jerry Long and his entire team at Jan-Care in West Virginia!

    They partnered with Quality Insights, their CMS Quality Improvement Network/Quality Improvement Organization (QIN/QIO), to develop two EXCELLENT videos.

    This one explains Community Paramedicine to patients:

    And, this one is an excellent Community Paramedicine overview for providers

    For those who may be unfamiliar with CMS QINs, they bring Medicare beneficiaries, providers, and communities together in data-driven initiatives that increase patient safety, make communities healthier, better coordinate post-hospital care, and improve clinical quality. By serving regions of two to six states each, QIN-QIOs are able to help best practices for better care spread more quickly, while still accommodating local conditions and cultural factors.

    Every part of the country has a CMS QIN/QIO assigned to it, and they can be a great partner in healthcare quality improvement.  For example, some of you may know that TMF, the QIN/QIO for Texas and other states, is doing a white paper for providers and payers on the key success factors for long-term sustainability for MIH-CP programs.


  • 13 Sep 2018 8:44 PM | AIMHI Admin (Administrator)

    Source Article | Article & Comments Courtesy of Matt Zavadsky

    The author and those he interviewed do a very good job sharing insight into the roles and challenges of the fire service of today… And tomorrow….

    A New Day in the Firehouse

    The job of firefighter has change almost beyond recognition, It’s not easy to do – or recruit those necessary to do it.

    BY DANIEL C. VOCK | SEPTEMBER 2018

    The job of a firefighter isn’t what it used to be. Take Charlottesville, Va., for example, where in just the past 18 months the fire departments in the city and surrounding Albemarle County have searched the wreckage of a plane crash in a hard-to-reach wooded area, performed water rescues after spring floods, responded to the derailment of a passenger train carrying Republican members of Congress and, most memorably, provided medical assistance during white supremacist rallies in Charlottesville, including one incident that left three people dead last summer. This was all in addition to dealing with downed power lines, an ammonia leak, frozen pipes and yes, even a few fires.

    The workload of fire departments has grown substantially, even as their core mission -- putting out fires -- has dwindled.

    “Communities tend to lean on the fire service in times of crisis,” says Charlottesville Fire Chief Andrew Baxter. “People are looking to the fire service for leadership and partnership for all aspects of emergency response.”

    But that ever-evolving mission has brought new strains. It requires training and planning for new dangers such as civil disturbances or active shooters. With increased call volumes, it requires more personnel at a time when a growing number of agencies are finding it difficult to recruit both career and volunteer firefighters, and to diversify their workforces to include more women and minorities. And it comes as some cash-strapped cities are questioning whether the old system of responding to larger call volumes by deploying more firefighters with bigger equipment at more fire stations is sustainable anymore. 

    Continued...

    Read Full Article>
  • 13 Sep 2018 8:24 PM | AIMHI Admin (Administrator)

    Source Article | Comments Courtesy of Matt Zavadsky

    Interesting publication in today’s HealthAffairs…

    While the NEMT model in most states do not include ambulances, some do… More disruptive innovation centered on enhanced patient experience and reduced costs.

    Shifting Non-Emergency Medical Transportation To Lyft Improves Patient Experience And Lowers Costs

    Brian Powers  Scott Rinefort  Sachin H. Jain

    SEPTEMBER 13, 2018

    Limited access to reliable transportation causes millions of Americans to forgo important medical care every year. Transportation barriers are most prominent among the poor, elderly, and chronically ill—populations for whom routine access to ambulatory and preventive care is most important.

    Payers that focus on vulnerable populations have taken steps to address transportation barriers by providing non-emergency medical transportation (NEMT) benefits to select beneficiaries.  A majority of Medicare Advantage (MA) plans and state Medicaid programs currently provide NEMT benefits.

    NEMT benefits are typically administered by specialized brokers that coordinate and dispatch private cars, taxis, or specialized vehicles to bring patients to medical appointments. Multiple reports have highlighted challenges with traditional approaches to NEMT delivery, including poor customer service, inadequate responsiveness, and fraud and abuse. In the face of these challenges, payers and health care delivery organizations have been experimenting with new strategies for delivering NEMT.

    An approach that has attracted considerable attention is the use of transportation network companies (TNCs)—such as Uber or Lyft—to provide NEMT services. NEMT brokers such as such as American Logistics CorporationNational MedTransAmerican Medical Response, and Access2Care are all now piloting TNC-based rides. New companies, such as Circulation and RoundTrip, have emerged to help hospitals and health plans offer TNC-based rides. And both Lyft and Uber are contracting directly with health plans and delivery organizations to provide NEMT services.

    Despite the proliferation of these programs, there is scant data regarding their impact. Here we report the results from a large-scale, system-wide implementation of Lyft-based NEMT services at CareMore Health.

    Partnering With Lyft And ALC To Provide Transportation

    CareMore Health is a physician-founded, physician-led integrated care delivery system. For many patients enrolled in its MA plans, CareMore provides a diverse range of NEMT services free of charge. Curb-to-curb (C2C) rides are most similar to traditional taxi or private car services. Patients that require extra assistance or specialized transport have access to door-to-door (D2D) and wheelchair accessible van (WAV) services.

    As is typical for MA plans, CareMore contracts with brokers to administer its NEMT benefits. Historically, these NEMT brokers arranged for rides using private car services. In 2016, CareMore launched a pilot program to evaluate the impact of Lyft-based C2C rides on patient experience and costs. The pilot ran for two months at select CareMore locations in Southern California, during which a total of 479 rides were provided. Results were encouraging: wait times decreased by 30 percent and per-ride costs decreased by 32 percent, and satisfaction rates were 80 percent.

    In light of the encouraging results from the pilot, CareMore expanded the program system wide. Partnering with NEMT broker American Logistics Corporation (ALC), CareMore began offering Lyft-based rides throughout all MA markets in August 2016, which included 75,000 members across 18 counties in California, Nevada, Arizona, and Virginia. 

    During the pilot, Lyft-based services occasionally led to confusion. Accustomed to branded vehicles, and inexperienced with Lyft and other TNCs, patients were sometimes confused when an unfamiliar car arrived to bring them to their medical appointments.

    Based on this feedback, adjustments were made to improve patient experience. First, the experience of booking did not change—patients call a CareMore associate who takes down information regarding time, pick-up, and drop-off locations. This information is then securely relayed to ALC, who uses custom-built software to schedule a Lyft driver at the requested time. Second, CareMore makes clear that Lyft, not the car services that patients may be accustomed to, will be providing the ride. This occurs when the ride is booked, and again when CareMore calls to confirm the ride.

    Members that would like to know the specific make and model of the car that has been dispatched are able to call a CareMore associate to obtain that information. Third, CareMore and ALC released a smart phone application—MyRide Manager—that allows patients, caregivers, and care team members to track and manage rides via an interface that resembles Lyft’s or other TNCs’ native applications. 

    Impact And Results

    The CareMore-Lyft-ALC partnership was launched across all CareMore MA markets in August 2016. Within three months, half of all C2C rides were Lyft-based. By the end of 2017, CareMore provided 91 percent of all C2C rides through Lyft, accounting for up to 7,000 rides per month, and a total of 68,993 rides over the course of 2017 (See Exhibit 1). At this point, the absence of Lyft availability in certain counties has limited the ability to scale the program any further.


    Results through the end of 2017 are in line with those reported during the pilot:

    • On Time Performance: On time performance (rides arriving within 20 minutes of scheduled pick-up time) for Lyft-based C2C rides was 92 percent, compared to 74 percent for non-Lyft rides. 
    • Wait Times: The average wait time for Lyft-based C2C rides was 9.2 minutes, compared to 16.6 minutes for non-Lyft C2C rides, a 45 percent decrease. Reductions in wait times were most pronounced among “on-demand,” return rides from clinics or other health care settings.
    • Patient Experience: Patient satisfaction results exceeded those from the pilot program, possibly reflecting the strategies discussed above aimed at reducing confusion. In a survey of CareMore patients using Lyft-based rides, 96 percent reported feeling “Safe” or “Very Safe” during their ride and 98 percent reported being “Satisfied” or “Very Satisfied” with the service (timeliness, cleanliness, and professionalism of the driver).
    • Costs: Lyft-based C2C rides cost CareMore 39 percent less, on average, than non-Lyft C2C rides. Reducing per-ride costs allowed CareMore to expand its NEMT benefit throughout the course of 2017, providing an additional 28,000 rides (a 12 percent increase) at no additional cost to the system.

    Next Steps

    From late 2016 through 2017, CareMore Health rapidly scaled access to Lyft-based NEMT rides across its MA patients. Lyft now provides the vast majority of C2C rides for CareMore patients, and doing so has improved patient experience, reduced wait times, and increased the overall efficiency of CareMore’s NEMT benefit.

    Although these results are encouraging, it is important to remember that TNC-based NEMT is not a panacea. Rural areas remain under-served by TNCs and there does not yet exist a robust TNC offering for older, sicker patients who require D2D or WAV services. Nonetheless, the cost-savings generated by switching to Lyft for C2C rides can help support increased access to NEMT for patients requiring specialized services.

    It remains to be seen whether or not the benefits of TNC-based NEMT extend beyond improved satisfaction and lower costs to fewer missed appointments and better health outcomes. The structure of the CareMore-Lyft-ALC partnership did not permit a formal evaluation on these dimensions. Though there are anecdotal reports that TNC-based NEMT can reduce missed appointments, rigorous analyses have not shown an effect. As TNC-based NEMT grows, attention should be paid to better clarifying this potential impact.


  • 12 Sep 2018 9:23 AM | AIMHI Admin (Administrator)

    Source Article | Insights Courtesy of Matt Zavadsky

    Interesting article… 

    There is currently legislation pending in Congress (H.R. 3780) which proposes to place quality requirements and mandatory cost reporting for air ambulance providers to be eligible for Medicare participation.  In summary:

    The Department of Health and Human Services (HHS) shall establish minimum standards that must be met by air-ambulance suppliers and providers as a condition of their participation in Medicare.

    These standards must address:

    1. scope of practice, training, and clinical capability;
    2. medical equipment and vehicle attributes;
    3. documentation;
    4. medical direction and oversight;
    5. reporting of specified events;
    6. patient safety and infection control;
    7. clinical quality-management and performance-improvement programs; and
    8. particular populations. An air-ambulance provider or supplier that is accredited by an HHS-approved organization shall be deemed to be in compliance with these standards.

    HHS must establish an air-ambulance quality-reporting and performance program under which Medicare payment is determined according to a specified performance-based formula. Performance measures shall address patient safety, clinical quality, and over-triage.

    An air-ambulance provider or supplier must, subject to suspension of payment under Medicare, annually submit specified cost data to HHS.

    https://www.congress.gov/bill/115th-congress/house-bill/3780

    Lawmakers call for greater oversight of air ambulance operators

    By Susannah Luthi 

    September 11, 2018

    Two senators are pushing the Trump administration to use regulation to target exorbitant air ambulance charges faced by airlifted patients.

    Sens. Claire McCaskill (D-Mo.) and Roger Wicker (R-Miss.) led a Monday letter to Transportation Secretary Elaine Chao to urge more oversight and support for consumer complaints. The lawmakers represent states that have seen headlines with sticker-shock stories of patients finding themselves facing tens of thousands of dollars in charges after being airlifted to a hospital.

    The Senate continues to mull changing air ambulance regulation through its upcoming Federal Aviation Administration reauthorization bill. State efforts to curb prices have faced a hurdle in courts due to the Airline Deregulation Act, which prevented federal regulation of airline prices.

    "Congress hardly could have imagined when the ADA was passed nearly 40 years ago that it would block states from overseeing healthcare services," McCaskill and Wicker wrote. "Given this dynamic, the Department of Transportation (DOT) should aggressively and effectively exercise its authority as perhaps the only regulator over air ambulance operators."

    The senators have asked Chao to explain how the Transportation Department is investigating consumer complaints against air ambulance operators and to specify how the agency is managing oversight and investigations of these operators.

    The letter requests a thorough explanation of the authorities the department has to regulate charges and require insurers to cover "reasonable costs," and asks whether the Federal Trade Commission or state attorneys general can prosecute air ambulance operators on behalf of consumers.

    The lawmakers reference a 2017 report from the Government Accountability Office that found the median charges from air ambulance operators doubled from 2010 to 2014, from about $15,000 to about $30,000 per trip.

    "Anecdotally, it is clear that a greater share of this cost is being passed along directly to consumers through a practice known as balance billing, but GAO was unable to determine the prevalence of this practice because of a lack of data," McCaskill and Wicker said.

    McCaskill for months has been probing balance billing issues including the charges left for patients by air operators and insurers that refuse to shoulder the full cost of transport. States are also increasingly taking up legislation to address balance billing, but their authorities are limited by ERISA law.


  • 10 Sep 2018 12:39 PM | AIMHI Admin (Administrator)

    Source Article | Courtesy of Matt Zavadsky

    Written by Julie Spitzer, Becker's Hospital Review 

    September 05, 2018

    As payers increasingly turn to alternate modes of care delivery as a way to keep patients with low-acuity conditions out of expensive emergency departments, recent evidence suggests that urgent care centers and retail clinics — not telehealth — appear to be patients' go-to options, a JAMA Internal Medicine investigation has found.

    A team of researchers led by Sabrina Poon, MD, a physician in the department of emergency medicine at Brigham and Women's Hospital in Boston, reviewed a set of deidentified claims data from Aetna between Jan. 1, 2008, and Dec. 31, 2015. The cohort included about 20 million insured members per study year.

    Here are six study highlights:

    1. Visits to the ED for low-acuity conditions decreased 36 percent during the eight-year study period.
    2. Visits to non-ED facilities increased 140 percent.
    3. Retail clinics saw the greatest increase in visits for low-acuity conditions (214 percent), followed by urgent care centers (119 percent).
    4. Patients did not often utilize telemedicine for treatment. Specifically, telehealth saw an increase from 0 visits in 2008 to 6 visits per 1,000 members in 2015.
    5. Utilization (31 percent) and spending (14 percent) per person per year for low-acuity conditions increased during the study period.
    6. The increase in spending was driven by a 79 percent price hike per ED visit for the treatment of low-acuity conditions

    "From 2008 to 2015, total acute care utilization for the treatment of low-acuity conditions and associated spending per member increased, and utilization of non-ED acute care venues increased rapidly," the study authors concluded. "These findings suggest that patients are more likely to visit urgent care centers than EDs for the treatment of low-acuity conditions."

    To access the complete study, click here.



  • 4 Sep 2018 11:35 PM | Matt Zavadsky (Administrator)

    A very nice report, part of the IHI Patient Safety in the Home initiative.  

    A full report, with additional case studies can be found in the No Place Like Home: Advancing the Safety of Care in the Home report.

    --------------------------

    Can Paramedics Help Achieve the Triple Aim?

    By IHI Multimedia Team

    Friday, August 24, 2018

    Source Article 

    Background of the Problem

    Left unidentified and unaddressed, the medical, social, and patient safety concerns that arise in the home can increase the burden on emergency medical services and emergency departments. In particular, patients with complex medical conditions and/or challenging socioeconomic situations may be more reliant on emergency health care resources because they may face multiple barriers to accessing health care and other services, have unmet medical and social needs, or grapple with unsafe home conditions. Paramedics are proficient in interacting with patients in home settings and can respond quickly when patients need help. Paramedics thus represent an important resource for providing critical support and services to individuals who face safety and health care challenges at home.

    Description of the Program

    MedStar Mobile Healthcare, an EMS provider in the greater Fort Worth, Texas, area, developed a suite of programs designed to leverage the skills and expertise of paramedics to intervene with high-risk, high-need patients in home settings. These Mobile Integrated Healthcare (MIH) programs aim to ensure that patients receive safe, effective care in the most appropriate setting.

    Each of the MIH programs includes these components:

    • Processes to identify patients who are eligible for the program.
    • In-depth, home-based visits are conducted by specially trained Mobile Healthcare Paramedics (MHPs) to identify patients’ medical, social, behavioral, and safety-related needs.
    • Bimonthly care coordination meetings are held in which a MedStar program coordinator confers with hospital caseworkers, community service agencies, and other care providers to review the needs of enrolled patients.
    • Alternative services help patients avoid having to call for EMS, including the ability to request a home or telephone visit from an MHP instead of calling 911.
    • A continuously updated electronic medical record provides mobile access to information about the patient’s entire course of assessments and treatments while participating in the program.
    • Contractual arrangements exist between MedStar and hospitals, commercial insurers, and other health care service organizations to receive payments for the MIH services.

    MedStar identifies patients who qualify for its MIH programs using a variety of approaches and data sources:

    • MedStar identifies patients for the High Utilizer Program (those who have called 911 at least 15 times in the past 90 days) by analyzing 911 utilization data and receiving referrals from emergency departments, frontline MedStar staff, and other first-responder agencies, as well as agencies and payers partnered with MedStar.
    • Participating hospitals and physicians refer patients assessed as being at high risk for readmission within 30 days of discharge to the Readmission Prevention Program.
    • Agencies partnered with MedStar refer patients to the Home Health Partnership Program, the Hospice Revocation Avoidance Program, and the Observation Admission Avoidance Program.

    After a patient is deemed eligible for one of MedStar’s MIH programs, a specially trained MHP or a representative from a partner organization contacts the patient to explain the benefits of the program. If the patient agrees to participate, the patient signs a consent form authorizing the appropriate parties to share relevant patient information via the electronic medical record system.

    The MHP conducts an in-depth, in-home visit with the patient, family members, and caregivers. During the visit, the MHP performs a full medical assessment, evaluates the patient’s home environment and safety-related factors, and identifies opportunities to enroll the patient in other programs to help meet the patient’s clinical, social, or behavioral health needs (e.g., medication compliance, nutritional support, healthy lifestyle changes).

    Based on the assessment findings, the MHP works with the patient and family to develop or reinforce an individualized care plan, in coordination with the patient’s primary care network. This plan outlines the patient’s needs, associated goals, and steps needed to reach the goals. The patient and family members receive a copy of the plan, which is entered into the electronic medical record system and thereby is readily accessible to MHPs and other providers.

    The patient receives a telephone number to use to request an MHP home or telephone visit as an alternative to calling 911. Because MedStar is the 911 provider in the service area, if the patient calls 911, the MHP is dispatched to the patient’s location, along with the normal EMS system response. Once on scene, the MHP may apply established care protocols to address the patient’s needs, thereby preventing an unnecessary ambulance transport.

    The MHP conducts periodic follow-up visits with patients based on their needs. These visits provide an opportunity to evaluate any new medical or safety needs, monitor progress in meeting care plan goals, and provide the patient with additional supports or referrals.

    A MedStar MIH program coordinator meets bimonthly with hospital caseworkers, community service agencies, and other care providers to review the needs of patients who are enrolled in the program and to coordinate resources.

    Some of MedStar’s MIH programs have a formal “graduation” process for patients whose social and safety needs have been addressed and who can manage their own health care needs.

    Program Results

    MedStar’s MIH programs have garnered domestic and international interest as a promising strategy to address the health care and home safety needs of patients with complex medical conditions. MedStar has hosted site visits by representatives of more than 221 communities from 46 states and seven other countries who are interested in learning how the MIH programs work and replicating the MIH model.

    Across its portfolio of MIH programs, MedStar has “graduated” more than 8,500 patients. MedStar’s MIH programs have improved the quality of life for enrolled patients and reduced EMS transports to the hospital, ED visits, and hospital admissions, suggesting that the health of these patients is better because their health and safety needs were addressed at home.

    Evidence includes the following:

    • A retrospective evaluation [Published in the American Journal of Emergency Medicine] assessed pre- and post-intervention data for 64 patients who completed MedStar’s MIH High Utilizer Program. The evaluation showed that:
      • Patients who had reported problems with mobility, pain control, and ability to perform activities of daily living before participating in the program reported improvements in these areas (38, 42, and 58 percent, respectively) after participation.
      • After participation, 73 percent of patients rated their health as improved.
      • Patients had 61 percent fewer EMS transports, 66 percent fewer ED visits, and 56 percent fewer hospital admissions.
    • A MedStar report analyzed trends in pre- and post-enrollment utilization data among 581 patients enrolled in the MIH High Utilizer Program between October 2013 and March 2018. The analysis showed that:
      • Ambulance transports to the ED were reduced by 5,133 (58 percent), and ED visits and hospital admissions were reduced by 2,395 and 462, respectively.
      • The reductions in utilization decreased health care spending by $9.3 million during the evaluation period, for a savings of $16,046 per enrolled patient.
    • MedStar found a total expenditure savings of more than $14 million across all MIH programs between June 2012 and March 2018.13 This represents savings of about $3.2 million in ambulance transport, $4.5 million in ED visits, and $6.4 million in hospital admissions.
    • Between September 2013 and March 2018, 388 patients identified by a hospice agency as likely to disenroll from hospice were enrolled in MedStar’s Hospice Revocation Avoidance Program. Of those, only 18 percent had a disenrollment.
    • The patient experience across MedStar’s MIH programs was favorable, with overall average ratings ranging from 4.69 to 4.84 on a 5-point Likert scale assessing 12 items related to patient experience.
    • Between October 2013 and July 2017, 295 patients with a prior 30-day readmission were identified as being at high risk for another 30-day readmission and enrolled in the Readmission Prevention Program. Of those, 47.5 percent had a 30-day readmission, which evaluators considered lower than would have been expected.
  • 3 Sep 2018 5:28 PM | AIMHI Admin (Administrator)

    Source Article | Courtesy of Matt Zavadsky

    Nice article in JEMS that boils down the results of the PART study into understandable, and potentially actionable bites.

    Key statement(s) from the authors:

    Results

    The trial began enrollment on Dec. 1, 2015, and completed enrollment on Nov. 4, 2017. A total of 3,004 subjects were enrolled, with 1,505 assigned to initial King LT and 1,499 assigned to initial ETI. Patient demographics and arrest characteristics were similar in both groups.

    Elapsed time from first EMS arrival to airway start was shorter for King LT than ETI (mean 11.0 mins. vs. 13.6 mins.). Initial airway success rate was 89.9% in the King LT group and 51.3% in the ETI group. Overall, the King LT and ETI airway success rates (initial plus rescue airway attempts) were 94.2% and 91.5%, respectively. The ETI group was more likely to require more than three insertion attempts (18.9% vs. 4.5%).

    The main outcome of the study, 72-hour survival, was significantly higher for King LT than ETI (18.3% vs. 15.4%), a difference of 2.9%. Secondary outcomes were also better for King LT than ETI including: ROSC (27.9% vs. 24.3%), hospital survival (10.8% vs. 8.1%), and favorable neurological status at discharge (7.1% vs. 5.0%).

    The ETI group had higher rates of multiple airway insertion attempts, unsuccessful airway insertion, and unrecognized airway misplacement or dislodgement. Other in-hospital adverse events were similar between treatment groups.

    What It Means

    In this trial of 3,004 adults, we found that a strategy of initial King LT resulted in better 72-hour survival than initial ETI. Initial King LT also had better outcomes including ROSC, survival to hospital discharge, and favorable neurologic status at hospital discharge. Although these differences seem small, they’re important.

    If all EMS systems across the country were to shift to King LT as the primary advanced airway for OHCA patients and saw a similar 2.7% increase in hospital survival rate, more than 10,000 extra lives would be saved each year.

    ETI vs. SGA: The Verdict Is In

    A field guide to the results of the Pragmatic Airway Resuscitation Trial (PART)

    Thu, Aug 30, 2018

     By Shannon W. Stephens, EMT-P , Henry E. Wang, MD, MS , Pam Gray, EMT-P , Randal Gray, MEd, BS, EMT-P , Linda Mattrisch, BS, EMT-P , Ahamed H. Idris, MD , Mohamud Daya, MD, MS

    Read full article

  • 30 Aug 2018 5:29 PM | AIMHI Admin (Administrator)

    Congratulations to Alexia Jobson of REMSA on her unanimous election to Chair of the AIMHI Public Relations & Communications Committee. 


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