News & Updates

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  • 18 Feb 2020 8:30 AM | AIMHI Admin (Administrator)

    Source Article | Comments courtesy of Matt Zavadsky

    Bente Bouthier did a nice job reporting on a complex topic…

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

    Senate Bill Would Set Universal Rate For EMS Transport, Providers Say It's A Bad Idea

    By BENTE BOUTHIER

    February 18, 2020

     

    https://indianapublicmedia.org/news/senate-considering-bill-to-set-universal-rate-for-ems-transport,-providers-say-its-a-bad-idea.php

     

    Indiana lawmakers are considering legislation that would peg all of the state’s ambulance and transportation costs to in-network rates.

    The Senate’s Insurance and Financial Institutions Committee will decide by the end of February whether to pass the bill with its current language.

    House Bill 1372 attempts to eliminate instances of patients getting surprise bills after receiving emergency medical services that weren’t covered by insurance.   

    Many EMS providers lobbied against the bill, saying setting costs at in-network rates will dramatically cut the industry’s already low revenue.

    Matt Zavadsky is the president of the National Association of Emergency Medical Technicians. He says EMS providers don’t reap the same benefits of in-network rates as regular healthcare providers. Primary care physicians who go with in network rates usually get more patients, which usually compensates for reduced fees.

    “People aren’t going to call 9-1-1 more just because we’re now in-network with any of their insurance payers,” he says.  "The concept of accepting an additional rate without having an additional volume to help cover the lost revenue per call doesn't work in the emergency medical services industry setting."

    In-network rates would lock in the universal rate for transportation costs.

    Zavadsky says this means Indiana EMS services could receive less compensation than what it costs to operate.

    He also says tax payers will either have to make up for the revenue loss or accept a decrease in services in their community if the bill’s language remains unchanged.

    Before any laws are passed changing reimbursement rates for EMS providers, Zavadsky says lawmakers should examine how much healthcare costs more carefully. 

    He suggests using the FAIR database which looks at costs of all healthcare by region, rather than setting a statewide average.

    "Instead of going right to, setting a statewide, in-network rate for ambulance services, maybe the first step is finding out what it really costs to provide ambulance services in the communities across the state of Indiana."

    He says under HB 1372's current language, insurance companies would be the primary beneficiary. 

    "If the insurance companies have to pay less, they benefit financially," Zavadsky says. "The patient is going to get a higher bill from the ambulance provider. The ambulance providers are going to have a reduced reimbursement, which means they're going to suffer."

    The Senate committee is considering two amendments to the bill, one of which would remove the in-network rates for providers that are owned by or have a contract with a municipality.

    The other would allow ambulance providers and insurance companies negotiate prices of transportation costs.

  • 17 Feb 2020 7:35 AM | AIMHI Admin (Administrator)

    Tribune-Star Source | Comments Courtesy of Matt Zavadsky

    Lots of YELLOW in this one – shrouded by all the discussions about “surprise billing” (which is actually more appropriately termed “surprise coverage”), insurers are increasingly sending reimbursement for ambulance services to the patient instead of the provider – despite executed assignment of benefits authorizations from the patient. 

    This has a significant impact on revenue for ambulance providers and is leading to additional financial hardships for agencies and taxpayers.

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    Ambulance providers warn of pending Indiana House bill

    It has unintended consequences for patients, maybe even on taxes, they say

    By Howard Greninger Tribune-Star

    2/16/20

     

    https://www.tribstar.com/news/local_news/ambulance-providers-warn-of-pending-indiana-house-bill/article_93a86117-482c-5c73-8170-80087ffb70f9.html

    A group that represents ambulance service providers says a bill pending in the Indiana General Assembly could cut their insurance reimbursements and result in layoffs, longer response time and possibly even higher local taxes.

    House Bill 1372, heard last week Wednesday before the Senate’s Insurance and Financial Institutions Committee, initially would set all ambulance transportation costs to in-network insurance rates.

    That would have the effect of setting rates without the knowledge or agreement of ambulance service providers, the Indiana Emergency Medical Services Association, which represents emergency medical services companies.

    “This bill’s original wording was not intended to do what it would end up doing if it [goes through unchanged] … which is to put [the] EMS industry out of business,” said Russell Ferrell, chief executive officer and president of Trans-Care Ambulance, a company that employs 350 people statewide. It is based in Terre Haute and has 40 employees here.

    The bill as it stands also could result in cities or counties increasing taxes, Ferrell argued.

    “Testimony to the [Senate] committee from Fort Wayne stated it would cost $2.8 million more to that city,” Ferrell said. “That is public-private ambulance service there.”

    Nate Metz, president of the Indiana Emergency Medical Services Association, said the issue arose in 2017, when private insurance companies decided to cover only about 30 percent of charged costs with direct payments to ambulance services and then made direct payments to patients for the rest of the benefit.

    “Then the patient is responsible and has to wait on a second bill from an ambulance provider…” Metz said. “That tactic significantly delays cash flow to an ambulance provider and turns the patient into a self-pay patient. That creates the perception that patients are getting 100 percent of the bills from ambulance [providers]. We want an assignment of benefit to force [insurance firms] to pay an EMS provider off of our bill and not [pay] the patient.”

    Metz said it costs $400,000 to $500,000 a year to operate an ambulance, with ambulance runs costing $285 to $500 per trip. And profit margins are slim, with many ambulance firms operating on a break-even status, he said.

    “Our state has lost 12.8 percent of its service providers from 2018 to 2019,” Metz said.

    The Senate committee is considering two amendments, one that removes the in-network reimbursement for ambulance services owned by a municipality or an ambulance service that has a contract with a municipality or government agency.

    Another amendment would allow a negotiation between ambulance firms and insurance providers, with disputes going to binding arbitration.

    Metz said that could be difficult for volunteer organizations because they would have to pay court costs to go to arbitration. Instead, Metz said the issue needs more discussion. Metz said he hopes the ambulance billing language can be removed from the House bill and a revised reimbursement system can be addressed in the 2021 session.

    Multiple attempts last week to reach bill author Rep. Martin Carbaugh, R-Fort Wayne, for comment were not successful.

    The Senate committee is slated to meet again on the issue Feb. 19, but may not make a decision until the last week of February.

    Legislative committees have until Feb. 27 to pass bills to their full chambers. The General Assembly is slated to adjourn March 14.


  • 14 Feb 2020 8:06 AM | AIMHI Admin (Administrator)

    Axios Source Article | Comments Courtesy of Matt Zavadsky

    Interesting findings, for us both as healthcare providers, employers, and consumers!

    Health care prices still rising faster than use of services

    2/14/20

    Bob Herman

     

    Employers, workers and families continued to spend a lot more on health care in 2018, but that wasn't because people used more services, according to the latest annual spending report from the Health Care Cost Institute, which analyzes commercial health insurance claims.

     

    The bottom line: Higher prices remain the main culprit for exploding spending among those with private health insurance.

     

    By the numbers: Annual per-person spending among the commercially insured, after accounting for inflation and drug rebates that help reduce premiums, grew by an average of 3.8% between 2014 and 2018, according to HCCI.

    • Three-quarters of that rise was attributed to hospitals, doctors, drug companies and others raising prices.

     

    The intrigue: Two small pieces of data stick out within the report.

    • The average out-of-pocket price for emergency room visits jumped 37%, from $368 in 2014 to $503 in 2018 — a reflection of surprise billing tactics.

     

    • The average price of drugs administered in doctors' clinics soared 73% from 2014 to 2018. These infusion medicines overseen by doctors are driving up drug spending by a lot, and they don't usually come with rebates.

     

    Go deeper: HCCI is getting a new health insurance partner to submit data


  • 6 Feb 2020 5:38 PM | Matt Zavadsky (Administrator)

    Commentary: Interesting news, especially in light of the revolutionary new ET3 model CMMI is rolling out for ambulance services…

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    House lawmakers introduce bill to tighten CMMI's reins

    MICHAEL BRADY 

    February 04, 2020

    https://www.modernhealthcare.com/politics-policy/house-lawmakers-introduce-bill-tighten-cmmis-reins

    A bipartisan group of House lawmakers on Monday introduced a bill to ramp up transparency and accountability efforts for the CMS' Center for Medicare and Medicaid Innovation.

    The Strengthening Innovation in Medicare and Medicaid Act—HR 5741—would require the HHS secretary to keep track of how a demonstration model affects beneficiaries' access to care. HHS would also have to monitor the effects of delivery and payment changes on healthcare disparities and alleviate related issues that could negatively affect health outcomes.

    The bill aims to boost transparency by creating an expedited process for Congress to reject models and makes it easier for the public to comment on proposed models and changes.

    The Innovation Center, also known as CMMI, would also have to consult with experts on the healthcare needs of minorities, rural and underserved populations, and the financial demands of safety-net and rural providers.

    Providers and suppliers could seek hardship exemptions from the Innovation Center if they would be subject to undue economic hardship or if the agency's requirements caused vulnerable populations to lose access to specific providers.

    Reps. Terri Sewell (D-Ala.), Adrian Smith (R-Neb.), Tony Cárdenas (D-Calif.) and John Shimkus (R-Ill.) introduced the legislation.

    "It is essential that Congress ensures that CMMI functions as intended, to improve the quality and efficiency of care delivered, and incorporates greater opportunity for public input," Sewell said. "The legislation we introduced today would safeguard the center from implementing politically driven or other policy changes made unilaterally by any administration that could be harmful to patients and providers."

    Lawmakers, especially those who represent rural or underserved populations, have expressed concern that the Innovation Center has too much discretion to design, test and implement new payment models without adequately considering their effects on healthcare delivery outcomes.

    "This bill would reduce uncertainty throughout the healthcare marketplace by providing for appropriate oversight of CMMI," Smith said.


  • 6 Feb 2020 5:37 PM | Matt Zavadsky (Administrator)

    House leader aims for surprise billing deal by Presidents Day

    RACHEL COHRS  

    January 28, 2020

    Source Article: https://www.modernhealthcare.com/politics-policy/house-leader-aims-surprise-billing-deal-presidents-day

    House Majority Leader Steny Hoyer (D-Md.) wants the House to move on legislation banning balance billing as soon as mid-February, he told reporters Tuesday.

    So far, the House Energy & Commerce and Ways & Means committees have been at odds over the best approach to address payment for bills a patient receives from an out-of-network provider at an in-network facility.

    "We are trying to bring those together and create a consensus so that we can move a bill, and move a bill sooner rather than later. Sooner meaning within this work period if we can get to agreement," Hoyer said, referring to the House work period that ends the week of Feb. 10.

    However, some are skeptical House leaders can work out their differences that quickly after a bipartisan, bicameral compromise brokered by leaders of the House Energy & Commerce and Senate health committees fizzled last year amidst intense insurance and provider industry lobbying.

    The Ways & Means Committee leaders have not yet elaborated on their proposal beyond a one-page outline released in December. Ways & Means health subcommittee Chair Lloyd Doggett (D-Texas) said Tuesday he has not seen policy details beyond the one-pager.

    "When we really get going it's a short month," Doggett said.

    Ways & Means Committee Chair Richard Neal (D-Mass.) said Monday that he wants to shape the legislation in concert with the Energy & Commerce Committee and expects to hold a markup in the next three weeks.

    Several stakeholders including hospital groups, a new conservative coalition, and physician staffing firms that oppose the Energy & Commerce proposal because of its inclusion of benchmark payment rates have not yet thrown their weight behind the Ways & Means idea and are awaiting more information.

    Ways & Means ranking Republican Kevin Brady of Texas has said that he and Neal are pursuing a revenue-neutral approach to ban balance billing, though lawmakers by May 22 have to find a way to fund extensions of several Medicare and Medicaid programs including funding for community health centers and delaying cuts to Medicaid disproportionate-share hospital payments.

    Neal said Monday that there may be alternative funding sources other than surprise billing legislation.

    "I've got some ideas," he told reporters.

    House Energy & Commerce Committee leaders estimated their bill would provide nearly $20 billion to fund community health centers for five years.

    House committee chairs have missed leadership goals for surprise billing legislation before.

    House Speaker Nancy Pelosi (D-Calif.) in December gave the chairs of the House Energy & Commerce, Ways & Means and Education & Labor committees a deadline to come to a consensus ahead of an appropriations package, but they failed to do so.


  • 6 Feb 2020 5:36 PM | Matt Zavadsky (Administrator)

    Industry Voices—Generation Z is a game changer for healthcare

    by Rick Halton

    Jan 15, 2020

    Source Article: https://www.fiercehealthcare.com/practices/industry-voices-generation-z-a-game-changer-for-healthcare

    There is no question that technology continues to impact healthcare, altering how patients receive care, communicate with providers and stay informed about their own health. However, members of the newest generation of young adults—Generation Z—are likely to turn the health industry on its head with their unique expectations for how healthcare should be delivered. 

    Gen Z has no idea what a rotary telephone is, rarely ever waits in line at the deli and will never know the cathode ray tube—despite the fact that it inspired YouTube, which they use every day.

    They are the first generation to be born into a world with the internet, smart devices and apps. As a result, they have radically different views from the older population on what privacy, trust and relationships mean in the digital world.

    Think of the way Booking.com acts as a gateway to travel, simplifying the entire reservations pathway—serving up flights, car rentals and hotels, tailored to customer preferences and requirements. With younger generations increasingly expecting that kind of convenience and simplicity, healthcare needs to find its own “gateway.”

    New entrants in the market will address the needs of Gen Z, adapting to their demands by delivering virtualized and automated care pathway experiences. For the first time, these experiences will revolve and adapt around their needs, every day, with no need to wait in line, providing instant assessment, instruction and motivation while coordinating a team of care professionals around individuals' health needs.


    Swapping privacy for convenience

    The traditional approach to healthcare data privacy is, firstly, data are not owned by the individual, but by the physician, and now the provider, in a highly regulated environment.

    Institutions are the guardians of highly sensitive content, potentially including personal information, financial information and healthcare data, and, as such, are risk-averse when it comes to data sharing. Any mistake comes with huge consequences.

    Gen Z doesn’t have the same boundaries for data privacy. They have grown up with apps such as Google, Facebook, Amazon and Instagram, cementing the idea that sharing their data in multiple formats is normal—especially in exchange for convenience. The risk-reward balance has shifted, with younger generations opting to share data in exchange for a service, whether that’s shopping on Amazon or seeking out healthcare services.

    Gen Z accepts those terms because they have never known anything different, and industry stakeholders need to rethink the future of healthcare data privacy for that very reason. Younger generations are much more willing to share their personal health data if there is a clear benefit to them, and the population at large, on the other end.


    Convenience at all costs

    Convenience is paramount for this new generation—so much so that they are often willing to forgo a personal relationship with their healthcare provider.

    Baby boomers—and even older millennials—grew up with the idea that trust should be established between two people when transacting a service. Whether it was at the bank with a teller and customer, or with a doctor and patient, there was a face-to-face relationship. That is no longer the case.

    Gen Z was raised on social media, smartphones and apps. These individuals have a completely different outlook on what it means to obtain a service. Most of the time, it can be done automatically with very limited human interaction (if any) and without waiting in line.

    With the rise of online shopping and on-demand apps—for everything from buying groceries to ordering food and taxis or managing online banking—convenience has become a staple. The danger for providers is, if Gen Z doesn’t get that desired convenience, they’ll go elsewhere.

    This is an important lesson for healthcare providers: They must make their experience convenient. As value moves to the edges of the network architecture, access to data becomes much easier. There are numerous services offered that can improve individuals’ health. This will all be seeded through technologies and the virtualization of services, such as an artificial intelligence-driven persona that is always available to help individuals with their health issues.


    Focusing on prevention, holistic health

    While younger generations want convenience with their healthcare, they also want a trusted adviser who can guide them toward holistic health and wellness.

    Younger generations don’t want the “old school” style of medicine where they have no input in decision-making. These individuals want to be armed with information from a trusted expert who can guide them toward the right decision.

    Gen Z attitudes toward doctor relationships are a deviation from previous generations who likely encountered more healthcare issues, such as the baby boomers. That generation is accustomed to a different type of patient-doctor relationship—one that’s long-standing, where the doctor is the fount of all knowledge and their diagnosis is definitive.

    Younger generations also have more awareness of whole-person wellness—not just their acute medical condition but how it interplays with nutrition, fitness, sleep and stress management. This is something the healthcare industry has historically not touched.

    Physicians are sought out for physical health problems, but now there are also health coaches, therapists and self-monitoring solutions—all of which can be connected to through endless online apps and services. From Fitbit to track wellness stats in real-time to genome services like 23andMe, which expose potential genetic vulnerabilities, Gen Z has the means to take preventive care into their own hands.

    Whether they like it or not, Gen Z will come to their physician and provider armed with data, information and knowledge unlike in generations past. This is why providers need to continue improving on how best to help patients take advantage of the tools already at their disposal.


    Transforming to patient-centric healthcare

    Healthcare is still far from a truly consumer-centric experience. While there are some aspects of convenience popping up in the industry, such as online appointment booking, increased pharmacy services (vaccinations, etc.) or text appointment reminders, those services are patchy.

    The industry is so huge and entrenched in the old way of working. There must be a transformational disrupter that will come along and completely change how healthcare is delivered. Other services and innovators will bubble up around this transformation, and the old guards will die away—just as they have in other industries.

    The internet of things and connected medical devices now form the “edge” of the network architecture. This is where data are produced and then sent into the centralized repository for processing.

    This shift is going to create almost unprecedented access to data for healthcare, and it will also help move the industry away from a physician-centric model.

    Delivering patient-centric care, where we capitalize on real-world data and automated care experiences, will be key to transforming healthcare.

    We must deliver care as part of the entire patient journey—not just one specific episode at a time. We can make care accessible for patients—including Gen Z—when and how they want it while using data to tailor their experiences and treat them like real customers.

    As Jerry Seinfeld once said, “I hate when they make you wait in the waiting room. It says, ‘waiting room’, so there’s no chance of not waiting—and they’ve got it, so they’re gonna use it—it’s all set up for you to wait.” 

    When healthcare providers innovate and create completely seamless patient experiences that emulate everyday consumer experiences, will Gen Z know what a “waiting room” is?

    Rick Halton is vice president of product and marketing for Lumeon. He has extensive experience in both the U.S. and European healthcare markets and was previously co-founder and vice president of sales and marketing at Chicago-headquartered Apervita. He has also held executive positions at Fortune 100 companies, including Hewlett Packard, and senior roles at Vodafone and Openwave.


  • 4 Feb 2020 2:02 PM | AIMHI Admin (Administrator)

    The AIMHI Excellence in Integration Awards celebrate and promote high performance, high value EMS. In the spirit of promoting true healthcare integration, award-winners are primarily sought from EMS agencies and other healthcare providers outside of the AIMHI membership. Nominations for the 2020 awards are due April 15, 2020. Please review all details below before submitting a nomination.

    Learn more & nominate!

  • 22 Jan 2020 10:16 AM | AIMHI Admin (Administrator)

    The International Board of Specialty Certification (IBSC) is collecting data to better understand the scope of practice between community paramedics practicing in a various countries, their own expectations regarding their ability to provide optimal patient care, and their perception of their role compared to that of their traditional emergency response ambulance counterparts.

     

    They are circulating a brief, 10 question survey and asking folks from around the world to contribute their input into the analysis.  It would be very valuable if you could invest a few minutes to answer this quick 10 question survey is posted on SurveyMonkey…  Also feel free to share this with others so we can help better understand this scope even better!!

    https://www.surveymonkey.com/r/RMYPMZR

    The survey results will be available on the IBSC website and the International Roundtable on Community Paramedicine (IRCP) website by 31 March 2020. 


  • 17 Jan 2020 10:15 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article

    CMS rejects Wyoming plan to lower air ambulance costs

    January 16, 2020

    By RACHEL COHRS

    The CMS earlier this month rejected a Wyoming Medicaid waiver proposal that aimed to lower air ambulance costs for all residents of the state.

    Wyoming essentially proposed making air ambulances into a public utility by using a Medicaid waiver to make all residents eligible for Medicaid coverage of air ambulances, regardless of their income level. The Wyoming Department of Health submitted the waiver to the CMS on Oct. 28, 2019 and it was denied on Jan. 3.

    "We do appreciate the timely decision from CMS on our waiver application related to air ambulance service. Working with our policymakers here at the state, we will look at the options of what we might do next," said Kim Deti, a spokesperson for the Wyoming Department of Health.

    Federal law limits states' power to regulate air ambulance billing, and the CMS said Medicaid waivers should not be used to circumvent federal law.

    CONTINUE READING►



  • 16 Jan 2020 2:09 PM | AIMHI Admin (Administrator)

    Florida Mobile Integrated Healthcare Community Paramedicine Program Guidebook PDF Download

    From AIMHI Education Chair Matt Zavadsky. "Congratulations to Jane Bedford and the team at the Florida EMS Bureau for publishing an excellent guidebook for MIH-CP."

    From the introduction:

    The purpose of this Guidebook is to do just that – guide you through the research, analysis, planning, development, and successful

    launch of your own customized Florida Mobile Integrated Healthcare – Community Paramedicine (MIH-CP) Program. This resource

    is straight-forward and easy to read. In addition to guidance, it provides recommendations and lessons learned from MIH-CP

    programs in Florida, advice from experts across the country, with expanded resources and templates.

    This Guidebook is not designed to tell you what you must do,

    but to provide suggestions and ideas on what to consider in

    developing your own MIH-CP. As you read it, remember that

    not all the information in the Guidebook will apply to you or

    your organization. Use it to think through the elements of

    your program and remember that a successful program must

    be anchored in your community



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