News & Updates

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  • 18 Mar 2019 9:56 AM | AIMHI Admin (Administrator)

    D Magazine Source Article | Comments Courtesy of Matt Zavadsky

    Interesting.  Note the reference to the 64% of premium $ spent in healthcare services for the ACA plans

    There is a requirement that these plans (and some others) spend 85% of premium $ on healthcare services, or potentially rebate the premiums to the premium payers.

    This has been a conundrum for some health plans desiring to invest in EMS-based MIH programs.  Since most MIH programs are not a covered health benefit, insurers would pay the cost for MIH services from their “margin” and, if it’s successful, have lower healthcare costs – potentially leading to rebates if their healthcare expenses are less than 85%

    Blue Cross Blue Shield of Texas Parent Company More Than Tripled Profits to $4.1B in 2018

    03/15/2019by Will Maddox

    Health Care Services Corporation, the parent company for Blue Cross Blue Shield of Texas, did not pay federal taxes in 2018 and netted $4.1 billion, receiving a $1.7 billion tax refund last year, according to financial statements. In 2017, the company had a net income of $1.3 billion, an increase of over 315 percent for this year.

    The tax overhaul passed by Congress and increasing profitability of health insurance played a large role in the increase, according to Axios. Profits don’t include fees from self-insured employers pay to HCSC, and the Affordable Care Act Marketplace was a big winner for HCSC. Only 64 percent of healthcare marketplace premiums were spent on medical care, resulting in $2.7 billion in gross profit. ACA plan holders may be in store for rebates due to premiums that were too high. Axios reports that there were certain tax loopholes that benefitted the Blue Cross companies.

    HCSC launched a $1.5 billion initiative called Affordability Cures to reduce healthcare costs of health plan holders, teaming up with research institutions around the state to focus on behavioral health, vaccine adherence, and analyzing usage data to improve efficiency. As a part of the initiative, BCBS of Texas will launch a healthy meal delivery service to neighborhoods that lack access to quality food.

    The initiative looks to address social determinants of health and learn about how to head off healthcare costs before they become too expensive.

  • 18 Mar 2019 9:29 AM | AIMHI Admin (Administrator)

    Becker's Source Article | Comments Courtesy of Matt Zavadsky

    Couple of interesting highlights in Becker’s review…

    Trump's 2020 budget proposal: 5 healthcare takeaways

    Ayla Ellison

    March 12, 2019

    President Donald Trump released his $4.75 trillion budget for fiscal year 2020 on March 11. The proposal, titled "A Budget for a Better America: Promises Kept. Taxpayers First," calls for reductions to Medicare and Medicaid over 10 years and includes provisions related to drug pricing and many other health-related issues.

    Below are five healthcare-related proposals in the president's budget:

    1. Discretionary funding for HHS. The budget requests $87.1 billion in discretionary spending for HHS, a 12 percent decrease from 2019 funding levels.

    2. Efforts to curb HIV. Keeping with President Trump's promise in his State of the Union address to end the spread of HIV in the U.S. over the next decade, the budget plan calls for HHS to receive $291 million next year to help curb the spread of the virus. A large portion of the funding — $140 million — would go to the CDC to improve diagnosis and testing for HIV in areas of the U.S. where the virus is continuing to infect people not getting proper treatment.

    3. Broad overhaul of Medicaid. Under the budget, nearly $1.5 trillion would be cut from Medicaid over 10 years. However, the budget seeks $1.2 trillion over the next decade for block grants or per-person caps that would start in 2021, according to The Washington Post. The budget plan would also end funding for Medicaid expansion.

    4. Medicare funding changes. Under the budget, Medicare spending would be reduced by an estimated $800 billion over 10 years. The budget would reduce the growth of various Medicare provider payments and includes changes aimed at addressing waste and abuse in healthcare and lowering drug prices, according to The Washington Post.

    5. Medical research. The plan includes a proposal to cut $897 million from the National Cancer Institute's budget and an additional $1 billion in cuts to other institutes that do medical research, according to Politico.

  • 11 Mar 2019 10:15 AM | AIMHI Admin (Administrator)

    Opinion of Chris Kelly, PWW | Comments Courtesy of Matt Zavadsky


    Special thanks to Chris Kelly of PWW for sharing this OIG Advisory Opinion regarding an MIH program.

    This opinion is very interesting and worth reading – a couple of the most interesting statements include:

    “Under the Arrangements, Requestor provides the Services to qualifying patients, some of whom may be Federal health care program beneficiaries. The Services provide a significant benefit to patients in the form of free health care services and care management furnished in their home. While not dispositive, the fact that a Medicaid program in the Health System’s service area reimburses for similar community-paramedic services also indicates their value. For these reasons, we believe the Services constitute remuneration from Requestor to patients participating in the Arrangements.”

    “…although the remuneration provided under the Arrangements implicates the Beneficiary Inducement CMP because it could influence a patient to select Requestor or the Clinic for federally reimbursable items or services, we believe that the Arrangements’ benefits outweigh any risk of inappropriate patient steering that the statute was designed to prevent.”

    “Finally, the scope and duration of the Services provided by the community paramedics appear reasonably tailored to accomplish Requestor’s goals of increasing patient compliance with discharge plans, improving patient health, and reducing hospital inpatient admissions and readmissions. It is reasonable to assume these patient populations—who Requestor certified are at higher risk of hospital inpatient admission or readmission—will benefit from the continuity of care offered by the Arrangements. For instance, the Arrangements make available a health care professional who can assist patients with following the discharge plan or treatment plan developed by Requestor or the Clinic, as applicable. In addition, the community paramedics can keep patients’ providers apprised of patients’ health by documenting all activities and interventions in their electronic medical records between discharge and a follow-up appointment. Access to free care also may foster patient safety and improve quality of care by preventing or detecting health care issues after discharge or after a treatment plan has been developed.”

    “Based on the facts certified in your request for an advisory opinion and supplemental submissions, we conclude that, although the Current Arrangement and the Proposed Arrangement could potentially generate prohibited remuneration under the anti-kickback statute if the requisite intent to induce or reward referrals of Federal health care program business were present, the OIG will not, and would not, respectively, impose administrative sanctions on [name redacted] under sections 1128(b)(7) or 1128A(a)(7) of the Act (as those sections relate to the commission of acts described in section 1128B(b) of the Act) in connection with the Current Arrangement or the Proposed Arrangement. In addition, the OIG will not, and would not, respectively, impose administrative sanctions on [name redacted] under section 1128A(a)(5) of the Act in connection with the Current Arrangement or the Proposed Arrangement.”

  • 4 Mar 2019 10:27 AM | AIMHI Admin (Administrator)

    USCF Source Report (PDF) | Comments courtesy of Matt Zavadsky

    With special thanks to Lou Meyer from the California Healthcare Foundation and the California EMS Authority, here is the most recent report by UCSF on the 13 California CP Pilot programs.

    With all the interest in ET3, we’ve attached highlights of the Alternate Destination – Urgent Care programs. The results from these programs could provide agencies with specific information you may want to consider when researching keys to success for alternate destination models.

    In the next few days, we’ll also send out the report findings from RTI on the REMSA Ambulance Transport Alternative (ATA) program they did as part of their CMMI Healthcare Innovation Award (HCIA).

    The full report is available here.

    From the UCSF Report 

    All three Alternate Destination – Urgent Care projects enrolled patients who had any of the following five

    conditions: isolated closed extremity injury, laceration with controlled bleeding, soft tissue injury, isolated

    fever or cough, and other minor injury. One site, Carlsbad, also enrolled patients who had generalized weakness.

    Forty-eight persons were enrolled in the three Alternate Destination – Urgent Care projects through November 2017. Orange County’s project had the largest enrollment (34 patients), and Carlsbad’s project had the smallest enrollment (two patients). UCLA’s Alternate Destination – Urgent Care project closed in May 2017, and Carlsbad’s and Orange County’s projects closed in November 2017. All closures of Alternate Destination – Urgent Care projects were due to low enrollment.

    There are multiple reasons why enrollment in the Alternate Destination – Urgent Care projects was substantially lower than anticipated. All three sites had fewer patients than expected who met all of the criteria for inclusion in the pilot project. In addition, many 911 calls occurred at times of the day during which urgent care centers were closed. In the case of Carlsbad’s project, enrollment was limited to non-elderly adults who had insurance coverage through a single health plan.


    The Alternate Destination – Urgent Care projects did not harm patients. Among the 48 patients enrolled in the Alternate Destination – Urgent Care projects, two patients (4%) were subsequently transferred to an ED within six hours of arrival at an urgent care center. In addition, nine patients (19%) were transported to an urgent care center but then rerouted to an ED because clinicians at the urgent care center declined to treat the patient. None of these patients had life-threatening conditions, and there were no adverse outcomes. The reasons for transport from an urgent care center to an ED are listed in Table 11. Additional detail about the two transfers to an ED within six hours of arrival at an urgent care center can be found in the initial public report on the community paramedicine pilot projects.


    The community paramedicine pilot projects have demonstrated that specially trained paramedics can provide services beyond their traditional and current statutory scope of practice in California. No adverse outcome is attributable to any of these pilot projects.

    These pilot projects integrate with existing health care resources and utilize the unique skills of paramedics and their availability 24 hours per day, 7 days per week. The community paramedics operate at all times under medical control – either directly or by protocols developed by physicians experienced in EMS and emergency care.

    Research conducted to date indicates that community paramedicine programs are improving the effectiveness and efficiency of the health care system. The seventh concept, Alternate Destination – Urgent Care, shows potential, but further research involving a larger volume of patients transported to urgent care centers with wider ranges of services and expanded hours is needed to draw definitive conclusions.

  • 1 Mar 2019 9:40 AM | AIMHI Admin (Administrator)

    Thank you to AIMHI's leaders for serving mobile healthcare with passion, dedication, and integrity. The 2019 AIMHI Board Leadership is listed below.

    • President: Chip Decker, Richmond Ambulance Authority  (2021)
    • President-Elect: Kevin Smith, Niagara EMS (2021, then President 2021-2023)
    • Treasurer: Dean Dow, REMSA (2021)
    • Secretary: Jon Swanson, MEMS (2021)
    • Immediate Past President Doug Hooten, Medstar Mobile Healthcare (2022)
    • Director Joe Penner, Medic (Mecklenburg EMS Agency) (2022)
    • Director Gary Booher, Three Rivers Ambulance Authority (2022)
    • Director Craig Hare, Pinellas County (2021)
    • Director Linda Frederiksen, Medic EMS (Davenport) (2020)
    • Director Jim Winham, EMSA (2020)
    • Director Alan Schwalberg, Northwell Health (2020)

  • 25 Feb 2019 8:10 AM | AIMHI Admin (Administrator)

    FierceHealthcare Source Article | Comments Courtesy of Matt Zavadsky

    The report is over 1mb, so not attached, but it is very good – strongly recommend to download it at the link below… 

    During NAEMT visits with key congressional committee leaders this week in DC, this was a hot topic for them!

    Lauren Block and her team at the Health Division of the National Governors Association Center for Best Practices, has done a wonderful job bringing stakeholders together to try and mitigate these issues!


    How states can take the lead on mitigating surprise out-of-network billing

    by Jacqueline Renfrow | 

    Feb 20, 2019 4:08pm

    There are policy options, at the state level, which could help mitigate the costs of surprise out-of-network billing. According to a recent report from the USC-Brookings Schaeffer Initiative for Health Policy, surprise out-of-network costs, such as ambulance transports or care delivered by an out-of-network physician at an in-network hospital, are a huge burden.

    If not prohibited by the state’s law, 1 in 5 visits to the emergency department results in a surprise out-of-network bill. And 50% of all ambulance cases involved an out-of-network ride in 2014, according to the report.

    “The financial consequences of surprise out-of-network bills can be substantial,” noted the paper. Especially for patients enrolled in HMOs, who can be liable to provide payment for all charges on out-of-network care. 

    Just how pricey?

    According to data in the report, collected from a large national insurer, out-of-network emergency physicians charged about eight times what Medicare pays for the same service. And a survey of American Society of Anesthesiologists reports that contracted payments to anesthesiologists averaged 350% of the Medicare rates in 2018.

    Plus, the costs can also be high for the physicians who are charging for out-of-network billing. These doctors often end up settling with patients or health plans for payments below what was fully charged. Collecting an out-of-network bill has more administrative hassle, too, according to the report. 

    But the problem lies at the hospital level, where it would be more expensive to require its out-of-network physicians to go in network, in turn, making it more expensive for insurers to encourage hospitals to take this approach, the report found. Then, physicians would most likely require higher stipends to compensate for the loss of income.

    Therefore, the demand would likely need to come from patients asking that hospitals pay the balance to physicians, which is unlikely as many patients only require these arrangements in an emergency or are not aware of surprise out-of-network charges at all, the report said.

    Still, the American Hospital Association (AHA) and several other hospital groups sent a letter (PDF) urging Congress to enact legislation that protects patients from surprise medical payments. 

    "The last thing a patient should worry about in a health crisis is an unanticipated medical bill,” AHA President and CEO Rick Pollack said in a statement. "We must protect patients from surprise bills that could unintentionally impact their out-of-pocket costs and undermine the trust and confidence patients have in their caregivers.”

    The Brookings paper sets forth five approaches that individual states need to consider in order to change the current policies surrounding surprise out-of-network billing. 

    • Take the patient out of the equation and require insurers and providers to resolve the problem and payment. 
    • Patients should be made aware of all out-of-network services within a facility before a procedure occurs. 
    • States should limit or ban all billing without prior consent, in writing, from patients. 
    • States have the power to manage enforcement through existing processes for managing licensure and certification and resolving patient disputes. 
    • Due to ERISA—which bars states from regulating self-insured employer health plans—state policy needs to focus on the regulation via health care providers. 

    Brookings suggests a policy setting “billing regulation,” which caps or sets limits on what out-of-network providers can charge patients in surprise situations.

    The second approach, “contracting regulation”, makes it impossible for services to be out-of-network when the facility itself is in network. Although if new contracts are formed, facilities will need to be mindful of state kick-back laws and rules about the contracts between healthcare providers and insurers. 

    The paper also suggests a billing regulation approach or a hybrid approach, drawing upon billing regulation and contracting regulations. The authors believe either two options could be enacted on the federal level as well, with only a few modifications. 

    “If pursuing option No. 1, the federal government could require self-insured (in addition to fully-insured) health plans to hold enrollees harmless for any costs beyond normal in-network cost- sharing amounts associated with surprise out-of-network services,” the paper noted. “If enacting a federal solution, Congress would also have to decide whether to supersede existing state reforms, which range widely in their comprehensiveness and effectiveness.” 

    The letter to Congress agreed with the sentiment that federal decisions should be mindful of state regulations and ultimately leave patients out of any payment debates.

  • 15 Feb 2019 2:18 PM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    Something we should all keep a close eye on – could have serious financial impact on safety-net providers, including EMS agencies.


    New Medicaid barrier: Waivers ending retrospective eligibility shift costs to providers, patients

    By Harris Meyer  | February 9, 2019

    Last year, Jackson Memorial Hospital in Miami admitted an uninsured, low-income patient who stayed in the hospital for 86 days and ran up total charges of more than $1 million.

    It took the public hospital's staff 65 days to complete a Medicaid application for the patient. Once it was approved, the Florida Medicaid agency covered bills for the previous 90 days, as per federal Medicaid policy in effect across the country since 1972. Jackson received a payment of $82,000, based on the state's limit of 45 covered hospital days per year.

    But on Feb. 1, Florida ended retrospective Medicaid eligibility under a waiver granted by the CMS in November and effective through June, which likely will be extended. Now it will only cover claims back to the first day of the month in which an application is filed. The state projects this will save it and the federal government $100 million a year. The Trump administration so far has granted similar waivers to five other states.

    If the waiver had been in effect last year, Jackson would have eaten that patient's entire bill. It estimates the new policy will cost the hospital at least $4 million a year in uncompensated care, and likely far more.

    “We get trauma cases where we can't identify the patient or get documentation for weeks,” said Myriam Torres, Jackson's vice president of revenue cycle. “This will save Medicaid dollars at providers' and patients' expense.”

    A costly incentive

    Over the past two years, despite strong objections from hospitals and other provider groups, the CMS has granted waivers of 90-day retrospective eligibility to Arizona, Arkansas, Florida, Iowa and Kentucky. Some were part of broader Medicaid Section 1115 demonstrations of work requirements. Maine also received a waiver but its new Democratic governor announced she won't implement it. The CMS is considering similar waiver requests from Ohio and other states. 

    In its approval letters, the CMS argued that demonstrations ending 90-day retrospective eligibility will test whether that gives beneficiaries an incentive to enroll in Medicaid before they need healthcare services, so they can receive preventive services and stay healthier. It also says the change will facilitate a smoother transition of beneficiaries into commercial health plans, which don't offer retroactive coverage. 

    The CMS is requiring states to develop outreach and education strategies to encourage providers and beneficiaries to submit Medicaid applications as early as possible, though providers say they haven't seen any significant new state activity there.

    A CMS spokesman said that as in all Section 1115 demonstration waivers, the agency is requiring states to monitor and regularly report the outcomes and financial impact.

    But experts say there's no evidence that eliminating retrospective eligibility encourages Medicaid-eligible people to sign up earlier, and there are plenty of reasons why that hypothesis is implausible.

    “Many people who aren't enrolled are not aware they are eligible or they have difficulty with the enrollment process,” said Dr. Benjamin Sommers, an associate professor of health policy and economics at Harvard University. “The notion that most people will sign up by getting rid of retrospective eligibility is unlikely. They typically do not even understand it.”

    Critics say eliminating retrospective eligibility is one more administrative barrier the Trump administration has erected to make Medicaid and other public benefits harder to access. These include work and reporting requirements, premium payments, healthy behavior incentives, benefit lockouts, and proposed penalties for legal immigrants who use public programs. States like Arkansas that have added new hurdles have seen sharp drops in Medicaid enrollment.

    “Shortening the (retrospective eligibility) window gives people less time to figure out they'd be eligible,” said Pamela Herd, a public policy professor at Georgetown University, who calls that form of administrative burden a learning cost. “Republicans have employed these types of changes to reduce use of social welfare programs.”

    Changing nature of waivers

    Under previous administrations, Delaware, Indiana, Maryland, Massachusetts, New Hampshire and Tennessee received waivers of the federal requirement for retrospective eligibility, typically as part of coverage expansions. In contrast, the Trump administration's waivers have been part of programs to restrict coverage.

    Most of these waivers retain retroactive coverage for pregnant women, infants, disabled people and those in nursing homes. Florida's waiver, however, excludes such coverage for the nursing home population.

    Herd and other experts say that if the goal is to get people to enroll as soon as they are eligible, there are proven ways to achieve that, such as streamlining the enrollment process and doing more aggressive outreach. The Trump administration has sharply cut funding for enrollment education and assistance.

    On the other hand, if the goal is to reduce federal and state spending on Medicaid and shift costs to providers and patients, eliminating retroactive eligibility likely is effective. 

    Actuarial analyses of Medicaid payments have shown that about 5% of Medicaid payments occur during the retrospective eligibility period. Ending retrospective coverage would reduce Medicaid outlays by an estimated $13.3 billion from 2017 to 2026, according to the Commonwealth Fund.

    In 2016, Indiana reported that 14% of beneficiaries to whom the waiver applied ran up significant out-of-pocket medical expenses as a result, averaging more than $1,500 per person. Sixteen percent of providers said they saw charity cases and bad debt increase as a result of the policy.

    “If this is really an experiment, what is the policy goal other than to reduce program costs?” asked Joseph Antos, a conservative health policy analyst at the American Enterprise Institute. “Presumably this should have something to do with patient outcomes or efficiencies. I don't see the word efficiency in any of this. I see cut.”

    A history lesson and the impact on beneficiaries

    Retrospective eligibility was built into federal Medicaid law early on as a safety net protection for very low-income people and their medical providers. It encourages providers to treat patients knowing they'll get paid and to help them sign up quickly for the program. 

    Another key rationale is that unlike in private insurance, many Medicaid beneficiaries “churn” on and off coverage due to changes in income and because states impose a demanding annual eligibility redetermination process. It's estimated that 25% or more of beneficiaries are at least temporarily disenrolled as a result of the redetermination process and other factors. 

    Many other people aren't even aware they are eligible. The Kaiser Family Foundation recently reported that 6.8 million uninsured adults and children were eligible for Medicaid but were uninsured in 2017. 

    All these factors leading to loss of coverage for eligible people makes retrospective eligibility an important backstop, patient advocates say.

    But some state and federal officials long have complained about the cost of retroactive coverage, which generally can't be passed on to the private Medicaid plans that administer most state programs. 

    Tennessee received a waiver in 1994 as part of its major Medicaid coverage expansion program known as TennCare. Even though that program largely has been rolled back and the state has not expanded Medicaid under the Affordable Care Act, the elimination of 90-day retroactive coverage remains in place for nearly all beneficiaries.

    That has led to many Medicaid-eligible people incurring large medical bills before their Medicaid applications are approved, with some facing lifetime debt, said Michele Johnson, executive director of the Tennessee Justice Center, which tries to help people clear up these bills.

    The problem was exacerbated by a recent major computer glitch in the state's Medicaid enrollment system, which left thousands unable to file their annual enrollment redetermination applications online.

    Before her Medicaid application was approved, one Memphis woman racked up $250,000 in bills resulting from her baby being born with severe health problems. “She said that was the hardest thing in her life—going home with a disabled child and being consigned to poverty for the rest of her life,” said Johnson, whose group helped with her case. 

    After a nine-month court fight, the woman finally got Tennessee's Medicaid program to pick up the entire bill.

    Yet there has never been a study of the policy's impact in Tennessee. “It hasn't led people to sign up ahead of time,” Johnson said. “All these other policies make it almost impossible to sign up. If the state were interested in that, they would make the whole process less bureaucratic.”

    In 2017, Iowa received a CMS waiver of the 90-day retrospective eligibility requirement, including for nursing home residents, despite warnings that nursing homes would refuse to admit people who were awaiting Medicaid eligibility. Last year, under pressure from nursing homes, the state Legislature restored retroactive coverage for that population.

    Brent Willett, CEO of the Iowa Health Care Association, said it takes an average of 71 days to assemble complicated income and assets information, file the application, and receive approval for Medicaid nursing home coverage. Under the policy the state reversed, facilities only received payment back to the first day of the month when the application was filed, even though they may have admitted the resident many weeks earlier. 

    The association projected that policy would cost Iowa nursing homes $7 million in the first year. “It sounds nice that people should start the application process early and we agree, but it's not practical in practice,” Willett said. “If we are maintaining a system to ensure coverage for people who don't have assets for care, it makes no sense to penalize providers for providing that care. That policy wasn't cost containment, it was a cost shift to providers.”

    Iowa hospitals looking for a reversal

    As to the broader group of beneficiaries affected by Iowa's waiver, the Iowa Hospital Association is pushing to have 90-day retroactive eligibility reinstated this year. The policy hurts urban trauma centers that provide intensive care to people before an application can be completed, as well as rural hospitals that lack a profit cushion to absorb those unexpected costs, said Scott McIntyre, the association's vice president of communications.

    The Legislature ordered it as a cost-containment measure, with the state projecting it would affect nearly 40,000 Iowans and save it and the feds $36.7 million a year. The CMS waiver required the state to provide outreach and education to the public to ensure that eligible people apply for Medicaid as soon as possible.

    But McIntyre said the state has not ramped up enrollment outreach to mitigate the end of retrospective eligibility. 

    In addition, Iowa, which expanded Medicaid in 2014, has not conducted any review of the cost savings to the government or of the financial impact on providers and beneficiaries, according to a spokesman for the Iowa Department of Human Services. The CMS, he said, did not require the state to conduct such a report on the impact of eliminating retrospective eligibility. “We've made so much progress with Medicaid expansion to reduce uncompensated care, and this really undermines that progress,” McIntyre lamented.

    There's already an effort to roll back the new retrospective eligibility waiver in Florida, which didn't expand Medicaid, so that it applies to nursing home residents and all other Medicaid eligibles except pregnant women and children. 

    It's basically impossible for many people who may need a nursing home placement to apply for Medicaid ahead of time because they're living in the community and don't qualify until they enter institutional care, explained Tom Parker, director of reimbursement for the Florida Health Care Association. 

    “I would think that undercuts the main argument for this policy,” he said.

  • 13 Feb 2019 6:29 PM | AIMHI Admin (Administrator)

    Becker's Hospital Review Source Article | Comments Courtesy of Matt Zavadsky

    Customer-focused; disruptive innovation…

    Ambulnz is an interesting model worth visiting their website at the hyperlink below…

    Providers can now request Uber rides for patients: 6 notes

    Jackie Drees 

    Feb 13, 2019

    Uber Health and ambulance services provider Ambulnz teamed up to enable healthcare providers to order non-emergency medical transportation for their patients.

    Six notes:

    1. Ambulnz integrated Uber Health's application programming interface into its platform, which provides healthcare organizations with on-demand medical transport.

    2. Through the new partnership, providers can use Ambulnz's platform to request patient transportation to and from destinations such as a physician's office, clinic or hospital.

    3. Healthcare organizations can also integrate Ambulnz's API into various EHRs, giving providers the option to request non-emergency medical transportation directly from their clinical workflow.

    4. Ambulnz currently operates in Colorado, New York, California and Tennessee. UCHealth in Aurora, Colo., had already been using Ambulnz's platform, and recently began using the Uber Health integration. "By having the ability to order a sedan, ambulette or an ambulance from a single web portal or an app, our facilities will be able to more efficiently manage transportation needs, improving the overall experience and care of our patients," UCHealth CIO Richard Zane, MD, said in a news release emailed to Becker's Hospital Review.

    5. Dan Trigub, head of business development for Uber Health, added: "With access to different types of Uber Health and Ambulnz rides in a centralized place, healthcare providers can spend more time focused on patients instead of the tools and technology to get them where they need to go at exactly the right moment."

    6. Both Uber Health and Ambulnz's platforms are HIPAA compliant, according to the news release.

  • 11 Feb 2019 10:23 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    Interesting, but not surprising results from this report.

    The report is attach, with a section highlighted noting the following quote:

    Many ACOs have established themselves as the central hub to enable community organizations and PCPs to more effectively meet the needs of patients. This includes teaming with employers and local gyms to offer exercise and nutrition-based counseling. Others have established free clinics, where food is available, to reduce ED visits for non-medical needs, as well as partnered with community paramedicine programs to build 911 services to support at-risk patients and facilitate home visits to reduce potentially preventable admissions.”


    Unnecessary ED visits from chronically ill patients cost $8.3 billion


    FEBRUARY 7, 2019

    About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis.

    The report, released Thursday by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.

    The frequency of unnecessary ED visits from the chronically ill is unsurprising given the fee-for-service payment environment the majority of providers remain in, said Joe Damore, senior vice president of population health consulting at Premier. On average, only 10% of providers' payment models are tied to value-based models, he said, so providers don't have an incentive to effectively manage patients to prevent disease progression and promote wellness.

    Premier's findings are in line with other research on patients with chronic diseases, finding they are more likely to use the ED and get admitted to hospitals because they experience poor care coordination. 

    "Value-based care is managing a chronically ill patient in a coordinated way, and the traditional payment model hasn't rewarded that. It's episodic," Damore said. 

    The six chronic conditions used in the analysis are asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension and behavioral health conditions, such as mental health or substance abuse issues. They were selected because they are often cited in the academic literature as the most common and costly conditions in the healthcare system, Premier said. 

    The data from the 24 million ED visits at 747 hospitals comes from Premier's database, which has information on 45% of U.S. patient discharges, according to Premier. To get the results, Premier identified hospitals with the lowest quartile visit rate, or those that had the lowest ED admission rates by condition, and calculated how many visits at the remaining hospitals could be prevented if all hospitals achieved those rates for the six chronic conditions. 

    And then to arrive at the $8.3 billion in costs, Premier used the average cost for an ED visit estimated by the Health Care Cost Institute, which is $1,917. 

    Damore said that although the industry is "mostly fee-for-service at this time," he expects an eventual transition to value. "More and more providers are convinced that the future is going to be value-based payment," he said.

  • 11 Feb 2019 10:21 AM | AIMHI Admin (Administrator)

    EMS1 Source Article | Comments Courtesy of Matt Zavadsky

    Behavioral health patients are a significant challenge for EMS systems and their partner healthcare facilities. 

    The AMR program in Stanislaus County, CA pilot project to provide medical clearance for people with mental health needs and arrange for them to be transported directly to a county-operated mental health crisis center demonstrated excellent outcomes for the patients and healthcare system! 

    Nice to see this study on the project published in the Annals of Emergency Medicine.

    The USCF review of the project is attached for your information.

    Tip of the hat to Paul Ford from Las Cruces Fire Department for this article!

    Journal Watch: Medical Clearance of Psych Patients

    Authors: Trivedi TK, Glenn M, Hern G, Schriger DL, Sporer KA.  

    Published in: Ann Emerg Med, 2018 Sep 28.   

    Patients with an altered mental status can be challenging, particularly those experiencing a psychiatric emergency. Not only can they be a potential danger to you and your partner, they typically end up in an ED for a lot longer than necessary. Studies have demonstrated that these patients can tax EMS systems and add to ED overcrowding. 

    One factor that contributes to the difficulty of caring for them is that field providers are typically required to transport patients to an ED even if they are sure an ED is not the appropriate destination for their patient. Further, patients who are experiencing psychiatric emergencies are often required to be medically cleared by an ED physician to ensure a life-threatening illness is not responsible for their behavior. Additionally, there is a sizable population of psychiatric emergency patients transported involuntarily to protect their safety or the safety of others. 

    What if we were permitted to choose alternative destinations for our behavioral-emergency patients? Would this be better for them, the EMS system, and the hospitals? Would it be safe for our patients? UCLA emergency physician Tarak Trivedi, MD, and his coauthors recently published a manuscript that seeks to answer these questions. 

    Just for background, there have been some smaller studies that reported that mistaking a psychiatric emergency for a nonpsychiatric life-threatening illness is rare. There are also reports of emergency medicine experts questioning the value of transporting these patients to EDs for medical clearance. 

    Trivedi’s is a retrospective observational study—in other words, that data had already been collected, and there were no interventions introduced by the investigators. The data were collected over five years from EMS systems in Alameda County, Calif. The authors were evaluating a protocol that allows EMS providers to transport patients with isolated psychiatric complaints (i.e., no medical complaint or abnormal vital signs) directly to an appropriate psychiatric facility. 

    The authors had two study objectives. First they sought to describe the characteristics of patients who received involuntary psychiatric holds and compare them to patients transported for other reasons. They defined involuntary-hold patients as those who had at least one involuntary hold during the study period. They also sought to evaluate the safety of the protocol allowing EMS providers to divert these patients to psychiatric emergency services. The authors used “failed diversion” as a proxy measure for safety. A failed diversion was defined as an event in which a patient was initially brought to a psychiatric emergency facility but required transport to an ED within 12 hours. 

    During the study period there were 265,625 unique EMS patients who received care by Alameda County EMS. Almost 10% (26,283) had at least one involuntary hold. When comparing involuntary-hold patients to those who’d never been involuntarily held for a psychiatric emergency, involuntary-hold patients were more often men; they also accounted for substantially more EMS usage. Of the involuntary-hold patients, 48% had only one EMS transport during the study period, compared to 74% of “never-held” patients. Moreover, 4% (1,072) of involuntarily held patients had more than 20 encounters during the study period. There were only 0.4% (820) of never-held patients in this category.

    Besides unique patients, the authors also looked at total EMS calls. During the study period there were 541,731 patient encounters, and 10% of these (53,887) were for patients receiving involuntary holds. Yes, 26,283 patients accounted for 53,887 EMS encounters involving involuntary holds. They also accounted for 74,116 encounters that did not involve involuntary holds. In total, involuntary-hold patients accounted for almost a quarter of all EMS encounters in this county (128,003; 24%). 

    Of the 53,887 involuntary-hold encounters, 41% (22,074) resulted in direct transport to a psychiatric emergency facility. Only 0.3% (60) of these could be classified as failed diversions!

    What is even more impressive is that the authors conducted a manual chart review and discovered that in 54 of the 60 failed diversions, the patient developed new symptoms after arrival at the psychiatric emergency facility, and there was nothing in the PCR that supported transporting these patients to the ED.

    Of the six patients who should have been transported directly to an ED, none died or required CPR or an advanced airway during their second transport. Three patients required critical interventions; these included one glucagon administration, one naloxone administration, and placement of one nasopharyngeal airway. 


    The authors of this study did a nice job outlining their limitations. They included that this study was performed in one county, which the authors note has a notably higher rate of involuntary holds compared to the rest of California.

    The protocol studied has been in place for years, and results may be different during an implementation phase. They also discussed limitations in the data and the matching algorithm they used to identify unique patients. 

    This was a well-done study that significantly adds to the literature. It strongly suggests that a protocol that allows EMS providers to divert psychiatric patients to dedicated psychiatric facilities appears to be safe and beneficial.

    Antonio R. Fernandez, PhD, NRP, FAHA, is research director at the EMS Performance Improvement Center and an assistant professor in the Department of Emergency Medicine at the University of North Carolina–Chapel Hill. He is on the board of advisors of the Prehospital Care Research Forum at UCLA.

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