News & Updates

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  • 22 Aug 2019 7:05 AM | Matt Zavadsky (Administrator)

    A very innovative proposal by Wyoming!  There are several Public Utility Model (PUM) EMS systems that have stood the test of time by continually proving value.  These systems provide exceptional clinical outcomes, excellent operational effectiveness and unparalleled economic efficiency. 

    PUM systems are set up under the premise that the fixed cost of providing EMS (capital, readiness, etc.) are best managed by empowering a governmental authority with the responsibility to provide all services – thus assuring consistency of clinical oversight and QA, maximizing operational synergy and distributing the infrastructure cost over all ambulance calls in the service area.


    Wyoming's air ambulance coverage pitch

    Wyoming has come up with a unique way to make air ambulances — a common source of huge surprise medical bills — more affordable, according to the Georgetown University Health Policy Institute's blog.

    The big picture: The state is essentially proposing to turn air ambulances into a public utility.

    • Wyoming's health department has put together a Medicaid waiver that would make all residents, regardless of their income, eligible for Medicaid coverage of air ambulance services.
    • Providers would submit bids to serve as the only air ambulance operator within a particular geographic region.
    • The state would make flat payments to the operator that wins the bid, rather than paying them for each ambulance ride.
    • Patients' cost-sharing would vary based on their income, and insurers would pay into the program rather than covering air ambulances themselves.

    What we're watching: To go into effect, the proposal first has to be approved by CMS. State lawmakers would then have to make the necessary policy changes.

    Yes, but: The blog's author, Sabrina Corlette, correctly warns that "both federal officials and state lawmakers will likely be lobbied extensively by the air ambulance industry, which has a vested interest in maintaining the status quo."


    Will it Fly? Wyoming Attempts End Run Around High Air Ambulance Prices

    August 21, 2019 

    by Sabrina Corlette

    As we’ve written before in this space, air ambulance charges are a growing source of surprise medical bills for consumers, and the charges can be eye-popping – five figures or more. Unfortunately, state-level efforts to limit balance billing by air ambulance companies have thus far been stymied by the Airline Deregulation Act (ADA) of 1978, which prevents states from enacting laws regulating the prices of any air carrier, including air ambulance. In 2018, the U.S. Congress considered legislation that would have given state officials the ability to regulate the more egregious billing practices of air ambulance providers, but congressional leaders ultimately bowed to pressure from the industry. The enacted bill authorized a Department of Transportation advisory committee to study the issue, the ultimate “kick the can” solution to the problem.

    This year, although Congress is debating several bills to protect patients from surprise medical charges, only one – sponsored by Senators Lamar Alexander and Patty Murray – would extend those protections to patients needing emergency air transport. Meanwhile, air ambulance bills are only getting higher (for example, air ambulance charges in New Mexico have risen 300 percent since 2006) and more air ambulance providers are choosing not to participate in health plan networks, making it easier for them to sock patients directly with their high charges.

    Some states have tried to protect consumers, but the scope of these efforts are curtailed by federal law. For example, Texas and North Dakota laws to limit air ambulance balance billing were ruled as preempted by the ADA in two federal district courts. Another federal law – the Employee Income Security Act (ERISA) – preempts states from regulating self-funded employer plans, including any imposition of a requirement that these plans include air ambulances in their networks or hold enrollees harmless for out-of-network charges.

    Wyoming may have hit on a unique solution. The state is proposing to turn air ambulances effectively into a public utility.

    Wyoming’s Plan

    The Wyoming Department of Health has developed an 1115 Medicaid waiver application that would make all Wyoming residents, regardless of income, eligible for Medicaid for air ambulance services only. Under the plan, the state would:

    • Set the basic parameters of air ambulance coverage under the Medicaid program.
    • Solicit competitive bids from air ambulance providers to serve as the sole provider within a prescribed geographic area within the state.
    • Create a centralized call center that would direct all calls for air ambulance services to the approved providers.
    • Make regular flat payments to these providers (instead of reimbursing on a fee-for-service basis).
    • Set patient cost-sharing on a sliding scale, based on income.
    • Recoup costs for operating the program from private insurers, employer plans, and individuals already paying for transports.

    In its pitch to state lawmakers and stakeholders, the Department of Health argues that the air ambulance industry is an example of market failure, noting that most patients cannot “shop around” for air ambulance services. Even in situations when the patient is conscious or in serious medical distress, the cost is not transparent because of differences in network arrangements and cost-sharing among plans. Officials further note that the supply of air ambulances has risen dramatically in the past five years, and these providers have very high fixed costs that they must recoup, largely from private payers and patients. Indeed, in 2018, Wyoming employers paid an average of $36,000 per flight. The Department argues that, as with other critical commodities with high fixed costs such as water and electricity, a regulated monopoly is a more efficient way to deliver the needed services.

    Questions and Next Steps

    There remain a number of hurdles before Wyoming’s unique plan can take effect. First, the federal government would have to approve the waiver proposal. The Wyoming legislature would then have to enact state-level legislative changes to authorize the program. Both federal officials and state lawmakers will likely be lobbied extensively by the air ambulance industry, which has a vested interest in maintaining the status quo. Also, although the state argues that the Medicaid program should not be preempted under the Airline Deregulation Act, that premise has not yet been tested in court. Other questions include whether self-funded employer plans, which are not subject to state regulation, will opt-in to the state program, enabling it to be budget neutral.

    Wyoming has posted its waiver application and invited public comment. It expects to submit the proposal to federal authorities by September 1, 2019, with another public comment period expected later in the year.

  • 16 Aug 2019 6:12 AM | Matt Zavadsky (Administrator)

    The latest report from the Healthforce Center and Philip R. Lee Institute for Health Policy Studies at UC San Francisco. 

    The full report can be downloaded at the link below, but we’ve included some outcome highlights, specifically because many of you are evaluating the initiation of similar programs, and one, the Alternate Destination – Urgent Care project seems to be similar to one of the interventions included in the CMMI ET3 model.  The experience and findings in the CA model may help potential ET3 participants refine their programs.


    Evaluation of California’s Community Paramedicine Pilot Program

    Author(s): Janet M. Coffman, Cynthia Wides, Lisel Blash,Ginachukwu Amah, Igor Geyn and Matthew Niedzwiecki

    Date: August 6, 2019

    Community paramedicine, also known as mobile integrated health, is an innovative model of care that is being implemented throughout the United States. The California Emergency Medical Services Authority has sponsored a pilot project under which specially trained paramedics perform duties beyond their traditional roles of responding to 911 calls, transporting patients to emergency departments and performing inter-facility transfers. Healthforce Center at UCSF is conducting an evaluation of the pilot project that was funded by the California Health Care Foundation.

    The evaluation found that community paramedics are collaborating successfully with physicians, nurses, behavioral health professionals and social workers to fill gaps in the health and social services safety net. The evaluation has yielded consistent findings for six of the seven community paramedicine concepts tested. All of the post-discharge, frequent 911 users, tuberculosis, hospice, and alternate destination – mental health projects have been in operation for at least two and one half years and have improved patients’ well-being. In most cases, they have yielded savings for payers and other parts of the health care system. Findings regarding outcomes of a project testing the sixth concept, alternate destination – sobering center, suggest that this project is also benefitting patients and the health care system over the course of its first 14 months. The seventh concept, alternate destination – urgent care, shows potential but further research involving a larger volume of patients is needed to draw definitive conclusions.


    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. The projects are enhancing patients’ well-being by improving the coordination of medical, behavioral health, and social services, and reducing ambulance transports, ED visits, and hospital readmissions. The majority of potential savings associated with these pilot projects accrued to Medicare and Medi-Cal and hospitals that care for Medicare and Medi-Cal beneficiaries because Medicare and Medi-Cal beneficiaries accounted for the largest share of persons enrolled in the pilot projects.


    Alternate Destination – Mental Health

    ·       The three Alternate Destination – Mental Health projects enrolled 2,045 persons between September 2015 and March 2019.

    ·       The City of Los Angeles launched an Alternate Destination – Mental Health project in late June 2019 and will be included in subsequent updates to this report.

    ·       Across the three Alternate Destination – Mental Health projects, 28% to 45% of patients screened were transported to the mental health crisis center rather than an ED. In Stanislaus County, an additional 27% could have been transported to the crisis center if the county had more inpatient psychiatric beds or if the crisis center accepted people with private insurance or Medicare.

    ·       Transport of these patients directly to a mental health crisis center has reduced the number of persons in EDs who need only mental health services, which can help reduce ED overcrowding.

    ·       Only 2% of patients enrolled in the three Alternate Destination – Mental Health projects (n = 47) were transferred from the mental health crisis center to an ED within six hours of admission. None of the transfers involved a life-threatening condition, and only four of the patients transferred to an ED were admitted for inpatient medical care.

    ·       In addition to responding to 911 calls regarding mental health emergencies, the community paramedics in Stanislaus County screen “walk-in” clients, who come to the mental health crisis center on their own or who are brought by friends or family, to determine whether they have any medical conditions that might necessitate transport to an ED instead of direct admission to the crisis center.

    ·       Law enforcement officers in Stanislaus County report that having community paramedics available enhances their ability to respond effectively to persons with mental illness.

    ·       The three Alternate Destination – Mental Health projects avoided potential costs of $2.2 million by reducing the number of 911 calls that resulted in an ED visit and subsequent transport of a patient from an ED to an inpatient psychiatric facility.

    Alternate Destination – Urgent Care

    ·       The three Alternate Destination – Urgent Care projects enrolled 48 persons from September 2015 through November 2017.

    ·       One of the Alternate Destination – Urgent Care projects closed in May 2017, and the other two projects closed in November 2017.

    ·       Enrollment in the Alternate Destination – Urgent Care projects was substantially lower than anticipated because fewer 911 calls than expected met the strict inclusion criteria and many calls for eligible patients occurred at times of the day during which urgent care centers were closed. In addition, clinicians at urgent care centers were reluctant to treat some conditions, such as a dislocated shoulder, that could be treated safety and effectively in that setting.

    ·       Most patients enrolled had a laceration or an isolated closed extremity injury.

    ·       During the time period in which the Alternate Destination – Urgent Care projects enrolled patients, two patients (4%) were transferred from an urgent care center to an ED within six hours of arrival at the urgent care center. Nine patients (19%) were transported to an urgent care center and then rerouted to an ED because clinicians at the urgent care center declined to treat the patient.

    Alternate Destination – Sobering Center

    ·       San Francisco’s Alternate Destination – Sobering Center project enrolled 1,627 persons from February 2017 through March 2019. Two hundred and thirty-three patients (14%) were treated at the sobering center more than once.

    ·       97.9% of patients enrolled in the Alternate Destination – Sobering Center project were treated safely and effectively at the sobering center. Only 34 patients (2%) were transferred to an ED within six hours of admission to the sobering center, and only two (0.1%) were rerouted from the sobering center to an ED because registered nurses at the sobering center declined to accept them. Only two patients were admitted to a hospital for inpatient medical care.

    ·       Community paramedics participating in the project provide feedback to paramedics on 911 crews on how to screen acutely intoxicated persons to determine if they are candidates for transfer to the sobering center. They are also collaborating with homeless outreach workers to encourage people who use the sobering center frequently to seek treatment for chronic alcoholism, housing, and other services.

    ·       San Francisco’s Alternate Destination – Sobering Center project avoided potential costs of $551,257 by replacing ED visits with sobering center services. The majority of potential savings accrued to Medi-Cal because the majority of patients enrolled in the project are Medi-Cal beneficiaries.

    ·       The Santa Clara County EMS Agency and the Gilroy Fire Department launched a new Alternate Destination – Sobering Center project in June 2018, but the project had not enrolled any patients as of March 2019.

    ·       The City of Los Angeles launched an Alternate Destination – Mental Health project in late June 2019 and will be included in subsequent updates to this report.

  • 16 Aug 2019 6:09 AM | Matt Zavadsky (Administrator)

    Interesting that the community paramedic concept has made it into the presidential campaign discussions…  J


    Pete releases white paper on rural health care 

    South Bend Tribune Report

    Aug 9, 2019

    Presidential candidate Pete Buttigieg on Friday called for efforts to increase affordable health care options for people living in rural communities.

    In a statement of his rural health care plan released Friday, Buttigieg would strengthen the Affordable Care Act and implement Medicare for all who would want such coverage. He also promised to work to increase subsidies for low-income Americans and expand those for middle class consumers.

    Access to rural health care and availability of medical professionals would be bolstered by his plan to increase incentives for loan forgiveness programs for health professionals. Plans call for offering incentives for doctors to settle in rural areas, and increasing community paramedic programs.

    Rural hospital closures also are having an impact on delivery and availability of health services. Buttigieg proposes using incentives, technology and designations to help keep these facilities open with the type of staffs to serve rural communities.

    He also offered ways to improve health outcomes for veterans and tribal communities with a series of programming and personnel improvements and proposals.

  • 15 Aug 2019 10:18 PM | Matt Zavadsky (Administrator)

    Nice article by Charlotte Huff, who has been a big supporter of EMS collaborations designed to reduce preventable acute care utilization. 


    Paramedics providing care before it is an emergency

    EMS providers are making house calls and helping people gain access to primary care with the goal of reducing unnecessary ED utilization.

    July 5, 2019


    Amid heightened efforts to reduce unnecessary emergency visits, including a recently announced federal pilot to treat low-acuity patients elsewhere, some insurers have already been striving to intervene even before patients resort to 911.

    Some patients return to the emergency department again and again because they don’t know where else to seek help, says Eugene Sun, MD, chief medical officer at Blue Cross Blue Shield of New Mexico. “A lot of times it’s a social issue,” Sun says. “They’re hungry. They’re lonely. And sometimes it’s a clinical issue,” he says, “but they don’t know how to get into primary care or they don’t have a primary care doctor assigned.”

    So starting in 2016, the New Mexico insurer began contracting with Albuquerque paramedics to provide home support for frequent users of the emergency department as well as some recently discharged hospital patients. Once at-risk patients are referred, a paramedic visits the home at least once, checking on everything from home safety to medication difficulties.

    The New Mexico program is just one of a number of initiatives that have health care systems, payers, and others teaming up with local emergency responders to reduce unnecessary ED trips. By 2017, there were at least 129 such programs, according to the most recent survey by the National Association of Emergency Medical Technicians. Until recently the lack of payment was a hurdle, but now the money is beginning to flow.

    Since early 2018, Anthem has been paying ambulance providers for treatment of minor injuries and illnesses at home or another site, an option that’s now available in all 14 states where Anthem has commercial plans, according to a spokeswoman. In February, CMS announced a pilot program in which it will reimburse ambulance providers for treatment on scene or transport to a nonemergency site, such as an urgent care clinic or a doctor’s office.

    Like the New Mexico Blues plan, other payers are channeling payment upstream for services delivered to at-risk patients before they seek out emergency care. In Milwaukee, for example, UnitedHealthcare Community Plan has contracted with the city fire department to make home visits—typically four of them—to vulnerable patients. The first eight patients referred to the program had visited the emergency department a total of 96 times during the prior six months, says Kathleen Schoenauer, director of medical and clinical operations at the plan, which manages care for Medicaid and dual special needs patients in Wisconsin. During the visits, paramedics help patients with their medications and identify any hurdles to primary care access, among other challenges. UnitedHealthcare coordinators accompany the paramedic on the fourth visit to introduce themselves as the patient’s new contact moving forward. “They know that they can call us, if their housing is at risk again, if they are having trouble getting transportation to their doctor, if they want to change doctors,” Schoenauer says.

    In the first group of eight patients, costs from ER visits dropped by 42% from the six months prior to their enrollment compared with the six months after. Schoenauer says that as additional patients enrolled in the program who weren’t as-frequent users of the ED, the reduction in ED visit costs leveled off to 27%. Currently the program is enrolling about 60 people annually.

    In 2018, Blue Cross Blue Shield of New Mexico’s program reached about 2,000 high utilizers. The reduction in emergency visits has stayed pretty consistent in recent years at 50% to 60% when comparing before and after enrollment, according to Sun. In 2018, the total savings was about $1.3 million due to reduced emergency visits and hospital readmissions.

    Now the New Mexico Blues plan is also looking at contracting with additional first responders to provide in-home support, Sun says. The insurer is talking with other hospitals, ambulance services, and health care organizations in Albuquerque about developing a triage system for the city and its surrounding county that would, among other things, send nonemergency patients to urgent care centers instead of hospital EDs. The approach being discussed is similar to what federal officials plan to pilot, says Scott Kasper, executive director of the Albuquerque Ambulance Service. “Lots of patients don’t need to go to the ED,” he says. “We could be taking them to a more appropriate place.”

  • 12 Aug 2019 6:04 PM | AIMHI Admin (Administrator)

    Source Article | By Chuck Gipson, MEDIC EMS

    Knowing and studying engagement can yield some great techniques to encourage engagement with your staff but nothing beats firsthand knowledge of what motivates your staff. When we started asking this of the crews, we had some of the same questions that others may have. What would make anyone in their right mind run into, rather than away from, a stressful and possibly dangerous situation day after day to altruistically care for others? Some of the answers are what you would expect and others were somewhat of a surprise. Many of the usual answers of why our staff was motivated to come to work was the great partner that they had, the good equipment they had to use, the desire to be part of something bigger than themselves and do something for others. Some of them are engaged to come to work simply to collect a paycheck and pay their bills. Many of them were engaged by not knowing what was going to happen next in their course of work, appreciating the excitement of the unknown, as well as the varied work environment...

    Read on in JEMS!►

  • 1 Aug 2019 8:29 AM | AIMHI Admin (Administrator)

    MobiHealthNews source articles | Comments courtesy of Matt Zavadsky

    Big time disruptive innovation!  Tip of the hat to EMS industry icon Don Jones for sharing this article!


    Uber Health inks deal to integrate with Medpod

    The new plan will help doctors send practitioners with a medical microcart out to patients' homes.

    By Laura Lovett

    August 01, 2019

    Uber Health is diving into remote care this week after it inked a deal with medical supply company Henry Schein Medical and Medpod, maker of the medical microcart MobileDoc 2, on Monday. The former agreed to integrate into Medpod's platform, allowing doctors to conduct remote telediagnostic exams. 

    As part of the deal doctor’s using Medpod’s telediagnostic platform will be able to tap into Uber Health to send a trained practitioner out to a patient, or send a patient to a clinical location and perform a remote exam. This initial announcement will be followed by a pilot of the program. 

    The MobileDoc 2 is still in the works. Right now, the system is patent pending, but eventually the company said it will be able to offer remote consultations. It will also have professional diagnostic tools that will be able to gather information including temperature, peripheral capillary oxygen saturation (Sp02), blood pressure, height, weight and BMI. The service will also include a “mobile medical infrastructure” with services like video chats. 


    Missed medical appointments cost the healthcare industry billions of dollars each year. Now many are looking for ways to make both medical appointments and diagnostic exams easier for patients. 

    “Our new partnership with Uber Health, and launch of Medpod MobileDoc 2, will help break down barriers that had previously required diagnostic exams to take place in traditional care settings,” Jack Tawil, chairman and CEO of Medpod Inc., said in a statement. “With the MobileDoc 2’s ability to take the physician office environment into patients’ homes and other non-traditional settings, we can create new convenient care delivery options and access points for patients.”


    The ridesharing app has been increasingly interested in the health space. Last year it officially launched its healthcare arm Uber Health at HIMSS18

    “What we did, from the ground up, we built an infrastructure,” Aaron Crowell, head of Uber Health, told MobiHealthNews in February. “We brought in consultants who were experts in those fields to make sure we were doing it right. Our data is encrypted, our staff is HIPAA-trained. Those things are really important or you can’t work in the space; we wouldn’t really be protecting the clients and organizations we work with. Obviously from a patient standpoint, [we have] GPS tracking, knowing exactly where riders are, and obviously the background checks.”

    Since its launch, Uber Health has inked a number of deals including with Grand Rounds and Carisk

    However, it is hardly the only ridesharing service targeted at the health space. Lyft has become a competitor in this space as well. In fact, in June Lyft announced its move into the Medicaid space following an announcement this morning that the rideshare company has landed approval as a Medicaid provider in Arizona, specifically as a non-emergency medical transportation service. This new approval means that Arizona Medicaid patients will have the option to use Lyft to get to and from medical appointments. 

  • 1 Aug 2019 8:23 AM | AIMHI Admin (Administrator)

    Governing source article | Comments courtesy of Matt Zavadsky

    Mattie did a great job on this article in this month’s Governing Magazine - a very important publication for our profession!


    Can we Fix 911? Bringing EMS into the 21st Century


    An ambulance’s wailing sirens, a fire truck’s flashing lights: These are a constant feature of urban life, as ubiquitous as a Starbucks on every corner or a traffic jam at 5 p.m. 

    But nearly a third of the times an ambulance or a fire truck speeds by to answer a 911 call, there is no actual emergency.

    The number of 911 callers who don’t need to go to a hospital emergency department sits at around 30 percent, according to Kevin McGinnis of the National Association of State EMS Officials. 

    The “false alarms” are more than an annoyance; they are a drain on the public purse, a frustration for responders and often an unhelpful source of assistance for the caller. It’s a problem that’s been around almost as long as 911 systems have. What is changing is the approach some cities and counties are taking to the way emergency medical services are delivered. Namely, a number of EMS officials are working to align their services with other community health goals. For instance, instead of automatically dropping a 911 caller at a hospital’s emergency department, an ambulance could, when appropriate, be rerouted to bring a person in distress to a sobering center, an urgent care clinic or a warming center. “Frequent flyers” -- those who call 911 more than once a month -- could be enrolled in a program that would help them address their chronic health conditions. Health issues that aren’t truly an emergency could be triaged by a nurse watching via an iPad in a call center when the call comes in. 


  • 29 Jul 2019 8:08 AM | AIMHI Admin (Administrator)

    NYT source article | Comments courtesy of Matt Zavadsky

    Interesting article in the NYT. 

    Here are a few of the key statements that illustrate the difference in ambulance economic models, compared to other healthcare providers, and the impact of government subsidies on provider charges:

    Congress has shown little appetite to include ambulances in a federal law restricting surprise billing. One proposal would bar surprise bills from air ambulances, helicopters that transport patients who are at remote sites or who have life-threatening injuries. (These types of ambulances tend to be run by private companies.)

    But that interest has not extended to more traditional ambulance services — in part because many are run by local and municipal governments.

    Anthony Wright, executive director of Health Access California, worked on a 2016 California law to restrict surprise billing. Initially, he thought it made sense to include ambulances in that legislation.

    But obstacles quickly began to mount. Some were about policy, like whether California would need to offset the revenue local governments would lose.

    Local governments generally finance their ambulance services through a mix of user fees and taxes. If ambulances charge less to patients, they typically need more government funding.

    Municipal governments often publish the prices of their ambulance services online, and they can range substantially. In Moraga and Orinda, in the Bay Area, the base rate for an ambulance ride is $2,600, plus $42 for each mile traveled. In Marion County, Fla., the most basic kind of ambulance ride costs $550, plus $11.25 per mile.


    Politicians Tackle Surprise Bills, but Not the Biggest Source of Them: Ambulances

    A legislative push in Congress and states to end unexpected medical bills has omitted the ambulance industry.

    By Sarah Kliff and Margot Sanger-Katz

    July 22, 2019

    After his son was hit by a car in San Francisco and taken away by ambulance, Karl Sporer was surprised to get a bill for $800.

    Mr. Sporer had health insurance, which paid for part of the ride. But the ambulance provider felt that amount wasn’t enough, and billed the Sporer family for the balance.

    “I paid it quickly,” Mr. Sporer said. “They go to collections if you don’t.”

    That was 15 years ago, but ambulance companies around the nation are still sending such surprise bills to customers, as Mr. Sporer knows well. These days, he oversees the emergency medical services in neighboring Alameda County. The contract his county negotiated allows a private ambulance company to send similar bills to insured patients.


  • 26 Jul 2019 8:00 PM | AIMHI Admin (Administrator)

    Civil Beat source article | Comments courtesy of Matt Zavadsky

    A VERY well done article and even better program!  Kudos to our pacific island EMS crews and their governing body for taking this step!

    Note the use also of Community Health Workers.  And, Hawaii has a nearly universal payer system, which helps these types of programs demonstrate value.

    We were blessed to host Jesse Ebersole and Vern Hara from Hawaii County EMS at MedStar a couple of years ago, they have very unique challenges and now, it seems, unique solutions!


    State Aims To Reduce Unnecessary ER Visits By Empowering Paramedics

    Hawaii is creating a community paramedicine program that officials hope will mean fewer ambulance trips to hospitals.

    By Lorin Eleni Gill

    July 26, 2019

    Minor wounds, rashes, gout pain — these are some of the many medical conditions that should be taken seriously, but they may not merit a 911 call or a trip to the emergency room.

    Hawaii health officials are considering how to reduce unnecessary ER visits through a community paramedicine program. The revised emergency transport system that could begin next year would allow medical professionals to transfer patients to predesignated destinations, such as urgent care clinics, or even provide complete treatment at the scene.

    “Can paramedics go treat people in the field, in the community setting under a physician’s direction, and offer a treatment when they don’t need to go anywhere?” asked James Ireland, a nephrologist and the former director of the Honolulu Emergency Services Department. “Can they do some simple wound cleaning and start the patient on some antibiotics under the guidance of a physician? I think that’s where the huge cost savings can be.”

    When Gov. David Ige signed Act 140 into law June 25, it marked the latest development in an effort to make Hawaii’s emergency response system run more smoothly. Starting as early as next year, the law will allow paramedics or other medical professionals to treat some patients at the scene of an emergency — or nonemergency —  and navigate them to appropriate care at other clinical sites.


  • 23 Jul 2019 10:42 AM | AIMHI Admin (Administrator)

    Fierce Healthcare source article | Comments courtesy of Matt Zavadsky

    A very interesting perspective on our healthcare system as experienced by an “insider”.  We’ve all heard similar tales from our partners IN the healthcare system. 

    This is why healthcare system partners, especially that payer community, is more and more looking to partner with “EMS” to assist with patient navigation from 9-1-1 activations, and to help manage super-utilizer patients.

    Here’s a link to a tragically ironic video depicting what it would be like if air travel worked like our healthcare system.  It’s hilarious, but only because it’s sadly true – worth the 7 minutes you will invest watching the video – you’ll laugh, but maybe it will spur some thoughts on how we fix this.

    Editor's Corner—I write about healthcare. I still found myself lost in the unnavigable healthcare system

    by Jacqueline Renfrow | 

    Jul 15, 2019


    We need a healthcare system that uses all of the amazing technology and ingenuity that is available in 2019 while staying affordable and, most importantly, puts the patient’s well-being first.

    It began back in January with a simple rash—or so we thought.

    My daughter had a rash all over her body, so I took her to the pediatrician. “Maybe it is a virus, or maybe it is just dermatitis. Don’t worry about it,” the doctor said. I was told to apply lotion and give it time.

    A month later, we were at the dermatologist. We went back two weeks later, and then four weeks later, and then again another two times. With each visit, we got another cream, another possible diagnosis. No change in the rash.

    So we returned to our pediatrician's office, which employs more than half-a-dozen physicians. 

    Each of the five times we went back, a different physician offered a different diagnosis. I'd repeat the same story and answer the exact same line of questioning (both to a nurse and a doctor at every visit). At doctor after doctor, my daughter’s height and weight were taken, to the point that she’d announce, “47 inches and 47 pounds” before she even got on the scale. She knew the drill by heart, as did I.

    The ones not in the know were the physicians.

    Each specialist we saw asked which creams she had tried, which antibiotics she had taken and which labs had been run. After my daughter’s second blood draw, I realized that from one doctor to another, no one knew which tests had already been performed. So I started carrying a folder with lab results and a bag of medicine bottles so I had the answers in hand.

    As a mother, I knew something serious was wrong. My daughter had headaches, stomachaches, she couldn’t sleep and was barely eating. Plus, she had one dilated pupil. And her skin was so itchy that she scratched until she bled, meaning several rounds of antibiotics had to be taken to avoid infection.

    We met with an ophthalmologist, an allergist, a rheumatologist and then another dermatologist. I was given ridiculous answers such as: “It’s most likely that the headaches are just behavioral.”

    I was also given scary possible scenarios such as: “There could be a mass behind her eye.”

    And beyond my new role as the walking data collector, I had to fight to get my child in for an appointment.

    Apparently, specialists for children are few and far between, even around the major metropolitan area in which I live. I was told I’d have to wait more than two months to get an appointment with a pediatric ophthalmologist and around the same amount of time for a pediatric allergist.

    But how can you tell a mother that her child could have a brain mass and then expect her to wait to see a physician for more than eight weeks?

    I called in favors. I called friends with specialists and doctors and asked them to get me in. I was willing to pay out of pocket. Insurance was an afterthought at this point. I was willing to travel to any office, any time of day or take any cancellation. And I considered myself lucky to get scheduled with a nurse practitioner at the rheumatologist’s office because the doctor could not get us in until the fall.

    Almost six months after this all began, I reluctantly took my daughter to yet another dermatologist. I’d been on his waiting list awhile. I was told he was older, unfriendly and very off-putting to children. But at this point, I had nothing to lose: The next step was the neurologist.

    Bedside manner aside, this gruff physician finally gave us the answer we'd been searching for. He found a rare bacteria on my daughter’s skin and told us how to treat it. Two weeks later, her rash, along with all of her other symptoms, were gone. It was a relief. 

    But the experience left me feeling frustrated, exhausted, lost and desperate for a different way. I wondered how anyone, sick or healthy, could be expected to navigate a system so divided in communication.

    As a reporter, I’m well aware of the challenges in the U.S. healthcare system. I’ve followed the debates on pricing transparency, drug rebates, value-based care, electronic health record connectivity, physician burnout and access to care. But I learned how frightening it is to be a patient—or the parent of a patient—and have so many physicians give you so many varying opinions and diagnoses.

    I also learned that no one in the healthcare system was going to advocate for my daughter, so it was going to have to be me.

    And I learned that healthcare providers and systems do not communicate with one another. There is no sharing of opinions, lab results, data or doctor-patient relationships.

    I am left with a stack of medical bills and a pit in my stomach that this country has a long way to go to create a clear, navigable system for Americans. We need a system that uses all of the amazing technology and ingenuity that is available in 2019 while staying affordable and, most importantly, puts the patient’s well-being first.

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