News & Updates

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  • 15 Nov 2018 2:13 PM | AIMHI Admin (Administrator)

    FierceHealthcare Source Article | Comments courtesy of Matt Zavadsky

    Interesting comments from Sec. Azar, especially with the recent pace of activity from CMS and CMMI conducting conference calls with several EMS organization, requesting SOPs, protocols, outcome measures and ROI determinations for things like Ambulance Transport Alternatives, Community Paramedicine and 9-1-1 Nurse Triage. 

    Even interviewing current payers who are paying EMS agencies for these transformational services.

    Interesting!

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

    Why HHS wants Medicare Advantage plans to pay for home modifications, transportation for seniors

    by Tina Reed | 

    Nov 14, 2018 1:27pm

    https://www.fiercehealthcare.com/hospitals-health-systems/azar-and-social-determinants-health

    Starting next year, Medicare Advantage plans will be allowed to pay for a wider array of health-related benefits including transportation and home health visits, Health and Human Services Secretary Alex Azar said on Wednesday.

    And by 2020, HHS will extend the range of benefits even further to allow MA plans to cover benefits such as home modifications and home-delivered meals, he said. 

    Why?

    "These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too," Azar said. "If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be."

    Azar was speaking in D.C. at a healthcare policy symposium focused on social determinants of health hosted by Utah-based Intermountain Healthcare and the Orrin G. Hatch Foundation's Hatch Center.

    He was focusing on the agency's approach to social determinants a day after it was announced that CMS would begin allowing states to cover a broader range of mental health services under Medicaid. Specifically, CMS would consider Medicaid demonstration waivers covering short-term stays for acute care provided in psychiatric hospitals or residential treatment centers in return for states expanding access to community-based mental health services.

    As he spoke, Azar also teased new focus areas coming from CMS' Center for Medicare and Medicaid Innovation (CMMI) for helping vulnerable populations.

    “What if we provided more than connections and referrals? What if we provided solutions for the whole person including addressing housing, nutrition and other social needs all together?" Azar said. "What if we gave organizations who work with us more flexibility so they can pay beneficiaries' rent if they are in unstable housing or make sure that a diabetic has access to and can afford nutritious food? If that sounds like an exciting idea, then stay tuned to what CMMI is up to.” 

    Azar said the moves are part of a broader push under the Trump administration to better harness the flexibility of existing programs to address social determinants that drive up health costs and hurt patient outcomes. 

    “It probably won’t surprise you to hear that this administration is thinking about how to improve healthcare and social services while preserving what is unique about our American system: its decentralized nature and the key role played by the private sector and civil society," Azar said. “But it may surprise you that we are thinking about this very specifically in the context of social determinants of health. We are deeply interested in this question, and thinking about how to improve health and human services through greater integration has been a priority throughout all of our work."

    Medicare Advantage (MA) plans are offered by private companies approved by Medicare and paid by Medicare to cover patients' benefits including hospital and medical insurance.

    While the idea has been lauded by health experts, Kaiser Health News reported few seniors will actually be able to access these changes. Medicare officials estimate about 7 percent of Advantage members — 1.5 million people — will have access, KHN reported.

    Companies offering MA plans both compete for patients and hold the risk for them, Azar said. "They've got incentives to offer benefits that are both appealing to their members and that will bring down healthcare costs whether those benefits are traditionally thought of as health services or not," Azar said. "The key is just that we need to give them the flexibility to do this, which we generally don't do."


  • 15 Nov 2018 2:08 PM | AIMHI Admin (Administrator)
    mHealth Intelligence Source Article | Comments Courtesy of Matt Zavadsky

    Ohio Hospital Using Telehealth to Tackle 911 Calls, ER Overcrowding

    Atrium Medical Center is partnering with the local fire department to launch a telehealth service aimed at local residents who frequently dial 911. The community paramedicine program is one of hundreds popping up across the country.

    By Eric Wicklund

    November 14, 2018

    https://mhealthintelligence.com/news/ohio-hospital-using-telehealth-to-tackle-911-calls-er-overcrowding

    An Ohio hospital is partnering with the local fire department and Miami University Oxford to launch a telehealth program aimed at the most frequent users of the 911 emergency system.

    Middletown-based Atrium Medical Center and the  Monroe Fire Department are launching a community paramedicine pilot program in the southwest Ohio community, with the goal of bringing connected health services to the region’s most frail and homebound residents.

    Also known as Mobile Integrated Health, the community paramedicine program involves sending healthcare providers – usually paramedics – on scheduled visits to the homes of people who most often call 911. The paramedics perform health and wellness checks using telemedicine equipment, check out the home for potential health hazards and educate residents on community health resources.

    Atrium officials say the program aims not only to reduce unnecessary ambulance calls and ER visits, but to improve the health and wellness of residents who have problems accessing regular healthcare services.

    As part of the program, Miami University students in social work programs will participate in the visits to chart their effectiveness. And the teams will carry a telemedicine kit developed by HNC Virtual Solutions.

    “Not only is the patient’s health and prognosis proactively improved through this revolutionary approach, but healthcare costs will be reduced, and the hospital’s existing healthcare delivery system will be enhanced by freeing up further resources to respond to more significant medical emergencies,” Julian Shaya, the company’s executive vice president, said in a press release. “This virtual solutions tool is a game changer for healthcare.”

    As of mid-2017, some 260 EMS programs across the country were using some sort of community paramedicine program, up from 100 programs in 2014, according to the National Association of Emergency Medical Technicians.

    “Having the opportunity to work with patients in the homes or work sites gives us the chance to be proactive instead of reactive,” Amie Allison, EMS Director for Montana’s Glacier County, said when the Glacier County Community Health Center launched its first-in-the state Integrated Mobile Health Service Program in early 2017.

    Earlier this year in New Mexico, American Medical Response unveiled its Mobile Integrated Healthcare (MIH) program in Valencia County following talks with Blue Cross Blue Shield of New Mexico and Molina Healthcare, which will be funding the program for its members.

    “Each assessment takes about an hour, but can vary in length,” Shelley Kleinfeld, AMR’s MIH supervisor for New Mexico, told the Valencia County News Bulletin.  “It differs from the assessments done traditionally by EMS providers dealing with acute injuries or illnesses. It focuses more on the whole well-being of the individual providing resources, services and education to the patients so they can better manage their health.”

    “When doing an assessment, we perform a risk assessment, needs assessment, fall assessment, and assess patients’ current needs,” she added. “Community paramedics know resources and services that are available in the community and can assist patients to better utilize them. During the needs assessment we can determine if patient is urgently in need of something, whether it’s a food box, water, medications and durable medical equipment. The community medic provider can than help the patients to quickly obtain those resources.”

    In Milwaukee, meanwhile, a program launched in 2015 by the Milwaukee Fire Department has reduced 911 calls from so-called “frequent flyers” by more than 50 percent over the past two years.

    One variation of the service, Houston’s Project Ethan (Emergency TeleHealth And Navigation), launched in 2014, sends first responders with telehealth equipment to the scene of a 911 call to assess the caller before deciding on transport.


  • 14 Nov 2018 9:57 AM | AIMHI Admin (Administrator)

    Learn what high performance, high value EMS means to MedStar Mobile Healthcare CEO and AIMHI President Doug Hooten.


  • 9 Nov 2018 10:05 AM | AIMHI Admin (Administrator)
    Learn what high performance EMS means to AIMHI President-Elect Chip Decker of Richmond Ambulance Authority.



  • 8 Nov 2018 4:28 PM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments courtesy of Matt Zavadsky

    Mixed issues here – on one hand, limited access to primary care may exacerbate health issues in this population, potentially resulting in more acute care use, including ambulance.  On another hand, this may lead to an acceleration of Medicaid potentially paying for EMS-Based MIH services for prevention and patient navigation as a way to meet the Triple Aim®.

    The inclusion of non-emergency ambulance transportation has been undetermined in this policy.  Some officials have indicated it was not, but other indicated it did include non-emergency ambulance transportation.

    CMS is developing a rule that could curtail Medicaid transportation access

    By Virgil Dickson  | November 7, 2018

    https://www.modernhealthcare.com/article/20181107/NEWS/181109932  

    The CMS is drafting a proposed rule that would make it easier for states to stop paying for non-emergent medical transportation for Medicaid beneficiaries, a move that could drastically cut into providers' revenue.

    While details of the potential rulemaking are scarce, a notice on the White House's Office of Management and Budget website said the regulation is projected to be released in May 2019.

    Just the suggestion that states could cut Medicaid transportation to medical appointments already has providers on edge. Annual Medicaid spending for these trips is around $3 billion, with roughly 103 million non-emergent medical trips each year, according to researchers.

    Medicaid enrollees already have a high no-show rate, and that could get worse if the CMS finalizes the rule, according to Dr. Theresa Rohr-Kirchgraber, a practicing pediatrician in Indianapolis and associate professor of clinical internal medicine and pediatrics at Indiana University.

    Many Medicaid enrollees lack access to vehicles due to their low incomes. There are also few public transportation options in Indiana, especially in rural areas, Rohr-Kirchgraber said.

    "Our feet are really held to the fire that we have high productivity in terms of the number of patients we have to see," she said. "We're the ones that are making the money for our institutions, and we can't we can't afford to keep our doors open if we can't get our patients in."

    Currently, states have to obtain a waiver from the CMS if they don't offer non-emergent transportation services. The Trump administration first floated the idea of changing that policy earlier this year in its 2019 budget proposals.

    Non-emergent transport to medical appointments has been a mandatory Medicaid benefit since the program's inception in 1965. 

    Iowa and Indiana are the only states with a waiver to opt out of providing transportation. Kentucky and Massachusetts have both asked the CMS for similar permission.

    It's unclear whether patients' health declines if Medicaid doesn't pay for rides to medical care. A February 2016 report from the Lewin Group said the impact of the transportation benefit waiver in Indiana has been minimal. Most beneficiaries could find other forms of transportation not paid for by Medicaid. Of the 286 beneficiaries interviewed, 11% cited lack of transportation as their reason for missing appointments. A report from Iowa had similar findings.

    But the Medical Transportation Access Coalition, a group made up of advocates, transportation providers and managed-care plans, noted that these waivers largely targeted adults who became eligible under Medicaid expansion and had not previously relied on the non-emergency transportation benefit.

    The group insists that making it easier for states to opt out of offering these services will harm access to care.

    Medicaid enrollees regularly use the benefit to get to dialysis, substance abuse treatments and chronic care visits for diabetes. A survey of Medicaid enrollees last summer by the coalition revealed that low-income patients found it critical to their day-to-day lives. 

    "Over half the trips taken today are for life-sustaining treatments," said Tricia Beckmann Faegre, an adviser to the coalition. "Some said that they would die or probably die if they didn't have transportation." Medicaid saved more than $40 million in hospitalization and other medical costs for patients receiving rides to dialysis and wound care treatments, according to a report by the coalition.

    It's unclear if the CMS has the authority to make this change to transportation benefits, according to Eliot Fishman, who oversaw 1115 waivers under the Obama administration and is now senior director of health policy at Families USA.

    "Making NEMT optional hasn't been tested in court," Fishman said. "If the administration goes in that direction, I expect there will be a legal challenge."

    The CMS does not comment on pending rulemakings, according to a spokesman.


  • 8 Nov 2018 7:56 AM | AIMHI Admin (Administrator)

    Longview News-Journal Source Article | Comments courtesy of Matt Zavadsky

    Hats off to our Texas neighbors!

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

    Longview starts pilot program to reduce EMS trips for high-volume patients

    By Jimmy Daniell Isaac

    Nov 7, 2018

    Emergency and mental health authorities are building toward a multiagency pilot program aimed at high-volume patients of local ambulance services.

    The program currently is unstaffed, but Community HealthCore is seeking grant funding with help from Longview health systems and the fire department’s Emergency Medical Services Division to pay for what is described as a proactive approach to patient care.

    The approach involves using in-home assessments to identify the needs of patients with the highest number of ambulance trips to local emergency rooms and other health centers — some who average more than 20 ambulance rides a month.

    “We had quite a few of those that use our ambulances quite often,” Longview EMS Section Chief Amy Dodgen said during a meeting Tuesday of the city’s EMS Advisory Board.

    The program targets people who call for emergency services with issues that can be served by a number of other agencies besides an ER visit, she said.

    EMS personnel will continue responding to 911 calls and transporting patients who need emergency room services, she said, but the goal of the program is to determine if the patient might, instead, need social, mental health or other services for issues not physical in nature. Those issues could be anxiety over where their next meal might come from or how they’ll pay a utility bill, which is why several social service agencies are involved in the program, Dodgen said.

    “We really want to solve their problems (and) what they’re needing, not just be a Band-Aid,” she said. “We have awesome people and awesome services in Longview. We’ve just got to connect people to them, and some people need assistance with that.”

    The EMS Advisory Board is made up of local hospital officials, health agents and first responders who advise the Longview City Council on matters dealing with EMS responsibilities such as financial and manpower investment priorities.

    Advocates hope to hear by the end of the year whether the Fort Worth-based Episcopal Health Foundation awards a grant to the local program — currently called the Gregg County Wellness Collaborative.

    Dodgen, a city staff liaison to the board, told members that a 270-page report of patients who used Longview ambulance services at least five times a month last year included one patient who took about 120 ambulance rides in one year.

    “That same patient is at 72 (trips) this year for 2018,” she said. “These patients, they’re the driving force behind the community health care medicine program that we’re wanting to start.”

    Community health care medicine programs have been tried in other cities and can be tailored to fit the Longview area’s specific needs, Dodgen said. It’s a partnership involving local hospitals and EMS agencies.

    “For Longview, the concept would be to take these high utilizers and go into their home with their permission and meet with them and see what we can do to mitigate their issues,” she said.

    A pilot program has been initiated with about five of the top ambulance users in Longview, including the highest user, who once averaged between 20 and 30 ambulance calls a month but has since reduced to about 10 times a month, Dodgen said, adding, “Although there were patient contacts with her, we didn’t transport her to the hospital as many times.”

    Advocates hope the program develops into a way to help patients who need assistance but do not need an emergency room visit.

    “Currently, EMS does not get paid if we don’t transport,” Dodgen said.


  • 8 Nov 2018 7:54 AM | AIMHI Admin (Administrator)
    HealthAffairs Source Article | Comments courtesy of Matt Zavadsky

    This is a nice summary of the possible healthcare implications post-election…

    What the 2018 Midterm Elections Means for Health Care

    Billy Wynne

    NOVEMBER 7, 2018

    Whatever you want to call the 2018 midterm elections – blue wave, rainbow wave, or purple puddle – one thing is clear: Democrats will control the House.

    That fundamental shift in the balance of power in Washington will have substantial implications for health care policymaking over the next two years. Based on a variety of signals they have been sending heading into Tuesday, we can make some safe assumptions about where congressional Democrats will focus in the 116th Congress. As importantly, there were a slew of health care-related decisions made at the state level, perhaps most notably four referenda on Medicaid expansion.

    In this post, I’ll take a look at which health care issues will come to the fore of the Federal agenda due to the outcome Tuesday, as well as state expansion decisions. And it should of course be noted that, in addition to positive changes Democrats are likely to pursue over the next two years, House control will allow them to block legislation they oppose, notably further GOP efforts to repeal the Affordable Care Act (ACA).

    Drug Pricing

    Democrats have long signaled they consider pharmaceutical pricing to be one of their highest priorities, even after then-candidate Trump adopted the issue as part of his campaign platform and maintained his focus there through his tenure as President.

    While aiming to use the issue to drive a wedge between President Trump and congressional Republicans, who have historically opposed government action to set or influence prices, Democrats will also strive to distinguish themselves by going further on issues like direct government negotiation of Medicare Part D drug reimbursement.

    Relevant House committee chairs, perhaps especially likely Oversight and Investigations chair Elijah Cummings (D-MD), will also take a more aggressive tack in investigating manufacturers and other sector stakeholders for pricing increases and other practices. Democratic leaders believe it will be easier to achieve consensus on this issue than on more contentious issues like single payer (more detail below) among their diverse caucus, which will include dozens more members from “purple” districts as well as members on the left flank of the party  

    Preexisting Condition Protections

    If you live in a contested state or district, you have probably seen political ads relating to protecting patients with preexisting conditions. As long as a Republican-supported lawsuit seeking to repeal the ACA continues, Democrats believe they can leverage this issue to demonstrate the importance of the ACA and their broader health care platform.

    A three-legged stool serves under current law to protect patients with chronic conditions: (1) the ban on preexisting condition exclusions; (2) guaranteed issue; and (3) community rating. Democrats will likely seek to bolster these protections with measures to shore up the ACA exchange markets. In the same vein, they will likely strive to rescind Trump Administration proposals to expand association-based and short-term health plans, which put patients with higher medical costs at risk by disaggregating the market.  

    Opioids

    Congressional Democrats believe that there were some stones left unturned in this year’s opioid-related legislation, especially regarding funding for many of the programs it authorized. This is a priority for likely Ways & Means Committee Chair Richie Neal (D-MA) and could potentially be a source of bipartisan compromise.

    Medicare for All

    While this issue could become a bugaboo for old guard party leaders, the Democratic base will likely escalate its calls for action on Medicare for All now that the party has taken the House. Because the details of what various camps intend by this term are still vague (some believe it is tantamount to single payer, others view it as a gap-fill for existing uninsured, etc.), we will likely see a variety of competing proposals arise in the coming two years. Expect less bona fide committee action and more of a public debate aired via the presidential primary season that will kick off about, oh, right now.

    Surprise Bills

    The drug industry is not the only health care sector that can expect heightened scrutiny of their pricing practices now that Democrats control the people’s chamber. Most notably, the phenomenon of surprise bills (unexpected charges often stemming from a hospital visit) has risen as a salient issue for the public and thus a political winner for the party. Republicans have shown interest in this issue as well, so it could be another source of bipartisanship next year.

    Regulatory Oversight

    Democrats believe they are scoring well with the public, and certainly their base, every time they take on President Trump. The wide range of aggressive regulation (and deregulation) the Administration has pursued will be thoroughly investigated and challenged by Democratic committee leaders, especially administration efforts to dismantle the ACA and to test the legal bounds of the hospital site neutrality policy enacted in the Bipartisan Budget Act (BBA) of 2015.

    Extenders

    While it instituted permanent policies for Medicare physician payments and some other oft-renewed ‘extenders’, the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 left a variety of policies in the perennial legislative limbo of needing to be repeatedly extended. While the policies in the Medicare space have dwindled to subterranean, though not necessarily cheap, affairs like the floor on geographic adjustments to physician payments, a slew of Medicaid-related and other policies are up for renewal in 2019.

    For example, Medicaid Disproportionate Share Hospital (DSH) payments face a (previously delayed) cliff next year. That and the most expensive extender, ACA-initiated funding for community health centers, alone spring the cost of this package into the high single digit billions at least, driving a need for offsetting payment cuts and creating a vehicle for additional policy priorities.

    A likely addition to this discussion will be the fact that Medicare physician payments, per MACRA, are scheduled to flatline for 2020-2025 before beginning to increase again, albeit in divergent ways for doctors participating in the Merit-Based Incentive Payment Program (MIPs – 0.25 percent/year) and Advanced Alternative Payment Models (APMs – 0.75 percent/year). The AMA assuredly noticed this little wrinkle in the celebrated legislation but hundreds of thousands of doctors probably did not.

    Medicaid Expansion

    Of the variety of state-level health policy decisions voters made on Tuesday, perhaps the most significant related to Medicaid expansion. In there states where Republican leaders have blocked expansion under the ACA – Nebraska, Idaho, and Utah – voters endorsed it via public referenda. Increasing the Medicaid eligibility level in those three states to the ACA standard will bring coverage to approximately 300,000 people.

    Notably, voters in Montana rejected a proposal to continue funding the Medicaid expansion the state enacted temporarily in 2015 by an increase to the state’s tobacco tax. Their expansion is now scheduled to lapse in July 2019 if the legislature doesn’t act to maintain it. If they do not act, about 129,000 Montanans will lose Medicaid coverage.

    Finally, Democratic gubernatorial wins in Maine, Kansas, and Wisconsin will make Medicaid expansion more likely in those states.

    As they say, elections have consequences. While the Republican-controlled Senate and White House can block any Democratic priorities they oppose, the 2018 midterm elections assure a busy two years for health care stakeholders.


  • 1 Nov 2018 9:22 AM | AIMHI Admin (Administrator)

    Meet Matt Zavadsky, Chair of the AIMHI Education Committee.

  • 29 Oct 2018 9:09 AM | AIMHI Admin (Administrator)

    Congratulations to Sherry Willingham of Medstar Mobile Healthcare! Sherry was unanimously elected Chair of the AIMHI Reimbursement Committee on Friday. We thank her for her service!


  • 26 Oct 2018 9:31 AM | AIMHI Admin (Administrator)

    Source Article | Comments courtesy of Matt Zavadsky

    A very logical step being taken by the Pennsylvania legislature! 

    And, one that is currently in place for payers such as Anthem and the Medicaid programs in Arizona and Georgia.  Additional payers are looking to implement similar programs.

    Decoupling payment from transport helps enhance patient outcomes, improve the patient’s experience of care, and significantly reduce the down-stream cost of care. 

    The misalignment of incentives of only reimbursing ambulance TRANSPORT to an ED is a significant cost driver.  In 2013, Health Affairs published a RAND study that determined that 12.9 – 16.2% of Medicare ambulance trips to the ED could have safely and effectively been managed in an alternate setting, and giving EMS flexibility to navigate patients could save the Medicare program up to $560 million annually.

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

    Barrar's bill to reimburse ambulance companies heads to governor

    Digital First Media Oct 23, 2018

    WEST CHESTER—Legislation drafted by state Rep. Steve Barrar, R-160, that would require ambulance companies to be reimbursed for providing medical treatment, even if the patient is not transported to a hospital, was successfully voted on concurrence by the House.

    “The critical services provided by ambulance companies to Commonwealth citizens in their time of need will remain endangered, potentially to the point of extinction, if they aren’t reimbursed for their costs to render emergency care. My bill would entitle ambulance companies to payment when emergency medical responders treat and stabilize patients without a trip to the hospital,” Barrar said.

    Under current practice, EMS agencies can only be reimbursed by insurance companies if they transport the patient, even though time is spent, supplies are used and services are provided regardless of whether a transport takes place. This is a significant contributor to the financial challenges facing ambulance companies, especially when many are facing the grim reality of pending closures.

    House Bill 1013 would require reimbursement when transport to a facility does not take place as long as the following conditions are met: The Basic Life Support (BLS) or Advanced Life Support (ALS) unit must be dispatched by a county 911 center, and the EMS provider must have rendered emergency services even though the transport was declined.

    Also, the House approved legislation to close a loophole that PennDOT has been using to deny free emergency vehicle license plates to volunteer fire companies that also have paid employees.

    “Volunteer ambulance services all across the Commonwealth have been forced to pay for a plate that should have been given to them at no cost. It’s disappointing that PennDOT would take advantage of volunteer companies that save Pennsylvania so much money, but I’m pleased that I was able to influence the addition of an amendment on the bill to address this issue,” Barrar added.

    Both bills now advance to Gov. Tom Wolf for consideration.


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