News & Updates

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  • 3 Mar 2021 2:47 PM | AIMHI Admin (Administrator)

    Fierce Healthcare source | Comments courtesy of Matt Zavadsky

    Many of us have discussed the opportunity for the potential ‘permanency’ of some of the more valuable CMS waivers, and telehealth has been prominent in those discussions.

    This may be a good sign for the telehealth waivers.

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    House health leader calls for permanent Medicare telehealth expansions

    by Heather Landi 

    Mar 2, 2021

    https://www.fiercehealthcare.com/tech/house-health-leader-calls-for-permanent-medicare-telehealth-expansions-but-concerns-about

    House health subcommittee chair Rep. Anna Eshoo said Tuesday it's time to make telehealth flexibilities enacted during the COVID-19 pandemic permanent to help close gaps in care.

     

    The Centers for Medicare & Medicaid Services (CMS) waived many telehealth payment policies during the public health emergency, which helped open up access to virtual care. It drove 10.6 million Medicare beneficiaries to use telehealth visits by the end of July, Eshoo said during a Committee on Energy and Commerce health subcommittee hearing.

     

    "The wide adoption of telehealth has been a bright spot during a very dark time in our country," she said. "For the first time, we’ve had substantiative data on the quality and the use of telehealth at scale."

     

    CMS has taken steps to add services to the telehealth list, but a permanent expansion of coverage across the country will require an act of Congress. Only certain areas will continue to get telehealth services after the public health emergency ends.

     

    Many providers would like to see Congress take action to lift legislative barriers, such as removing limitations on originating sites of care, enabling payment parity for virtual visits, and allowing more providers to offer telehealth visits, witnesses said during the hearing.

     

    "Based on experience and what we have learned to-date, these policy changes should be made permanent. They have dramatically improved access to patient-centered care without increasing overall healthcare utilization," said Megan Mahoney, M.D., chief of staff at Stanford Health Care and a witness at the hearing.

     

    She also called for CMS to continue adding services to the list of telehealth services it reimburses and for policy leaders to reevaluate medical licensing restrictions.

     

    But telemedicine’s ability to make care convenient and more accessible may also be its Achilles’ heel, according to Ateev Mehrotra, M.D., an associate professor of healthcare policy at Harvard Medical School.

     

    "The concern is that in some circumstances telemedicine is too convenient and translates into more care and increased healthcare spending," he said. "Policymakers face a difficult challenge in designing an optimal payment and regulatory policy for telemedicine."

     

    One strategy is to move away from fee-for-service to alternative payment models such as full or partial capitation and bundled payments, he said. He also recommended that telemedicine visits be paid for at a lower rate than for in-person visits as virtual care will have lower costs. 

     

    Consistency across insurers also is important, he said. "If Medicare covers telemedicine for opioid-use disorder but private insurers or Medicaid do not, then substance use providers will be less likely to embrace telemedicine," he said.

     

    Without proper oversight by policymakers and purchasers, greater use of telehealth could lead to increased fragmentation, duplicative and unnecessary spending, higher rates of fraud and ultimately higher overall costs and worse outcomes for patients, said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health.

     

    Mitchell's organization does not support making permanent any payment parity requirements for Medicare and urges policymakers to focus on a telehealth value-based payment system, she said.

     

    Rep. Frank Pallone Jr., chairman of the Committee on Energy and Commerce, said he continues to have concerns about telehealth driving overutilization of healthcare services and ways to combat fraud and abuse.

     

    "While the convenience of telehealth can help provide critical services to hard-to-reach populations, it can also lead to overutilization or low-value care. It’s important to consider how future policies can encourage the use of high-value care, while, at the same time, discouraging potential low-value care and overutilization in Medicare fee-for-service," he said.

     

    The Department of Health and Human Services' Office of Inspector General said last week it's conducting "significant oversight work" assessing telehealth services during the public health emergency, including fraud, abuse and misuse. 

     

    Mahoney said the perception that telehealth may be overused and lead to increased healthcare costs has not become reality.

     

    "Telehealth is a tool in our toolkit and it is largely substitutive and not additive to in-person care," she said. About 30% to 40% of Stanford clinics' visits are conducted via telehealth.

     

    "We believe this will be our new normal going forward," Mahoney said.


  • 26 Feb 2021 2:02 PM | AIMHI Admin (Administrator)

    From JAMA on February 24, 2021

    Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams

    Question  Is mobile integrated health care (MIH) delivered by emergency medical services more efficient than regular ambulance responses in addressing the needs of urgent care in the community?

    Findings  This economic evaluation compared 1740 calls serviced by MIH in 2018 to 2019 with propensity score–matched ambulance calls for the same period and 2 years prior and found that MIH was associated with a decrease in the proportion of patients transported to the emergency department and saved health care costs compared with regular ambulance responses.

    Meaning  These findings suggest that MIH is a promising and viable solution to meeting urgent health care needs while improving the efficiency in using emergency care resources.

    Continue Reading►

  • 10 Feb 2021 12:04 PM | AIMHI Admin (Administrator)

    CDC Source | Comments Courtesy of Matt Zavadsky

    Passing along an interesting opportunity from the CDC.

     

    Would be good to have a few (ok, many) EMS folks participating to education policy makers and influencers about the crucial role EMS agencies can play in this process.

     

    Tip of the hat to Rob Lawrence for passing this info along!

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    https://www.cdc.gov/coronavirus/2019-ncov/vaccines/forum/factsheet.html

     

    In support of the Biden-Harris administration’s National Strategy for the COVID-19 Response and Pandemic Preparedness, the Centers for Disease Control and Prevention is organizing a virtual National Forum on COVID-19 Vaccine that will bring together practitioners from national, state, tribal, local, and territorial levels who are engaged in vaccinating communities across the nation.

     

    The Forum will facilitate information exchange on the most effective strategies to:

    • Build trust and confidence in COVID-19 vaccines
    • Use data to drive vaccine implementation
    • Provide practical information for optimizing and maximizing equitable vaccine access

     

    Practitioners include representatives of organizations focused on vaccine implementation in communities from:

    • State, tribal, local, and territorial public health departments
    • Healthcare system providers and administrators and their national affiliate organizations
    • Pharmacies
    • Medical and public health academic institutions
    • Community-based health service organizations

     

    Dates and Deadlines:

    • February 9: Registration opens: www.cdc.gov/covidvaccineforum
    • February 16: Last day to register
    • February 22: Building Trust and Vaccine Confidence
    • February 23: Data to Drive Vaccine Implementation
    • February 24: Optimize and Maximize Equitable Access


  • 26 Jan 2021 8:59 AM | AIMHI Admin (Administrator)

    AP Source Article | Comments Courtesy of Matt Zavadsky

    OUTSTANDING report by AP’s Stefanie Dazio!  Message is spot on, depiction fully accurate, and images are excellent!

    EMS providers face this real enemy every day – and just like the rest of the healthcare system, are stretched beyond belief across America.

    These heroes have earned, and deserve our thanks, our respect, and our support!!

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    In Ambulances, an Unseen, Unwelcome Passenger: COVID-19

    By STEFANIE DAZIO

    January 25, 2021 

    LOS ANGELES (AP) — It’s crowded in the back of the ambulance.

    Two emergency medical technicians, the patient, the gurney — and an unseen and unwelcome passenger lurking in the air.

    For EMTs Thomas Hoang and Joshua Hammond, the coronavirus is constantly close. COVID-19 has become their biggest fear during 24-hour shifts in California’s Orange County, riding with them from 911 call to 911 call, from patient to patient.

    They and other EMTs, paramedics and 911 dispatchers in Southern California have been thrust into the front lines of the national epicenter of the pandemic. They are scrambling to help those in need as hospitals burst with a surge of patients after the holidays, ambulances are stuck waiting outside hospitals for hours until beds become available, oxygen tanks are in alarmingly short supply and the vaccine rollout has been slow.

    EMTs and paramedics have always dealt with life and death — they make split-second decisions about patient care, which hospital to race to, the best and fastest way to save someone — and now they’re just a breath away from becoming the patient themselves.

    CONTINUE READING►

  • 15 Jan 2021 7:49 AM | AIMHI Admin (Administrator)

    ICMA Source Article | Comments Courtesy of Matt Zavadsky

    Hopefully, education like this will help cities and counties consider the impact on EMS as they consider public safety changes...

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

    Hidden Costs: How Police Reform Could Change the Shape of Other Public Safety Agencies

    Emergency medical services start a new year with uncertain futures.

    By Matt Zavadsky, senior associate, CPSM | Jan 14, 2021

    The year 2020 presented a number of new challenges to the emergency medical services (EMS) world, pushing paramedic and fire services to overhaul many longstanding practices. With every day delivering new findings on COVID-19 and how it might impact communities, chiefs, union officials, city managers, and other leaders have had to adapt in unprecedented ways. But this summer’s protests and calls to “defund the police” have presented new and completely different challenges. 

    As jurisdictions consider the effects of reforming police department budgets and the allocation of funds, they often look to redistribution of responsibilities and limiting police presence in certain areas. In these cases, EMS departments (frequent partners of the police) might be caught in the crosshairs of budgetary changes and be forced to completely shift the way they operate. As public agencies start a new year with uncertain futures, there are some major implications of budget changes that should be addressed to ensure EMS agencies continue to operate at an optimal level.

    How Could EMS Change?

    It’s important for agencies to address how “defunding the police” could have a ripple effect on their emergency medical services. EMS workers are often called into dangerous situations, but do not carry their own protective equipment or weapons. Instead, they rely on police co-response for their own safety, particularly when responding to calls involving possible drug use, behavioral issues, or suicidal patients. And, it’s not always apparent if a situation will be dangerous until police arrive to assess scene safety.

    Should police departments reduce or eliminate their involvement in non-emergency calls, as some groups are suggesting, EMS workers would be expected to head into potentially unknown situations without police protection.

    This could lead to expensive adjustments for the agency.

    For one, unions would likely demand higher compensation and/or increased insurance benefits to make up for the increased dangers of the job. And if a worker is injured while providing emergency medical services, the agency could be liable.

    Another possibility is that EMS teams would demand personal protective equipment like ballistic vests, or even weapons of their own. They might also demand the ability to restrain unpredictable and violent patients (currently the responsibility of police). These requests would require specialized training, the hiring of new staff, or other changes that are not only expensive but nullify efforts to remove weapons from the scene of “non-emergency” calls. Another possibility, and perhaps the most problematic, would be for EMS departments to deem situations too unsafe for responders and begin to decline calls entirely, citing the need to protect their personnel. In cities that receive a high volume of drug overdoses or behavioral health calls, this could be particularly detrimental.

    While it’s unclear exactly how these situations would unravel in specific agencies, it’s important to consider the possibilities to best prepare for any outcome.

    How Can Cities Prepare?

    Before any meaningful action can be taken to prepare a city for changes in public safety operations, it’s essential to first understand the needs of their community.

    Determining these needs would ideally be a collaboration between a combination of city management; police, fire, and EMS leadership; city council; community leaders; and an outside analytics group that can provide unbiased data. 

    The goal of this process should be to flag major call categories in the area (i.e., overdoses, suicidal patients, mental health issues, etc.), as well as what destination options the city has for patients. Oftentimes, there are only two options for such calls—either the hospital or jail, but some areas might have sobering centers/detox facilities, behavioral health centers, homeless shelters, or transitional housing.

    Once data is collected and input is received, city leadership can then work on a solution with solid information to guide their decisions. If, for example, your city receives a high percentage of nonviolent behavioral health calls, it might be worth exploring how to reduce the nights these patients spend in jail and instead support them with a transitional mental health facility. If the number of jail intakes is reduced, that jail budget could be reduced and used to fund a mental health facility—just as a for instance. Solutions will take time, collaboration, and creativity, but they are possible.

    Maximize Your Agency’s Reimbursement Now

    As a final reminder, whenever the subject of budget reform comes up, it is wise to take a hard look at the numbers and become intimately familiar with the costs and revenues associated with local EMS. When these numbers are transparent, it’s easier to maximize revenue sources now to better weather a potential budgetary storm.

    When it comes to EMS, a data analytics partner (like CPSM) can deliver raw, unbiased data to illustrate specific points, such as the payer mix of patients that the department sees, deployment models (down to how many minutes certain pieces of equipment are deployed), and the kinds of calls to which the department is responding. This kind of data is invaluable to all cities, but particularly those that are in financial crisis. Not only can these numbers help maximize the revenues being brought in by EMS now, but they could potentially offer support for maintaining police services in conjunction with EMS by illustrating the department’s need.

    While every agency is different, and there is no one-size-fits-all solution to the prospect of police reform, it’s imperative for all public safety leadership to ask questions, prepare for a variety of outcomes, and maximize their revenue ASAP. The sooner those steps are taken, the sooner answers—and hopefully solutions—will be ready for action. 


  • 14 Jan 2021 7:57 AM | AIMHI Admin (Administrator)

    CNN Source Article | Comments Courtesy of Matt Zavadsky

    Further national recognition of the amazing job EMS providers, provider agencies, and the entire healthcare system is doing around the country! 

    We are very thankful for our heroes managing this crisis!

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    Los Angeles ambulance ride-along shows the pandemic's grueling toll on EMTs

    By Josh Campbell, Jack Hannah and Eric Levenson, CNN

    Mon January 11, 2021

    https://www.cnn.com/2021/01/11/us/los-angeles-ambulance-emt-coronavirus/index.html

    (CNN)  EMT Sadi Pope takes pride in her job, but the recent Covid-19 surge in Los Angeles County has made for some grueling 10-hour shifts.

    The mother of three and former stay-at-home mom has been running an ambulance for the last six months, but the call volume has grown so much in this latest wave of the coronavirus pandemic that "we're running and running" all day now, she said.

    "A few months ago, there would be times where we'd sit for a couple hours just waiting for a call in our area, but now ... we're lucky if we sit for a half an hour," she said.

    To understand how Los Angeles' crushing Covid-19 surge has impacted first-responders, CNN spent a day with EMTs and at the emergency communication hub for Care Ambulance, the largest emergency ambulance service in Southern California. Over nearly eight hours, the group of hard-working yet harried workers tried to handle a large volume of calls and brought sick patients to hospitals so full that the patients were left waiting for hours for an available bed.

    CONTINUE►

  • 29 Dec 2020 8:05 AM | AIMHI Admin (Administrator)

    #EMS association leaders say THANK YOU to #paramedics, #EMTs, #dispatchers, and other #MobileHealthcare professionals. Thank you for serving on the very front lines of our nation’s #COVID19 response!


  • 22 Dec 2020 1:17 PM | AIMHI Admin (Administrator)

    ABC Source | Comments Courtesy of Matt Zavadsky

    Many systems may be considering similar protocols as healthcare system capacity becomes more strained...

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

    American Ambulance will only transport Fresno County 911 callers who have life-threatening or emergency conditions

    Instead of transferring patients to a local hospital, paramedics will evaluate them first.

    By Gilbert Magallon

    Monday, December 21, 2020

     

    https://abc30.com/american-ambulance-fresno-county-911-emergency-call/8962755/

     

    FRESNO, Calif. (KFSN) -- The way American Ambulance responds to your 911 calls in Fresno County is changing.

     

    As of Monday, only patients with life-threatening and emergency conditions will be transferred to the hospital.

     

    "If you feel like you need to call 911, if your family member is sick and you need to call 911, call 911," said Edgar Escobedo, American Ambulance operations manager. "We are going to be there, we are going to assess that patient and if necessary we are going to transfer that patient."

     

    The new Assess and Refer Policy was implemented Monday to relieve overwhelmed emergency rooms.

     

    Escobedo said instead of transferring patients to a local hospital, paramedics will evaluate them first.

     

    Their condition will then determine if they go to the hospital or if they're referred to an urgent care facility, their primary care doctor, or telemedicine.

    CONTINUE READING>

  • 17 Dec 2020 8:29 AM | AIMHI Admin (Administrator)

    Comments Courtesy of Matt Zavadsky

    For those who may have missed it, the American Ambulance Association hosted a webinar and Facebook live event last evening explaining the recent Phase 3 distribution of Provider Relief Funds (PRF).  Scott Moore, Brian Werfel and Asbel Montes did a wonderful job explaining the Phase 3 distribution, and answering many questions from the attendees.

    We strongly encourage all ambulance suppliers and providers to watch the recording of the webinar, which is available here è https://www.youtube.com/watch?v=ne-7ka2Vw6Q&t=42s

    Background:

    HHS recently announced the distribution of funds for Phase 3 under the COVID-19 Provider Relief Fund.  According to the announcement, “ambulance or transportation service providers will be receiving $1.48 billion in Phase 3 funding”. The funding is in addition to the approximately $350 million distributed to ambulance service providers and suppliers under Phase 1 and 2 for a total of $1.83 billion. The American Ambulance Association has been tirelessly advocating for a total of $2.89 billion in relief for our industry.

    The new funds are being distributed to those providers and suppliers who applied for funds under Phase 3. The funds cover lost revenue and increased expenses incurred during the first and second quarters of 2020 due to the COVID-19 pandemic.

    The funding under Phase 3 is intended to cover up to 88 percent of losses so those applicants who previously reached that threshold will not receive any funds under the latest round. While the AAA encouraged members to apply for Phase 3 even if they did not believe they would be eligible for additional funds, we will be pushing for another round of funds to enable those who didn’t apply to receive additional relief.


  • 14 Dec 2020 2:21 PM | AIMHI Admin (Administrator)

    Traverse City Eagle Source | Comments courtesy of Matt Zavadsky

    Let’s see.... 

    Annual Cost = $755,000 - $1,548,000, plus capital.  Annual Revenue = $484,000.  Clearly this is a tough decision...  J

    If they require MMR to pay for First Responder services, bet the payer would then require an EMD process that only trigger a first response unit for cases that evidence shows a first response may make a difference in the patient’s outcome.  That will certainly reduce the fire department’s response volume!

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

    Ambulance study shows changes could cost millions

    By Jordan Travis

    jtravis@record-eagle.com  

    Dec 13, 2020

    TRAVERSE CITY — Making Traverse City Fire Department the city’s primary emergency management services transport provider would be a costly undertaking.

    Buying two new ambulances, as would be needed, would cost up to $500,000 for both, according to a study by TriData. Then, the city would need to spend $755,000 to $1,548,000 on staffing to add seven to nine employees to each shift. That doesn’t include the costs of modifying Stations 1 and 2 to accommodate the larger crews.

    Charging for services would cover some of the costs, but EMS transport rarely turns a profit, according to the study. The city could anticipate $484,000 in revenues for transport each year, and up to $338,000 if it charges for EMS first responder services without transport.

    That’s the findings of a study city commissioners will hear more about at their study session Monday. City Fire Chief Jim Tuller said the idea of Traverse City becoming a primary EMS transport provider goes back to the 1980s when a countywide ambulance service dissolved and Munson Healthcare took over.

    Continue Reading►

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