News & Updates

  • 1 Nov 2019 5:54 PM | AIMHI Admin (Administrator)

    DHealthcare Source Article | Comments Courtesy of Matt Zavadsky

    Will Maddox from DHealthcare does an excellent job profiling MedStar’s MIH programs in his article.  Although MedStar was one of the first, EMS agencies across the country are now doing similar programs, with similar results.

    This IS EMS’ new value proposition in the transforming value-based healthcare environment!

    To learn more about MedStar’s programs, and the EMS Transformation, click the links below:


    How MedStar Saved $25 Million by Avoiding Unnecessary Emergency Services

    10/31/2019by Will Maddox

    These days, every aspect of the medical industry is looking to find cost savings, and 9-1-1 service is part of that movement as well. MedStar Mobile Healthcare, a North Texas organization that provides emergency services, has avoided over $25 million in medical costs for residents and payers over the past seven years.


    The emergency department is one of the most expensive pieces of the medical industry, especially when it is full of problems that don’t belong in an emergency room. And when emergency physicians are operating out-of-network at in-network hospitals, surprise bills are end up with those who thought they were making the responsible decision in a time of emergency. These bills have made headlines and inspired legislation to fight them in past years. Emergency service providers can play an outsized role in avoiding these costs by treating problems upstream and diverting patients from expensive and often unnecessary services.


    Created in 1986 to serve the Fort Worth area, MedStar is a public authority that provides emergency services, and the organization is governed by an appointed board from the fifteen cities the organization serves in North Texas. But despite the public governance, MedStar is not funded by tax dollars, and receives all of its funding through healthcare payers, just like other medical providers.


    Because they are only paid when their services are necessary and only at set rates, they are forced to look for efficiencies where they can, and avoid services that won’t be reimbursed. The entity sees itself as a key player in avoiding unnecessary medical costs, which often occur in the emergency room. “We believe that we should have always been part of the solution,” says MedStar Executive Director Doug Hooten.


    Patients known as high utilizers, who sometimes call 9-1-1 up to 20 times a month, are part of the problem, and MedStar has created initiatives to make sure that only emergencies receive ambulance rides to the emergency room.


    For some people, navigating where to go with what problem can be daunting, and 9-1-1 offers a simple way to ensure that medical treatment will be received, but it isn’t efficient. MedStar created curriculum to train its staff to recognize whether an emergency transport or emergency room is necessary, and providers also look at medications to make sure several different doctors haven’t prescribed the same medication. The program also looks at social determinants of health to see if housing, food, transportation or other needs can improve conditions in a more appropriate and cost-effective way than calling an ambulance with every issue.


    Continue Reading>

  • 29 Oct 2019 9:47 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    Continued disruptive innovation in healthcare – even mobile healthcare.  Note the Lyft and Uber integration into healthcare system’s EHRs – this is something EMS computer aided dispatch developers should take note of – one future path for EMS is for 9-1-1 centers to implement Nurse Triage programs similar to the programs here at MedStar, Las Vegas, D.C., Niagara and Memphis.  Planned CMS ET3 funding for dispatch centers to implement medical triage systems designed to reduce ambulance responses could potentially accelerate this process.  Ride share options to alternate destinations are a good alternative for low/no acuity 9-1-1 callers.

    Also note Lyft and Uber’s shift to addressing social determinants of health – food delivery and free rides to healthy grocery options for people in food deserts.  Could be a good partnership with EMS-based MIH programs looking for those options for enrolled patients.

    Lyft, Uber expand reach into healthcare


    October 28, 2019

    The nation's two ride-sharing giants are continuing their push into healthcare, announcing major expansions of their work within days of one another.

    Uber on Monday announced its healthcare arm plans to integrate an app into Cerner Corp.'s electronic health record system, which would allow caregivers to schedule rides for patients. Lyft last week said it is now providing covered rides for eligible Medicaid beneficiaries in Georgia, Michigan, Missouri, Tennessee and Virginia.

    Healthcare is a massive opportunity for on-demand transportation companies like Lyft and Uber, according to analysts, and the companies—despite two very different announcements this week—are largely tackling the industry with similar strategies, beginning with a focus on providing patients with free or affordable rides to non-emergency medical appointments.

    Lyft last year unveiled a collaboration with EHR vendor Allscripts. Uber is also offering rides to Medicaid beneficiaries in some states, including Arizona. Lyft has been working with LogistiCare, and Uber with American Logistics—two companies that manage patient transportation to medical appointments for providers and payers.


  • 29 Oct 2019 8:31 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    CMS wants prior authorization for non-emergency ambulances nationwide


    The CMS wants to expand prior authorization for non-emergency ambulance transportation nationwide and on Friday requested ambulance services for information that could help achieve that goal.

    The agency has been testing prior authorization for repetitive, scheduled, non-emergency ambulance transportation for its Medicare beneficiaries in several states since 2014.

    In a notice, the CMS said it will collect information from ambulance providers on how many and what type of transportation services are necessary. Prior authorization would require providers to hand over all medical records associated with ambulance services.

    The agency would freeze payments for review and approval if the ambulance supplier doesn't submit a prior authorization request after four round trips during a 30-day period.

    The CMS has been testing whether prior authorization cuts healthcare spending by curbing Medicare-covered ambulance transportation. The program's early results show substantial declines in utilization and spending during the first year of implementation.

    The agency announced in September that it's extending the trial for another year in Delaware, the District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia and West Virginia.

  • 28 Oct 2019 11:37 AM | AIMHI Admin (Administrator)

    One Zero Source Article | Comments Courtesy of Matt Zavadsky

    Interesting profile of Ambulnz…  Most notable quote is at the end:

    If there’s one thing observers can agree on it’s that the emergency medical service needs an overhaul: EMTs need higher pay, better career opportunities, affordable benefits, and less grueling schedules. As aging populations increase, these needs will only become more apparent. Unfortunately, Ambulnz, a company focused on commoditizing and optimizing an already precarious workforce, is not likely to alleviate these issues.

    This is the reason many of us, and our respective associations, are working so hard to change the economic model for EMS away from simply a per-transport model to one based on the value EMS systems can bring by serving in a triage and patient navigation role.

    Tip of the hat to our friend Bob McCaughan of the Allegheny Health Network for finding this article!


    Ambulnz Promised to Disrupt Emergency Transport — But Workers Paint a Grim Picture

    The company promises EMTs a “flexible schedule” and “a path to entrepreneurship.”

    Ashwin Rodrigues

    October 23, 2019

    Cory, a 26-year-old emergency medical services professional, had been working in southern California for several years when he started seeing teal ambulances, emblazoned with the words “Ambulnz,” zipping around Los Angeles. Founded in 2015, Ambulnz transplanted the push-button ride hailing model to non-emergency medical transport, offering on-demand patient transport services for hospitals and other care providers. The majority of Ambulnz business involves moving patients from hospitals to their homes, or transferring patients between medical facilities. This type of service is called interfacility transfer, or IFT.

    Cory, who requested anonymity for this piece, was enrolled in paramedic school at the time. He needed a part-time gig to complete his internship so he could simultaneously complete his paramedic classes, and the Ambulnz gig fit into his schedule.

    After applying and interviewing with Ambulnz, Cory received an offer, and went to the company’s office in Carson, California, for orientation. The office, he remembers, was “pretty legit” and “very modern looking.” It reminded him of an Apple Store. There was an employee break room with snacks.

    But his experience with Ambulnz quickly soured. Cory says that in his orientation class of approximately 32 people, most new employees seemed “socially awkward, or flat out weird, as if they were turned down by every other ambulance company.” He says one new hire told him that his only serious prior work experience was 12 years as a seasonal Halloween scare actor at Universal Studios. As part of the orientation, Cory says, the class FaceTimed with Ambulnz CEO Stan Vashovsky, who bragged about the company. “It was awkward,” he recalls.

    Though he says he’d been told in his job interview that he’d be paid $16 per hour, at the orientation that rate dropped to $12. Then Ambulnz told him the station he’d be working at had changed to a location one hour further from his home. After 20 minutes as an Ambulnz employee, Cory quit. He signed a voluntary resignation form, received a check for four hours of work, and went home.

     Continue Reading►

  • 24 Oct 2019 7:56 AM | AIMHI Admin (Administrator)

    DHealth Source Article | Comments Courtesy of Matt Zavadsky

    In addition to these findings, MedStar’s experience has been that these facilities often result in an increase in call volume responding to calls at the facility.

    In recent conversations with C-Suite members of two health systems that opened FSER’s, both related that their main campus ERs did not see any reduction in ER volume, even though the FSERs saw 15-30 patients/day.

    Healthcare is certainly an interesting market. As the author states, one of the only markets where supply creates demand….


    Emergency Costs Went Up When Freestanding ERs Arrived in Texas

    10/23/2019| by Will Maddox

    When an additional freestanding emergency department (FED) entered a local market in Texas, out-of-pocket costs and emergency provider reimbursement went up 3.6 percent per insured beneficiary, according to Rice University research published this month in American Emergency Medicine.

    The study looked at data in four states, but Texas FEDs were especially prolific. The study analyzed 495 Public Use Microdata Areas (PUMA), looking at the number of FEDs in each location and comparing other cost and demographic data. By 2017 there were only 51 PUMAs in Texas without an FED, meaning 74% of PUMAs in Texas had at least one. In Arizona, only 28% of PUMAs had one, 22% in Florida, and 14% in North Carolina had one or more FrEDs.

    Continue Reading►

  • 21 Oct 2019 9:30 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments courtesy of Matt Zavadsky

    Interesting that the authors opine that the Department of Transportation may have the ability to create regulations for air ambulance services.  The ‘lead’ federal agency for EMS is in fact NHTSA, which resides within the Department of Transportation.


    Are Air Ambulances Truly Flying Out Of Reach? Surprise-Billing Policy And The Airline Deregulation Act

    Karan Chhabra

    Kevin A. Schulman

    Barak D. Richman

    OCTOBER 17, 2019

    It wasn’t long ago that congressional leaders in both parties seemed to agree that something had to be done about surprise medical bills. But recent headlines suggest that federal legislative momentum has stalled, despite an initial surge of bipartisan interest.


    One reason for the slowing response in Washington is that policy makers appear to have realized that surprise bills do not have an easy fix. To the contrary, surprise bills are pervasive throughout our health system, with many parts of the industry explicitly relying on surprising patients with out-of-network charges. The problem is typified by the rise (and political clout) of the air ambulance industry. The House Energy and Commerce Committee recently heard that 50–60 percent of air ambulance rides lead to out-of-network bills, such as the well-publicized charge of more than $55,000 for a helicopter ride after a snake bite and other shockingly high charges. In Massachusetts, which has collected all-payer surprise billing data, ambulance services in general account for 52 percent of all out-of-network claims.


    The profitability of air ambulances has caught the attention of private equity firms, whose investments have allowed the industry to expand and consolidate. (These investment firms have also funded the lobbying campaign that has helped stall surprise-billing legislation.) 


    It is critical to understand how air ambulances have become so lucrative, for their success reveals the core of the policy challenges that underlie other surprise bills. The air ambulance business model does not rely on a new technology or providing a valuable service; instead, it rests upon a carefully devised legal strategy that exploits the basic charge model in health care and then hides behind a legal loophole to prevent state policy makers from policing the industry.  

    The Injustice Of Collecting Charges

    Air ambulances rely on the ability to collect charges. Charges are what providers impose unilaterally, usually after a service has already been provided, without any assent from the consumer. Charges are different from prices, which emerge from voluntary market interactions between sellers and buyers. Prices are creations of market forces, whereas charges are foisted on the unknowing.

    Continue Reading>

  • 10 Oct 2019 10:28 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    This is encouraging news for those who have quietly questioned whether the arrangements where hospitals, physician groups, hospice and home health agencies are paying EMS to provide care coordination for their patients could be construed as running afoul of the Stark Law.

    Although these proposed rules apply to non-EMS agencies, it may signal the intent of the OIG.

    Recall that JEMS published an article Steve Wirth penned on this issue in March 2019 -

    Stark Law, anti-kickback updates may boost value-based payments

    October 09, 2019


    HHS on Wednesday unveiled its long-awaited proposal to change its anti-kickback and self-referral laws, a move that was largely well-received by industry observers who expect the proposals to facilitate more value-based payments and coordinated care.

    In two proposed rules from the CMS and HHS Office of Inspector General, the agencies said the current regulations limit data sharing and care coordination in their attempts to root out fraud.

    Under the proposed rules, specialty physician practices could share patient information with primary care physicians to manage care or work with hospitals on discharges using data analytics. It also would allow local hospitals to work together on cybersecurity issues without running afoul of data sharing concerns.

    The safe harbors include allowing hospitals to pay physicians incentives as part of CMS-sponsored care models.

    Continue reading►

  • 9 Oct 2019 12:17 PM | AIMHI Admin (Administrator)

    Reasons to Be Cheerful Source Article | Comments Courtesy of Matt Zavadsky

    Very nice article about the Eagle County and MedStar MIH-CP programs!

    No highlights, because it’s ALL good!  J


    Free the Paramedics!

    They’re the medical system’s eyes and ears, yet they’re treated as crisis managers. Now some cities are letting their paramedics get to know their patients, with remarkable results.

    October 4, 2019

    By: Allison McNearney

    Twice a week, Amy Yang drives her white Chevy Malibu to Mollie Wagar’s apartment in a senior living community in Fort Worth, Texas. Wagar, 78, lives alone and is a bit of a night owl, so Yang always calls her a few minutes before her scheduled 9 a.m. arrival to warn her she’s on the way. 

    Once situated in Wagar’s living room, an array of devices appear from Yang’s black cargo pants and medical bag—a stethoscope, a blood pressure cuff, a blood sugar meter. While the paramedic gets to work, she chats with Wagar about her recent road trip to Mississippi and new developments in her health since they last saw each other four days earlier.

    These casual visits and friendly chats are a gratifying change for Yang, who, until about a year ago, spent 11 years speeding patients to emergency rooms in an ambulance. Now, she is able to develop a slow-paced relationship with patients like Wagar, witnessing and monitoring their health improvements first-hand. Wagar’s situation isn’t an emergency, but in another city it might be treated as one, not because she requires urgent care, but because most cities don’t have a system like Fort Worth’s. 

    In most cities, a call placed to 911 triggers an automatic series of responses involving an ambulance, a crew of paramedics and a rush to the ER, sirens blaring. But this response is often excessive—one in three 911 calls don’t require an ER visit. Yet few cities have a system in place to deal with cases like Wagar’s—non-emergencies that nonetheless necessitate a medical professional to be dispatched to the person’s home.

    Continue reading and see pictures►

  • 2 Oct 2019 11:26 AM | AIMHI Admin (Administrator)

    Kaiser Health News Source Articles | Comments Courtesy of Matt Zavadsky

    Hospital and EMS-based Mobile Integrated Healthcare (MIH) partnerships to reduce readmissions continues to be one of the most popular programs. 

    Effective partnerships have shown excellent reductions in preventable readmissions.

    NOTE: At the end of this article, KHN provides links to download all the readmission penalties since 2015 for all hospitals, and a look up tool where you can look up hospital’s readmission penalties.  

    An exceptional resource!


    New Round of Medicare Readmission Penalties Hits 2,583 Hospitals

    Jordan Rau

    October 1, 2019



    Medicare cut payments to 2,583 hospitals Tuesday, continuing the Affordable Care Act’s eight-year campaign to financially pressure hospitals into reducing the number of patients who return for a second stay within a month.

    The severity and broad application of the penalties, which Medicare estimates will cost hospitals $563 million over a year, follows the trend of the past few yearsOf the 3,129 general hospitals evaluated in the Hospital Readmission Reduction Program, 83% received a penalty, which will be deducted from each payment for a Medicare patient stay over the fiscal year that begins today.


  • 25 Sep 2019 8:05 AM | AIMHI Admin (Administrator)

    JEMS Source Article | Comments Courtesy of Matt Zavadsky

    Interesting commentary from Dr. Bledsoe…

    Many of us, when asked if there is a paramedic ‘shortage’ have difficulty answering the question.  The reason? By definition, to express a shortage of anything, we first need to know the answer to the question “How many do we need?”  Once we have the answer to that question, then we might be able to determine if there is a shortage.

    Some systems have an overabundance of paramedics, while others struggle to recruit and retain paramedics.  So, you could say we have a paramedic mal-distribution?

    Dr. Bledsoe asks the tough questions…


    The Paramedic Shortage — Opportunity or Crisis?

    By Bryan Bledsoe, DO, FACEP, FAAEM, EMT-P | 9.24.19

    There has been a great deal discussion, of late, related to a shortage of paramedics in the United States. It is often debated, and there are deniers, as well as believers. However, the data are clear in that fewer people are entering EMS when compared to a decade or two ago. The reasons are debatable but include such things as poor pay, working conditions, schedules, work type, and cultural changes in younger individuals and their belief systems. Many lament this but it may actually be the opportunity needed to drive EMS to the next level.

    At a most fundamental level, the term “shortage” refers to a state or condition where something needed cannot be attained in sufficient amounts. From a business standpoint, it is the difference between supply and demand. A shortage can be rectified by increasing the supply of the necessary product. It can also be rectified by decreasing demand for that product. This is the basis of this discussion.

    Keep reading►

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