News & Updates

  • 13 May 2019 5:04 PM | AIMHI Admin (Administrator)

    Vox Source Article | Comments Courtesy of Matt Zavadsky

    Interesting perspective…  Tip of the hat to Don Jones for sending this article along.

    “Am I a bad person?” Why one mom didn’t take her kid to the ER — even after poison control said to.

    The emergency room bill I can’t stop thinking about.

    By Sarah Kliffsarah@vox.com  

    May 10, 2019

    Two years ago, 36-year-old Lindsay Clark was facing a terrible decision.

    Her 2-year-old daughter Lily had gotten into a small bottle of the anti-nausea drug Dramamine.

    “It had a child lock on it, but I caught her sitting there with a bunch of white stuff in her mouth,” Clark says. “I immediately swept her mouth with my finger, but I wasn’t sure how many pills she ate.”

    Clark had to decide: Should she take Lily to the emergency room?

    She called a poison control hotline and the answer was yes: A Dramamine overdose could lead to seizures. The little girl should be monitored. When Clark asked what doctors would likely do, she was told they would likely give her activated charcoal and possibly pump her stomach.

    Read the rest of the article on Vox►

  • 9 May 2019 8:14 AM | AIMHI Admin (Administrator)

    Milwaukee Journal Sentinel Source Article | Comments Courtesy of Matt Zavadsky

    Huge Kudos to Captain Wright and his team at Milwaukee Fire!  Even re-opened a closed fire station to serve as a home-base for their MIH program!

    Nice work, Michael!

    New effort to stem overdose deaths, streamline access to treatment announced in Milwaukee

    Alison Dirr, Milwaukee Journal Sentinel

    May 3, 2019

    Milwaukee officials announced a data-driven effort Friday to help stem the opioid crisis by following up with people who have overdosed and streamlining access to treatment.

    "We are here for one reason: We want to change the outcomes of what we see in this city, this county and this country, and it's all about partnerships," Ald. Michael Murphy told those gathered for the announcement Friday at Milwaukee Fire Department Station 31, 2400 S. 8th St. 

    He said there remains a stigma around addiction that enforces the idea that people who are addicted got themselves into the situation they're in and should, therefore, pull themselves out of it.

    That's not true, he said.

    The program is expected to roll out in June on Milwaukee's south side, in Ald. José Pérez's 12th aldermanic district.

    "This district has been hit severely by this opioid crisis," Pérez said.

    Dubbed the Milwaukee Overdose Response Initiative, the effort puts into practice the recommendations of the Milwaukee City-County Heroin, Opioid, and Cocaine Task Force. It aims to save lives by finding trends in data while also providing more direct avenues to treatment and providing in-school education.

    The effort is led by the Milwaukee Fire Department and the Milwaukee Health Department.

    More specifics about the program will be available after a May 9 meeting.

    The data shows that substance use disorder is still widespread, but innovations in treatment, prescribing and awareness are helping. 

    How the program works

    The program allows data to be used proactively, Milwaukee Fire Department Capt. Mike Wright told those gathered for the announcement. Under the program, he receives a report each morning that details what happened in the last 24 hours. That includes the narrative of each case, the person's age and whether opioid overdose-reversing drug naloxone was used. 

    "All this data has never been at our disposal in such a ready fashion," he said. 

    A packet is produced on each patient. Then, paramedics and a peer-support person from Community Medical Services, a service for people who struggle with addiction, head out to follow up with the person who overdosed.

    They will first ask if that person needs clean needles, Wright said. If so, the AIDS Resource Center of Wisconsin also responds.

    The response team then would offer ongoing assistance to the person who overdosed and their loved ones.

    "At any time the patient is ready for treatment, we will go out," Wright said. "And then if they say we are ready to go, we stay with them" as they go to a facility.

    It's critical, he said, to respond quickly when a person with an addiction wants treatment.

    The program will be implemented by the Milwaukee Fire Department Mobile Integrated Healthcare Program, which aims to proactively address the chronic health issues that cause residents to repeatedly call 911.

    The Mobile Integrated Healthcare Program on Friday also celebrated its continued expansion. Station 31, one of six that closed in 2018 under Milwaukee Mayor Tom Barrett's 2018 budget plan, has reopened for the program.

    "It's an amazing program, and it's growing," Fire Chief Mark Rohlfing told those gathered.

    Its first paramedics were trained in 2015.

    The department has seen reductions in repeat 911 calls among the people who participated in the program since it launched, he said. Those calls fell by 56% in 2016, by 62% in 2017, and by 55% in 2018, he said.

    What they're doing is working, Rohlfing said, and other agencies have come on board.

    "We're reaching more patients than ever, and the important thing is we really are meeting them where they are — and where they are in their life, in their health situation but where they are in the community," he said.



  • 6 May 2019 9:04 AM | AIMHI Admin (Administrator)

    FierceHealthcare Source Article | Comments Courtesy of Matt Zavadsky

    Several folks have asked opinions on what a “Medicare for All” option may actually entail, and how it might impact EMS and other healthcare agencies.  This is a nice ‘primer’ on the various issues.

    One exercise to dabble with is to take your average Medicare/Medicaid reimbursement amounts and apply that to all the FFS services you provide, including a majority of the typically low/no payments generated from ‘bill patient’ (uninsured) patients, since ‘uninsured’ patients would be dramatically reduced.  That may give you a glimpse into the potemtial revenue side.

    Lots of variables on the expense side, like what would an employer contribute (if any) to a single payer, in addition to what may be taxed to the employee.

    $35 Trillion over ten years ($3.5 Trillion annually) seems like a lot, but estimates of the expenditures for our current system in 2017, are exactly that, …  https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html

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    The CBO analyzed what it would take to shift to a single-payer system. Here are 5 takeaways

    by Paige Minemyer | 

    May 1, 2019

    As chatter about "Medicare-for-All" ideas heats up—at least among the field of Democratic presidential hopefuls—the Congressional Budget Office decided to offer its own take.

    Well, sort of.

    Wednesday, the CBO issued a report that dove into the key considerations policymakers might want to think about before they overhaul the U.S. healthcare into a single-payer system. Putting it mildly, they said, the endeavor would be a "major undertaking."

    They don't actually offer up specific cost estimates on any of the Medicare-for-All bills floating around, though other researchers put Bernie Sanders’ Medicare-for-All plan at between $32.6 trillion and $38.8 trillion over the first decade.

    But the CBO analysts did weigh in on a slew of different approaches to financing, coverage, enrollment and reimbursement that could be built into a single-payer plan.

    “Establishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates and financing methods of healthcare in the United States,” the CBO said.

    So what exactly did the CBO have to say about what it would take to create a single-payer system? Here are some key takeaways:

    1. There could be a role for private insurance—or not 

    There has been plenty of heated debate around Medicare for All focused on the role that existing private coverage could—or could not—play in that system. Most insured Americans are enrolled in a private plan today, including about one-third of Medicare beneficiaries. 

    If they’re allowed, commercial plans could play one of three roles in a single-payer system, according to the report: as supplemental coverage, as an alternative plan or to offer “enhanced” services to members in the government plan. 

    Allowing private insurers to offer substitutive plans is unlikely, because they could potentially offer broader provider networks or more generous benefits, which would draw people into them. A solution to this issue could be mandating that providers treat a minimum number of patients who are enrolled in a single-payer plan. 

    Private payers could also offer coverage for care that is traditionally outside of the purview of government programs, such as dental care, vision care and hearing care.

    Supplemental plans like these are offered in the existing Medicare program, and several countries with single-payer systems allow this additional coverage. 

    For example, in England, private plans offer “enhancements” to members of the government plan, including shorter wait times and access to alternative therapies, but members of these plans must pay for it in addition to tax contributions to the country’s National Health Service. 

    2. Other government programs could stick around 

    In addition to Medicare and Medicaid, the federal government operates several health programs targeting individual populations: the Veterans Affairs health system, TRICARE and Indian Health Services.

    A single-payer system could be designed in a way that also maintains these individualized programs, the CBO said. Canada does this today, where its provinces operate the national system while it offers specific programs outside that for indigenous people, veterans, federal police officers and others.

    There could also be a continuing role for Medicaid, according to the report.  

    “Those public programs were created to serve populations with special needs,” the CBO said. “Under a single-payer system, some components of those programs could continue to operate separately and provide benefits for services not covered by the single-payer health plan.” 

    On the flip side, though, a single-payer plan could choose to fold members of those programs into the broader, national program as well, the office said. 

    3. A simplified system could also mean simplified tech 

    Taiwan’s government-run health system has a robust technology system that can monitor patients’ use of services and healthcare costs in near real-time, according to the report.  

    Residents are issued a National Health Insurance card that can store key information about them, including personal identifiers, recent visits for care, what prescriptions they use and any chronic conditions they may have.  Providers also submit daily data updates to a government databank on service use, which is used to closely monitor utilization and cost. Other technology platforms in Taiwan can track prescription drug use and patients’ medical histories. 

    However, getting to a streamlined system like this in the U.S. would be bumpy, the CBO said. It would face many of the same challenges the health system is already up against today, such as straddling many federal and state agencies and addressing the needs of both rural and urban providers.  

    But the payoffs could be significant, according to the report. 

    “A standardized IT system could help a single-payer system coordinate patient care by implementing portable electronic medical records and reducing duplicated services,” the agency wrote. 

    4. How to structure payments to providers? Likely global budgets 

    Most existing single-payer systems use a global budget to pay providers, and may also apply in tandem other payment approaches such as capitation or bundled payments according to the report. 

    How these global budgets operate varies between countries. Canada’s hospitals operate under such a model, while Taiwan sets a national healthcare budget and then issues fee-for-service payments to individual providers. England also uses a national global budget. 

    Global budgets are rare in the U.S., though Maryland hospitals operate under an all-payer system. These models put more of the financial risk on providers to keep costs within the budget constraints. 

    Many international single-payer systems pay based on volume, but the CBO said value-based contracting could be built into any of these payment arrangements. 

    5. Premiums and cost-sharing are still in play, especially depending on tax structures 

    A government-run health system would, by its nature, need to be funded by tax dollars, but some countries with a single-payer system do charge premiums or other cost-sharing to offset some of those expenditures. 

    Canada and England operate on general tax revenues, while Taiwan and Denmark include other types of financing. Danes pay a dedicated, income tax to back the health system, while the Taiwanese have a payroll-based premium. 

    The type of tax considered would have different implications on financing, according to the CBO. A progressive tax rate, for instance, would impose higher levies on people with higher incomes, while a consumption tax, such as one added to cigarettes, would affect people more evenly.  

    Policymakers will also have to weigh when to impose new taxes, shifting the economic burden between generations. 

    The CBO did not offer any cost estimates in terms of the amount the federal government would need to raise in taxes to fund a single-payer program.


  • 29 Apr 2019 10:30 AM | AIMHI Admin (Administrator)

    StarTribune source article | Comments courtesy of Matt Zavadsky

    Nice story about North Memorial’s program.  Interesting that their finding in medication inventories is very similar to those we hear from multiple programs across the country…

    Visiting medics prevent problems

    Community paramedics are often dispatched after colleagues on emergency scenes notice that patients have problems beyond their immediate injuries.

    By Jeremy Olson Star Tribune  APRIL 27, 2019

    North Memorial’s community paramedic program is expanding to provide more at-home, nonemergency support to people who might otherwise call 911 for costly and avoidable ambulance rides.

    A UCare health plan grant is extending the reach of the Twin Cities program to include Faribault, Forest Lake and Princeton. Leaders said the program in its first six years has produced measurable results, including lower costs by helping people avoid intensive medical services they don’t need.

    Many patients with nonemergency concerns call 911 because the health care system doesn’t present them with obvious alternatives, said Dr. Peter Tanghe, medical director of the program. “That’s part of the problem we’re trying to solve. We have had sort of one solution for a thousand problems.”

    Community paramedics are often dispatched after colleagues on emergency scenes notice that patients have problems beyond their immediate injuries. Doctors and nurses might request visits as well if they suspect patients have problems at home that are worsening their medical conditions.

    The state Medicaid program pays for visits to its poor and disabled members. Visits generally aren’t covered by private health insurance, though, so North EMS has used its own investments and UCare grants to keep the program running.

    North EMS leaders said the investment will hopefully pay off in the future, as health insurance plans switch from paying per procedure to paying for efficient care that improves patient health while lowering costs.

    Studying community paramedic visits in the first half of 2018, North Memorial found no cost savings during that time period. But in the second half of 2018, the costs of patients who had received those visits declined by $1,969 per member per month. North EMS leaders said this might reflect less usage of the ER because medics referred these patients to primary care doctors and instructed them on how to safely take their medications.

    “We find a medication error on almost every visit that we go out on,” Tanghe said.

    Medics have eagerly sought to join the program, completing the required additional training and then alternating shifts between traditional ambulance runs and community visits, said Shannon Gollnick, North Memorial’s director of ambulance operations.

    The change of pace gives medics a chance to help people beyond stabilizing them in emergencies and running them to hospitals, he said. “They like to take care of people.”

  • 18 Apr 2019 6:20 PM | AIMHI Admin (Administrator)

    Governing source article | Comments courtesy of Matt Zavadsky

    Interesting….  Law enforcement officers trained to do blood draws…

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    A New Way for Cops to Catch Impaired Drivers: Draw Blood

    BY STATELINE | APRIL 18, 2019 AT 7:10 AM

    By Jenni Bergal

    It was about 6:30 on a Friday night in January when Phoenix Police Det. Kemp Layden pulled over a white Jeep Cherokee that was speeding and weaving in and out of its lane.

    The 47-year-old driver spoke slowly, his eyes were red and watery, and his pupils were dilated. The inside of the Jeep reeked of marijuana, and the driver failed a field sobriety test, which includes walking heel-to-toe and standing on one leg.

    He told the officer he had smoked marijuana a few hours earlier and taken a prescription sedative the night before, police say. The man passed a portable breath test — he wasn’t drunk. But Layden suspected he was impaired by drugs, which the test can’t detect.

    A DUI police van equipped with a special chair and table for blood testing pulled up. The man refused to submit to a blood draw. So Layden grabbed his laptop and filled out an electronic warrant, or e-warrant, which was transmitted directly to a judge.

    Within 10 minutes, Layden had a search warrant. Another officer drew the man’s blood. A lab report later confirmed he had active THC and a sedative in his blood.

    Police photographed and fingerprinted the driver and issued him a citation for DUI. It took 79 minutes from the time he was stopped until he was picked up by an Uber.

    Drugged driving is a growing concern as more states legalize marijuana and the opioid epidemic rages on. To fight it, more communities are training police officers to draw drivers’ blood at police stations or in vans, as in Arizona. And on-call judges are approving warrants electronically, often in a matter of minutes at any time of day or night.

    Together, the blood tests and e-warrants “could be a game-changer in law enforcement,” said Buffalo Grove, Illinois, Police Chief Steven Casstevens, the incoming president of the International Association of Chiefs of Police.

    While it’s easy for police to screen drivers for alcohol impairment using breath-testing devices to get a blood alcohol concentration level, there’s no such machine to screen for drug impairment.

    That’s why blood tests are so important, traffic safety experts say. And alcohol and drugs such as heroin and the psychoactive compound in marijuana are metabolized quickly in the body, so the more time that elapses, the lower the concentration.

    Having an officer draw the suspect’s blood soon after he is stopped gives a truer picture of his impairment because he doesn’t have to be taken to a health center for a blood draw after he is arrested, they say. Police departments also save money because they don’t need to pay phlebotomists and hospitals for blood draws.

    And having a system in which a judge can sign off quickly on an electronic warrant for a blood test streamlines the process.

    Whether or not a state has legalized marijuana for medical or recreational use, you can’t get behind the wheel while you’re impaired. Police make that determination based on your driving pattern, physical appearance, interaction with the officer and roadside sobriety tests. The blood test identifies which substances, if any, are causing that impairment.

    A 2016 U.S. Supreme Court ruling found that police don’t need a warrant if a driver suspected of impairment refuses to take a breath test, but they do for a blood test, which pierces the skin. But critics say blood draws outside of a traditional medical setting are unhygienic and that e-warrants could infringe on an individual’s rights.

    “There’s an absolute potential for a dilution of a citizen’s constitutional protections against unreasonable search and seizure when it’s done that way,” said Donald Ramsell, a Wheaton, Illinois, DUI attorney and Illinois Association of Criminal Defense Lawyers board member. “A judge can just wake up in his bedroom and hit ‘accept’ [on his device] and go back to sleep.”

     

    Deadly Crashes

    Impaired driving kills and injures thousands of Americans every year. Alcohol-related crashes claimed 10,874 lives in 2017, according to the National Highway Traffic Safety Administration.

    There isn’t comparable fatality data for drugged driving because reporting requirements differ from state to state and not all of them test fatally injured drivers for drugs. But a report from the Governors Highway Safety Association found that in 2016, about 44 percent of fatally injured drivers who were tested for drugs had positive results, up more than 50 percent compared with a decade earlier. The data does not specify how many were at fault.

    Police blood-draw programs and e-warrants speed up the investigative process.

    “It especially helps with drug-impaired driving by getting a blood sample as close to the time someone is operating the vehicle, versus two hours later,” said Jake Nelson, AAA’s traffic safety advocacy and research director.

    It’s not only quicker for a certified phlebotomist officer to take the blood, he said, but it also helps with the chain of custody because fewer people are handling the evidence.

    “That helps tie it up in a nice bow,” said Nelson, whose organization is advocating for more law enforcement phlebotomy and e-warrant programs. “It protects the suspect and it’s stronger in a court of law.”

     

    Drawing Blood

    Police who draw blood from suspected impaired drivers must be trained and certified before they can pull out a needle.

    At least nine states have law enforcement phlebotomy programs: Arizona, Indiana, Maine, Minnesota, Ohio, Pennsylvania, Rhode Island, Utah and Washington state, and Illinois is starting one, according to the national highway safety agency.

    Police phlebotomist training varies. In Arizona, for example, officers take 100 hours of training, during which they do 100 clinical blood draws. They also get eight hours of refresher training every two years.

    In Phoenix, where police use blood draws as the primary testing method, 49 officers and three police assistants are phlebotomists, according to Layden. They wear gloves when they draw blood, and work in a clean environment, following Occupational Safety and Health Administration standards and sanitizing the chair and table.

    But Ramsell, the Illinois DUI lawyer who also practices in Arizona, questions whether blood draws should be done outside of a medical facility, saying it’s “ripe for infection and disease.”

    And since officers aren’t in the healing profession, Ramsell said, they’re not concerned about pain reduction or hitting a vein. He cited the case of a client arrested in Arizona who had a blood draw in a police DUI van.  “The officer poked him at least 15 times, and because he has a medical condition it was next to impossible to draw enough blood to fill a 10-cc tube,” he said, referring to the size of the tube in cubic centimeters. “Those knuckleheads just kept poking the hell out of him. They only got 3 ccs.”

    Electronic Warrants

    Forty-five states have legislation, court rules or a combination that allow the issuance of warrants by telephone, video or electronic affidavits, according to a 2018 study by Responsibility.org, a Virginia-based nonprofit funded by distillers that aims to eliminate impaired driving. Twenty-one states and the District of Columbia specifically allow electronic transmission.

    But having a law or rule doesn’t mean court systems are using e-warrants for DUI cases. Nor does it mean they need one to do so.

    The study examined five states that use e-warrants — Arizona, Delaware, Minnesota, Texas and Utah. Delaware has neither a law nor a court rule specifying requirements for transmitting warrants.

    In Utah, where more than 400 officers are trained phlebotomists, police submitted 2,219 DUI blood draw e-warrants last year, according to Highway Patrol Sgt. Nick Street. He said the vast majority came back positive.

    According to Utah Highway Patrol Trooper Janet Miller, a certified phlebotomist, “It’s been a great tool not only for law enforcement but for the individual placed under arrest.

    “Instead of spending three to six hours with the officer, it’s been cut down to one to two,” she said. “They can get to the jail sooner and get out sooner.”

    But critics worry that the e-warrant process for DUI blood draws can end up being the electronic version of a rubber stamp.

    “It’s primarily a question of whether judges are actually reading the warrants with the degree of attention that one would expect,” DUI attorney Ramsell said.


  • 18 Apr 2019 7:38 AM | AIMHI Admin (Administrator)

    Money Magazine Source Article | Comments Courtesy of Matt Zavadsky

    This article is from October of 2018, but not sure how widely it was widely circulated… 

    This is essentially an economics 101 “chicken and the egg” discussion.  Wages are typically tied to the perceived value of the position (NFL Quarterback vs. EMT).  As a profession, if we articulate and demonstrate higher value, it’s likely we’ll be compensated differently, and could pay differently.

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    'The Pay Is Just Not Enough.' EMTs Are Working Multiple Jobs Just to Make Ends Meet

    And the complexities of the job are often misunderstood.

    KRISTEN BAHLER

    October 31st, 2018

    If the thought of being rushed to the hospital in a speeding ambulance gives you goosebumps, here’s something that will really make your skin crawl.

    Chances are, the person behind the wheel — and the one administering life-saving care in the back — are both tired, overworked, and underpaid.

    Paramedics and Emergency Medical Technicians (EMTs) make an average of $16.05 an hour, according to the Bureau of Labor Statistics. That’s about 40% less than the average employed American earns, and one of the worst-paying medical jobs out there. And thanks to grassroots organizing efforts like the “Fight For $15,” some service industry jobs nearly match that pay now.

    Wages vary by state and municipality, but in many parts of the country, the going rate for an EMT or paramedic job is well below the threshold needed to meet the cost of living. As a result, many have to work multiple gigs; often hopping off one ambulance, only to start another route immediately after.

    “These are the people assigned to the front lines, whether someone has a heart attack in their living room or there’s a terrorist attack,” says David Fifer, a paramedic and educator. “And they’re having to keep a lot of balls in the air.”

    Moonlighting to make ends meet is a burden facing much of the U.S. workforce — the plight of teachers, who sometimes work side jobs on nights and weekends to provide for their families, have dominated news cycles this year. But the challenges facing Emergency Medical Services (EMS)—the umbrella term for EMTs and paramedics—are rarely discussed outside of hospital break rooms. And the implications are dire.

    “You get what you pay for,” Fifer says. “If you’re only willing to fund EMS agencies to a level that results in a minimum wage, you’re unlikely to get the type of EMTs you would like to have.”

    Undervalued and Overworked

    One of the most stable jobs Amy Eisenhauer ever took as an EMT paid about $450 a week, after taxes.

    It wasn’t a lot — barely enough to cover her bills, groceries, and car payments. But it came with benefits, and a set schedule: Wake up, work a 14 hour shift, fall into bed, repeat.

    At previous EMT jobs, Eisenhauer had been hired on a per-diem basis, so she took whatever hours she could get, even if it meant working overnights, weekends, and back to back shifts. For awhile, she worked a part-time job at Starbucks, too. Eisenhauer drinks a lot of coffee, and if she picked up enough hours, she qualified for the chain’s health insurance plan.

    It’s never been an easy job: The EMT profession is threaded with hazards that range from injury to infectious disease to a host of mental health issues (the suicide rate of EMS personnel is 5 times greater than the general population, according to research from Eastern Kentucky University).

    For some, it’s a stepping stone to a more lucrative medical career; an entry-level job you can put on a med school resume. Others fall into the occupation, and end up making decades-long careers out of it.

    Eisenhauer, for her part, started on a volunteer squad in high school, and has worked in a variety of paid EMT jobs throughout New Jersey in the years since. Today, she’s an EMS consultant and educator, and picks up about 5 to 6 EMT shifts a month to keep her skills relevant.

    There’s a certain vigilantism baked into the profession — nobody becomes an EMT to make money. But while compassionate, community-minded employees flock to this field in droves, the turnover rate—about 20%—is higher than most industries.

    “You have to work two or more jobs to be able to live, and each comes with a multitude of regular workplace stressors,” Eisenhauer says. “[The pay] is just not enough.”

    Why There’s No Money (and Why That’s a Big Problem)

    The complexities of EMS roles are largely misunderstood, experts say.

    These are jobs that require employees to be clear-headed in high-stress environments, and have core competencies in everything from CPR to mental health training. But most people don’t have a clue as to what goes on in the back of an ambulance. And neither do regulators.

    “The average person thinks that, in an emergency situation, we come running, we take them to the hospital, and then something is done,” says Dennis Rowe, president of the National Association of Emergency Medical Technicians (NAEMT). “We’re not defined as an ‘essential service.’”

    You can look to your local government’s budget to see how this plays out in the policy world — EMS departments usually get a fraction of the funds earmarked for police and fire squads. New York City, which employs more than 3,000 EMTs and paramedics, and has allotted $321.1 million to its EMS department for the coming year. “Fire Extinguishment/Emergency Response,” gets four times that amount. Smaller cities, like Austin and Seattle, also tend to allocate at least twice as much to their fire departments as they do to EMS.

    Insurance is another pain pointMedicaid and Medicare cap reimbursement rates for ambulance rides; in many cases, experts say, it’s lower than the actual cost of service. Patients sometimes stiff the bill, too. In cities like North Lauderdale, Florida, unpaid ambulance bills have cost taxpayers millions in debt. And since ambulance services, like the rest of the healthcare industry, operate like a business, salaries suffer when bills go unpaid.

    There are other reasons EMS pay is so low.

    Certification is minimal — it only takes 120 to 150 hours of training to become an EMT (paramedics require significantly more). Ambulances in rural communities are often staffed by volunteers, which depresses wages for those who do pursue the role as a career. And there’s little opportunity for advancement.

    “In a police department, you can be a patrol officer, and be promoted to a shift supervisor, and then captain, and then division chief, and then assistant chief, and then, chief,” says Greg Friese, an industry veteran and editor of EMS1.com. “EMS agencies don’t have that promotion pathway. You’re either an EMT or you’re running the agency, with very little in between.”

    ‘A Pillar of Public Safety’

    The world is changing in ways that impact every facet of healthcare. Our population is aging — the number of Americans ages 65 and older is expected to more than double by 2060. And the opioid crisis, now responsible for more than 40,000 overdoses a year — is complicating patient care even further.

    EMS workers, often the first line of defense in keeping these populations alive, will be even more important in the coming years. But unlike most medical professionsincluding those that don’t require a college degree, like medical health technicians and Licensed Practical Nurses (LPNs), EMS pay remains stagnant.

    Advocates have floated several solutions, though most require insurance reform, a redistribution of taxpayer money, and a level of advocacy that is unlikely to catch hold anytime soon.

    Looking towards academia, one solution is gaining steam.

    As of now, communities have an uneasy (and unbalanced) relationship with the EMS departments that serve them. The low barrier to entry makes it difficult to value those professions the same way we do nurses, firefighters, and police officers. More extensive schooling, and degree programs for advancement, could change that. And it would probably drive up wages, too.

    Already, schools like the University of South Alabama and George Washington University in D.C. have added bachelor’s degrees in EMS studies to their rosters.

    So has Eastern Kentucky University, where David Fifer teaches.

    Fifer says he hopes this becomes a national trend — and soon.

    “These are individuals tasked with administering critical healthcare across the nation,” he says. “They’re a pillar of public safety, and they’re not making livable wages.”


  • 17 Apr 2019 11:40 AM | AIMHI Admin (Administrator)

    Many thanks to JEMS magazine for publishing "Caring for the Caregiver: I'm Not OK and That's OK" in today's newsletter. This vitally important piece was written by AIMHI President-Elect Kevin Smith of Niagara EMS, Treasurer Dean C. Dow of REMSA, Medstar's Desiree Partain, and Niagara's Mayram Traub. You will not want to miss it, or the related on-demand webinar.

    Read the piece in JEMS>

  • 17 Apr 2019 7:49 AM | AIMHI Admin (Administrator)

    DCEO Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    Interesting…

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    The Potential Impact of Blue Cross Blue Shield’s Medical Centers

    04/16/2019by Will Maddox

    https://healthcare.dmagazine.com/2019/04/16/the-potential-impact-of-blue-cross-blue-shields-medical-centers/ 

    Last week, Blue Cross Blue Shield of Texas announced its entry into the provider space with 10 clinics opening near Dallas and Houston next year. The clinics will include primary care, urgent care, lab and diagnostic imaging services, care coordination, and wellness and disease management programs, and were framed as part of the insurer’s desire to advance value-based care in the medical space – but other providers see the clinics as direct competition.

    Value-based care is growing in popularity as the industry transitions away from fee-for service, where providers are paid based on the number of procedures or tests that are performed. By focusing on value, providers are held accountable for the outcomes of their practice, which should lead to lower overall healthcare costs and reduce unnecessary medical care.

    BCBSTX will be partnering with Sanitas USA, a branch of the Spain-based provider that has several clinics in Florida, New Jersey, and Connecticut. The clinics will be in Irving, Las Colinas, Mesquite, and Richardson in Dallas County, and be exclusively for BCBSTX plan holders. “Our partnership with Sanitas is another example of collaborating with health care providers to deliver the best possible care and support to our members,” said Dan McCoy, M.D., president of BCBSTX via release. “We believe that this partnership will advance primary care services and is an effective approach to providing quality health care outcomes, improving member engagement and experience, and lowering costs for our members, including populations that may have difficulty accessing care.”

    The healthcare industry is seeing segments expand into new territory in an attempt to consolidate marketshare and mitigate risk. BCBSTX is far from the first insurer to enter the provider marketplace. Optum, one of the largest physician groups in the country, is owned by UnitedHealthcare. Pharmacy behemoth CVS has opened clinics in their locations, and physicians are lobbying for a bill in the Texas legislature to be able to distribute common medications in their clinic.

    Employers have their own clinics and health systems have their own health plans.

    But some area primary care providers in BCBSTX’s network don’t necessarily see the new clinics as something to be celebrated. Chris Crow is President of Catalyst Health Network, which is made up of independent primary care physicians who focus on value-based care. He says the new clinics are competing directly with physicians, and an intrusion into the provider space. “It’s a stay in your lane moment,” he says.

    Crow is concerned that clinics that are owned by BCBSTX will receive better treatment than other offices. “The insurance company is choosing to directly compete with you, even though you contract with them to be in network. It might benefit those guys differently,” Crow says.

    BCBSTX Chief Medical Officer Dr. Paul Hain, says locations for the clinics were chosen based on their analysis of areas where their members were having trouble accessing primary care and aren’t meant as competition. “We looked at where we are hearing about our members getting access in a timely manner. The reality is that we are always short of primary care doctors in Texas,” he says. “This is not an attempt to compete; it was an addition that was carefully thought out.”

    The impending shortage of primary care doctors has been well documented, though the greatest shortages have been in rural and small town communities. When I searched primary care physicians through the BCBSTX Find a Doctor site, 40 family practice, internal medicine, and pediatric physicians were found in ZIP code 75038, which surrounds North Lake College in Las Colinas, one of the areas for a future Sanitas/BCBSTX clinic.

    Crow wonders why BCBSTX didn’t decide to partner with a local primary care provider rather than an international company. “You would have wish they would have partnered with someone local,” he says. “None of them (local providers) received calls or were notified until two weeks before the announcement.”

    Hain says that Sanitas was chosen because of their experience with value-based care in other states. While many local providers have some level of value-based care, Hain says they wanted to “move fast as possible to full value-based arrangement, with upside and downside risk on patients.” Sanitas was ready to deliver with that model, where they would be held accountable if they didn’t meet certain quality and cost standards.

    While the Sanitas clinics will provide primary care for patients, they will only be available for BCBSTX patients. Because most families get their insurance through their employer, a job change that results in a new insurance company will mean those patients won’t be able to keep their Sanitas primary care doctor.

    “Life expectancy goes up if you have a primary care physician,” Crow says. “If the continuity of care is important, insurance or employer clinics based on where people work can be very disruptive to the relationship that is really important in your life.” Crow says they could have worked with local providers who were already providing care. “Wouldn’t that be a good place to start rather than opening up your own?”

  • 15 Apr 2019 8:49 AM | AIMHI Admin (Administrator)

    MassLive Source Article | Comments Courtesy of Matt Zavadsky

    Nice comments from Scott Cluett – his new role at the state is similar to other state EMS offices, such as Georgia, who are implementing MIH specialists in their departments.

    Tip of the hat to Kolby Miller of Medstar Ambulance (Michigan) for forwarding this article.

    Massachusetts ambulance services urged to launch preventive health programs that could reduce ER trips

    4/12/19

    By James F. Lowe

    https://www.masslive.com/news/2019/04/massachusetts-ambulance-services-urged-to-launch-preventive-health-programs-that-could-reduce-er-trips.html

    NORTHAMPTON — The state is urging local ambulance services to branch out into preventive health programs that could reduce trips to hospital emergency rooms.

    That includes assessing fall risks in seniors’ homes, ensuring safe disposing of syringes used by diabetics and heroin users, performing mass vaccinations and more.

    “There are some great opportunities for EMS companies to start doing some point-of-care testing,” said Scott Cluett, manager of the state’s Mobile Integrated Health program. For instance, EMTs could screen patients for asthma, or make referrals to a primary care physician.

    The Community EMS program is meant to get ambulance services working collaboratively with local public health officials and related organizations. Since the state started taking applications in October, six EMS providers in the eastern part of the state have already been approved to launch programs, including in Boston, Fall River and Brockton. Cluett hopes there will be 40 to 50 such programs proposed across the state by July.

    Cluett was the featured speaker Thursday at the annual meeting of Western Massachusetts Emergency Medical Services, a nonprofit support organization for fire departments and private ambulance companies in the four western counties.

    “Community EMS, especially for our smaller, more rural towns, it’s a perfect fit,” said Deborah Clapp, WMEMS executive director. “EMS are trusted providers. They’re already in people’s homes.”

    One benefit of Community EMS programs could be aiding public health nurses, who have limited time and resources. Community EMS could also bring health services to people without transportation or limited mobility.

    Clapp said her organization is working with two consultants to assess needs in Western Massachusetts and develop programs in areas like fall prevention and opioid education.

    Many first responders already carry nalaxone, a drug that can reverse the effects of opioid overdoses. Mark Miller, director of the state Office of Emergency Medical Services, said changes in federal regulations could allow first responders to supply nalaxone to family members of opioid users to safeguard against future overdoses.

    Community EMS program proposals must be reviewed and approved by the state, and must be recertified every two years, Cluett said. High-value categories the state hopes EMS providers will address include opioid abuse, housing stability, mental health and disease control.

    Cluett said Community EMS programs will benefit public health and save money for the health care system as a whole.

    As things stand today, ambulance services are reimbursed by Medicare only when they transport patients to an emergency room. But Cluett said the federal Centers for Medicare & Medicaid Services is rolling out a new model that would reimburse EMS providers for treatment in the field and transportation to alternative destinations like urgent care centers — something he called a “game changer.”

    Thursday’s WMEMS meeting and luncheon was attended by about 75 people and included an award ceremony recognizing 12 people who helped save the life of Linwood Clark of Haydenville, who stopped breathing Jan. 31.

    They were: Daryl Springman, Jason Connell and Alex Kassell of the Williamsburg Fire Department, Robert Reinke and Mitchell Cichy of the Williamsburg Fire Department, Drew Morse, Kim Dresser, Maryellen McQueston and Keith Cotnoir of Highland Ambulance, first responder Tim McQueston and dispatcher Wendy Pariseau of Northampton Control.

    Clark’s wife, Karthyn Warner, was also credited for dialing 911.

    “Her calling was what saved his life,” said Highland Director Michael Rock.



  • 8 Apr 2019 6:01 PM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    This may me an area where an EMS-Based MIH program that assists with a ‘safe landing/safe transition’ program might demonstrate value. 

    BCBS of New Mexico, and other similar programs that deploy community paramedics to check in on recently discharged patients, have shown promise.

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

    CMMI seeks feedback on pay bundles for post-acute care

    SUSANNAH LUTHI  

    April 8, 2019

    https://www.modernhealthcare.com/payment/cmmi-seeks-feedback-pay-bundles-post-acute-care 

    The top deputy for the Center for Medicare and Medicaid Innovation told hospital leaders on Monday he is eying a bundled payment model for post-acute care.

    Innovation Center Director Adam Boehler told the audience at the American Hospital Association's annual meeting that he's seeing a flood of interest from industry, and he called for ideas on how a new approach could save money while improving care.

    "We've heard a lot of comment there, and I think we are interested in the concept of acute-care bundles," Boehler said. "Now is the time to raise ideas there."

    After the speech, the CMMI director declined to give a timeline for a prospective model other than there's nothing coming imminently. For now the the agency is in "listen mode," he added.

    "Post-acute care is an area where we can improve quality and save money," he said. "From that perspective we like it. The devil's in the details on how to set up the models correctly."

    This expensive segment of the healthcare industry has been drawing investment both from private equity firms and big hospital systems as they buy up nursing homes.

    Hospitals are increasingly reluctant to release patients to skilled-nursing facilities if they can send them home, citing quality reporting issues. This is supported by an October report from Welltower that said the post-acute provider world will shrink in the face of changing regulations and a shift to new payment systems.

    And, as evidenced by ProMedica's $1.4 billion acquisition of the bankrupt nursing home operator HCR ManorCare last year, health systems have the infrastructure and financial position to invest in a population poised to grow as baby boomers age. The number of 80- to 85-year-olds is slated to grow at about 5% per year over the next decade, and to more than double within the next 20 years.

    On the rural healthcare front, Boehler is also mulling new payment ideas as momentum continues to try to avert more hospital closures. In Monday's speech he echoed last year's discussions on Capitol Hill about global payment models as a way to give those hospitals time and space to figure out how they can reconfigure their operations.

    "We're thinking about the opportunity to say, 'Hey, let's give people the cover of night for a little bit, let's kind of freeze things for a while,' " Boehler said.

    He gave the example of a hospital reducing its number of inpatient beds while expanding its ambulatory clinics and telemedicine offerings, as well as incorporating more behavioral health into its treatment.



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