News & Updates

  • 16 Feb 2022 4:13 PM | AIMHI Admin (Administrator)

    Telehealth in Transit: How Cleveland Clinic Achieves ED Avoidance & Reduced Readmissions through its ET3 Model and Other Virtual Care Programs

    Thursday, February 24th, 2022 | 12:00 PM - 1:00 PM CT

    Receiving quality care from an emergency medicine physician following a 9-1-1 call is critical, but how can you bring the expertise of the physician directly to the patient without transport to the ED to reduce delays in care and unnecessary admissions? From initial emergency dispatch and treatment in place to in-transit care, telehealth has a place in the EMS care. At least that’s what Cleveland Clinic found with its ET3 Model.

    In the webinar, Dr. Bryan Graham, Medical Director of the Virtual Emergency Medicine Program at Cleveland Clinic, and Chris O’Rourke, Institute Administrator for the Emergency Services Institute at Cleveland Clinic, will discuss how the health system has scaled and grown its ET3 Model to divert unnecessary emergency department admissions and reduce readmission, all while replicating emergency care in the field.

    Register for the webinar to learn how Cleveland Clinic

    • Avoided ED transports for 70% of ET3 patients by virtually triaging them in the field
    • Secured EMS buy-in for the ET3 Model workflow
    • Partnered with a major wireless network operator to improve connectivity in the field
    • Staffed its ET3 program with dedicated emergency medicine physicians
    • Replicated the ET3 Model to reduce transports in other settings like nursing homes

    REGISTER NOW►

  • 14 Feb 2022 7:49 AM | Matt Zavadsky (Administrator)

    In an outstanding demonstration of collaboration and focus on provider, patient, and community safety, 14 national and international associations have partnered on the release of a Joint Statement on Lights & Siren Vehicle Operations on Emergency Medical Services (EMS) Responses.

    This level of agreement on any topic in EMS delivery is exceptionally rare, and we are grateful to the leaders of these associations for coming together to recognize the importance of balancing provider, patient, and community safety, with patient outcomes and community expectations!

    The link to the full statement is below, and the key provisions of the statement are here.  

    The sponsoring organizations of this statement believe that the following principles should guide L&S use during emergency vehicle response to medical calls and initiatives to safely decrease the use of L&S when appropriate:

    • The primary mission of the EMS system is to provide out-of-hospital health care, saving lives and improving patient outcomes, when possible, while promoting safety and health in communities. In selected time-sensitive medical conditions, the difference in response time with L&S may improve the patient’s outcome.
    • EMS vehicle operations using L&S pose a significant risk to both EMS practitioners and the public. Therefore, during response to emergencies or transport of patients by EMS, L&S should only be used for situations where the time saved by L&S operations is anticipated to be clinically important to a patient’s outcome. They should not be used when returning to station or posting on stand-by assignments.
    • Communication centers should use EMD programs developed, maintained, and approved by national standard-setting organizations with structured call triage and call categorization to identify subsets of calls based upon response resources needed and medical urgency of the call. Active physician medical oversight is critical in developing response configurations and modes for these EMD protocols. These programs should be closely monitored by a formal quality assurance (QA) program for accurate use and response outcomes, with such QA programs being in collaboration with the EMS agency physician medical director.
    • Responding emergency agencies should use response based EMD categories and other local policies to further identify and operationalize the situations where L&S response or transport are clinically justified. Response agencies should use these dispatch categories to prioritize expected L&S response modes. The EMS agency physician medical director and QA programs must be engaged in developing these agency operational policies/guidelines.
    • Emergency response agency leaderships, including physician medical oversight and QA personnel should monitor the rates of use, appropriateness, EMD protocol compliance, and medical outcomes related to L&S use during response and patient transport.
    • Emergency response assignments based upon approved protocols should be developed at the local/department/agency level. A thorough community risk assessment, including risk reduction analysis, should be conducted, and used in conjunction with local physician medical oversight to develop and establish safe response policies.
    • All emergency vehicle operators should successfully complete a robust initial emergency vehicle driver training program, and all operators should have required regular continuing education on emergency vehicle driving and appropriate L&S use.
    • Municipal government leaders should be aware of the increased risk of crashes associated with L&S response to the public, emergency responders, and patients. Service agreements with emergency medical response agencies can mitigate this risk by using tiered response time expectations based upon EMD categorization of calls. Quality care metrics, rather than time metrics, should drive these contract agreements.
    • Emergency vehicle crashes and near misses should trigger clinical and operational QA reviews. States and provinces should monitor and report on emergency medical vehicle crashes for better understanding of the use and risks of these warning devices.
    • EMS and fire agency leaders should work to understand public perceptions and expectations regarding L&S use. These leaders should work toward improving public education about the risks of L&S use to create safer expectations of the public and government officials.




    Joint Statement on Red Light and Siren Operations with Logos - FINAL.pdf

  • 4 Feb 2022 9:38 AM | AIMHI Admin (Administrator)

    MedPage Source Article | Comments Courtesy of Matt Zavadsky

    Many patients who call 911 don’t need ambulance transport to an ER.  But, if that is the only way EMS providers are reimbursed for an emergency response, you generally get what you pay for…

    One of the ways we can help preserve Medicare is to transform the reimbursement model for EMS away from the model that only pays if we use the highest cost mode of transportation (an ambulance), to the highest cost setting for care (an ER). 

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

    Senators Mull Ways to Cut Costs in Medicare

    — "The Medicare system is hemorrhaging money on scams and fraud," says Sen. Warren

    by Joyce Frieden, Washington Editor

    February 3, 2022 

    WASHINGTON -- The Medicare program could easily become solvent if regulators cracked down harder on fraudsters and profiteers, Sen. Elizabeth Warren (D-Mass.), chair of the Senate Finance Subcommittee on Fiscal Responsibility and Economic Growth, said Wednesday.

     

    "The Medicare system is hemorrhaging money on scams and fraud," Warren said at a hearing on Medicare financing. "It is critical that we stop the flow and if we do, the system will have more than enough money to operate at its current level and increase coverage."

     

    Concerns About Drug Prices

    Pharmaceutical companies were one target of Warren's ire. "In 2019, total Medicare spending on prescription drugs was $220 billion," she said. "Because Medicare cannot negotiate prices, drug companies are able to rake in billions in profits. Now that's bad enough, but the drug companies have more ways to juice their profits: they use anti-competitive tactics like 'pay for delay,' product hopping, and patent thickening, all while anti-trust regulators turn a blind eye. It's enough to gag a maggot."

     

    She also pointed to the private insurers who participate in Medicare Advantage. "Medicare Advantage was ... built on vague promises of cost savings, but instead, it has cost Medicare almost $150 billion extra over the past 12 years," Warren said. "Because greedy private insurers are gaining the program's rules, including its risk adjustment process, its benchmark policy, and its quality bonus program, all to squeeze more money out of Medicare and to drive up the costs for taxpayers."

     

    Making changes to both those programs could save more than $900 billion over 10 years, while the estimated shortfall in Medicare's hospital insurance trust fund is $517 billion between 2026 and 2031, and the cost of extending Medicare coverage to include dental, vision, and hearing benefits is just under $360 billion. "In other words, we don't need to cut Medicare benefits. We need to cut out the scams that are bringing Medicare down," she said.

     

    Arguments Against Expanding Medicare Benefits

    Sen. Bill Cassidy, MD (R-La.), the subcommittee's ranking member, had different ideas. Expanding Medicare benefits "doesn't make sense to me," he said. "We have an obligation to the people currently being covered, and yet we will expand the benefit and maybe have insolvency come even quicker." Cassidy noted that if Medicare were to become insolvent, "under current law, it would be an immediate cut to providers of roughly 20% to 30%," something that providers would not be able to afford, leading to less provider access for beneficiaries.

     

    Although some people have suggested doing away with beneficiary cost-sharing, "there's a lot of data showing that one thing that puts the brakes on it is if you have just a little bit of cost-sharing, Cassidy said. "Not too much so the diabetic does not get her needed care, but at least a little bit so people think twice."

     

    "It's time to take a modern approach to the way we deliver healthcare," using an approach "that rewards providers for keeping patients out of hospital beds and one that recognizes the patient, and the doctor, and that relationship as the ultimate arbiter of value, health, and well-being," he continued. "We can get there without disrupting the quality and access our constituents need, but the discussion has to begin today."

     

    Hearing witness James Capretta, senior fellow at the American Enterprise Institute, a right-leaning think tank here, suggested five ways to modernize the program: putting the Medicare benefit together into one understandable, coordinated benefit with rational cost-sharing; making the choices between various Medicare plans more understandable for patients; strengthening premium competition among the available options; improving price competition among providers; and consolidating the various Medicare trust funds, so the financing of the entire program would be more clear.

     

    Amy Kapczynski, JD, faculty co-director of the Law and Political Economy Project at Yale Law School in New Haven, Connecticut, noted that current drug pricing doesn't accurately reflect companies' research and development costs. She had several suggestions for improving Medicare drug coverage. In addition to allowing Medicare to negotiate drug prices, "we should also have legislation that penalizes price spikes to prevent price gouging on existing drugs," she said. "We should explore legislation to curb anti-competitive patent-thickening, and [legislation] that would strengthen rules against 'pay for delay' settlement deals. And we should also critically provide the [Federal Trade Commission] with more resources and authority to address anti-competitive conduct in the sector."

     

    Direct Contracting in the Spotlight

    A Medicare demonstration program known as Direct Contracting came under some criticism at the hearing. Under the program, accountable care organizations (ACOs), insurance companies, and health systems, would agree to provide care for a certain number of traditional Medicare beneficiaries in a geographic area for a set amount of money.

     

    "CMS has invited the same insurers that are already scamming Medicare and dozens of new investor-owned organizations to cover traditional Medicare beneficiaries through a new privatized Direct Contracting model that lets them pocket -- get this -- as much as 40% in profits," Warren said. "This invites fiscal disaster, and I hope this administration will reverse this decision."

     

    Susan Rogers, MD, president of Physicians for a National Health Program, a lobbying group for single-payer healthcare that has protested against Direct Contracting, agreed. "We cannot let Medicare become a playground for Wall Street investors," Rogers said. "We need to get back to what we know works, and that's traditional Medicare."

     

    On the other hand, Katherine Baicker, PhD, professor of public policy at the University of Chicago, spoke in favor of more use of alternative payment models in Medicare, including ACOs. "Right now, Medicare's fee-for-service traditional structure gets the prices wrong, despite all best efforts," she said. "It's very difficult to write down prices that align with value on a line-by-line basis. And we see overuse of some services at the same time that we see underuse of other services. And that's not the best way to ensure we get the most health for beneficiaries for every dollar that we spend."

     

    Instead, "reforms that align payments to providers with the value of healthcare that the service provides could help our dollars go further in promoting health and well-being for beneficiaries," Baicker said. "That would include some alternative payment models, each of which has challenges but has potential. We've seen experiments in the Medicare program with alternative payment models like bundled payments or capitated payments or ACOs ... Some of the experiments in bundled payments, particularly those looking at joint replacement, have seen reduction in costs while maintaining the quality of outcome for beneficiaries."



  • 21 Jan 2022 10:56 AM | Matt Zavadsky (Administrator)

    A good reminder that all types of EMS services are important.  If we do not figure out ways to maintain good relationships and service delivery, it could spawn larger issues.


    EMS, hospital association at odds over hospital transport delays

    By: Christiana Ford

    Jan 19, 2022

    https://www.lex18.com/news/ems-hospital-association-at-odds-over-hospital-transport-delays

    FRANKLIN COUNTY, Ky. (LEX 18) — A bill introduced in the state legislature has EMS workers across Kentucky speaking out.

    House bill 296 calls for major changes including a maximum response time of 60 minutes for hospital patient transfers and a transfer of regulatory power.

    The bill calls for regulation to be returned from the Kentucky Board of Emergency Medical Services (KBEMS) to the office of the Inspector General.

    It would also create an advisory committee to study the response times of ambulances and other medical transportation.

    Dr. Walt Lubbers, EMS provider and state medical advisor, says the emergency medical services community is outraged about the proposed changes.

    "It's gonna make things worse. It's going to move medical direction from physicians and put it in the hands of a government bureaucrat. It's gonna put a lot of impositions on the EMS worker who's already got a pretty tough job to start off with," said Lubbers.

    Lubbers says they're also concerned about how many trained EMS professionals would be on the committee.

    On the other hand, the Kentucky Hospital Association says it would be a welcomed change.

    President Nancy Galvagni says the average wait time for a patient transport is 7-8 hours.

    "We're talking about heart attack, stroke victims that need to get to a tertiary Medical Center because they need maybe immediate intervention. We're talking sometimes gunshot victims. These are patients that need to be transported in a timely manner," said Galvangi.

    She believes the proposed changes would speed up the wait and says opposition to the bill goes against their mission to put patients first.

    "No one's expecting that every time we call and saying type of patient that that means to go to Lexington for example, from a rural area. We understand that ambulances can't always do that. But today under the current structure, a hospital is not allowed to call another ambulance provider unless the local ambulance provider gives them the permission," said Galvangi.

    Lubbers argued the opposite and said wait times for people outside of the hospital would only increase.

    "The irony is that this bill doesn't actually change any of that. There's nothing in it that addresses how you would get more ambulances or how you would transfer people more," Lubbers said.

    He also believes it will make the lives of EMS workers more difficult.

    "It's going to make it harder for them to do their job and to care for patients in a way that you need to," said Lubbers.

    Republican Representative Ken Flemming is sponsoring the bill.

    He says nothing is set in stone yet and the bill was introduced to start the conversation.

    Flemming says a meeting is set for Friday to talk to both stakeholders about how to solve patient transport issues.

    On behalf of Kentucky Board of Emergency Medical Services Executive Director Michael Poynter:

    “The Kentucky Board of Emergency Medical Services has concerns that a passage of House Bill 296 as it is will set Kentucky EMS back decades. We have made, and continue to make, huge improvements to EMS. We realize there’s still progress to be made, but for us to keep moving forward we must all be willing to work together. We want and are ready to do just that. It’s important to collaborate and make sure a variety of EMS experts and stakeholder voices are heard so we can continue to figure out EMS solutions together, not create more challenges”


  • 11 Jan 2022 2:14 PM | AIMHI Admin (Administrator)

    Becker's Source | Comments Courtesy of Matt Zavadsky

    Interesting news, especially as we get ready to start work on this issue for ground ambulance services.

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

    Medical organizations continue to fight surprise-billing dispute process: 5 details

    Alia Paavola – 1/11/2022

    A coalition of medical organizations, including the Physicians Advocacy Institute and 16 state medical associations, filed an amicus brief supporting a legal challenge to the No Surprises Act dispute resolution process, according to a news release emailed to Becker's.

    Five things to know:

    1. The groups are supporting a lawsuit filed by the American Hospital Association and American Medical Association. The lawsuit challenges the dispute resolution process outlined in CMS' surprise-billing rule released Sept. 30. 
    2. The lawsuit alleges that the independent dispute resolution process, which requires arbiters to first consider the health plan's median in-network rate as the appropriate reimbursement amount, unfairly favors health plans.
    3. Specifically, the medical organizations that filed the brief Jan. 4 argue that federal regulators ignored congressional intent of the No Surprises Act by relying almost exclusively on the median in-network billing rate to resolve billing disputes instead of considering a multitude of factors.
    4. "Physicians have an obligation to reinforce for the court just how far federal regulators walked away from the No Surprises Act's balanced approach to resolving payment disputes and explain how bypassing the law will unfairly empower insurers at the expense of patients and their physicians," said Dustin Corcoran, president of Physicians Advocacy Institute and CEO of the California Medical Association, both of which joined the amicus brief. "If the court allows this damaging example of regulatory overreach to stand, patients and physicians will pay the price."
    5. There are 26 physician organizations that joined the amicus brief. Read the full list of organizations here

     


  • 3 Jan 2022 9:40 AM | AIMHI Admin (Administrator)

    NBC Source | Comments Courtesy of Matt Zavadsky

    A growing issue facing EMS agencies across the country, regardless of provider type.

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

    Local Fire Departments Make Emergency Changes in the Face of Staffing Shortages

    “It's about 10% of the career staff and a smaller percentage of the volunteer personnel [out sick], but it's a large impact to our ability to respond to your calls and help our citizens," one fire chief said.

    By Jackie Bensen, News4 Reporter • Published on December 30, 2021


    https://www.nbcwashington.com/news/coronavirus/local-impact/local-fire-departments-make-emergency-changes-in-the-face-of-staffing-shortages/2922502/

     

    Many fire departments in the D.C. area are making emergency changes to keep serving the public as they continue to lose staff to COVID-19.

     

    Chief Scott Goldstein, of Montgomery County Fire & Rescue, spoke Wednesday night about the challenges within his department that led him to make changes in the last 24 hours.

     

    “It's about 10% of the career staff and a smaller percentage of the volunteer personnel [out sick], but it's a large impact to our ability to respond to your calls and help our citizens," he said. “We’ve had some previously trained folks that joined our department, that had graduated our academy, that were still in their last couple days of orientation that were turned over and they became minimum staffing as well today."

     

    Some of the measures are connected to a steady increase in hospitalizations, including 2,000 patients - a record number - hospitalized for COVID-19 statewide.

     

    “Unlike previous spikes, we are depleted in terms of staff available to care for everyone,” Bob Atlas, the president and CEO of the Maryland Hospitals Association, said.

     

    The figures have led to calls for Gov. Larry Hogan to reinstate a limited public health emergency declaration. In a statement, Hogan said hospital capacity levels are being watched closely, with alternate care sites ready if necessary. The state is also committing $100 million to address urgent staffing needs.

     

    Montgomery County is not alone in this situation. Measures like Goldstein's are in effect at nearly every fire department statewide.

     

    The story’s much the same in Fairfax County. At last count, 66 fire department employees are on sick leave. Another dozen are in quarantine.

     

    The agency has resorted to cross staffing among some specialized units to allow them to remain in service. Four units that have sufficient back-up are being temporarily placed out of service.

     

    Back in Montgomery County, Goldstein had a message for residents.

     

    “We are here to help, we are absolutely available to assist in your emergency, but only call 911 for medical emergencies, medical situations that require immediate attention," he said.

     

    For other situations, people are advised to call their doctors or visit urgent care centers.


  • 9 Dec 2021 5:55 PM | Matt Zavadsky (Administrator)

    This is pretty good news, especially for us EMS agencies partnering with telehealth!

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

    Key lawmakers seek to make telehealth flexibilities permanent

    JESSIE HELLMANN

    December 09, 2021

    https://www.modernhealthcare.com/politics-policy/key-lawmakers-seek-make-telehealth-flexibilities-permanent

    A powerful House chairman introduced a bill Thursday that would permanently remove restrictions on where Medicare patients can access telehealth services but would make other telehealth coverage policies only temporary.

    The bill, sponsored by Ways and Means Committee Chairman Lloyd Doggett (D-Texas), would permanently lift a restriction that says patients must live in rural areas and receive telehealth services at participating health facilities for it to be covered by Medicare. Rep. Devin Nunes (Calif.), the senior Republican on the panel's health subcommittee, is a cosponsor.

    The government has temporarily waived those restrictions during the pandemic, allowing Medicare patients from all over the country to receive telehealth services in their homes in every part of the country. Without congressional intervention, that benefit will end when the COVID-19 public health emergency declaration does.

    Lawmakers from both parties and advocates have pushed Congress to permanently eliminate the coverage restrictions before then, calling it an outdated barrier to care.

    "Expanded access to telehealth, permitted by emergency waivers, has transformed healthcare delivery—helping patients connect easily and safely with their physicians in a timely manner," Doggett said in a news release. "As the pandemic enters an unpredictable new stage and emergency waivers may expire, patients and providers should not face a cliff of uncertainty."

    Download Modern Healthcare’s app to stay informed when industry news breaks.

    The public health emergency is set to end in mid-January, but it will likely be extended for at least another 90 days as COVID-19 continues to pummel the U.S.

    Congressional staffers and lobbyists expect Congress to act before the end of the emergency so Medicare enrollees don't lose access to telehealth services to which they have become accustomed since last year.

    Expanded access to telehealth hasn't been a top priority for lawmakers this year even as Congress advances other healthcare legislation along with President Joe Biden's domestic agenda. Lower-priority items frequently aren't addressed until the last minute, so Doggett's telehealth measure likely will have to wait until next year, perhaps as soon as February when Congress tackles its annual spending bills.

    "I would be surprised if the [public health emergency] were to end and nothing has happened" on telehealth, said Christina McCauley, legislative director for Rep. Doris Matsui (D-Calif.), who has worked on several telehealth bills.

    Eliminating the geographic and site restrictions is not expected to be controversial. Another bill that would do so has 61 sponsors in the Senate—enough to evade a filibuster and pass. The list of sponsors includes two of the top three GOP leaders in the upper chamber, Sens. John Thune (S.D.) and John Barrasso (Wyo.), who is a medical doctor.

    Lawmakers have introduced dozens of bills in the past few years to expand telehealth access, illustrating the broad support for action on the issue. But these measures differ on whether other telehealth services should be covered permanently or just for a few years while data is collected.

    The Doggett bill would temporarily extend other emergency authorities for two years after the public health emergency, allowing Medicare coverage of a wider range of providers via telehealth, including occupational therapists and speech-language pathologists.

    The legislation would also temporarily allow Critical Access Hospitals to continue providing outpatient behavioral therapy services through telehealth and allow payment for audio-only services for two years after the public health emergency.

    Some lawmakers and advocates want these changes to be made permanent immediately, but the Medicare Payment Advisory Commission has recommended temporary extensions of so policymakers can evaluate telehealth utilization and efficacy.

    Telehealth utilization in Medicare increased massively during the pandemic, from 840,000 visits in 2019 to 53 million in 2020, according to data the Health and Human Services Department released last week. About 92% of those patients received services at home, which was not covered before the pandemic. About one-third of the visits were for behavioral health.

    The legislation would also put restrictions on some telehealth services to crack down on potential fraud, including requiring in-person appointments within six months prior to ordering high-cost durable medical equipment or major clinical laboratory tests. Lawmakers pointed to charges the Justice Department brought against telehealth executives and doctors in 2019 for ordering unnecessarily back, shoulder and knee braces as well as cancer genetic tests.


  • 9 Dec 2021 5:53 PM | Matt Zavadsky (Administrator)

    This is not encouraging news for EMS providers. Imagine the impact on revenue from a 6% cut to Medicare payments…

    The American Ambulance Association is leading an effort to assure Congress acts to prevent these looming payment cuts automatically kicking in next month.

    How can you help?  Use the AAA’s link below to send an e-mail to your members of Congress, urging them to act!

    Click the link below to log in and send your message – it takes literally < 2 minutes, but would have a significant impact!

    https://www.votervoice.net/BroadcastLinks/GSn2KGU-5FBoFQjPKqXpIg

    ------------------- 

    Federal spending deal leaves looming Medicare cuts in place

    December 02, 2021

    JESSIE HELLMANN

    https://www.modernhealthcare.com/politics-policy/federal-spending-deal-leaves-looming-medicare-cuts-place

    Congressional leaders have struck a deal to avert a government shutdown, but they didn't include a major priority for healthcare providers: preventing significant Medicare reimbursement cuts that are slated to take effect next month.

    Medicare providers stand to lose about $36 billion in reimbursements stemming from a 4% cut set to take effect in January, according to the nonpartisan Congressional Budget Office.

    The continuing resolution lawmakers will consider also does not address the 2% Medicare cuts dictated by the 2011 budget sequestration law that Congress postponed last year as part of the government's response to the COVID-19 pandemic. Hospitals want Congress to continue the pause through at least next year. Lawmakers on Thursday didn't detail concrete next steps but indicated the issues will be resolved before Congress concludes its business for the year.

    "There is work being done, I understand, on a comprehensive, bipartisan solution by the end of the year for all of the medical provider issues," House Appropriations Committee Chair Rosa DeLauro (D-Conn.) said during a hearing Thursday.

    Congress has other options to heed providers' warnings and halt or postpone the cuts. For example, the matter potentially could be dealt with in legislation to raise the debt ceiling or included in other bills that need to pass by the end of the year. But time is running short and legislators have a full slate of other issues to address.

    "The [continuing resolution] isn't the last train out of town. We will continue to pursue this," said Chip Kahn, president and CEO of the Federation of American Hospitals. "There's a clear recognition by the leadership in both chambers that this could create a desperate situation and it needs to be solved."

    The looming rate reductions derive from laws passed in 2010 and 2011 aimed at reducing the budget deficit.

    The budget law known as PAYGO requires that increases in the deficit be offset by raising revenue or reducing spending. Because the COVID-19 relief package that passed this year enlarged the deficit, it will trigger a 4% cut to Medicare and other programs if Congress doesn't act by mid-January.

    Congress has never let PAYGO cuts to Medicare payments take effect, but providers have been urging lawmakers to deal with the issue sooner rather than later.

    The Budget Control Act of 2011, which created sequestration, has resulted in automatic, across-the-board spending cuts in multiple programs since 2013, including a 2% reduction to Medicare payments that has been on hold since last year.

    The American Medical Association sounded a sour note Thursday, noting that provider groups have been pressing lawmakers to deal with the issue all year.

    "The end of the year is quickly approaching and it is clear that Congress is not prioritizing support for the nation's healthcare providers who have been on the front lines of the COVID-19 pandemic," AMA President Gerald Harmon said in a news release.

    The House passed a bill earlier this summer waiving PAYGO, but it stalled in the Senate, where Republicans said they didn't want to help Democrats waive cuts associated with a COVID-19 relief package that they didn't support.

    Still, Congress appears unlikely to let PAYGO cuts take effect given its negative impact on providers, especially ahead of an election year.

    Lawmakers also haven't resolved whether to extend a temporary 3.75% fee hike for physicians under Medicare, which Congress established last year and is due to expire Jan. 1.

    Physician groups have been pressuring Congress to extend it through at least 2022. Efforts to extend the increase, led by Reps. Ami Bera (D-Calif.) and Larry Bucshon (R-Ind.), have bipartisan support.

    "I'm hopeful that it's going to happen," said Claire Ernst, director of government affairs for Medical Group Management Association. "It has so much provider community support and we have the support from members of Congress, especially ones in the Doctors Caucus."


  • 1 Dec 2021 7:00 AM | Matt Zavadsky (Administrator)

    Modern Healthcare Source Article | Comments courtesy of Matt Zavadsky

    Interesting development.  Several agencies, including ours, recently received written notice from some facilities within the past 2 weeks requiring EMS providers to be vaccinated in order to enter their facility.

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

    Federal judge blocks healthcare worker vaccine mandate nationwide

    JEFFREY YOUNG

    November 30, 2021 08:25 PM

    President Joe Biden's bid to boost COVID-19 vaccination rates among healthcare personnel hit a roadblock when a federal judge halted its enforcement Tuesday.

    The Centers for Medicare and Medicaid Services published an interim final rule this month that effectively made COVID-19 inoculations a condition of participation in Medicare and Medicaid, meaning healthcare employers that don't comply by mandating shots risk losing reimbursements from those programs.

    Under the rule, an estimated 17 million workers at 76,000 healthcare sites needed to have received their first dose of a coronavirus vaccine by Dec. 6 and to be fully immunized by Jan. 4.

    That regulation is on hold after Judge Terry Doughty of the U.S. District Court for the Western District of Louisiana issued a preliminary injunction halting it. Republican officials from 14 states filed the lawsuit challenging the vaccine mandate. Officeholders from Alabama, Arizona, Georgia, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Montana, Ohio, Oklahoma, South Carolina, Utah and West Virginia initiated the legal challenge.

    "This matter will ultimately be decided by a higher court than this one. However, it is important to preserve the status quo in this case. The liberty interests of the unvaccinated require nothing less," Doughty wrote in his ruling.

    CMS's rule for healthcare workplaces and the Occupational Safety and Health Administration's regulation for employers with at least 100 workers are key elements of Biden's COVID-19 response, and have been subject to numerous lawsuits.

    The Louisiana federal judge's decision came a day after a federal judge in Missouri paused the CMS rule in Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming as part of a separate lawsuit. A federal judge in Florida rejected that state government's attempt to block the healthcare worker mandate last week.

    In addition to federal rules requiring healthcare workers to be vaccinated against COVID-19, a number of states have enacted similar mandates. A dozen states mandate vaccinations and another three require that healthcare employees be inoculated or be tested weekly. Another dozen states have outlawed employer vaccine mandates. The U.S. Supreme Court denied a request by healthcare employees in Maine to stop that state's rule last month.

    In practice, vaccine mandates in healthcare settings have been effective, but the results vary by geography and provider type.

    Some hospitals and health systems that instituted vaccination requirements prior to state and federal actions saw significant successes. Overall, 70% of hospital workers had been vaccinated as of mid-September, according to the Centers for Disease Control and Prevention. But vaccination rates at rural healthcare employers, in particular, have lagged. Healthcare companies haven't been outspoken against the mandates, but many have expressed concern that these rules can worsen the ongoing staffing shortage facing hospitals, nursing homes, home health agencies and others.


  • 1 Dec 2021 6:57 AM | Matt Zavadsky (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    The use of paramedics in health systems as a result of the nursing shortage is not ‘news’ to many of us, but here it is in ‘print’…

    Not only are health systems reconfiguring their workforce due to shortages, but it’s also resulting in many EMS systems re-evaluating their staffing and deployment models.  Well respected and innovative systems like REMSA (Reno, NV); MEMS (Little Rock, AR); MEDIC EMS (Charlotte, NC); EMSA (Tulsa, OK); and MedStar (Ft. Worth) have used patient outcomes based on EMD determinants to refine their response plans.

    Right patient, right time, right response configuration, right outcomes, right staffing!

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    Health systems reconfigure workforce amid shortages

    ALEX KACIK

    November 30, 2021

    Hospital labor costs continue to rise as nurses seek higher pay, requiring providers to reconfigure their workforce.

    Total labor expenses rose 12.6% from October 2020 to October 2021, and 14.8% from October 2019 to October 2021, according to Kaufman Hall's analysis of around 900 hospitals. Full-time equivalents per adjusted bed decreased 4.5% year over year while labor expense per adjusted discharge increased 16.3%, suggesting higher salaries prompted by nationwide labor shortages are driving up labor expenses rather than increased staffing levels, the report concluded.

    "We continue to see labor expenses rise at a much greater rate than you'd normally imagine," said Erik Swanson, senior vice president at Kaufman Hall. "Comparing elevated labor expenses to a drop in discharge rates shows how higher acuity care, longer stays, higher wages and contract labor support are driving a really dramatic increase in labor costs."

    CommonSpirit Health's financial metrics mirrored national trends. Labor costs across the 140-hospital system were up 16.3% year over year in the quarter ended Sept. 30, primarily because of higher contract labor costs, premium pay, overtime, etc.

    CommonSpirit is reworking its staffing models as a result. It is tasking virtual registered nurses with administrative duties, like supervising non-licensed personnel, to relieve onsite RNs. CommonSpirit has used a team-based patient care model using pharmacists, licensed practical nurses, nursing assistants and paramedics in its Iowa division over the past year. It plans to roll out that model across the entire system over the next five years, the organization said in its latest earnings report.

    Contract labor rates have been out of control, said Don Lilly, chief networks and affiliates officer at University of Alabama-Birmingham Medicine.

    "If we can't find revenue stability for many of these safety-net hospitals, we are really concerned about what is going to happen in the next two to four years," he said. "CARES dollars have benefited some hospitals. But the costs associated with what we have had to pay nurses to compete with staffing agencies and other providers aren't going away once the pandemic is less than it is now."

    UPMC's labor expenses rose nearly 5% through the first nine months of 2021 compared to the same prior-year period.

    Transfer times between hospitals are going up due to staff shortages. Both COVID-19 and non-COVID-19 patients are being turned away as the labor market tightens and practitioners leave the profession, hospital executives and industry observers said.

    "Nurses are leaving rural hospitals to go to their larger urban counterparts, become travel nurses or work at brick-and-mortar retailers like Walmart for better pay. The stress of this pandemic has also caused a number of nurses and administrators to simply say enough and retire early. No one can blame them," said Michael Topchik, national leader for the Chartis Center for Rural Health, adding that some nurses are also leaving because of COVID-19 vaccine mandates. "This has led to skyrocketing costs."

    It has been even harder to find specialty nurses, like ones with expertise in neurology and critical care, health system executives said.

    Vanderbilt University Medical Center has tried to fill the gap via telehealth and advanced practice providers, but there is still a supply-demand mismatch, president and CEO Dr. Jeffrey Balser said.

    "We have to make sure we're using all practitioners at the top of their license," he said.


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