News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January, 2021, over 1,800 news reports have been chronicled, with 49% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 83% of the media reports! 96 reports cite EMS system closures/agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log as of 3-27-24 READ Only.xlsx

  • 30 May 2019 8:54 AM | AIMHI Admin (Administrator)

    Source Study | Comments courtesy of Matt Zavadsky

    Interesting study recently conducted on the EMS professional’s perspectives of Community Paramedicine:

    Emergency Medical Services Professionals’ Attitudes About Community Paramedic Programs

    10.5811/westjem.2017.3.32591

    Introduction: The number of community paramedic (CP) programs has expanded to mitigate the impact of increased patient usage on emergency services. However, it has not been determined to what extent emergency medical services (EMS) professionals would be willing to participate in this model of care. With this project, we sought to evaluate the perceptions of EMS professionals toward the concept of a CP program.

    Methods: We used a cross-sectional study method to evaluate the perceptions of participating EMS professionals with regard to their understanding of and willingness to participate in a CP program. Approximately 350 licensed EMS professionals currently working for an EMS service that provides coverage to four states (Missouri, Arkansas, Kansas, and Oklahoma) were invited to participate in an electronic survey regarding their perceptions toward a CP program. We analyzed interval data using the Mann-Whitney U test, Kruskal-Wallis one-way analysis of variance, and Pearson correlation as appropriate. Multivariate logistic regression was performed to examine the impact of participant characteristics on their willingness to perform CP duties. Statistical significance was established at p ≤ 0.05.

    Results: Of the 350 EMS professionals receiving an invitation, 283 (81%) participated. Of those participants, 165 (70%) indicated that they understood what a CP program entails. One hundred thirty-five (58%) stated they were likely to attend additional education in order to become a CP, 152 (66%) were willing to perform CP duties, and 175 (75%) felt that their respective communities would be in favor of a local CP program. Using logistic regression with regard to willingness to perform CP duties, we found that females were more willing than males (OR = 4.65; p = 0.03) and that those participants without any perceived time on shift to commit to CP duties were less willing than those who believed their work shifts could accommodate additional duties (OR = 0.20; p < 0.001).

    Conclusion: The majority of EMS professionals in this study believe they understand CP programs and perceive that their communities want them to provide CP-level care. While fewer in number, most are willing to attend additional CP education and/or are willing to perform CP duties. [West J Emerg Med. 2017;18(4)630-639.]


  • 30 May 2019 8:42 AM | AIMHI Admin (Administrator)

    WFAA Source Article | Comments Courtesy of Matt Zavadsky

    Excellent news story by Teresa Woodard on the plight of high ER utilizer patients, and the expense to the community in caring for them. 

    Community collaborations, often including an EMS-Based Mobile Integrated Healthcare (MIH) program like the one here at MedStar, have demonstrated significant improvements in care coordination (including addressing the important social determinants of health), enhancing patient experience of care, improved health status, and significant reduction in acute care utilization, including EMS resources (and the cost associated avoiding preventable utilization).

    Note that Parkland estimates the cost to the community for caring for high utilizer patients at $14 million!

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

    80 people went to Dallas emergency rooms 5,139 times in a year — usually because they were lonely

    Parkland Hospital officials say the cost of taking care of repeat ER patients is “absolutely passed on to you.”

    Teresa Woodard

    May 28, 2019

    DALLAS — Michael Johnson is 57. He’s from Dallas. He’s diabetic. He has a job in fast food. He rents a home. He gets by.

    Until recently, no one ever explained to him how hospitals, doctors and emergency rooms work.

    “My momma always told me when something’s wrong with you, go see the doctor,” Johnson said.

    The only way he knew to see a doctor was go to the emergency room at Parkland Hospital, which is why he racked up 31 ER visits in 24 months.

    Johnson’s numbers are not at all surprising for administrators at Parkland, which has one of the busiest emergency rooms in the country.

    “It’s not unusual for us to see in excess of 700 people in a 24-hour period in our emergency room,” said Dr. Esmail Porsa, executive vice president and chief strategy and integration officer for Parkland Health and Hospital System.

    Parkland’s ER is busy for countless reasons, but chief among them is repeat patients like Johnson. He’s considered a high emergency department utilizer because of those repeated visits.

    High ER utilizers often take up valuable space which can lead to long waits, Porsa said. Because Parkland is a public hospital, these frequent patients cost Dallas County taxpayers money.

    The hospital wanted to determine why these high utilizers keep coming in. But to do that, they needed to identify who they are.

    “We looked at the data every which way. We looked at zip codes, gender, race, education, income. One day we sorted the data by medical record and realized — lo and behold — there were three patients on the top of the list,” Porsa said.

    Those three patients visited the hospital 500 times in one year.

    "Five hundred times," Porsa repeated.

    Porsa and his team expanded their research to include data from other health systems in Dallas County, which led to a revelation.

    They identified 80 patients who, collectively, went to four Dallas County emergency rooms 5,139 times in a 12-month period.

    “The same people are basically going from emergency room to emergency room,” Porsa said.

    Parkland estimates those visits cost more than $14 million.

    “It is absolutely passed on to you,” Porsa said of the cost to taxpayers.

    Once they determined who those high utilizers were, it was time to get back to why they keep coming in.

    That research led to a painful reality: the cause for most of the repeat visits is loneliness.

    “It’s a lack of relationships and support structure,” Porsa said.

    Poverty and food shortage are factors for the frequent visits, but they aren't the main reason.

    "The No. 1 determinant of high emergency department utilization is relationships," Porsa said.

    Dr. Jeffery Metzger, chief of emergency services at Parkland Health and Hospital System, calls the challenges some of these patients face heartbreaking.

    “In medical school, we get taught how to take care of medical illnesses, but there’s a group of patients who come in who are here for some other reason,” he said. “If we just throw medicines at them when they keep coming in, they’re not going to get better.”

    Parkland began intense case management with the high ER users. Teams of administrators, doctors, nurses, social workers and chaplains meet regularly to track them. 

    Every 90 days, Parkland re-evaluates the data to identify new high users.

    Freedom McAdoo, chaplain at Parkland Health and Hospital System, is also leading a new DFW Faith Health Collaborative.

    Baylor Scott and White Health, Methodist Health System and Children’s Health are working together on the effort, to partner church and community organizations with patients who need companions, “so they’re not alone,” McAdoo said.

    “If you are isolated and lonely, but you have someone that you remember, like nurse April, nurse Tina, or nurse John, and they’re like, ‘Hey, how are you doing?’ And you’re greeted with warmth and love, well yeah, I’m gonna come back,” she said, explaining why patients keep returning.

    Michael Johnson didn’t know community clinics, like Parkland’s Bluitt-Flowers Health Center, even existed. The clinic on Overton Road is near the fast food restaurant where he works.

    After social worker Jo Black began managing his case and educating him, his ER visits fell by 70 percent.

    “We just look at what constitutes an emergency, what (the ER) is there for and what we can do here,” Black said. “A lot of times, patients just really do not know.”

    Black shows tough love with patients like Johnson, holding them accountable for missed appointments and follow up visits.

    “Now I know,” Johnson said. “And I’m glad I know.”

    Johnson is a success story, but he’s just one patient among many.

    He’s proof that human connections matter. Widespread change depends on all of Dallas realizing that and then living it.


  • 28 May 2019 7:50 AM | AIMHI Admin (Administrator)

    Washington Post Source Article | Comments Courtesy of Matt Zavadsky

    This is one of the most amazing articles about the plight of healthcare and hospitals in rural America.  Yes, it’s very long, but exceptionally well written.

    Strongly encourage you to read this, and click on the link to see some of the photos – it wrench your gut, and likely bring tears to your eyes.

    EMS agencies in these areas, often volunteers, face immense struggles as they become the default healthcare in areas where hospitals have closed – and have to transport patients great distances, taking resources away from the community for longer periods of time.

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

    ‘Who’s going to take care of these people?’

    As emergencies rise across rural America, a hospital fights for its life

    By Eli Saslow 

    MAY 11, 2019

    https://www.washingtonpost.com/news/national/wp/2019/05/11/feature/whos-going-to-take-care-of-these-people/ 

    Fairfax, Okla. - The hospital had already transferred out most of its patients and lost half its staff when the CEO called a meeting to take inventory of what was left. Employees crammed into Tina Steele’s office at Fairfax Community Hospital, where the air conditioning was no longer working and the computer software had just been shut off for nonpayment.

    “I want to start with good news,” Steele said, and she told them a food bank would make deliveries to the hospital and Dollar General would donate office supplies.

    “So how desperate are we?” one employee asked. “How much money do we have in the bank?”

    “Somewhere around $12,000,” Steele said.

    “And how long will that last us?”

    “Under normal circumstances?” Steele asked. She looked down at a chart on her desk and ran calculations in her head. “Probably a few hours,” she said. “Maybe a day at most.”

    Continue Reading at The Washington Post►


  • 28 May 2019 7:47 AM | Amanda Riordan (Administrator)

    CBS News Source Article | Comments Courtesy of Matt Zavadsky

    Scary statistics from the National Safety Council:

    • 71% of drivers admitted to taking photos and texting while driving by emergency workers.
    • Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road.
    • Forty first responders were killed on the side of the road last year, up 60% from 2017.
    • So far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

    Please help keep our First Responders safe as they try to keep others safe!

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

    Distracted drivers an increasing threat to first responders

    CBS NEWS May 27, 2019, 7:40 AM

    New research shows that many drivers are profoundly distracted by their phones when they're going past first responders working accidents on the roadways.

    New research from the National Safety Council found 71% of drivers admitted to taking photos and texting while driving by emergency workers; that's nearly triple the 24% who admitted to doing it under normal driving conditions. Sixty percent admitted to posting to social media; two-thirds have emailed about what they're driving by.

    And the results are increasingly deadly. Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road. Forty first responders were killed on the side of the road last year, up 60% from 2017. And so far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

    "What surprised us most about this study was the magnitude of people who are really exercising very dangerous behavior," said Kelly Nantel of the National Safety Council. "They're adding another level of exposure to these first responders."

    Last December, Florida Highway Patrol Trooper Mithil Patel was on the shoulder of interstate 95 working an accident when, despite a traffic lane being closed as a safety buffer, a suspected distracted driver was the cause of a car losing control and swerving towards him.

    Video captured Patel throwing another man to safety right before being hit by the car himself.

    "It's a different feeling definitely, seeing where I almost got killed – definitely a weird feeling,' Patel said.

    "Do you feel lucky to have survived that?" Van Cleave asked.

    "I feel extremely lucky," Patel replied. "I have seen people, you know, pretty much die from this."

    Patel admitted to some nerves as he hit the road in his patrol car for the first time since the accident. "I still have the butterfly in my belly," he told Van Cleave. "Whenever you see the brakes squeeze really hard, you're always going to be back to be, like, is he coming toward my way or not?"

    Patel hopes to be back to full duty and working calls on the side of the road in the coming months.

    In Miami, Fire Captain Steve Perez, heading to a traffic accident, said as soon as they flip on the lights and sirens, drivers behave differently.

    Van Cleave asked, "Every call you see people paying more attention to their phones than the road? Is it that common?"

    "Sure, I'll venture to say it's very common to see somebody either on their phone or taking their phone out to try to videotape or get a snap of what's going on," said Captain Perez.

    Patel said, "I have seen it where they pull out the phone outside the window and take start taking pictures, not paying attention to the road."

    All 50 states have a "move over" law that requires drivers to give first responders room to work, but police say it's about 50-50 if people actually do it.

    Trooper Patel says, bottom line, put down the phone.


  • 28 May 2019 7:20 AM | AIMHI Admin (Administrator)

    While many excellent nominations were received, the following were selected by the AIMHI Board and Education Committee as the 2019 Excellence in EMS Integration Award winners.

    2019 Winners List

    Click each winner for a comprehensive look at their programs.

    Excellence in EMS Integration Award (Tie)

    Excellence in Public Information or Education Award

    Excellence in Value Demonstration or Research

    Leadership in Integrated Healthcare Award


  • 15 May 2019 5:35 PM | AIMHI Admin (Administrator)

    TimesUnion source article | Comments courtesy of Matt Zavadsky

    Congrats to our Montana team, especially Justin Grohs of Great Falls Emergency Services and Jim DeTienne, EMS lead for Montana in getting this legislation passed.

    Legislation text►

    New law allows emergency care providers to offer other aid

    By AMY BETH HANSON, Associated Press

    May 2, 2019

    HELENA, Mont. (AP) — Montana Gov. Steve Bullock has signed a bill allowing emergency care providers to offer non-emergency medical assistance in their communities to reduce noncritical calls to 911, especially in rural areas.

    The providers could fill gaps in the current medical system by helping people manage their medicine or chronic illnesses, giving them a ride to their doctor's office or home from a hospital, or connecting them with other medical or mental health services, supporters said.

    The bill, sponsored by Democratic Sen. Margie MacDonald, allows the Board of Medical Examiners to create rules detailing changes and a training program for paramedics and emergency medical technicians. It does not require volunteer emergency agencies to offer the services.

    Supporters said the measure, which Bullock signed Wednesday, will reduce the number of 911 calls from people who could have been helped earlier and less expensively.

    Hundreds of programs around the country are using emergency care providers to fill similar community medical needs. Montana has successful pilot programs in Cut Bank and Red Lodge, said Jim DeTienne, supervisor of the state health department's Emergency Medical Services and Trauma Systems section.

    Medicaid pays for similar programs in other states, and the department is talking with health insurers about covering the service. However, insurers wanted to see it credentialed and regulated, DeTienne said.

    Supporters said the program may draw volunteers who don't want to be on-call for emergency situations but would be willing to help with scheduled visits.

    The state has funding for six pilot projects that would gather data about the effectiveness of the programs, said Jon Ebelt, spokesman for the Department of Public Health and Human Services.

    Officials with fire and rescue services told lawmakers about 911 calls that could have been avoided if the callers had someone to help them manage their medication or give them a ride to a doctor instead of an emergency room if that would better serve them.

    The legislation gives emergency responders the ability to sit down with patients and get to the reason for repeated 911 calls, said Bob Drake, chief of the Tri-Lakes Volunteer Fire Department, northeast of Helena.

    Drake told lawmakers a resident, despite being in a wheelchair, kept falling and calling 911. He said he finally asked the man why he was falling so much and the man said the brakes on his wheelchair were broken and it kept rolling out from under him as he moved in or out of the chair.

    Drake said the man was a patient of the Department of Veterans Affairs, so he called the VA, but they said it would take a few weeks to get him a new wheelchair.

    Drake said he went home and got his late father's wheelchair and took it to the man.

    "The 911 calls stopped for three weeks," he said.


  • 15 May 2019 8:28 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

    There has been much discussion about surprise medical bills over the past few years.  The House Energy and Commerce committee released a discussion draft of a proposed Bill and today, requested formal feedback from industry stakeholders.

    The email to stakeholders and the supporting documents to the email are below and attached.

    Here is an interesting analysis of the Bill released by the Energy and Commerce Committee.

    Analyzing The House E&C Committee’s Bipartisan Surprise Out-Of-Network Billing Proposal

    Loren Adler, Paul B. Ginsburg, Mark Hall, Erin Trish

    MAY 14, 2019

    10.1377/hblog20190514.695693

    A new bipartisan discussion draft to address surprise out-of-network billing was released today, introduced by the Chairman and Ranking Member of the House Energy and Commerce Committee. This bill follows two Senate proposals released late last year, one from a bipartisan group composed of Senators Bennet, Carper, Cassidy, Grassley, McCaskill, and Young, and another from Senator Hassan.

    Surprise out-of-network bills can occur when a patient receives care from an out-of-network provider in situations they cannot reasonably avoid, typically when there is no real choice of provider. These surprise bills can arise both from emergency care (whether the facility itself is out-of-network, the ambulance that transports the patient is out-of-network, or a physician providing emergency treatment is out-of-network) and out-of-network nonemergency care received at an in-network facility (typically a hospital or ambulatory surgery center).

    Energy And Commerce Draft Approach

    The Energy and Commerce draft would eliminate surprise out-of-network billing for both emergency and non-emergency services (with the notable exception of ambulance services) and across different sites of care (e.g., hospitals, ambulatory surgery centers (ASCs), freestanding emergency departments). Importantly, the legislation would do so for all commercial insurance plan types, including self-insured health plans that can only be regulated by the federal government. The legislation achieves this objective by combining the following three components:

    • Require the health plan to treat the out-of-network service as if it were in-network for purposes of enrollee cost-sharing, deductibles, and out-of-pocket limits;
    • Set a minimum payment amount that the health plan must pay to the out-of-network provider; and
    • Prohibit out-of-network providers from “balance billing” patients -- that is, from billing the patient any amount above the patient’s in-network cost-sharing.

    These protections would apply to all out-of-network emergency services and to all out-of-network nonemergency services received at an in-network facility from “facility-based providers,” which the bill defines to include anesthesiologists, radiologists, pathologists, neonatologists, assistant surgeons, hospitalists, intensivists, and any additional provider types specified by the Secretary of Health and Human Services (HHS). Other provider types would still be allowed to treat patients on an out-of-network basis in nonemergency situations if they met the strong notice and consent requirements detailed in the discussion draft. Limiting notice and consent exceptions to physician specialties that patients typically actively choose strikes a sensible balance. It preserves patients’ ability to seek out-of-network care in circumstances where it is appropriate, while mitigating the risk that the flood of paperwork involved in seeking medical care will result in some patients consenting to out-of-network billing without understanding what they are consenting to or whether they have a reasonable alternative.

    Payment Standard

    By prohibiting balance billing by out-of-network emergency and facility-based providers, the Energy and Commerce draft addresses the market failure that allows these specialties to receive what appear to be very high in-network payment rates, relative to what specialties facing more typical market forces earn. In addition, to help providers, the draft requires health plans to pay out-of-network emergency and facility-based providers their plan-specific median contracted rate for the relevant service in that geographic area. Existing state laws that provide methods for determining out-of-network payment for surprise bills would remain for fully insured plans and would not be pre-empted.

    Notably, given that the threat of surprise billing allows emergency and ancillary physicians such as anesthesiologists to garner very high in-network rates today, tying a payment standard to current median contracted rates may fail to bring rates down to what normal market rates would be in the absence of the market failure. However, because median contracted rates for the specialties most commonly associated with surprise billing are typically considerably below the mean (due to the typical presence of a minority of physician groups garnering especially high rates), this bill represents a clear improvement over the status quo. For example, in one study of commercial claims data, mean reimbursement for the highest-level emergency physician service was 306 percent of Medicare’s payment for the same service, whereas median reimbursement was 257 percent of the Medicare rate.

    Therefore, the Energy and Commerce draft likely would result in lower insurance premiums in most markets and hence reduced federal deficits (from reducing loss of revenue from tax subsidies to health insurance), in addition to eliminating the scourge of surprise bills to patients. We also believe that a decision by Congress on an out-of-network payment standard is preferred to arbitration, which could be unpredictable, lacks transparency, and could involve significant administrative costs. While it may fall short of fully unwinding the increase in health care spending stemming from today’s market failure, the Energy and Commerce draft legislation represents the strongest proposal to date on the dual fronts of protecting consumers and reducing health care costs. The bill’s structure is most similar to state laws in California and Oregon.

    Areas For Further Consideration

    The Energy and Commerce Committee should be applauded for a serious bipartisan proposal to address surprise out-of-network billing. As is, the proposal would reduce system wide health costs and provide valuable protection from surprise bills to patients.

    The rest of this post discusses a few areas that Members should consider as they revise this discussion draft.

    How To Determine The Median Contracted Rate

    There are important considerations relating to the payment standard being tied to an insurer’s own median in-network rate for the relevant service in a geographic area. First, this approach gets around the technical challenge of setting different payment standards by geography from the federal perch, without sufficient data available to calculate median contracted rates by geographic market. Second, it leaves in place insurer-specific dynamics based on the rates they have negotiated for emergency services and “facility-based providers,” which may not be desirable to the extent that those rates largely reflect a plan’s current willingness to shield their enrollees from surprise bills.

    Third, over time this approach may allow health plans to drive down in-network payment rates toward normal market rates if the plan is able to undo contracts with physician groups earning especially exorbitant rates today and rachet down their plan-specific median contracted rate to more reasonable levels. And because the draft legislation requires the plan to make this payment directly to the provider and prohibits the provider from billing the patient any more than their in-network cost-sharing amounts, the distinction between these provider types technically being in- or out-of-network becomes meaningless from the patient’s perspective.

    Still, relying on insurer’s own median rates may lead to out-of-network payment rates being unpredictable for providers, although the HHS Secretary is tasked with determining a methodology for guaranteeing accurate and fair reporting by insurers, which may address this concern. States with all-payer claims databases could also be allowed to use those to determine a market-wide median rate.

    In the context of a relatively high payment standard such as median contracted rates, the insurer-specific median approach may be preferable. However, there would be value to pursuing a more transparent approach utilizing a payment standard tied to a lower rate set across a market or tied to a percentage of Medicare rates, which vary by geography.

    Lower Payment Standard

    For emergency physicians and ancillary clinicians (anesthesiologists, certified nurse anesthetists, radiologists, and pathologists), the natural market negotiation is between them and the facility at which they practice (that’s where the price-volume trade-off exists). To fully ameliorate the current market failure, an out-of-network payment standard would need to be set at or below the normal market rate for that specialist (that is, the rate that would be negotiated with the hospital in the absence of the ability to surprise bill patients).

    Fortunately, there is little risk to setting the payment standard below market rates because facilities would then have to step in to demand market rate payment from insurers in order to ensure adequate staffing – or, alternatively, pay these specialists more money directly. (See here for a more detailed discussion of the considerations in setting an out-of-network payment standard.) Given the difficulty of determining this normal market rate, we recommend setting an out-of-network payment standard at a percentage of the relevant Medicare payment rate equal to the ratio of average contracted rates to Medicare rates for other specialists (ones that patients do choose) in the same geographic region.

    Ambulances

    Similar to the two Senate bills last year, today’s draft does nothing to prevent surprise out-of-network bills from ground or air ambulances, despite ambulance services frequently being delivered out-of-network. Very similar market dynamics characterize ambulance services, and federal law prevents states from addressing this market failure for air ambulances in particular.  Federal legislation addressing surprise billing should incorporate ambulance services within the emergency service protections. The same approach, including a payment standard, could apply.

    Non-Physician Providers

    Non-physician providers often involved in surprise billing, such as certified nurse anesthetists (CRNAs), should be included in the draft’s list of “facility-based providers” that are subject to the law. Lab services are also a common source of surprise bills. While the draft includes laboratories in its list of health care facilities, it’s not clear that a patient would be protected from a surprise bill if their labs are sent to a non-participating facility.

    State Preemption

    As drafted, the Energy and Commerce bill appears to allow all existing state surprise billing laws that include a payment standard or arbitration process to supersede the new federal law, for the fully insured plans that states can regulate. This approach, however, allows for state laws that are worse for consumers to continue. One option to address this risk while still allowing for state flexibility would be to rely on the approach already built into the Public Health Service Act -- to allow states to maintain laws that are at least as protective as the federal one. The federal legislation could then include language clarifying that to be considered at least as protective, state protections must not increase premiums or include a payment standard tied to amounts greater than median contracted rates (or an arbitration process in which arbiters are, on average, selecting rates above the relevant median contracted rate).

    There is also a narrower question to be resolved regarding how preemption would function for state laws that have a method for determining out-of-network payment but exempt surprise bills below a certain dollar amount, such as in New York or Arizona. A federal law should at least serve as the default for the surprise bills currently not protected against by such state laws. Similarly, certain state surprise billing laws only apply to specific physician specialties, and it should be clarified that the federal default would then apply to other specialties providing out-of-network services for enrollees in state-regulated, fully insured plans.

    Post-Stabilization Protections

    While the draft legislation clearly protects consumers from surprise out-of-network bills for emergency services, there may remain a risk of patients receiving surprise bills for post-stabilization services performed at an out-of-network facility. One approach to ameliorate this concern is to extend protections from surprise out-of-network facility bills to 24 hours after stabilization from an emergency and require that the facility offer transfer to an in-network facility for continued care.

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

    Body of email from E & C:

    Dear Stakeholder:

     

    Last week, Energy and Commerce Committee Chairman Pallone and Ranking Member Walden announced their commitment to crafting a bipartisan solution to address the problem of surprise medical bills that are leaving families across the country with crippling amounts of financial debt.  As the Committee leaders said last week, no family should be left in financial ruin through no fault of their own.

     

    Today, Chairman Pallone and Ranking Member Walden are releasing a bipartisan discussion draft, the No Surprises Act, which would protect consumers from surprise medical bills and increase transparency in our health care system.  Attached you will find legislative text and a summary of the discussion draft, which the Chairman and Ranking Member are requesting your constructive feedback on.  Specifically, the Committee requests feedback on the following areas:

     

    ·        Increasing Transparency for Consumers.  Our health care system is confusing for even the most educated consumers.  The Committee is interested in feedback on ways to help consumers better understand their health plans and which providers are in their network.    

    ·        Ensuring Network Adequacy.  Consumers deserve adequate networks that offer the right care at the right time.  The Committee seeks feedback on ensuring that networks are sufficiently meeting the needs of individuals.    

    ·        Encouraging the Development of State All-Payer Claims Databases.  All-payer claims databases have the potential to bring greater transparency to health care costs and spur innovative policy solutions.  The Committee requests feedback on how to aide states in developing robust all-payer claims databases. 

    ·        Protecting Consumers from Surprise Bills from Air and Ground Ambulances.  While the No Surprises Act does not address the issue of surprise medical bills from ground or air ambulances, the Committee recognizes the need for solutions in these areas and seeks feedback on how to provide relief to consumers burdened with unexpected ambulance bills. 

    ·        Establishing a market-based benchmark to resolve out-of-network payment disputes between providers and insurers.  Payment disputes between providers and insurers must be resolved in a manner that takes the patient out of the middle, is transparent and does not increase federal healthcare expenditures.  The Committee requests feedback on how to adequately provide payment in these situations through a transparent, non-inflationary mechanism.

     

    The Committee requests your written feedback by May 28th and upon receiving your feedback welcomes the opportunity for further discussion.  We look forward to working with you to solve this critical issue for consumers.

     


  • 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

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

    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.


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