News & Updates

  • 6 Feb 2020 5:38 PM | Matt Zavadsky (Administrator)

    Commentary: Interesting news, especially in light of the revolutionary new ET3 model CMMI is rolling out for ambulance services…


    House lawmakers introduce bill to tighten CMMI's reins


    February 04, 2020

    A bipartisan group of House lawmakers on Monday introduced a bill to ramp up transparency and accountability efforts for the CMS' Center for Medicare and Medicaid Innovation.

    The Strengthening Innovation in Medicare and Medicaid Act—HR 5741—would require the HHS secretary to keep track of how a demonstration model affects beneficiaries' access to care. HHS would also have to monitor the effects of delivery and payment changes on healthcare disparities and alleviate related issues that could negatively affect health outcomes.

    The bill aims to boost transparency by creating an expedited process for Congress to reject models and makes it easier for the public to comment on proposed models and changes.

    The Innovation Center, also known as CMMI, would also have to consult with experts on the healthcare needs of minorities, rural and underserved populations, and the financial demands of safety-net and rural providers.

    Providers and suppliers could seek hardship exemptions from the Innovation Center if they would be subject to undue economic hardship or if the agency's requirements caused vulnerable populations to lose access to specific providers.

    Reps. Terri Sewell (D-Ala.), Adrian Smith (R-Neb.), Tony Cárdenas (D-Calif.) and John Shimkus (R-Ill.) introduced the legislation.

    "It is essential that Congress ensures that CMMI functions as intended, to improve the quality and efficiency of care delivered, and incorporates greater opportunity for public input," Sewell said. "The legislation we introduced today would safeguard the center from implementing politically driven or other policy changes made unilaterally by any administration that could be harmful to patients and providers."

    Lawmakers, especially those who represent rural or underserved populations, have expressed concern that the Innovation Center has too much discretion to design, test and implement new payment models without adequately considering their effects on healthcare delivery outcomes.

    "This bill would reduce uncertainty throughout the healthcare marketplace by providing for appropriate oversight of CMMI," Smith said.

  • 6 Feb 2020 5:37 PM | Matt Zavadsky (Administrator)

    House leader aims for surprise billing deal by Presidents Day


    January 28, 2020

    Source Article:

    House Majority Leader Steny Hoyer (D-Md.) wants the House to move on legislation banning balance billing as soon as mid-February, he told reporters Tuesday.

    So far, the House Energy & Commerce and Ways & Means committees have been at odds over the best approach to address payment for bills a patient receives from an out-of-network provider at an in-network facility.

    "We are trying to bring those together and create a consensus so that we can move a bill, and move a bill sooner rather than later. Sooner meaning within this work period if we can get to agreement," Hoyer said, referring to the House work period that ends the week of Feb. 10.

    However, some are skeptical House leaders can work out their differences that quickly after a bipartisan, bicameral compromise brokered by leaders of the House Energy & Commerce and Senate health committees fizzled last year amidst intense insurance and provider industry lobbying.

    The Ways & Means Committee leaders have not yet elaborated on their proposal beyond a one-page outline released in December. Ways & Means health subcommittee Chair Lloyd Doggett (D-Texas) said Tuesday he has not seen policy details beyond the one-pager.

    "When we really get going it's a short month," Doggett said.

    Ways & Means Committee Chair Richard Neal (D-Mass.) said Monday that he wants to shape the legislation in concert with the Energy & Commerce Committee and expects to hold a markup in the next three weeks.

    Several stakeholders including hospital groups, a new conservative coalition, and physician staffing firms that oppose the Energy & Commerce proposal because of its inclusion of benchmark payment rates have not yet thrown their weight behind the Ways & Means idea and are awaiting more information.

    Ways & Means ranking Republican Kevin Brady of Texas has said that he and Neal are pursuing a revenue-neutral approach to ban balance billing, though lawmakers by May 22 have to find a way to fund extensions of several Medicare and Medicaid programs including funding for community health centers and delaying cuts to Medicaid disproportionate-share hospital payments.

    Neal said Monday that there may be alternative funding sources other than surprise billing legislation.

    "I've got some ideas," he told reporters.

    House Energy & Commerce Committee leaders estimated their bill would provide nearly $20 billion to fund community health centers for five years.

    House committee chairs have missed leadership goals for surprise billing legislation before.

    House Speaker Nancy Pelosi (D-Calif.) in December gave the chairs of the House Energy & Commerce, Ways & Means and Education & Labor committees a deadline to come to a consensus ahead of an appropriations package, but they failed to do so.

  • 6 Feb 2020 5:36 PM | Matt Zavadsky (Administrator)

    Industry Voices—Generation Z is a game changer for healthcare

    by Rick Halton

    Jan 15, 2020

    Source Article:

    There is no question that technology continues to impact healthcare, altering how patients receive care, communicate with providers and stay informed about their own health. However, members of the newest generation of young adults—Generation Z—are likely to turn the health industry on its head with their unique expectations for how healthcare should be delivered. 

    Gen Z has no idea what a rotary telephone is, rarely ever waits in line at the deli and will never know the cathode ray tube—despite the fact that it inspired YouTube, which they use every day.

    They are the first generation to be born into a world with the internet, smart devices and apps. As a result, they have radically different views from the older population on what privacy, trust and relationships mean in the digital world.

    Think of the way acts as a gateway to travel, simplifying the entire reservations pathway—serving up flights, car rentals and hotels, tailored to customer preferences and requirements. With younger generations increasingly expecting that kind of convenience and simplicity, healthcare needs to find its own “gateway.”

    New entrants in the market will address the needs of Gen Z, adapting to their demands by delivering virtualized and automated care pathway experiences. For the first time, these experiences will revolve and adapt around their needs, every day, with no need to wait in line, providing instant assessment, instruction and motivation while coordinating a team of care professionals around individuals' health needs.

    Swapping privacy for convenience

    The traditional approach to healthcare data privacy is, firstly, data are not owned by the individual, but by the physician, and now the provider, in a highly regulated environment.

    Institutions are the guardians of highly sensitive content, potentially including personal information, financial information and healthcare data, and, as such, are risk-averse when it comes to data sharing. Any mistake comes with huge consequences.

    Gen Z doesn’t have the same boundaries for data privacy. They have grown up with apps such as Google, Facebook, Amazon and Instagram, cementing the idea that sharing their data in multiple formats is normal—especially in exchange for convenience. The risk-reward balance has shifted, with younger generations opting to share data in exchange for a service, whether that’s shopping on Amazon or seeking out healthcare services.

    Gen Z accepts those terms because they have never known anything different, and industry stakeholders need to rethink the future of healthcare data privacy for that very reason. Younger generations are much more willing to share their personal health data if there is a clear benefit to them, and the population at large, on the other end.

    Convenience at all costs

    Convenience is paramount for this new generation—so much so that they are often willing to forgo a personal relationship with their healthcare provider.

    Baby boomers—and even older millennials—grew up with the idea that trust should be established between two people when transacting a service. Whether it was at the bank with a teller and customer, or with a doctor and patient, there was a face-to-face relationship. That is no longer the case.

    Gen Z was raised on social media, smartphones and apps. These individuals have a completely different outlook on what it means to obtain a service. Most of the time, it can be done automatically with very limited human interaction (if any) and without waiting in line.

    With the rise of online shopping and on-demand apps—for everything from buying groceries to ordering food and taxis or managing online banking—convenience has become a staple. The danger for providers is, if Gen Z doesn’t get that desired convenience, they’ll go elsewhere.

    This is an important lesson for healthcare providers: They must make their experience convenient. As value moves to the edges of the network architecture, access to data becomes much easier. There are numerous services offered that can improve individuals’ health. This will all be seeded through technologies and the virtualization of services, such as an artificial intelligence-driven persona that is always available to help individuals with their health issues.

    Focusing on prevention, holistic health

    While younger generations want convenience with their healthcare, they also want a trusted adviser who can guide them toward holistic health and wellness.

    Younger generations don’t want the “old school” style of medicine where they have no input in decision-making. These individuals want to be armed with information from a trusted expert who can guide them toward the right decision.

    Gen Z attitudes toward doctor relationships are a deviation from previous generations who likely encountered more healthcare issues, such as the baby boomers. That generation is accustomed to a different type of patient-doctor relationship—one that’s long-standing, where the doctor is the fount of all knowledge and their diagnosis is definitive.

    Younger generations also have more awareness of whole-person wellness—not just their acute medical condition but how it interplays with nutrition, fitness, sleep and stress management. This is something the healthcare industry has historically not touched.

    Physicians are sought out for physical health problems, but now there are also health coaches, therapists and self-monitoring solutions—all of which can be connected to through endless online apps and services. From Fitbit to track wellness stats in real-time to genome services like 23andMe, which expose potential genetic vulnerabilities, Gen Z has the means to take preventive care into their own hands.

    Whether they like it or not, Gen Z will come to their physician and provider armed with data, information and knowledge unlike in generations past. This is why providers need to continue improving on how best to help patients take advantage of the tools already at their disposal.

    Transforming to patient-centric healthcare

    Healthcare is still far from a truly consumer-centric experience. While there are some aspects of convenience popping up in the industry, such as online appointment booking, increased pharmacy services (vaccinations, etc.) or text appointment reminders, those services are patchy.

    The industry is so huge and entrenched in the old way of working. There must be a transformational disrupter that will come along and completely change how healthcare is delivered. Other services and innovators will bubble up around this transformation, and the old guards will die away—just as they have in other industries.

    The internet of things and connected medical devices now form the “edge” of the network architecture. This is where data are produced and then sent into the centralized repository for processing.

    This shift is going to create almost unprecedented access to data for healthcare, and it will also help move the industry away from a physician-centric model.

    Delivering patient-centric care, where we capitalize on real-world data and automated care experiences, will be key to transforming healthcare.

    We must deliver care as part of the entire patient journey—not just one specific episode at a time. We can make care accessible for patients—including Gen Z—when and how they want it while using data to tailor their experiences and treat them like real customers.

    As Jerry Seinfeld once said, “I hate when they make you wait in the waiting room. It says, ‘waiting room’, so there’s no chance of not waiting—and they’ve got it, so they’re gonna use it—it’s all set up for you to wait.” 

    When healthcare providers innovate and create completely seamless patient experiences that emulate everyday consumer experiences, will Gen Z know what a “waiting room” is?

    Rick Halton is vice president of product and marketing for Lumeon. He has extensive experience in both the U.S. and European healthcare markets and was previously co-founder and vice president of sales and marketing at Chicago-headquartered Apervita. He has also held executive positions at Fortune 100 companies, including Hewlett Packard, and senior roles at Vodafone and Openwave.

  • 4 Feb 2020 2:02 PM | AIMHI Admin (Administrator)

    The AIMHI Excellence in Integration Awards celebrate and promote high performance, high value EMS. In the spirit of promoting true healthcare integration, award-winners are primarily sought from EMS agencies and other healthcare providers outside of the AIMHI membership. Nominations for the 2020 awards are due April 15, 2020. Please review all details below before submitting a nomination.

    Learn more & nominate!

  • 22 Jan 2020 10:16 AM | AIMHI Admin (Administrator)

    The International Board of Specialty Certification (IBSC) is collecting data to better understand the scope of practice between community paramedics practicing in a various countries, their own expectations regarding their ability to provide optimal patient care, and their perception of their role compared to that of their traditional emergency response ambulance counterparts.


    They are circulating a brief, 10 question survey and asking folks from around the world to contribute their input into the analysis.  It would be very valuable if you could invest a few minutes to answer this quick 10 question survey is posted on SurveyMonkey…  Also feel free to share this with others so we can help better understand this scope even better!!

    The survey results will be available on the IBSC website and the International Roundtable on Community Paramedicine (IRCP) website by 31 March 2020. 

  • 17 Jan 2020 10:15 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article

    CMS rejects Wyoming plan to lower air ambulance costs

    January 16, 2020


    The CMS earlier this month rejected a Wyoming Medicaid waiver proposal that aimed to lower air ambulance costs for all residents of the state.

    Wyoming essentially proposed making air ambulances into a public utility by using a Medicaid waiver to make all residents eligible for Medicaid coverage of air ambulances, regardless of their income level. The Wyoming Department of Health submitted the waiver to the CMS on Oct. 28, 2019 and it was denied on Jan. 3.

    "We do appreciate the timely decision from CMS on our waiver application related to air ambulance service. Working with our policymakers here at the state, we will look at the options of what we might do next," said Kim Deti, a spokesperson for the Wyoming Department of Health.

    Federal law limits states' power to regulate air ambulance billing, and the CMS said Medicaid waivers should not be used to circumvent federal law.


  • 16 Jan 2020 2:09 PM | AIMHI Admin (Administrator)

    Florida Mobile Integrated Healthcare Community Paramedicine Program Guidebook PDF Download

    From AIMHI Education Chair Matt Zavadsky. "Congratulations to Jane Bedford and the team at the Florida EMS Bureau for publishing an excellent guidebook for MIH-CP."

    From the introduction:

    The purpose of this Guidebook is to do just that – guide you through the research, analysis, planning, development, and successful

    launch of your own customized Florida Mobile Integrated Healthcare – Community Paramedicine (MIH-CP) Program. This resource

    is straight-forward and easy to read. In addition to guidance, it provides recommendations and lessons learned from MIH-CP

    programs in Florida, advice from experts across the country, with expanded resources and templates.

    This Guidebook is not designed to tell you what you must do,

    but to provide suggestions and ideas on what to consider in

    developing your own MIH-CP. As you read it, remember that

    not all the information in the Guidebook will apply to you or

    your organization. Use it to think through the elements of

    your program and remember that a successful program must

    be anchored in your community

  • 16 Jan 2020 1:31 PM | AIMHI Admin (Administrator)

    Please see this notice for information about an urgent recall of certain iStat cartridges. 

  • 13 Jan 2020 4:13 PM | AIMHI Admin (Administrator)

    ModernHealthcare source article | Matt Zavadsky

    Interesting editorial from Dr. Harrison with perhaps some peals for all participants and leaders in today’s healthcare environment!


    Healthcare leaders still learning how to offer value-based care

    Dr. Marc Harrison

    January 11, 2020


    A group of senior healthcare leaders and I recently discussed the transformation from volume-based care—in which providers are paid based on the number of services they provide and procedures they perform—to value-based care, which rewards us based on the health outcomes of our patients.

    This transition represents a huge change in incentives for health systems—encouraging hospitals and physicians to provide high-value, evidenced-based care—determined by comparing clinical results with the cost of care.

    Our discussion was held at the Intermountain Healthcare Leadership Institute and I’d like to share some key lessons learned from it, specifically for leaders embarking on the transformation toward value in healthcare.

     Continue reading►

  • 10 Dec 2019 8:34 AM | AIMHI Admin (Administrator)

    ModernHealthcare Source Article | Comments Courtesy of Matt Zavadsky

    • This pending recommendation from MedPAC is notable for EMS agencies on several fronts…

    • It’s the second time this month that MedPAC is recommending no rate increases for providers.  For ambulatory surgery centers it was based on lack of cost reporting, and in both ASCs and hospice providers, MedPAC is citing financial standing of the providers and the provider’s access to capital.  This finding may also be true for some EMS agencies.
    • Many innovative EMS agencies have partnerships with hospice agencies to reduce ED use and revocations.  Note that MedPAC is interested in further analysis of the ‘revocation’ issue.  Also note the ALOS for hospice enrollments.

    MedPAC thinks hospice payments are too high

    December 06, 2019




    The Medicare Payment Advisory Commission is expected to vote against a pay increase for hospice in January.


    Medicare hospice payments are probably too high, MedPAC's staff said at a meeting on Friday. Their research found that access to care is trending upward, while quality seems to have improved slightly. Hospices also have steady access to capital and robust Medicare margins—12.6% overall—so there's little reason to worry that beneficiaries' access to care would be hurt by financial problems anytime soon.


    "The hospice rates may be higher than needed to ensure appropriate access to care," said Karen Neuman, a principal policy analyst for MedPAC.


    The commission will likely recommend to Congress that they shouldn't increase the conversion factor, or base payment amount, for hospices. Most MedPAC members also favor reducing the hospice aggregate cap by 20% and instituting a wage adjustment for 2021.


    Their proposed recommendation was met with opposition from hospice providers.


    "(The National Hospice and Palliative Care Organization) does not support today's MedPAC recommendation to modify the hospice aggregate cap," said Edo Banach, president and CEO of NHPCO. "NHPCO shares MedPAC's goals, but this approach appears overly broad and likely to lead to a decrease in hospice access for patients and families. In the short term, we urge MedPAC to use a targeted approach that will have a higher likelihood of rewarding high quality, punishing low quality, and increasing access."


    Lowering the aggregate cap and wage adjustment would help level the playing field for hospice providers, generate cost savings and target the most profitable hospices with payment cuts.


    These changes wouldn't affect most providers because the hospices with the highest margins are mainly free-standing and for-profit providers. Those providers are disproportionately costly because their average lengths of stay are much higher.


    "Hospice margins increase with the length of stay," said Neuman.


    Not-for-profit hospices have an average length of stay of 68 days, while for-profit hospices have an average length of stay of 110 days. Likewise, free-standing hospices have an average length of stay of 92 days compared to just 70 and 57 days for home health- and hospital-based hospices, respectively.


    "For the same diagnosis, there tends to be a longer length of stay for the for-profits," said Dr. Jaewon Ryu, president and CEO of Geisinger. "They also tend to enroll folks who (are more likely) to have a longer length of stay."


    For-profit hospices have different patient mixes than other hospices, but it's not clear whether that's driven by the types of referrals they receive—or solicit—or if they're choosing to admit patients that are more likely to stay longer, he said.


    Some commission members also wanted to know more about high live-discharge rates among hospices that have exceeded the annual cap on hospice payments—hospices that go over the cap must repay Medicare for the overages.


    Most live discharges result from patients opting out of hospice or because they're no longer terminally ill, according to MedPAC's research. But there are questions about what's driving patients to leave hospice care.


    "Is the beneficiary choosing not to enroll? Is the beneficiary being encouraged to leave hospice?" said Neuman.


    Some larger hospice organizations track how close they are to the aggregate cap and their average length of stay, said James Mathews, executive director of MedPAC. They even adjust their business practices to make sure they don't exceed the limits.


    "They are able to change their referral sources . . . if they start to see they're having cap issues," said Mathews. "They might seek referrals from hospitals who are more likely to have shorter lengths of stay."


    Several MedPAC members lamented that Medicare's hospice benefit hadn't changed much since it was created for cancer patients in the early 1980's, even though the needs of Medicare beneficiaries and medical practice have transformed.


    It's time to rethink the design of the benefit in light of the "changing demography of end-stage disease, and an aging and increasingly disease-burdened society," said Dr. Jonathan Perlin, president of clinical services and chief medical officer of HCA Healthcare.

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