News & Updates

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

    HealthAffairs Source Article | Comments courtesy of Matt Zavadsky

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

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

    Karan Chhabra

    Kevin A. Schulman

    Barak D. Richman

    OCTOBER 17, 2019


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

     

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

     

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

     

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

    The Injustice Of Collecting Charges

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

    Continue Reading>

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

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

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

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

    Recall that JEMS published an article Steve Wirth penned on this issue in March 2019 - https://www.jems.com/articles/2019/03/recent-federal-advisory-opinion-favors-community-paramedic-programs.html

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

    October 09, 2019

    ALEX KACIK

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

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

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

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

    Continue reading►

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

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

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

    No highlights, because it’s ALL good!  J

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    Free the Paramedics!

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

    October 4, 2019

    By: Allison McNearney

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

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

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

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

    Continue reading and see pictures►

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

    Kaiser Health News Source Articles | Comments Courtesy of Matt Zavadsky

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

    Effective partnerships have shown excellent reductions in preventable readmissions.

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

    An exceptional resource!

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    New Round of Medicare Readmission Penalties Hits 2,583 Hospitals

    Jordan Rau

    October 1, 2019

     

     

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

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

    CONTINUE READING>

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

    JEMS Source Article | Comments Courtesy of Matt Zavadsky

    Interesting commentary from Dr. Bledsoe…

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

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

    Dr. Bledsoe asks the tough questions…

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    The Paramedic Shortage — Opportunity or Crisis?

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

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

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

    Keep reading►


  • 16 Sep 2019 8:26 AM | AIMHI Admin (Administrator)

    ModernHealthcare Source Article | Comments Courtesy of Matt Zavadsky

    This is a little long, but very much worth perusal. For our EMS stakeholders, what things have you changed in your organization to make your care more ‘person’ centered, as contemplated in the EMS Agenda 2050?

    Also, what role can transformed EMS agencies play in collaboration with other healthcare system stakeholders (hospitals, payers, physicians, home health agencies, etc.) in the march to ‘person centered care’? Supporting hospital in the home programs? Navigating 9-1-1 callers to dispositions other than a de facto transport to an ED (much like CMS’ ET3 model contemplates)?

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    Patient-centered care becoming 'person-centered care'

    JESSICA KIM COHEN

    September 14, 2019

    Health systems are broadening their definition of patient-centered care, sometimes extending the concept beyond clinical care by replacing the term “patient” with a seemingly more holistic “consumer” or “person.”

    Patient-centered care, a term popularized by the Institute of Medicine in 2001, initially described an approach to care that allows patients to guide their own clinical decisions. Now its definition has expanded—health systems see it as encompassing not just clinical care, but also patient experience, including how encounters stack up to patients’ expectations from other consumer-facing industries and, subsequently, whether patients view their care as worth the expensive price tag.

    But even as the term’s definition changes, health systems are in general agreement about the concept’s continued importance, according to Modern Healthcare’s most recent Power Panel survey of top healthcare CEOs. Nearly 70% of CEOs said they’ve made changes to the structure of their organization to be more patient-centered, and more than half have someone formally in charge of leading those efforts.

    CONTINUE READING►


  • 10 Sep 2019 8:19 AM | AIMHI Admin (Administrator)

    Axios source article | Comments courtesy of Matt Zavadsky

    How air ambulances got so expensive

     

     

    Air ambulances have become a lucrative business over the last few decades, at patients' expense, fueled by private equity and aided by the industry's relationships with providers, John Hopkins' Marty Makary writes in a new book out today.

     

    Why it matters: The rise of the air ambulance industry has resulted in massive surprise medical bills and a spike in unnecessary use.

    • Congress has included air ambulances in its effort to crack down on surprise medical bills, and the industry is fighting to avoid this regulation.

     

    Background: Air ambulances used to be owned and operated by hospitals, which sometimes took financial losses on their helicopter programs.

    • But that changed when investors saw a profit opportunity and began buying the ambulance services from hospitals. They then billed patients directly for rides.

     

    By the numbers: Between 2007 and 2016, the average price charged by one air ambulance company for a transport rose from $13,000 to $50,000.

    • With this kind of money on the table, the number of air ambulance companies rose by 1,000% between the 1980s and 2017.

     

    People in rural areas are hit the hardest. While some of these transports are necessary and life-saving, many others could be avoided, Makary writes.

    • Of the more than half a million ambulance flights a year, 80% aren't emergencies, but rather more like routine transfers.
    • To grow their business, companies began paying paramedics, nurses and doctors to become advisers with "informal agreements" to promote the company to emergency personnel and other providers.

     

    The other side: Air ambulances say that they have to charge higher rates to commercially insured patients to make up for lower government rates.

     

    The bottom line: "The air ambulance industry has become big business in America," Makary writes.

     


    Order the book.


  • 9 Sep 2019 12:23 PM | AIMHI Admin (Administrator)

    FierceHealthcare Source Article | Comments from Matt Zavadsky

    The findings in the referenced study could be due to a myriad of reasons – Many EMS agencies have protocols that determine patient destinations – including patient preference.

    Two seemingly most important quotes:

    Although proximity is important, previous studies reveal that the capabilities of an ED are also significant when EMS or patients make decisions about which ED to visit. For example, patients with a history of using inpatient care at a specific hospital may prefer to be transported to their so-called "home ED."

    The study also supports the idea that family or patient choice of ED may have a big impact on transport. Although data were not given specifically for ED destination by patient preferability, there was considerable overlap in the ED destination patterns of EMS transports and walk-ins (61.3% versus 52.9%), supporting this notion that patients have a choice in their destination hospital.

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    White Medicare patients transported to closest ED more often than blacks, Hispanics

    by Jacqueline Renfrow 

    Sep 6, 2019

    White Medicare patients are more likely to be transported to the closest emergency department (ED) than their black or Hispanic counterparts, according to a new study out of Boston University’s School of Medicine.

    Researchers recently set out to discover whether black and Hispanic Medicare patients are likely to be transported by emergency medical services (EMS) to the same emergency departments as white Medicare patients living in the same area—and to the closest available ED, according to proper protocol.

    KEEP READING>


  • 27 Aug 2019 9:56 AM | AIMHI Admin (Administrator)

    New York Times Source Article | Comments by Matt Zavadsky

    Nice article about North Carolina’s efforts.  Raleigh was one of the 1st EMS systems in the country to deploy EMS-based Mobile Integrated Healthcare with outstanding results!

    And, prior to joining BCBS of North Carolina, Dr. Conway was the CMO at CMMI – in meetings with Dr. Conway in that role, we was acutely aware of the impact EMS-based MIH programs were having in their communities – CMMI funded several MIH initiatives with Health Care Innovation Award grants.

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    Inside North Carolina’s Big Effort to Transform Health Care

    By Steve Lohr

    Aug. 26, 2019

     

    RALEIGH, N.C. — North Carolina seems like an unlikely laboratory for health care reform. It refused to expand Medicaid coverage under the Affordable Care Act, and ranks in the bottom third among states in measures of overall health.

    But the state has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for.

    North Carolina is in the early stages of turning away from the traditional fee-for-service model, in which doctors and hospitals are paid for each office visit, test or operation. Instead, providers will often be paid based on health outcomes like controlling diabetes patients’ blood sugar or heart patients’ cholesterol. The better the providers do, the more they can earn. If they perform poorly, money could eventually come out of their pocket.

    The goal is to keep people healthy and out of the hospital and to save money on health care spending.

    Continue Reading>


  • 22 Aug 2019 7:05 AM | Matt Zavadsky (Administrator)

    A very innovative proposal by Wyoming!  There are several Public Utility Model (PUM) EMS systems that have stood the test of time by continually proving value.  These systems provide exceptional clinical outcomes, excellent operational effectiveness and unparalleled economic efficiency. 

    PUM systems are set up under the premise that the fixed cost of providing EMS (capital, readiness, etc.) are best managed by empowering a governmental authority with the responsibility to provide all services – thus assuring consistency of clinical oversight and QA, maximizing operational synergy and distributing the infrastructure cost over all ambulance calls in the service area.

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    Wyoming's air ambulance coverage pitch

    Wyoming has come up with a unique way to make air ambulances — a common source of huge surprise medical bills — more affordable, according to the Georgetown University Health Policy Institute's blog.

    The big picture: The state is essentially proposing to turn air ambulances into a public utility.

    • Wyoming's health department has put together a Medicaid waiver that would make all residents, regardless of their income, eligible for Medicaid coverage of air ambulance services.
    • Providers would submit bids to serve as the only air ambulance operator within a particular geographic region.
    • The state would make flat payments to the operator that wins the bid, rather than paying them for each ambulance ride.
    • Patients' cost-sharing would vary based on their income, and insurers would pay into the program rather than covering air ambulances themselves.

    What we're watching: To go into effect, the proposal first has to be approved by CMS. State lawmakers would then have to make the necessary policy changes.

    Yes, but: The blog's author, Sabrina Corlette, correctly warns that "both federal officials and state lawmakers will likely be lobbied extensively by the air ambulance industry, which has a vested interest in maintaining the status quo."

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    Will it Fly? Wyoming Attempts End Run Around High Air Ambulance Prices

    August 21, 2019 

    by Sabrina Corlette

    http://chirblog.org/will-it-fly-wy-end-run-air-ambulance/

    As we’ve written before in this space, air ambulance charges are a growing source of surprise medical bills for consumers, and the charges can be eye-popping – five figures or more. Unfortunately, state-level efforts to limit balance billing by air ambulance companies have thus far been stymied by the Airline Deregulation Act (ADA) of 1978, which prevents states from enacting laws regulating the prices of any air carrier, including air ambulance. In 2018, the U.S. Congress considered legislation that would have given state officials the ability to regulate the more egregious billing practices of air ambulance providers, but congressional leaders ultimately bowed to pressure from the industry. The enacted bill authorized a Department of Transportation advisory committee to study the issue, the ultimate “kick the can” solution to the problem.

    This year, although Congress is debating several bills to protect patients from surprise medical charges, only one – sponsored by Senators Lamar Alexander and Patty Murray – would extend those protections to patients needing emergency air transport. Meanwhile, air ambulance bills are only getting higher (for example, air ambulance charges in New Mexico have risen 300 percent since 2006) and more air ambulance providers are choosing not to participate in health plan networks, making it easier for them to sock patients directly with their high charges.

    Some states have tried to protect consumers, but the scope of these efforts are curtailed by federal law. For example, Texas and North Dakota laws to limit air ambulance balance billing were ruled as preempted by the ADA in two federal district courts. Another federal law – the Employee Income Security Act (ERISA) – preempts states from regulating self-funded employer plans, including any imposition of a requirement that these plans include air ambulances in their networks or hold enrollees harmless for out-of-network charges.

    Wyoming may have hit on a unique solution. The state is proposing to turn air ambulances effectively into a public utility.

    Wyoming’s Plan

    The Wyoming Department of Health has developed an 1115 Medicaid waiver application that would make all Wyoming residents, regardless of income, eligible for Medicaid for air ambulance services only. Under the plan, the state would:

    • Set the basic parameters of air ambulance coverage under the Medicaid program.
    • Solicit competitive bids from air ambulance providers to serve as the sole provider within a prescribed geographic area within the state.
    • Create a centralized call center that would direct all calls for air ambulance services to the approved providers.
    • Make regular flat payments to these providers (instead of reimbursing on a fee-for-service basis).
    • Set patient cost-sharing on a sliding scale, based on income.
    • Recoup costs for operating the program from private insurers, employer plans, and individuals already paying for transports.

    In its pitch to state lawmakers and stakeholders, the Department of Health argues that the air ambulance industry is an example of market failure, noting that most patients cannot “shop around” for air ambulance services. Even in situations when the patient is conscious or in serious medical distress, the cost is not transparent because of differences in network arrangements and cost-sharing among plans. Officials further note that the supply of air ambulances has risen dramatically in the past five years, and these providers have very high fixed costs that they must recoup, largely from private payers and patients. Indeed, in 2018, Wyoming employers paid an average of $36,000 per flight. The Department argues that, as with other critical commodities with high fixed costs such as water and electricity, a regulated monopoly is a more efficient way to deliver the needed services.

    Questions and Next Steps

    There remain a number of hurdles before Wyoming’s unique plan can take effect. First, the federal government would have to approve the waiver proposal. The Wyoming legislature would then have to enact state-level legislative changes to authorize the program. Both federal officials and state lawmakers will likely be lobbied extensively by the air ambulance industry, which has a vested interest in maintaining the status quo. Also, although the state argues that the Medicaid program should not be preempted under the Airline Deregulation Act, that premise has not yet been tested in court. Other questions include whether self-funded employer plans, which are not subject to state regulation, will opt-in to the state program, enabling it to be budget neutral.

    Wyoming has posted its waiver application and invited public comment. It expects to submit the proposal to federal authorities by September 1, 2019, with another public comment period expected later in the year.


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