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

  • 13 Sep 2018 8:44 PM | AIMHI Admin (Administrator)

    Source Article | Article & Comments Courtesy of Matt Zavadsky

    The author and those he interviewed do a very good job sharing insight into the roles and challenges of the fire service of today… And tomorrow….

    A New Day in the Firehouse

    The job of firefighter has change almost beyond recognition, It’s not easy to do – or recruit those necessary to do it.

    BY DANIEL C. VOCK | SEPTEMBER 2018

    The job of a firefighter isn’t what it used to be. Take Charlottesville, Va., for example, where in just the past 18 months the fire departments in the city and surrounding Albemarle County have searched the wreckage of a plane crash in a hard-to-reach wooded area, performed water rescues after spring floods, responded to the derailment of a passenger train carrying Republican members of Congress and, most memorably, provided medical assistance during white supremacist rallies in Charlottesville, including one incident that left three people dead last summer. This was all in addition to dealing with downed power lines, an ammonia leak, frozen pipes and yes, even a few fires.

    The workload of fire departments has grown substantially, even as their core mission -- putting out fires -- has dwindled.

    “Communities tend to lean on the fire service in times of crisis,” says Charlottesville Fire Chief Andrew Baxter. “People are looking to the fire service for leadership and partnership for all aspects of emergency response.”

    But that ever-evolving mission has brought new strains. It requires training and planning for new dangers such as civil disturbances or active shooters. With increased call volumes, it requires more personnel at a time when a growing number of agencies are finding it difficult to recruit both career and volunteer firefighters, and to diversify their workforces to include more women and minorities. And it comes as some cash-strapped cities are questioning whether the old system of responding to larger call volumes by deploying more firefighters with bigger equipment at more fire stations is sustainable anymore. 

    Continued...

    Read Full Article>
  • 13 Sep 2018 8:24 PM | AIMHI Admin (Administrator)

    Source Article | Comments Courtesy of Matt Zavadsky

    Interesting publication in today’s HealthAffairs…

    While the NEMT model in most states do not include ambulances, some do… More disruptive innovation centered on enhanced patient experience and reduced costs.

    Shifting Non-Emergency Medical Transportation To Lyft Improves Patient Experience And Lowers Costs

    Brian Powers  Scott Rinefort  Sachin H. Jain

    SEPTEMBER 13, 2018

    Limited access to reliable transportation causes millions of Americans to forgo important medical care every year. Transportation barriers are most prominent among the poor, elderly, and chronically ill—populations for whom routine access to ambulatory and preventive care is most important.

    Payers that focus on vulnerable populations have taken steps to address transportation barriers by providing non-emergency medical transportation (NEMT) benefits to select beneficiaries.  A majority of Medicare Advantage (MA) plans and state Medicaid programs currently provide NEMT benefits.

    NEMT benefits are typically administered by specialized brokers that coordinate and dispatch private cars, taxis, or specialized vehicles to bring patients to medical appointments. Multiple reports have highlighted challenges with traditional approaches to NEMT delivery, including poor customer service, inadequate responsiveness, and fraud and abuse. In the face of these challenges, payers and health care delivery organizations have been experimenting with new strategies for delivering NEMT.

    An approach that has attracted considerable attention is the use of transportation network companies (TNCs)—such as Uber or Lyft—to provide NEMT services. NEMT brokers such as such as American Logistics CorporationNational MedTransAmerican Medical Response, and Access2Care are all now piloting TNC-based rides. New companies, such as Circulation and RoundTrip, have emerged to help hospitals and health plans offer TNC-based rides. And both Lyft and Uber are contracting directly with health plans and delivery organizations to provide NEMT services.

    Despite the proliferation of these programs, there is scant data regarding their impact. Here we report the results from a large-scale, system-wide implementation of Lyft-based NEMT services at CareMore Health.

    Partnering With Lyft And ALC To Provide Transportation

    CareMore Health is a physician-founded, physician-led integrated care delivery system. For many patients enrolled in its MA plans, CareMore provides a diverse range of NEMT services free of charge. Curb-to-curb (C2C) rides are most similar to traditional taxi or private car services. Patients that require extra assistance or specialized transport have access to door-to-door (D2D) and wheelchair accessible van (WAV) services.

    As is typical for MA plans, CareMore contracts with brokers to administer its NEMT benefits. Historically, these NEMT brokers arranged for rides using private car services. In 2016, CareMore launched a pilot program to evaluate the impact of Lyft-based C2C rides on patient experience and costs. The pilot ran for two months at select CareMore locations in Southern California, during which a total of 479 rides were provided. Results were encouraging: wait times decreased by 30 percent and per-ride costs decreased by 32 percent, and satisfaction rates were 80 percent.

    In light of the encouraging results from the pilot, CareMore expanded the program system wide. Partnering with NEMT broker American Logistics Corporation (ALC), CareMore began offering Lyft-based rides throughout all MA markets in August 2016, which included 75,000 members across 18 counties in California, Nevada, Arizona, and Virginia. 

    During the pilot, Lyft-based services occasionally led to confusion. Accustomed to branded vehicles, and inexperienced with Lyft and other TNCs, patients were sometimes confused when an unfamiliar car arrived to bring them to their medical appointments.

    Based on this feedback, adjustments were made to improve patient experience. First, the experience of booking did not change—patients call a CareMore associate who takes down information regarding time, pick-up, and drop-off locations. This information is then securely relayed to ALC, who uses custom-built software to schedule a Lyft driver at the requested time. Second, CareMore makes clear that Lyft, not the car services that patients may be accustomed to, will be providing the ride. This occurs when the ride is booked, and again when CareMore calls to confirm the ride.

    Members that would like to know the specific make and model of the car that has been dispatched are able to call a CareMore associate to obtain that information. Third, CareMore and ALC released a smart phone application—MyRide Manager—that allows patients, caregivers, and care team members to track and manage rides via an interface that resembles Lyft’s or other TNCs’ native applications. 

    Impact And Results

    The CareMore-Lyft-ALC partnership was launched across all CareMore MA markets in August 2016. Within three months, half of all C2C rides were Lyft-based. By the end of 2017, CareMore provided 91 percent of all C2C rides through Lyft, accounting for up to 7,000 rides per month, and a total of 68,993 rides over the course of 2017 (See Exhibit 1). At this point, the absence of Lyft availability in certain counties has limited the ability to scale the program any further.


    Results through the end of 2017 are in line with those reported during the pilot:

    • On Time Performance: On time performance (rides arriving within 20 minutes of scheduled pick-up time) for Lyft-based C2C rides was 92 percent, compared to 74 percent for non-Lyft rides. 
    • Wait Times: The average wait time for Lyft-based C2C rides was 9.2 minutes, compared to 16.6 minutes for non-Lyft C2C rides, a 45 percent decrease. Reductions in wait times were most pronounced among “on-demand,” return rides from clinics or other health care settings.
    • Patient Experience: Patient satisfaction results exceeded those from the pilot program, possibly reflecting the strategies discussed above aimed at reducing confusion. In a survey of CareMore patients using Lyft-based rides, 96 percent reported feeling “Safe” or “Very Safe” during their ride and 98 percent reported being “Satisfied” or “Very Satisfied” with the service (timeliness, cleanliness, and professionalism of the driver).
    • Costs: Lyft-based C2C rides cost CareMore 39 percent less, on average, than non-Lyft C2C rides. Reducing per-ride costs allowed CareMore to expand its NEMT benefit throughout the course of 2017, providing an additional 28,000 rides (a 12 percent increase) at no additional cost to the system.

    Next Steps

    From late 2016 through 2017, CareMore Health rapidly scaled access to Lyft-based NEMT rides across its MA patients. Lyft now provides the vast majority of C2C rides for CareMore patients, and doing so has improved patient experience, reduced wait times, and increased the overall efficiency of CareMore’s NEMT benefit.

    Although these results are encouraging, it is important to remember that TNC-based NEMT is not a panacea. Rural areas remain under-served by TNCs and there does not yet exist a robust TNC offering for older, sicker patients who require D2D or WAV services. Nonetheless, the cost-savings generated by switching to Lyft for C2C rides can help support increased access to NEMT for patients requiring specialized services.

    It remains to be seen whether or not the benefits of TNC-based NEMT extend beyond improved satisfaction and lower costs to fewer missed appointments and better health outcomes. The structure of the CareMore-Lyft-ALC partnership did not permit a formal evaluation on these dimensions. Though there are anecdotal reports that TNC-based NEMT can reduce missed appointments, rigorous analyses have not shown an effect. As TNC-based NEMT grows, attention should be paid to better clarifying this potential impact.


  • 12 Sep 2018 9:23 AM | AIMHI Admin (Administrator)

    Source Article | Insights Courtesy of Matt Zavadsky

    Interesting article… 

    There is currently legislation pending in Congress (H.R. 3780) which proposes to place quality requirements and mandatory cost reporting for air ambulance providers to be eligible for Medicare participation.  In summary:

    The Department of Health and Human Services (HHS) shall establish minimum standards that must be met by air-ambulance suppliers and providers as a condition of their participation in Medicare.

    These standards must address:

    1. scope of practice, training, and clinical capability;
    2. medical equipment and vehicle attributes;
    3. documentation;
    4. medical direction and oversight;
    5. reporting of specified events;
    6. patient safety and infection control;
    7. clinical quality-management and performance-improvement programs; and
    8. particular populations. An air-ambulance provider or supplier that is accredited by an HHS-approved organization shall be deemed to be in compliance with these standards.

    HHS must establish an air-ambulance quality-reporting and performance program under which Medicare payment is determined according to a specified performance-based formula. Performance measures shall address patient safety, clinical quality, and over-triage.

    An air-ambulance provider or supplier must, subject to suspension of payment under Medicare, annually submit specified cost data to HHS.

    https://www.congress.gov/bill/115th-congress/house-bill/3780

    Lawmakers call for greater oversight of air ambulance operators

    By Susannah Luthi 

    September 11, 2018

    Two senators are pushing the Trump administration to use regulation to target exorbitant air ambulance charges faced by airlifted patients.

    Sens. Claire McCaskill (D-Mo.) and Roger Wicker (R-Miss.) led a Monday letter to Transportation Secretary Elaine Chao to urge more oversight and support for consumer complaints. The lawmakers represent states that have seen headlines with sticker-shock stories of patients finding themselves facing tens of thousands of dollars in charges after being airlifted to a hospital.

    The Senate continues to mull changing air ambulance regulation through its upcoming Federal Aviation Administration reauthorization bill. State efforts to curb prices have faced a hurdle in courts due to the Airline Deregulation Act, which prevented federal regulation of airline prices.

    "Congress hardly could have imagined when the ADA was passed nearly 40 years ago that it would block states from overseeing healthcare services," McCaskill and Wicker wrote. "Given this dynamic, the Department of Transportation (DOT) should aggressively and effectively exercise its authority as perhaps the only regulator over air ambulance operators."

    The senators have asked Chao to explain how the Transportation Department is investigating consumer complaints against air ambulance operators and to specify how the agency is managing oversight and investigations of these operators.

    The letter requests a thorough explanation of the authorities the department has to regulate charges and require insurers to cover "reasonable costs," and asks whether the Federal Trade Commission or state attorneys general can prosecute air ambulance operators on behalf of consumers.

    The lawmakers reference a 2017 report from the Government Accountability Office that found the median charges from air ambulance operators doubled from 2010 to 2014, from about $15,000 to about $30,000 per trip.

    "Anecdotally, it is clear that a greater share of this cost is being passed along directly to consumers through a practice known as balance billing, but GAO was unable to determine the prevalence of this practice because of a lack of data," McCaskill and Wicker said.

    McCaskill for months has been probing balance billing issues including the charges left for patients by air operators and insurers that refuse to shoulder the full cost of transport. States are also increasingly taking up legislation to address balance billing, but their authorities are limited by ERISA law.


  • 10 Sep 2018 12:39 PM | AIMHI Admin (Administrator)

    Source Article | Courtesy of Matt Zavadsky

    Written by Julie Spitzer, Becker's Hospital Review 

    September 05, 2018

    As payers increasingly turn to alternate modes of care delivery as a way to keep patients with low-acuity conditions out of expensive emergency departments, recent evidence suggests that urgent care centers and retail clinics — not telehealth — appear to be patients' go-to options, a JAMA Internal Medicine investigation has found.

    A team of researchers led by Sabrina Poon, MD, a physician in the department of emergency medicine at Brigham and Women's Hospital in Boston, reviewed a set of deidentified claims data from Aetna between Jan. 1, 2008, and Dec. 31, 2015. The cohort included about 20 million insured members per study year.

    Here are six study highlights:

    1. Visits to the ED for low-acuity conditions decreased 36 percent during the eight-year study period.
    2. Visits to non-ED facilities increased 140 percent.
    3. Retail clinics saw the greatest increase in visits for low-acuity conditions (214 percent), followed by urgent care centers (119 percent).
    4. Patients did not often utilize telemedicine for treatment. Specifically, telehealth saw an increase from 0 visits in 2008 to 6 visits per 1,000 members in 2015.
    5. Utilization (31 percent) and spending (14 percent) per person per year for low-acuity conditions increased during the study period.
    6. The increase in spending was driven by a 79 percent price hike per ED visit for the treatment of low-acuity conditions

    "From 2008 to 2015, total acute care utilization for the treatment of low-acuity conditions and associated spending per member increased, and utilization of non-ED acute care venues increased rapidly," the study authors concluded. "These findings suggest that patients are more likely to visit urgent care centers than EDs for the treatment of low-acuity conditions."

    To access the complete study, click here.



  • 4 Sep 2018 11:35 PM | Matt Zavadsky (Administrator)

    A very nice report, part of the IHI Patient Safety in the Home initiative.  

    A full report, with additional case studies can be found in the No Place Like Home: Advancing the Safety of Care in the Home report.

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

    Can Paramedics Help Achieve the Triple Aim?

    By IHI Multimedia Team

    Friday, August 24, 2018

    Source Article 

    Background of the Problem

    Left unidentified and unaddressed, the medical, social, and patient safety concerns that arise in the home can increase the burden on emergency medical services and emergency departments. In particular, patients with complex medical conditions and/or challenging socioeconomic situations may be more reliant on emergency health care resources because they may face multiple barriers to accessing health care and other services, have unmet medical and social needs, or grapple with unsafe home conditions. Paramedics are proficient in interacting with patients in home settings and can respond quickly when patients need help. Paramedics thus represent an important resource for providing critical support and services to individuals who face safety and health care challenges at home.

    Description of the Program

    MedStar Mobile Healthcare, an EMS provider in the greater Fort Worth, Texas, area, developed a suite of programs designed to leverage the skills and expertise of paramedics to intervene with high-risk, high-need patients in home settings. These Mobile Integrated Healthcare (MIH) programs aim to ensure that patients receive safe, effective care in the most appropriate setting.

    Each of the MIH programs includes these components:

    • Processes to identify patients who are eligible for the program.
    • In-depth, home-based visits are conducted by specially trained Mobile Healthcare Paramedics (MHPs) to identify patients’ medical, social, behavioral, and safety-related needs.
    • Bimonthly care coordination meetings are held in which a MedStar program coordinator confers with hospital caseworkers, community service agencies, and other care providers to review the needs of enrolled patients.
    • Alternative services help patients avoid having to call for EMS, including the ability to request a home or telephone visit from an MHP instead of calling 911.
    • A continuously updated electronic medical record provides mobile access to information about the patient’s entire course of assessments and treatments while participating in the program.
    • Contractual arrangements exist between MedStar and hospitals, commercial insurers, and other health care service organizations to receive payments for the MIH services.

    MedStar identifies patients who qualify for its MIH programs using a variety of approaches and data sources:

    • MedStar identifies patients for the High Utilizer Program (those who have called 911 at least 15 times in the past 90 days) by analyzing 911 utilization data and receiving referrals from emergency departments, frontline MedStar staff, and other first-responder agencies, as well as agencies and payers partnered with MedStar.
    • Participating hospitals and physicians refer patients assessed as being at high risk for readmission within 30 days of discharge to the Readmission Prevention Program.
    • Agencies partnered with MedStar refer patients to the Home Health Partnership Program, the Hospice Revocation Avoidance Program, and the Observation Admission Avoidance Program.

    After a patient is deemed eligible for one of MedStar’s MIH programs, a specially trained MHP or a representative from a partner organization contacts the patient to explain the benefits of the program. If the patient agrees to participate, the patient signs a consent form authorizing the appropriate parties to share relevant patient information via the electronic medical record system.

    The MHP conducts an in-depth, in-home visit with the patient, family members, and caregivers. During the visit, the MHP performs a full medical assessment, evaluates the patient’s home environment and safety-related factors, and identifies opportunities to enroll the patient in other programs to help meet the patient’s clinical, social, or behavioral health needs (e.g., medication compliance, nutritional support, healthy lifestyle changes).

    Based on the assessment findings, the MHP works with the patient and family to develop or reinforce an individualized care plan, in coordination with the patient’s primary care network. This plan outlines the patient’s needs, associated goals, and steps needed to reach the goals. The patient and family members receive a copy of the plan, which is entered into the electronic medical record system and thereby is readily accessible to MHPs and other providers.

    The patient receives a telephone number to use to request an MHP home or telephone visit as an alternative to calling 911. Because MedStar is the 911 provider in the service area, if the patient calls 911, the MHP is dispatched to the patient’s location, along with the normal EMS system response. Once on scene, the MHP may apply established care protocols to address the patient’s needs, thereby preventing an unnecessary ambulance transport.

    The MHP conducts periodic follow-up visits with patients based on their needs. These visits provide an opportunity to evaluate any new medical or safety needs, monitor progress in meeting care plan goals, and provide the patient with additional supports or referrals.

    A MedStar MIH program coordinator meets bimonthly with hospital caseworkers, community service agencies, and other care providers to review the needs of patients who are enrolled in the program and to coordinate resources.

    Some of MedStar’s MIH programs have a formal “graduation” process for patients whose social and safety needs have been addressed and who can manage their own health care needs.

    Program Results

    MedStar’s MIH programs have garnered domestic and international interest as a promising strategy to address the health care and home safety needs of patients with complex medical conditions. MedStar has hosted site visits by representatives of more than 221 communities from 46 states and seven other countries who are interested in learning how the MIH programs work and replicating the MIH model.

    Across its portfolio of MIH programs, MedStar has “graduated” more than 8,500 patients. MedStar’s MIH programs have improved the quality of life for enrolled patients and reduced EMS transports to the hospital, ED visits, and hospital admissions, suggesting that the health of these patients is better because their health and safety needs were addressed at home.

    Evidence includes the following:

    • A retrospective evaluation [Published in the American Journal of Emergency Medicine] assessed pre- and post-intervention data for 64 patients who completed MedStar’s MIH High Utilizer Program. The evaluation showed that:
      • Patients who had reported problems with mobility, pain control, and ability to perform activities of daily living before participating in the program reported improvements in these areas (38, 42, and 58 percent, respectively) after participation.
      • After participation, 73 percent of patients rated their health as improved.
      • Patients had 61 percent fewer EMS transports, 66 percent fewer ED visits, and 56 percent fewer hospital admissions.
    • A MedStar report analyzed trends in pre- and post-enrollment utilization data among 581 patients enrolled in the MIH High Utilizer Program between October 2013 and March 2018. The analysis showed that:
      • Ambulance transports to the ED were reduced by 5,133 (58 percent), and ED visits and hospital admissions were reduced by 2,395 and 462, respectively.
      • The reductions in utilization decreased health care spending by $9.3 million during the evaluation period, for a savings of $16,046 per enrolled patient.
    • MedStar found a total expenditure savings of more than $14 million across all MIH programs between June 2012 and March 2018.13 This represents savings of about $3.2 million in ambulance transport, $4.5 million in ED visits, and $6.4 million in hospital admissions.
    • Between September 2013 and March 2018, 388 patients identified by a hospice agency as likely to disenroll from hospice were enrolled in MedStar’s Hospice Revocation Avoidance Program. Of those, only 18 percent had a disenrollment.
    • The patient experience across MedStar’s MIH programs was favorable, with overall average ratings ranging from 4.69 to 4.84 on a 5-point Likert scale assessing 12 items related to patient experience.
    • Between October 2013 and July 2017, 295 patients with a prior 30-day readmission were identified as being at high risk for another 30-day readmission and enrolled in the Readmission Prevention Program. Of those, 47.5 percent had a 30-day readmission, which evaluators considered lower than would have been expected.
  • 3 Sep 2018 5:28 PM | AIMHI Admin (Administrator)

    Source Article | Courtesy of Matt Zavadsky

    Nice article in JEMS that boils down the results of the PART study into understandable, and potentially actionable bites.

    Key statement(s) from the authors:

    Results

    The trial began enrollment on Dec. 1, 2015, and completed enrollment on Nov. 4, 2017. A total of 3,004 subjects were enrolled, with 1,505 assigned to initial King LT and 1,499 assigned to initial ETI. Patient demographics and arrest characteristics were similar in both groups.

    Elapsed time from first EMS arrival to airway start was shorter for King LT than ETI (mean 11.0 mins. vs. 13.6 mins.). Initial airway success rate was 89.9% in the King LT group and 51.3% in the ETI group. Overall, the King LT and ETI airway success rates (initial plus rescue airway attempts) were 94.2% and 91.5%, respectively. The ETI group was more likely to require more than three insertion attempts (18.9% vs. 4.5%).

    The main outcome of the study, 72-hour survival, was significantly higher for King LT than ETI (18.3% vs. 15.4%), a difference of 2.9%. Secondary outcomes were also better for King LT than ETI including: ROSC (27.9% vs. 24.3%), hospital survival (10.8% vs. 8.1%), and favorable neurological status at discharge (7.1% vs. 5.0%).

    The ETI group had higher rates of multiple airway insertion attempts, unsuccessful airway insertion, and unrecognized airway misplacement or dislodgement. Other in-hospital adverse events were similar between treatment groups.

    What It Means

    In this trial of 3,004 adults, we found that a strategy of initial King LT resulted in better 72-hour survival than initial ETI. Initial King LT also had better outcomes including ROSC, survival to hospital discharge, and favorable neurologic status at hospital discharge. Although these differences seem small, they’re important.

    If all EMS systems across the country were to shift to King LT as the primary advanced airway for OHCA patients and saw a similar 2.7% increase in hospital survival rate, more than 10,000 extra lives would be saved each year.

    ETI vs. SGA: The Verdict Is In

    A field guide to the results of the Pragmatic Airway Resuscitation Trial (PART)

    Thu, Aug 30, 2018

     By Shannon W. Stephens, EMT-P , Henry E. Wang, MD, MS , Pam Gray, EMT-P , Randal Gray, MEd, BS, EMT-P , Linda Mattrisch, BS, EMT-P , Ahamed H. Idris, MD , Mohamud Daya, MD, MS

    Read full article

  • 30 Aug 2018 5:29 PM | AIMHI Admin (Administrator)

    Congratulations to Alexia Jobson of REMSA on her unanimous election to Chair of the AIMHI Public Relations & Communications Committee. 


  • 30 Aug 2018 1:46 PM | AIMHI Admin (Administrator)
    Source Article Link | Courtesy of Matt Zavadsky & Scott Moore, Esq.

    Excellent overview of the EasCare program… 

    EasCare’s program was highlighted by Scott Cluett at the NAEMT EMS 3.0 Transformation Summit in April 2018.

    Tip of the hat to Scott for sharing this important news article!

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

    A new role for paramedics: treating patients at home

    By Priyanka Dayal McCluskey, Globe Staff

    August 29, 2018

    QUINCY — The sun was setting as paramedic Matthew Michaud arrived at the second-floor apartment where Jamal Lee sat in pain.

    Lee, who uses a wheelchair, had a urinary tract infection, a sore groin, a headache, and spells of feeling hot and cold. But instead of taking Lee to the hospital, as most paramedics would, Michaud treated him at home.

    Over the course of more than two hours, as a Superman movie blared on the bedroom TV and Lee’s children played video games in the next room, Michaud checked his breathing, blood, and urine. He surveyed the part of Lee’s body that hurt and took pictures. He gave Lee some medicine.

    Michaud is among a small number of paramedics in Massachusetts working in pilot programs that allow them to treat patients with urgent medical needs at home, a practice that soon will be more common through money included in the recently approved state budget.

    Under the supervision of physicians, and with special training, these paramedics — part of an emerging field known as community paramedicine or mobile integrated health — can examine patients, administer medications, and provide care instructions.

    The goal is to avoid unnecessary and costly hospital visits while treating patients where they are most comfortable.

    These programs, proponents say, can be particularly helpful for patients who are frail, elderly, have chronic conditions, live in remote areas, or need care at night when doctor’s offices are closed.

    The concept has critics who worry whether paramedics have the right training to treat patients at home. But many in Massachusetts have high hopes and argue that expanding the role of paramedics is an important strategy for slashing health care costs and improving patient care.

    “As we think about how we can improve the value of care — making sure individuals get the health care that they need at a reasonable cost and at superb quality — the mobile integrated health program is something I’m very excited about because it has the potential for doing that,” said Dr. Monica Bharel, the Massachusetts commissioner of public health.

    With an additional $500,000 included in this year’s state budget, the Department of Public Health is hiring five people to run the state’s mobile integrated health program and expects to begin accepting applications this fall. In August, health officials adopted new state regulations that govern these programs.

    Paramedics responding to emergencies are generally required to take sick patients to a hospital, unless the patient refuses to go. But the new state rules waive this requirement for medics who are part of mobile integrated health programs.

    Similar efforts are underway in many other states, though Massachusetts officials say their initiative will be the most comprehensive in the nation. As it is implemented, they are likely to draw on the experience of two local ambulance companies, EasCare and Cataldo, which have been experimenting with programs over the past four years.

    EasCare Ambulance sends specially trained paramedics to see patients of Commonwealth Care Alliance, a Boston-based medical provider and insurer that manages care for low-income patients with chronic health issues who are covered both by Medicare and Medicaid.

    Commonwealth Care is paid a set amount of money to manage care for its patients. So when patients avoid expensive hospital visits, the company saves money.

    Under this pilot, patients who feel sick can call a number, and then a nurse decides, based on the severity of the symptoms, whether the patient should get a visit from a paramedic that evening. (The alternatives: wait until the next day for an appointment with a provider or go to the hospital right away.)

    Since late 2014, paramedics have completed more than 2,300 home visits for Commonwealth Care patients with lung disease, heart failure, chest pain, dehydration, UTIs, and other medical issues. About 82 percent of the time, paramedics were able to treat patients at home. Other patients were deemed sick enough to be sent to hospitals.

    All the avoided hospital visits have saved Commonwealth Care at least $6 million, according to company officials. They estimate that paramedics can treat patients at home at one-third the cost of hospital emergency rooms.

    “This replaces an urgent care visit, this replaces an ER visit,” said Dr. John Loughnane, the chief of innovation at Commonwealth Care.

    “The paramedics are my eyes and ears,” Loughnane added. “They can take a picture and upload it. They take direction of what I think is the appropriate [evaluation and treatment plan].”

    Paramedics have treated patient David Drayton at his apartment in Roxbury about half a dozen times this year. If they hadn’t come, Drayton said, he would have gone to the emergency room.

    “I don’t want to go the hospital, sit in the ER all day,” said Drayton, 41, who is quadriplegic and said he has frequent UTIs and stomach pain. “They can do it right here for you. I think they’re a big help.”

    Lee, the Quincy patient, feels the same way. He has had health problems since a gunshot wound three decades ago caused a spinal cord injury that cost him most of the use of his limbs.

    The 47-year-old tries to stay active — he drives and looks after his children. But on a recent day this summer, he felt too sick to bring himself to his nurse practitioner’s office, and he didn’t want to go to the hospital.

    So Michaud, an EasCare paramedic, was dispatched to check on him. When Michaud arrived, he asked Lee a series of questions.

    “Pain?” he asked. “On a scale of 1 to 10, how bad [is it]?”

    “About 7 to 9,” Lee replied, propped up in bed.

    Michaud drew some blood and analyzed it instantly with a handheld device. He took a urine sample and made room on the kitchen counter to test it. Then he stepped out to his ambulance — a Ford Escape SUV — to confer with the doctor and nurse practitioner on call about what to do next.

    Michaud returned inside to give Lee an IV antibiotic for his infection. There are no IV poles in Lee’s bedroom, but Michaud found a nail on the wall that served the same purpose.

    Lee was still in pain. But “mentally,” he said, “I feel like I’m doing something about what’s going on. If you have to just deal with it, that’s depressing.”

    The expanded role for paramedics such as Michaud is in some ways similar to what visiting nurses have been doing for many years. But nurses typically visit patients on regular schedules — not for emergencies. And while nurses have higher levels of training, they don’t carry the stock of medicines that paramedics have in their ambulances.

    “Paramedics are very good at walking into a room and determining whether somebody is sick or not sick, just by looking at them and their environment,” said Scott Cluett, director of mobile integrated health for EasCare Ambulance. “Previously, working on an ambulance, they were just hooking and hauling — grabbing somebody in the street and bringing them to the ER. Now we’re really involved with that patient’s care, and it’s very rewarding.”

    Ambulance companies stand to benefit from the new state rules that allow them to grow their business with these new programs. The programs also might appeal to health care providers and insurers that have a financial stake in managing the health of their patients and are trying to reduce costs.

    More than 40 percent of emergency room visits are thought to be avoidable; they involve patients with problems that safely could be treated in less costly settings, according to state estimates.

    “Reducing readmissions and reducing visits to the emergency room is really what the program is about,” said Dennis Cataldo, vice president of Cataldo Ambulance Service.

    Cataldo Ambulance launched a pilot program with Beth Israel Deaconess Medical Center about four years ago. Most of the patients treated by paramedics in that program avoided hospital visits, Cataldo officials said.

    But not everyone likes the idea.

    Donna Glynn, president of the Massachusetts chapter of the American Nurses Association, a professional association, said nurses — not paramedics — should be treating patients at home.

    “Paramedics aren’t trained in chronic care management,” she said. “A paramedic is just jumping in, putting a Band-Aid on something, and leaving.”

    At the Home Care Alliance of Massachusetts, which represents home care agencies, executive director Patricia Kelleher said she supports programs that help patients avoid emergency room visits, but she worries about duplication of home care services already done by nurses.

    Doctors who work in emergency departments, meanwhile, are concerned that paramedicine programs might keep at home some patients who need or want to go to the hospital, said Dr. Scott Weiner, president of the Massachusetts College of Emergency Physicians.

    “It all depends on the details,” he said.


  • 30 Aug 2018 10:23 AM | Matt Zavadsky (Administrator)

    Nice to see this economic model growing!

    Highmark now joins payers like Anthem, Arizona Medicaid, BCBS in Texas and Georgia, paying EMS for things other than transporting patients to the hospital.

    Shout out to Robert McCaughan, our friend and former Pittsburg EMS Chief, now the vice president of pre-hospital care services for Allegheny Health Network! Surely Bob’s fingerprints are on this project!!

    Tip of the hat to Chris Kelly for making us aware of this article!


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

    Highmark pilot program to pay ambulance companies when patients not taken to hospital

    BRIAN C. RITTMEYER | Wednesday, Aug. 29, 2018


    Source Article


    Highmark will reimburse ambulance companies for certain calls where patients aren’t taken to hospitals as part of a new “treat-and-release” program.

    Highmark and Allegheny Health Network announced the pilot program Wednesday.

    Currently, Highmark’s benefits and medical policy, similar to most insurers’ policies, only allows payment for emergency ambulance services when the patient is taken to an emergency room.

    “We want to ensure that ambulance services are paid appropriately and members receive appropriate care,” said Robert Wanovich, vice president of ancillary provider strategy and management for Highmark.

    Sixteen ambulance services across 12 counties are participating, according to spokeswoman Stephanie Waite. They include Butler Ambulance, Cranberry Township EMS, Kittanning EMS, Medical Rescue Team South, Mon Valley EMS, Pittsburgh EMS, Plum EMS, Ross West View EMS, Rostraver EMS and Valley Ambulance.

    Waite said Highmark is not disclosing how much it will pay ambulance companies per call under the program.

    Under the pilot program, Highmark will contract with and reimburse participating emergency medical services for treating patients age 18 and older who have low blood sugar, asthma attacks and seizure disorders, without the requirement of being taken to an emergency department.

    “The goal of the pilot is to reduce unnecessary emergency department visits and improve the overall patient experience, decrease health care costs and ensure that ambulance services are paid fairly and members receive appropriate care,” a Highmark news release said.

    Patients will be treated and assessed on-scene based on standard state-approved protocols and under the oversight of an emergency medicine physician. Allegheny Health Network staff will follow up by phone within 48 hours to check the patient’s condition.

    “As a hospital system, patient care is our highest priority,” said Robert McCaughan, vice president of pre-hospital care services for Allegheny Health Network. “If patients who call for an ambulance in non-emergent situations can be assessed and treated on-site, that helps free up our emergency department and emergency department staff – as well as the ambulance service - for true emergencies and more efficient patient care.”

    Brian Maloney, director of operations for Plum EMS, called the program a good one.

    “Insurance doesn’t cover anything unless we transport to the hospital,” he said. “A lot of times we show up, we treat and many times because it’s a recurrent issue for them they don’t go to the hospital. What we provide them prevents them from going to the emergency department.”

    Treat-and-release “can prevent a lot of money from being spent where it doesn’t have to,” he said. “It’s a step in the right direction. It’s a significant step as well.”

    What Maloney said he likes the most about it is the follow-up call.

    “I really like the approach that’s being taken here,” he said.

    Wanovich said that patient participation in the pilot program is voluntary.

    “If a patient wants to be transported to a hospital, they will be,” he said.


  • 29 Aug 2018 8:04 PM | Matt Zavadsky (Administrator)

    Nearly 10% of hospitals are at risk of closure, according to a new analysis. 

    by Paige Minemyer | Aug 27, 2018 2:46pm

    Source Article

    Morgan Stanley, an investment bank and financial services company, analyzed data on more than 6,000 hospitals and found that 450, or 8%, are at risk for closure. Plus, an additional 10% are performing weakly, meaning close to 20% of hospitals are not operating in a “healthy” way. 

    Morgan Stanley attributed those figures to a number of potential risk factors, including: 

    • A higher-occupancy facility is located nearby.
    • Low capital expenditures.
    • For-profit status instead of nonprofit status.
    • A lower operating efficiency index, which measures how well a hospital can turn federal reimbursements into profit. 

    The report also cited new competitors and disruptors—such as retail healthcare—and the rise of high-deductible health plans amid skyrocketing prices as factors impacting hospital profits. 

    “While potential disruption from the new Amazon venture has been grabbing headlines, we think closures will enter the narrative on hospitals during the next 12 to 18 months,” the group said in the report. 

    Gurpreet Singh, partner and U.S. health services leader at PwC, told FierceHealthcare that these disruptors are especially a threat to smaller, rural hospitals that can’t adjust as quickly to the changing landscape of the industry. 

    Regional facilities are often so focused on day-to-day operational concerns that they’re not as agile in planning for new challenges—and often fail to react until it’s too late, Singh said. These facilities, too, often operate in a heavily fee-for-service way, creating additional “inefficiency in the value change.” 

    This uncertainty makes these smaller hospitals more likely to align with bigger systems, he said. “A standalone entity has difficulty having the right level of scale and the right level of offerings to patients and consumers,” he said. 

    Morgan Stanley flagged this trend, too, and noted that consolidation in healthcare may have paid off initially for providers but is “not a cure-all" for poor financial performance. 

    Plus, growing interested in vertical mergers—such as the proposed deal between CVS Health and Aetna—has forced providers to rethink their role in the healthcare system, Singh said. Academic medical centers, for example, can use their research arms for product development and larger health systems are able to offer a health plan on top of their traditional services. 

    However, the most at-risk hospitals lack the capabilities to try these new approaches, he said. 

    “If you’re not in the game of creating new growth opportunities, then you’re at risk of being upside down, so to speak, and at risk, obviously, of closure,” Singh said. 


© 2024 Academy of International Mobile Healthcare Integration | www.aimhi.mobi | hello@aimhi.mobi

Powered by Wild Apricot Membership Software