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

  • 18 Jun 2018 12:30 PM | AIMHI Admin (Administrator)

    HCA, private equity firm join forces to make bid for Envision

    Written by Ayla Ellison

    May 21, 2018

    https://www.beckershospitalreview.com/hospital-transactions-and-valuation/hca-private-equity-firm-join-forces-to-make-bid-for-envision.html

    Nashville, Tenn.-based HCA Healthcare and KKR & Co., a New York City-based private equity firm, have teamed up to make an offer for Nashville-based physician services provider Envision Healthcare, sources told Reuters. 

    HCA wants to take over Envision’s AmSurg ambulatory surgery division, and KKR would take over the remainder of Envision’s business, sources told Reuters.

    Envision, which has a market capitalization of $5.1 billion and $4.6 billion of long-term debt, has requested potential acquirers submit final offers later this month. The company announced it was exploring several strategic alternatives in 2017.

    KKR isn’t the only private equity firm interested in acquiring Envision. Sources told Reuters a consortium of Washington, D.C.-based Carlyle Group and San Francisco-based TPG Global are submitting bids for the company.

  • 18 Jun 2018 10:00 AM | AIMHI Admin (Administrator)

    Interesting model – an enhancement to a program started in 2014 in which the Maryland Health Services Cost Review Commissionmanages the global healthcare budget.

    This initiative allows Maryland to adopt new and innovative policies aimed at reducing per capita hospital expenditures and improving patient health outcomes.

    The Maryland HRCRC recently awarded Baltimore City Fire Department sizable funding to establish an MIH-CP program.  The authorization for that expenditure likely falls under the Care Redesign Program.

    ———————————-

    Maryland: The first state CMS will hold fully at risk for total healthcare costs

    Written by Morgan Haefner

    June 13, 2018

    https://www.beckershospitalreview.com/payer-issues/maryland-the-first-state-cms-will-hold-fully-at-risk-for-total-healthcare-costs.html

    CMS’ Innovation Center revealed June 8 that Maryland will become the first state fully at risk for the total cost of healthcare for Medicare beneficiaries. 

    Here are five things to know about the Maryland Total Cost of Care Model:

    • The model sets a per capita limit on the total cost of care Medicare beneficiaries receive in Maryland. It is founded on Maryland’s current all-payer model, launched in 2014, which limits the state’s per capita hospital expenses.
    • The performance period of the TCOC Model begins Jan. 1, 2019, and runs through Dec. 31, 2026.
    • The Maryland TCOC Model aims to save $1 billion-plus on Medicare beneficiaries’ care by the end of 2023, the model’s fifth performance year.
    • Three programs will operate under the TCOC Model:
    • The Hospital Payment Program, which will test population-based payments for Maryland hospitals. Each hospital will get a population-based payment to cover all hospital services within a year
    • The Care Redesign Program, which will allow hospitals to make incentive payments to partnering providers outside of the hospital
    • The Maryland Primary Care Program, which aims to incentivize primary care providers to offer advanced primary care services in return for additional monthly per beneficiary payments from CMS
    • Maryland will choose its own measures and targets it wants to hit across six population health areas. The measures require CMS approval.
  • 18 Jun 2018 6:00 AM | AIMHI Admin (Administrator)

    Two items of interest here…

    1. This potentially is fabulous tech, and one first responders have been asking about for years
    2. It’s Walmart – the next biggest healthcare organization??

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    Walmart patent proposes storing patient records on the blockchain

    Written by Julie Spitzer | June 18, 2018 | Print  | Email

    https://www.beckershospitalreview.com/healthcare-information-technology/walmart-patent-would-store-patient-records-on-blockchain.html

    Walmart was recently awarded a patent that describes a system of storing patient medical records on the blockchain within a wearable device so first responders can access patient data in emergency situations, according to CCN.

    The patent, titled “Obtaining a Medical Record Stored on a Blockchain from a Wearable Device,” describes three core devices starting with a wearable — ideally, a bracelet — that acts as the storage hub for the blockchain database, which only holds emergency-specific information to protect privacy. The patent also includes a biometric scanner to capture the patient’s biometric signature and a Radio-Frequency Identification scanner for scanning the wearable device.

    Walmart hopes the system will allow medical providers to access a patient’s vital medical records and information before the patient arrives at a particular facility. Here is how Walmart envisions its patent in action:

    1. When a first responder scans a patient’s wearable device with the RFID scanner, they would receive an encrypted private key and the public key associated with that particular patient.
    2. To decrypt the private key, the first responder would scan a biometric feature on the patient, such as their face, retina, iris or fingerprint.
    3. As soon as the private key is decrypted, the patient’s medical records can be viewed on the blockchain.
    4. The patent would also enable first responders to share the patient’s health information with other healthcare entities through the use of internet of things devices.
  • 11 Jun 2018 9:40 PM | AIMHI Admin (Administrator)

    By Shelby Livingston  | June 11, 2018

    Private equity firm KKR on Monday said it would buy physician staffing company Envision Healthcare for $9.9 billion. 

    http://www.modernhealthcare.com/article/20180611/NEWS/180619998

    The companies expect the deal to close in the fourth quarter of 2018.

    The announcement comes after Nashville, Tenn.-based Envision announced a strategic review to enhance shareholder value late last year. According to the announcement, Envision’s board of directors reached out to 25 potential buyers to purchase all or parts of the company, but concluded that KKR’s proposal offered the best value. The deal was approved unanimously by Envision’s board.

    “Envision’s leadership team, including both the board and management, have been singularly focused on driving value for our shareholders and have taken decisive action in furtherance of that goal, including the implementation of a comprehensive operational improvement plan and a robust review of strategic alternatives,” Envision President and CEO Christopher Holden said in the announcement. “Today’s announcement reflects the extensive efforts by our team to explore all opportunities to deliver value for our shareholders.”

    Nashville-based Envision, with annual revenue totaling $7.8 billion, is the nation’s largest physician staffing firm with 25,000 physicians and other medical practitioners who staff hospital departments, including the emergency department, radiology, anesthesiology and neonatology. The company has come under fire for sending patients big out-of-network ED bills.

    Envision and KKR have a history. The staffing firm last year sold its ambulance business to a subsidiary of KKR for $2.4 billion focus on its physician-staffing and its other major business line, ambulatory surgery centers.

  • 11 Jun 2018 9:30 AM | AIMHI Admin (Administrator)

    Air Ambulances Are Flying More Patients Than Ever, and Leaving Massive Bills Behind

    Rising prices, billing disputes, and a quirk in federal law are creating a new health-care headache.

    By John Tozzi

    June 11, 2018 

    https://www.bloomberg.com/news/features/2018-06-11/private-equity-backed-air-ambulances-leave-behind-massive-bills

    When three-year-old West Cox’s fever hit 107 degrees, doctors called a helicopter 

    Hours earlier, the toddler, who’d been prescribed an antibiotic for a suspected ear infection, was at home in Princeton, West Virginia, watching cartoons and eating chips and salsa. Then, during a nap, he started to have convulsions, and his mother, Tabitha Cox, a physician assistant, drove him to the emergency room, stripped to his shorts to cool.

    Tabitha remembers the triage nurse’s eyes widening when she took West’s temperature at Princeton Community Hospital, the only medical center in the small town on the southern edge of the state. Nurses covered him in ice packs to try to keep his temperature down.

    Patients running a fever that high can suffer permanent brain damage. Within an hour of his arrival at the emergency room, an air ambulance was on the way to take West to the CAMC Women and Children’s Hospital in Charleston. Flying would cut a 90-minute drive in half.

    During four nights in the pediatric intensive-care unit, West recovered from apparent encephalitis. Three years later, his parents are still reckoning with the aftermath of his 76-mile flight: a bill for $45,930 from for-profit helicopter operator Air Methods.

    At the heart of the dispute is a gap between what insurance will pay for the flight and what Air Methods says it must charge to keep flying. Michael Cox, West’s father and a track coach at Concord University, had health coverage through a plan for public employees. It paid $6,704—the amount, it says, Medicare would have paid for the trip.

    Air Methods billed the family for the rest. 

    The U.S. air-ambulance fleet has doubled in size in the past 15 years to nearly 90 helicopters making 300,000 flights annually, according to data compiled by Ira Blumen, a professor of emergency medicine and director of University of Chicago Aeromedical Network.

    That rapid growth has made stories such as the Cox family’s more common. The air-ambulance industry says reimbursements from U.S. government health programs, including Medicare and Medicaid, don’t cover their expenses. Operators say they thus must ask others to pay more—and when health plans balk, patients get stuck with the tab.

    “I was angry and I felt like we were being taken advantage of,” said Tabitha Cox. The family sued Air Methods in August 2017, seeking certification for a class-action lawsuit against the company on behalf of other patients in West Virginia who received similar bills.

    Air Methods has defended its billing and disputed other allegations in the complaint in court filings. The case is pending.

    “The fundamental problem is that the current reimbursement rates by Medicare, Medicaid, and some of the private insurance companies fall well short of what it actually costs to provide this lifesaving service,” Air Methods Executive Vice President JaeLynn Williams said in an interview. She declined to comment on specific patients’ cases.

    Favorable treatment under federal law means air-ambulance companies, unlike their counterparts on the ground, have few restrictions on what they can charge for their services. Through a quirk of the 1978 Airline Deregulation Act, air-ambulance operators are considered air carriers—similar to Delta Air Lines or American Airlines—and states have no power to put in place their own curbs.

    Prices for emergency medical flights have increased dramatically, as air-ambulance operators expanded their networks and responded to a wider set of emergencies, including traumas, strokes and heart attacks.

    The median charge to Medicare for a medical helicopter flight more than doubled to almost $30,000 in 2014, from $14,000 in 2010, according to a report last year by the U.S. Government Accountability Office. Air Methods’ average charge ballooned, from $13,000 in 2007 to $49,800 in 2016, the GAO said. Medicare, the federal health program for people 65 and older, pays only a fraction of billed charges; Medicaid, the state-federal program for the poor, pays even less.

    Air-ambulance operators’ special legal status has helped them thwart efforts to control their rates. West Virginia’s legislature passed a law in 2016 capping what its employee-health plan—which covered West Cox—and its worker-compensation program would pay for air ambulances.

    Another company, Air Evac EMS, successfully challenged the caps in federal court. A judge ruled that the caps were pre-empted by the federal deregulation law and blocked the state from enforcing them. West Virginia has appealed the ruling.

    The industry has used similar arguments to fight regulation in other states, winning cases in North CarolinaNorth DakotaTexas and Wyoming. A lawsuit recently filed in New Mexico challenges the state’s prohibition on balance billing on the same grounds.

    Wealthy investors lured by the industry’s rapid growth have acquired many of the biggest air-ambulance operators, leaving control of the business in the hands of private-equity groups. American Securities LLC bought Air Methods for $2.5 billion in March 2017. Rival Air Medical Group Holdings, which includes Air Evac and several other brands, has been owned by New York private-equity firm KKR & Co. LP since 2015. Two-thirds of medical helicopters operating in 2015 belonged to three for-profit providers, the GAO said in its report.

    Amy Harsch, a managing director at American Securities, declined to comment. Kristi Huller, a spokeswoman for KKR, declined to comment.

    Seth Myers, president of Air Evac, said that his company loses money on patients covered by Medicaid and Medicare, as well as those with no insurance. That’s about 75 percent of the people it flies.

    “I fly people based on need, when a physician calls or when an ambulance calls,” he said. “We don’t know for days whether a person has the ability to pay.”

    According to a 2017 report commissioned by the Association of Air Medical Services, an industry trade group, the typical cost per flight was $10,199 in 2015, and Medicare paid only 59 percent that. Air-medical operators back U.S. legislation proposed by Senator Dean Heller of Nevada and Representative Jackie Walorski of Indiana, both Republicans, that would boost reimbursements by as much as 20 percent over three years. The bill would also have Medicare collect cost data from air-ambulance companies and use it to update rates to reflect “the actual costs of providing air ambulance services.” Both versions have co-sponsors from both parties.

    For people with private insurance, short flights in an air ambulance are often followed by long battles over the bill.

    In 2015, Erin Roth’s father, Michael, was flown 18 miles by helicopter from Good Samaritan Hospital in Suffern, New York, to Westchester Medical Center in White Plains, after he collapsed on a work site and hit his head.

    Roth, who was 55, died from his injury. After workers-compensation insurance refused to cover the flight, his Aetna Inc. medical plan paid $4,370, and Air Methods’ subsidiary, Rocky Mountain Holdings LLC, sent the family a bill for $34,495. The air-ambulance company put a lien on Roth’s estate, preventing Erin from selling her father’s house. The dispute dragged on for two years, until a TV reporter Roth contacted looked into it, and Aetna paid the rest of the claim.

    “It was just kind of like a black cloud that was over my head the whole time,” she said.

    Air Methods and Aetna declined to comment on Roth’s situation.

    Williams, Air Methods’ executive vice president, said the company has hired “nearly 25” patient advocates since 2016 to “help them navigate the very complex process with their insurers, and we help them get the payments for these lifesaving critical emergency services that they’re entitled to.”

    The industry says insurers put patients in the middle. “We need to hold the insurers’ feet to the fire to say we need a reasonable rate,” said Myers, the Air Evac executive. He said health plans often won’t agree to network contracts that could lower costs. He declined to say how large in-network discounts are, citing nondisclosure agreements.

    Consumer groups and insurers counter that air-ambulance companies strategically stay out of health-plan networks to maximize revenue.

    In response to a complaint filed with the state insurance commissioner by a West Virginia consumer last year, insurer Highmark Blue Cross Blue Shield wrote that it tried to negotiate a contract with Air Methods, but the company “refuses to discount its services by more than 3% of its total charge.” The consumer was appealing a $51,209 bill for his daughter’s medical flight, of which Highmark paid $10,571.

    Williams, the Air Methods executive, declined to comment on what discounts the company offers insurers, but she said it is in “active negotiation” with about a dozen insurers nationally.

    “Air Methods is 100 percent committed to going in-network,” she said.

    Air-ambulance providers are “using consumers as leverage with the insurance companies,” said Betsy Imholz, director of special projects at Consumers Union, who helped write a report critical of the industry. Patients are “terrified” when they receive a five-figure bill for an air ambulance and press insurers to pay more, she said.

    “I think there is, frankly, in many cases, price gouging going on,” Imholz said.

    When air travel was deregulated, the air-ambulance business was in its infancy. A few dozen medical helicopters, mostly operated by hospitals, were in use in the early 1980s, according to data compiled by Blumen, the University of Chicago emergency-medicine professor.

    Then, in 2002, a new Medicare payment formula “effectively raised the payment amounts for air ambulance service,” according to the GAO. At the same time, new treatments for strokes and heart attacks expanded the number of patients who could survive such episodes if medics got to them sooner. As rural hospitals closed, air ambulances became lifelines for remote communities.

    The number of aircraft grew faster than the number of patients flown. In the 1990s, each helicopter flew about 600 patients a year, on average, according to Blumen’s data. That’s fallen to about 350 in the current decade, spreading the expense of keeping each helicopter at the ready among a smaller pool of patients.

    While adding helicopters has expanded the reach of emergency care, “there are fewer and fewer patients that are having to pay higher and higher charges in order to facilitate this increase in access,” Aaron D. Todd, chief executive officer of Air Methods, said on an earnings call in May of 2015, before the company was taken private. “If you ask me personally, do we need 900 air medical helicopters to serve this country, I’d say probably not,” he said.

    Despite the apparent glut, air-ambulance operators are profitable. Air Methods had an average annual profit margin of 9.1 percent from 2012 to 2016. Over the same period, companies in the S&P 500 Health Care Providers & Services index had margins of 7.9 percent, on average. PHI, a helicopter company that operates both medical flights and transports for oil and gas drillers, reported average operating margins of 15.7 percent from 2014 to 2017 in its medical segment, compared to 10.4 percent for the benchmark index in the same period.

    Air Methods declined to comment on its current profitability or to share financial details as a private company.

    If there are too many helicopters for the number of patients who need them, market forces should force less-efficient operators out of business, said Hank Perritt, a professor at the Chicago-Kent College of Law who has studied the industry.

    Montana Senator Jon Tester, a Democrat, has introduced legislation that would roll back the special status of air-ambulance companies. A Federal Aviation Administration reauthorization bill passed by the House in April would make medical services provided by air ambulances subject to state regulation.

    In West Virginia, the Cox family went through two appeals with their health plan. After they retained a lawyer, Air Methods offered to reduce their balance to $10,000 on reviewing their tax returns, bank statements, pay stubs, and a list of assets. The family decided to sue instead.

    “I felt like they were screening us to see just how much money they could get out of us,” Tabitha Cox said. “I think about people that really struggle—single moms, people that don’t have the financial blessings that we have. Bottom line, it’s just not fair.

  • 21 May 2018 9:35 PM | AIMHI Admin (Administrator)

    GAO calls on CMS to continue prior authorization experiments

    By Virgil Dickson  | May 21, 2018

    http://www.modernhealthcare.com/article/20180521/NEWS/180529994

    The CMS hasn’t moved to continue prior authorization experiments even though they could save Medicare billions of dollars, according to the U.S. Government Accountability Office.

    Under the experiments, the CMS only pays for some items and services after providers and medical product suppliers have shown they complied with coverage and payment rules. The CMS uses prior authorization in Medicare for non-emergency ambulance rides, hyperbaric oxygen therapy, home health services and power wheelchairs.

    The CMS may have saved as much as $1.9 billion thanks to prior authorization since it started the experiments in 2012.

    But most of the experiments have ended or will end soon, and the CMS hasn’t announced plans to continue the vast majority of those efforts, the GAO said in a report released Monday. The exception is power wheelchairs, which is a permanent prior authorization program.

    “By not taking steps, based on results from the evaluations, to continue prior authorization, CMS risks missed opportunities for achieving its stated goals of reducing costs and realizing program savings by reducing unnecessary utilization and improper payments,” GAO said.

    Providers and suppliers have struggled with prior authorization, the GAO found.

    It can take months to obtain necessary documentation from referring physicians and other relevant parties before submitting a prior authorization request, and clinicians don’t have financial incentives to provide that information.

    Referring physicians aren’t affected if a durable medical equipment, ambulance, or home health claim is denied due to insufficient documentation, the GAO said.

    Also, smaller ambulance providers that were not defrauding Medicare but had business models centered around repetitive, non-emergency transports have closed.

    CMS officials said the agency was evaluating the prior authorization programs and would take GAO’s findings and recommendations into consideration.

    The agency indicated it is considering new prior authorization experiments for items such as hospital beds and oxygen concentrators because these have high utilization or improper payment rates.

  • 21 May 2018 7:30 AM | AIMHI Admin (Administrator)

    HCA, private equity firm join forces to make bid for Envision

    Written by Ayla Ellison

    May 21, 2018

    https://www.beckershospitalreview.com/hospital-transactions-and-valuation/hca-private-equity-firm-join-forces-to-make-bid-for-envision.html

    Nashville, Tenn.-based HCA Healthcare and KKR & Co., a New York City-based private equity firm, have teamed up to make an offer for Nashville-based physician services provider Envision Healthcare, sources told Reuters.

    HCA wants to take over Envision’s AmSurg ambulatory surgery division, and KKR would take over the remainder of Envision’s business, sources told Reuters.

    Envision, which has a market capitalization of $5.1 billion and $4.6 billion of long-term debt, has requested potential acquirers submit final offers later this month. The company announced it was exploring several strategic alternatives in 2017.

    KKR isn’t the only private equity firm interested in acquiring Envision. Sources told Reuters a consortium of Washington, D.C.-based Carlyle Group and San Francisco-based TPG Global are submitting bids for the company.

  • 20 May 2018 5:00 PM | AIMHI Admin (Administrator)

    BCBS of Texas: Some members may have to pay entire bill for non-emergent use of out-of-network ED

    Morgan Haefner

    April 25, 2018

    https://www.beckershospitalreview.com/payer-issues/bcbs-of-texas-some-members-may-have-to-pay-entire-bill-for-nonemergent-use-of-out-of-network-ed.html

    BlueCross BlueShield of Texas may begin requiring some members who access non-emergent care at out-of-network emergency departments to pay their bills in full.

    Here are five things to know about BCBSTX’s emergency benefit management process.

    1. The process will affect BCBSTX’s fully insured group and retail health maintenance organization members with out-of-network ED claims filed after June 4. Those members may be on the hook for the entire out-of-network ED bill if they use the facility for care the insurer deems not serious or life-threatening.
    2. BCBSTX said some of its members are “using the emergency room for things like head lice or sprained ankles, for convenience rather than for serious or life-threatening issues. Doing so not only drives up costs for our members, but uses limited ER resources,” according to a document obtained and sharedon Twitter by Ed Gaines, chief compliance officer at the emergency medicine division of Zotec Partners.*
    3. In the document, BCBSTX said after June 4, it will begin reviewing out-of-network ED claims by requesting medical records and an itemized bill for the claim. The payer will consider members’ medical record and presenting symptoms during the review to ensure the services rendered were accurately billed to eliminate inappropriate charges. While the review takes place, members’ claims will be pending, and will not be denied without physician review.
    4. BCBSTX spokesperson Chris Callahan told Becker’sin an emailed statement, “We also want to make sure that what the ERs are billing us for is in line with the testing, medications and level of service our members actually received. For example, during some recent reviews, we discovered that a facility billed our member for an MRI that the medical record didn’t support.”  He added, “Our focus has been how to put the member first in reviewing these out-of-network ER claims so that we can be good stewards of their money and manage the cost of premiums.”
    5. BCBSTX’s emergency benefit management process is the latest in insurers’ attempts to push members with non-emergent care needs toward cheaper urgent and primary care services. However, similar policies rolled out by Anthem have drawn considerable backlash from providers and lawmakers.
  • 20 May 2018 1:00 PM | AIMHI Admin (Administrator)

    Congress Introduces Air Ambulance Quality and Accountability Act

    Summary: H.R.3780 — 115th Congress (2017-2018)

    Introduced in House (09/14/2017)

    Air Ambulance Quality and Accountability Act

    This bill amends title XVIII (Medicare) of the Social Security Act to modify standards and payment for air-ambulance services under the Medicare Program.

    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.

    The Medicare Payment Advisory Commission shall report to Congress on whether changes should be made with regard to reimbursement of air-ambulance providers and suppliers under Medicare.

  • 20 May 2018 10:00 AM | AIMHI Admin (Administrator)

    Uber to the ER?

    Ambulances are expensive. Some cities are beginning to offer other ways to get to the hospital.

    BY MATTIE QUINN

    MAY 2018

    http://www.governing.com/topics/public-justice-safety/gov-ambulances-expensive-uber.html

    It’s more than just an inexpensive, convenient way to get to the airport or back home safely from an evening of bar-crawling. More and more, people are calling Uber, Lyft and other ride-hailing services in place of ambulances to take them to the emergency room. There’s no mystery to their motivation. People see ride-hailing as more reliable and vastly cheaper than traditional emergency transport: A ride in an ambulance can cost a user as much as $1,200, depending on what insurance covers.

    So it probably shouldn’t be surprising that in March Uber announced that it was venturing into health care. Uber Health is a digital portal that allows health-care organizations to book rides for a patient or caregiver. The company says it is also working to allow people without access to a smartphone or computer to receive trip details.

    It’s not the first time that ride-hailing companies have been tapped to supplement traditional health-care transportation options. Last year, the AARP Foundation and UnitedHealth Group partnered with Lyft and the University of Southern California to offer free rides to low-income Los Angeles seniors who had missed two or more medical appointments in the previous year. And the University of Pennsylvania offered Lyft rides to 800 West Philadelphia Medicaid patients for scheduled appointments.

    The results for the Philadelphia project weren’t particularly encouraging: The missed appointment rate improved by barely a percentage point. Still, these projects are evidence for many in health care that the current model of health transportation and ambulatory services needs to be diversified. Ambulances, along with government-provided paratransit for the disabled, are increasingly thought of as overly expensive services plagued with bureaucratic inefficiencies and the high costs of “super-utilizers” who overuse the transportation services and emergency rooms.

    “We’ve done a wonderful job of telling people that they can call 911 and have emergency services show up,” says Dean Dow, president and CEO of the Reno, Nev.-based Regional Emergency Medical Services Authority (REMSA). “Now we must educate people on when to use and when not to use it, as well as give people alternate numbers [for nonemergency situations].”

    Serving Reno and Washoe County since 1986, REMSA is a nonprofit provider of emergency medical services that receives funding from both the state and federal government for a three-pronged effort aimed at taking some of the pressure off of its ambulance services. The program’s offerings include a nurse health line for people needing immediate health advice. There’s an alternate transportation program that sends people who don’t really need the ER to more appropriate services such as urgent care, a mental health facility or rehab. And a paramedicine program helps those super-utilizers with needs like nutrition and medication management.

    Similar efforts are underway elsewhere. In 2014, for example, the city of Houston launched its Emergency TeleHealth and Navigation program, which connects patients with a nurse over video chat if a paramedic responding to a 911 call deems a situation a nonemergency. In its first three years, the program has reportedly prevented some 6,000 emergency transports.

    There are barriers to quick, widespread adoption of these alternatives. Private insurers are reluctant to reimburse new models of care without years of data and evidence of effectiveness. Dow says REMSA struggles “on a weekly basis” to find long-term reimbursement streams, even with support from the state’s Medicaid program. But “the model has to evolve,” he says. “It’s not functionable for the future.”

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