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

  • 7 Nov 2017 2:59 PM | AIMHI Admin (Administrator)

    The question of what the healthcare of tomorrow will look like prompts a broad, compelling thought experiment. As healthcare professionals of all stripes gathered in downtown Washington, D.C., last week to discuss that very question, a few key ideas emerged.

    Here are the most interesting ideas Healthcare Dive found at U.S. News & World Report’s Healthcare of Tomorrow conference.

    Care is moving back into the patient’s home
    Health systems that embrace the patient movement toward consumerism are on the right track, according to several speakers at the conference. Locating services in a patient’s home or somewhere close by and easily accessible is more convenient for patients, but also produces more comprehensive and effective care.

    Aetna CEO Mark Bertolini (who, despite some clever questioning from the moderator, declined to comment on “market speculation or rumor” that the payer could be acquired by CVS) said the home is the least expensive and most convenient setting for care. If it can’t be in the home, it should be at a retail clinic only a few miles away, he said.

    “If you have to go to the hospital, we have failed you. What if that were the way the system was designed?” he said.

    One key way the home can become a primary setting for healthcare is through telemedicine. This is particularly true in rural areas, where a patient may have to drive hours to get to their doctor’s office. And it will become more and more common as telemedicine becomes more widely adopted and stops being perceived as a separate category from “regular” care.

    “The novelty of telehealth has fallen by the wayside,” said Christopher Northam, vice president for telehealth at HCA.
    “There used to be a lot more focus on the technology. Now the focus is on clinical measurement.”

    Younger people are a big part of the drive toward consumerism in healthcare, and they want to receive care at their homes, Northam said. “That will shut down hospitals,” he added.

    Dr. David Tsay, associate CIO at the New York-Presbyterian Innovation Center, agreed and said a lot of changes will take place in the next 10 years. “I think hospitals will look very, very different,” he said. “Hospitals will primarily be ICUs and ORs, and the rest of care will be done in the convenience of the home.”

    Bertolini said ultimately it will come down to what patients demand as consumers, so creating a compelling and enjoyable experience will be key. “Us as customers — as consumers — disrupt the industry. Because we say we no longer want that, we want this.”

    Conversion to value-based care continues — but at a glacial pace
    HHS under President Donald Trump has walked back some of the previous administration’s payment reform efforts. Although CMS is vocal that it wants to continue the shift from volume to value, the recently finalized Quality Payment Program rule for 2018 indicates otherwise considering the large amount of physicians the administration is exempting from the regulation. Still, albeit slowly, the industry continues to embrace this shift toward value-based care.

    The openness to change has resulted in olive branches being extended across the industry as incumbents look to figure out business in the shifting environment. The result is a mix of strategic partnerships and alliances as the lines between traditional healthcare companies begin to blur.

    Biotech company Amgen partnered with Humana for an outcomes-based research project that will identify high-risk patients using technology and real-world data, Dr. Jason Spangler, executive director of value, quality and medical policy at Amgen, shared at a keynote panel. “We believe these types of partnerships are where we need to be moving to provide value to patients.”

    Providers may be slower to adapt to value-based care. Lori Evans Bernstein, co-founder and COO at HealthReveal, said potential customers are discussing value but also want the ability “to find the good stuff” like reimbursable procedures under a fee-for-service model.

    Tom X. Lee, executive chairman at One Medical, said innovating from within the system is challenging. “We operate as if we’re in a value-based world today though the vast majority of our income is still fee-for-service,” Lee said. One Medical, a group of primary care offices that offers 24/7 connectivity with patients through video and chat services, engages with the industry at the primary care layer. This allows it to operate a little outside the system somewhat. He said organizations operating further downstream have a harder time finding such opportunities.

    Julie Bietsch, VP of population health management at Dignity Health, told Healthcare Dive the industry is at a tipping point for value-based efforts. About 10% of Dignity’s revenue is accrued from population health or value-based arrangements. “I think that those not investing in population health are going to be the ones left behind,” she said, adding providers need to take the first step toward population health. “If you don’t, you won’t know what happens when it’s mandated.”

    Lee believes more changes are coming in the next five to 10 years in care delivery. While the market has spent a lot of time building platforms, apps and services, he sees more changes over improving the virtualized and service experiences coming into healthcare. In addition, he sees more remote care delivery models as an oncoming disruptive force.

    “Those are going to be care systems of the future … I don’t think anyone denies that vision,” Lee told Healthcare Dive.
    “The question is, who’s going to execute it best? Easier said than done.”

    Spangler said he believes the industry could benefit from more care delivery and payment innovations. “One area I think we need to move toward is value-based insurance design,” he said during a keynote panel. “We should pay and incentivize patients toward high value care and disincentivize them against low value care.”

    In healthcare, there are no shortage of opinions, and discussions around value-base care will continue. Expect them to get more vocal.

    Social determinants of health — a trend that needs direction
    “Everyone’s talking about social determinants but no one’s talking about how to do it,” Bietsch told Healthcare Dive.
    Social determinants have been a popular topic as evidence mounts that food security and affordable housing help create good health outcomes. However, there isn’t a centralized assessment of the issue, Bietsch said. For example, if an individual tells seven people that they need a home but no one helps, then the process is inefficient.

    Social determinants of health and “understanding about how they drive our health” are currently buzzword concepts in the industry, she said. “But the success of it is not there.”

    Bertolini is a proponent of thinking about social determinants at every level of healthcare. He noted that a person’s ZIP code is often a bigger indication of life expectancy than their genetic code, and ignoring that reality results in an incomplete approach.

    He said it makes sense for payers to be thinking about social determinants of health because that’s how diseases can be prevented and savings can be realized. “Paying for a ramp, an Uber ride, food, fuel assistance is cheaper than one ER visit,” he said.

    Progress requires bipartisanship
    Calling for bipartisan agreement in D.C. is nothing new and hardly controversial, but at Healthcare of Tomorrow, it was an urgent demand. Budget deals are far from clear, the Children’s Health Insurance Program has still not been reauthorized and rumblings of “repeal and replace” continue despite the unlikeliness that any such legislation could gain traction. This environment breeds more and more uncertainty, which is toxic to the healthcare environment.
    Bertolini said major social programs need broad support to be successful, and Congress should shift from the idea of abandoning the ACA and work together to improve upon it. “We can fix it. The list is short,” he said. “We just need a group of people with level heads in the room to fix it.”

    Legislation of the magnitude and scope of the ACA isn’t going to be perfect right out of the gate, and the problem even proponents recognize will only get worse with inattention, he said. “If you were to leave Medicare alone for six years, seven years, it would fall apart just like this is,” he said.

    Virginia Gov. Terry McAuliffe had a similar message. “We’ve just got to shake up the system and we’ve got to do it together,” he said. McAuliffe said CHIP reauthorization is the most pressing issue today, and lamented that “moms and dads are going to bed tonight scared to death” their children won’t have healthcare coverage.

    He also criticized the White House’s decision to stop CSR payments, and said he personally talked to the Anthem CEO to convince the payer to cover nearly 60 counties in Virginia that would have otherwise not had any plan options.

    “The middle is gone,” he said, “and I come from a business background, and the middle is where you get stuff done.”

    Tom Daschle, former senator and the founder and CEO of The Daschle Group, said healthcare professionals need to make their voices heard in Congress by calling their legislators. “If you don’t know the name of … their health legislation assistant, you’re not engaged,” he said.

    Blair Childs, senior vice president for public affairs at Premier, said providers in particular need to lead change and tell lawmakers what is happening now in the market and where it needs to go. “Anyone thinks the healthcare system is going to be fixed by the government or by payers is crazy,” he said. “It’s only the providers who will innovate the system.”

  • 7 Nov 2017 3:00 AM | AIMHI Admin (Administrator)

    A new pilot program by the Las Vegas Fire and Rescue Department aims to reduce the number of ambulance trips for nonemergency 911 calls.

    As one part of providing the right care in the right setting, the city’s 911 operators are being trained to identify health-related complaints that might not require a full-blown emergency response. Those calls are transferred to a nurse who, with the help of computer protocol software, guides the caller to the right kind of care.

    An operator may still rush an ambulance to a 911 caller or reassure the caller that this health issue can be dealt with by seeing a primary care doctor through a normal appointment process.

    Or the operator may offer to send the patient to an emergency department or urgent care facility in an unexpected way: the ride-hailing service Lyft.

    The Emergency Communication Nurse System and the nonprofit Southern Nevada Community Health Improvement Program have teamed up to fund a ride-hailing option via Lyft for callers who are using 911 because they simply have no other way to get to a hospital, urgent care center or doctor.

    “EMS is probably one of the most reliable, time-sensitive services anyone can access,” says Las Vegas Assistant Fire Chief Sarah McCrea. “This program looks at people’s normal navigation through the system and then redirects it” when a call to 911 isn’t really an emergency. It is one component of dealing with access to nonemergency primary care, McCrea says.

    The chief medical officer of one of the Las Vegas Valley metro area’s busiest emergency departments agrees that access to primary care is lacking.

    “Many of the 170,000 ED visits we see annually are due to a lack of access to primary care physicians in our community.
    So, clearly a great many of these visits are a result of few alternatives, which also extends to the scarcity of urgent care facilities in our immediate service area,” says Jeff Murawsky, chief medical officer of Sunrise Hospital and Medical Center.

    The pilot program employs experienced nurses who have worked in high-acuity settings for at least three years, McCrea says. Before the nurses use the structured computer protocol on a phone call, they say, “Tell me exactly what is happening,” she says.

    “The nurse is free to do what they do best — ask probing questions to get the best idea possible, especially because they cannot see the patient,” McCrea says. “The software has a couple [of] hundred protocols to choose from, so we need to ask a lot of questions outside of the protocol first.”

    The program went live on July 17, with Melissa Giammarino, R.N., on the phones for the first shift. Giammarino, who is also a surgical recovery nurse at University Medical Center in Las Vegas, believes the program will free up emergency personnel and equipment for more urgent cases and lead to improvements in the hospital ED.

    From an ED nurse’s perspective, eliminating unnecessary ambulance calls helps providers focus on real emergencies, she says.

    “I was a charge nurse in an emergency room who had to triage every single ambulance lining up at the door,” Giammarino says. “Each ambulance carrying someone who didn’t truly need emergency care took me away from other emergencies, from helping other nurses and from dealing with other problems in the [ED].”

    As with any emergency services, certain safeguards are in place, McCrea says. First, 911 operators take the initial call, only sending certain calls to the emergency communications nurse. Second, nurses may only downgrade the computer-generated course of action to a less urgent response by one level, but may upgrade it as much as necessary. The nurse may always choose to immediately dispatch an ambulance. Third, ride-hailing is only used if the patient agrees to it. And fourth, there is follow-up. If an ambulance is not sent for a call, the nurse on duty the next day will call the patient to check on his or her welfare.

    Although 911 callers may have believed an ambulance ride was their only choice, “when they find out there are other options than an ambulance ride to the [ED], they’re excited and glad to use ride sharing or go to urgent care or whatever makes the most sense,” Giammarino says.

    Because the pilot program has only been active for just over two months, the department is not yet looking at hard data, but if it proves successful in safely eliminating some unnecessary ambulance trips McCrea hopes it will be expanded from its current 9 a.m. to 6 p.m. availability and cover a larger geographic area.

    “The partnership that exists between Las Vegas Fire, as well as all EMS providers and Sunrise Hospital, is an extremely important component of our community service,” Murawsky says. “We will work with our first responders to share feedback or recommendations as the pilot moves ahead.”

  • 6 Nov 2017 2:55 PM | AIMHI Admin (Administrator)

    It’s something we all hope never happens, but now, local school staff are being equipped to respond if the worst were to ever occur.
    8News got a look inside Richmond Public Schools as the new ‘bleed kits’ were delivered.

    Richmond Ambulance Authority and VCU Medical Center delivered the so-called “bleed kits,” or hemorrhage control kits, to Richmond Public Schools. The kits have essential tools to respond to an emergency.

    “We see a fair number of gunshot wounds,” said Karen Shipman, a trauma outreach coordinator at VCU Medical Center. “It’s not the majority of our trauma, but it’s very traumatic for patients and families.”

    That’s why she said VCU Medical Center wanted to team up with Richmond Ambulance Authority to give the schools these kits.

    “What it does is it teaches the community how to respond to these events,” Shipman said. “With our increase, I would say, in school shootings and mass shootings that are of course making the news more than we would like, this is what we thought we could bring to our community.”

    If a mass casualty situation were to occur in the schools, now some RPS employees are trained to take action.

    “Our student safety is very very important,” said RPS Assistant Superintendent of Exceptional Education and Student Services Michelle Boyd. “We focus on academics but we need our students to be safe first and foremost and while it’s a slim chance that students would need this information and these resources we always want to be proactive instead of reactive.”

    Preparing for a traumatic event like a mass casualty situation is becoming more of a focus for schools.

    “We do talk a lot about what can we do in the case of an emergency,” Boyd said. “We want to make sure that folks are knowledgeable and educated as to how to respond in cases where students may be injured on the athletic field or a science classroom, those types of things, so we offer education classes, we partnership for the CPR training and we want to make sure that we can continue to partnership for the bleed safety kits.”

    For now, many schools will keep the bleed kits in the nurse’s office until they can get more throughout the school.

    So what’s inside the backpack? First there’s a tourniquet. It’s used to apply pressure to a limb if you have a limb injury. Next, there’s what’s called “combat gauze.”

    “You put it inside a wound,” Richmond Ambulance Authority Chief Operating Officer Rob Lawrence explained. “The blood then absorbs into the gauze and it helps coagulate and therefore stop the bleeding.”

    There are also a variety of dressings, and even some common items that you might need in case of an emergency like gloves and scissors.

    It’s all to make sure school staff can treat someone who’s hurt before help arrives…

    “These folks that have this equipment are our very very first responders and therefore they arrive on scene and can stop the bleed, and control the patient until we arrive on scene,” said Lawrence, who added that it’s important for schools to have this type of equipment. “It’s a bit like the days of teaching everybody CPR, it’s a basic skill that we all need to have, we need to know how to do CPR, and we also need to know how to control a hemorrhage if a hemorrhage occurs.”

    Having the bleed kits could make all the difference if the worst were to occur.

    “The worst case scenario is with a gunshot wound, but that said, any penetrating type of trauma or any injury that penetrates the body you can apply these principals to control the bleeding…. and if we can control the bleeding we can save a life,” said Lawrence.

    So far, 70 school security officers and 40 nurse staff have been trained on how to use the equipment inside the Bleed Kits. The schools are organizing groups of other staff who want to do the training.

    If you work in a school and you’re interested in doing the training, contact your school administrators.

  • 6 Nov 2017 9:00 AM | AIMHI Admin (Administrator)

    CHARLESTON, W.Va. – Quality Insights has received funding from the Centers for Medicare & Medicaid Services (CMS) to help emergency medical service (EMS) providers offer expanded care to people with Medicare who live in West Virginia. The goal of this collaboration is to lessen unnecessary hospital admissions and emergency department visits while enhancing access to quality care for the state’s most vulnerable and rural residents.

    Hospital readmissions and emergency department visits are common and costly, particularly for people with chronic conditions and the elderly. In an effort to address this issue, Quality Insights will support EMS providers that offer mobile integrated health care services – commonly called “community paramedicine” – to help patients and hospitals with high rates of emergency department use or a large number of patients who are frequently readmitted.

    Specifically, Quality Insights will help:
    • Identify causes of hospital readmission or emergency department use
    • Develop and conduct assessments to identify local needs
    • Provide reports to participating health care providers that identify key drivers of hospital readmission
    • Select and share best practices to address key drivers of hospital readmission and emergency department overuse
    • Develop resources and educational materials to support both patients and health care providers
    • Engage patients and their families as partners through feedback on proposed strategies, usefulness of educational materials and assessment of improved knowledge as a result of community paramedicine efforts

    Community paramedicine is an emerging health care delivery model that increases access to basic services through the use of specially-trained EMS providers in an expanded role. Community paramedics provide care at home under the supervision of a physician or an advanced practice nurse. They can help fill gaps in rural health delivery caused by a shortage in available providers as well as long travel times to hospitals or clinics. Community paramedics are also considered trusted health care professionals and are often members of the community where they serve.

    “This project aims to provide appropriate care to the right patient, at the right time and in the right setting,” Beckey Cochran, Quality Insights’ Quality Innovation Network Director said. “Patients will remain at home for non-emergency medical needs that do not require hospital or emergency department services. This will hopefully result in a reduction in unnecessary hospital readmissions and as emergency department visits, and more importantly improve patient safety and access to care.”

    Quality Insights will work with consultant James Mason to implement the project. Mason has experience as a paramedic in four states. He became involved with community paramedicine in 2014, while a Rural Health Initiative student at the West Virginia Osteopathic School of Medicine. He helped achieve passage of a Senate bill for community paramedicine demonstration projects. He coordinated community paramedicine development with 19 agencies and 44 health care entities in West Virginia.

    “Mr. Mason’s experience and knowledge around community paramedicine will be critical to bridge the gap between existing care coordination efforts and new opportunities,” Cochran said.

    “This program is important because we’re going to be able to bring quality health care to the most rural and vulnerable citizens in West Virginia,” Mason said. “We hope to expand the viewpoint of the type of services that paramedics provide into more of a comprehensive health care provider realm.”

    A community paramedic can address both medical and social needs. Community paramedics can provide home safety assessments, triage and referral services, chronic disease management education, support for family caregivers, medication compliance support, vaccinations and more.

    “Offering community paramedicine services will allow patients to choose to use community resources rather than inpatient and emergency facilities for non-urgent care,” Cochran said. “This will also empower hospital-based doctors, who might be concerned about the availability of resources for chronically-ill patients, to make referrals for high-utilizers to the program.”

    About Quality Insights Quality Innovation Network
    Quality Insights is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Delaware, Louisiana, New Jersey, Pennsylvania and West Virginia. Quality Insights collaborates with healthcare providers, patients and allied organizations across the network to bring about widespread, significant improvements in the quality of care they deliver. We are committed to reaching the Centers for Medicare & Medicaid Services’ goals of better care, smarter spending and healthier people. To learn more about the network, visit http://www.qualityinsights-qin.org.

  • 30 Oct 2017 3:53 PM | AIMHI Admin (Administrator)

    Amidst these tumultuous times in healthcare, some companies are intent on transformation. Big box drugstore retailers added primary care services to their businesses a while ago. So it’s not so surprising that CVS Health sees room for expansion into health insurance as it engages Aetna in talks for a possible acquisition amounting to $66 billion, according to The Wall Street Journal.

    Neither Aetna nor CVS Health immediately responded to requests for comment.

    From the perspective of Steve Kraus, a partner with Bessemer Venture Partners, whose healthcare investments include health insurance startup Bright Health, among others, this is the logical next step in the consumerization of healthcare. This is a play to “own” the healthcare consumer, he said in an email.

    Kraus speculated that it may just as easily be a way to address the threat posed by Amazon as the online retailer formulates its healthcare strategy.

    “If CVS is the insurer and has the retail footprint to provide not only pharmacy but routine care through its minute clinic operations then it in many ways owns the lifecycle of the consumer from insurance to care provision.”

    For one healthcare industry insider who works with startups, the development conjured up comparisons with HBO program Game of Thrones as he pondered in an email: “I’m wondering if there’s a new business model ascending to the iron throne.”

    It’s an interesting time to enter the insurance industry. With open enrollment scheduled to kick off next week, the Trump administration is determined to dismantle Obamacare and put an end to paying subsidies to health insurers this month. A federal judge backed the decision to the dismay of attorneys general from eighteen states. And yet, Oscar, Clover Health, Bright Health and, more recently, Devoted Health don’t seem intimidated by these changes and see opportunities.

    Aetna once had its own expansion aspirations when it sought to acquire Humana until the Department of Justice, backed by a court decision, scuppered the deal in 2015.

    There’s more transformation to come. Anthem is parting ways with Express Scripts, a company that has its own transformation plans, to be a pharmacy benefits manager in its own right and Amazon is positioning itself in a way that suggests it could either be a pharmacy benefits manager or partner with one. The online retailer has acquired wholesale pharmacy licenses in at least 12 states, including Nevada, Arizona, North Dakota, Louisiana, Alabama, New Jersey, Michigan, Connecticut, Idaho, New Hampshire, Oregon and Tennessee, according to a story from the St. Louis Post-Dispatch.

    The pharmaceutical industry is also facing some significant changes depending on whether other states take a lesson from California to limit drug prices by forcing companies to justify why they need to increase them.

    One thing is undeniable: We live in interesting times.

  • 23 Oct 2017 3:51 PM | AIMHI Admin (Administrator)

    The quest of American EMS providers for more sensible reimbursement will reach a key threshold on January 1, 2018, when Anthem BlueCross BlueShield begins paying for treatment without transport for patients in states where it offers commercial coverage.

    The major insurer’s new policy marks a vital step toward the goal of sustaining community paramedicine and mobile integrated healthcare programs that have sometimes struggled to find ongoing financial footing.

    “We spend a lot of money in this country on healthcare, and our quality outcomes are not as good as other industrialized countries that spend less,” says Jay Moore, MD, senior clinical director for Anthem in Missouri. “We need to figure out a way to get a handle on that. We want to be able to provide healthcare in a way that’s affordable for people and sustainable for the future, and I think the only way to do that is to involve people at all levels of healthcare. Whether it’s physicians, nurses, paramedics, EMTs, whomever it might be, it’s something all of us are going to have to work together to solve. In my view this is definitely a step in the right direction.”

    The reimbursement will be offered for HCPCS A0998-coded 9-1-1 responses in California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. The company hopes to include its Medicare and Medicaid plans as well, though there are varying state requirements to navigate first. Due to those differences, not all 14 states will begin January 1, though most will.

    While similar efforts have been piloted here and there, Anthem is the first major insurer to take such a global approach to compensating care that doesn’t culminate at the ED.

    “For the first time we have a major private payer who’s looking to give reimbursement to EMS for services we normally don’t get paid for,” says Chris Cebollero, a veteran EMS leader and consultant who worked with the company on developing the plan. “This is really major in the EMS world and for the transformation of EMS into its new environment. This is the moment we’ve been waiting for.”

    The new policy grew from a collaboration between Cebollero and Moore that began when they both worked for hospitals in the St. Louis area. Moore noticed high numbers of low-acuity patients coming through his ER at SSM Health DePaul Hospital. Questioning it, he discovered carriers didn’t commonly compensate for calls under A0998, for ambulance response and treatment without transport; that forced EMS to bring patients to hospitals to get paid.
    As head of Christian Hospital’s EMS division, Cebollero was well aware of that as he worked to launch a community paramedic program. “I wanted to collaborate not only with our ED, but with other hospitals too,” he says. “If the frequent flyers we stopped taking to our emergency department started showing up at other emergency departments, we wanted to stop that too. We didn’t want to just shift high utilizers from one ED to the other.”

    Moore’s 2014 move to Anthem BlueCross BlueShield provided the opportunity for a bigger approach. He wanted to invest in community paramedicine; Cebollero was a consultant in building such programs. Moore initially sought Cebollero’s collaboration in developing CP programs for certain hotspot areas—then they realized they could aim higher. “We started looking,” Moore says, “at how we might be able to implement this in all our Anthem states across the country.” And he found Anthem’s leadership open to trying alternative approaches: “We’re interested and willing across the company,” he adds, “to engage with progressive providers who are interested in doing things besides the traditional fee-for-service model.”

    In the future that might involve things like non-9-1-1 home visits, medication checks and more, but for now the hope is a modest reduction in unnecessary ED transports, which Moore hopes to trim by 5%.

    Meanwhile, for EMS, a long-sought opportunity is finally at hand. Now the onus moves back to us to take advantage of it.

    “We have to be able to step to the table and use the code so Anthem can see the value and want to invest in the next pieces as well,” says Cebollero. “Community paramedicine has been going on for some time, and there have been a lot of great programs that failed because of financial sustainability. We have to be able to end our dependence on CMS and look more globally. We have to be proactive and engage the payers, the hospital systems, the ACOs, and say, ‘Look what we can do for you, but more important, what we can do for our patients.’ Even though this is a small component of our reimbursement model right now, the dominoes are all set up, and the finger is ready to flick. If you have a CP program, it’s time to put it into the next gear.”

  • 4 Oct 2017 3:50 PM | AIMHI Admin (Administrator)

    Austin, TX (Oct. 3, 2017) — ESO Solutions, Inc., the leading data and software company serving emergency medical services, fire departments and hospitals, announced today it has acquired the FIREHOUSE Software business and suite of emergency records management products from Conduent Government Systems, LLC., a wholly owned subsidiary of Conduent, Incorporated. In addition, ESO Solutions has hired all of Conduent’s employees on the FIREHOUSE team.

    The FIREHOUSE Software acquisition further accelerates ESO Solutions’ growth into the healthcare and fire service software and data sectors. With the acquisition, ESO will now serve more than 13,000 emergency medical services, fire departments and hospitals. The acquisition makes ESO the largest software provider focused exclusively on the fire, pre-hospital and hospital market.

    “This acquisition represents a bold next step in ESO becoming the preeminent provider of software and data for fire, EMS, and hospitals,” said Chris Dillie, president and CEO of ESO. “We have a clear vision, and now an accelerated path to bring community health and safety together to improve patient outcomes. By helping fire and EMS first responders more easily and intuitively capture data in complex and dangerous situations, then use the data to improve efficiency and efficacy across their operations we can help them focus on protecting and saving lives rather than data entry and analysis.”

    Based in Urbandale, Iowa, FIREHOUSE was founded in 1997 and is used by approximately 11,000 fire departments across the country for their incident reporting (NFIRS) and records management. The companies are not disclosing terms of the transaction.

    About ESO
    ESO Solutions, Inc., is dedicated to improving community health and safety through the power of data. Since its founding in 2004, the company has been a pioneer in electronic patient care records (ePCR) software for emergency medical services, fire departments and ambulance services. Today, ESO’s healthcare, public safety and technology experts deliver the most innovative software and data solutions on the market, including the industry-leading ESO Electronic Health Record (EHR); ESO Health Data Exchange (HDE), the first-of-its-kind healthcare interoperability platform; record management system (RMS) for fire departments; and ambulance revenue recovery/billing software. ESO is also playing a leading role in helping EMS provider organizations across the nation successfully transition to NEMSIS Version 3 and new state standards for electronic patient care reporting. ESO is headquartered in Austin, Texas. For more information, visit www.esosolutions.com.

  • 3 Oct 2017 3:48 PM | AIMHI Admin (Administrator)

    This is an excellent report on a “Bridges to Care” (B2C) program that used a multidisciplinary care team, including Community Health Workers (CHWs) to reduce preventable ED visits and hospital admissions in a Medicaid population.

    The extensive use of CHWs in the study can be compared to the use of trusted Community Paramedics with comparable training, as we have highlighted in the past. Imagine the added benefit of using an EMS-based MIH program, that could not only do the proactive home visits with providers similar to CHWs, but do an evaluation and possible primary care re-direction in the event of a 9-1-1 call.

    Interestingly, the study explains there were an average of 8 home visits over a 60-day enrollment – which is very similar to the average number of visits in MedStar’s and other MIH programs of 14 patient contacts (including 9-1-1 patient contacts) over 90-days.

    Finally, many of the findings in the study are eerily similar to what most established MIH programs have experienced regarding things like number of visits and length of enrollment to achieve the desired outcomes, the timing of the 1st enrollment visit, the linkage between the time of ED visit and the referral, and the most prevalent co-morbidities.

    http://content.healthaffairs.org/content/36/10/1705

    A few highlights from the study:
    “We evaluated how participation in Bridges to Care (B2C)—an ED-initiated, multidisciplinary, community-based program—affected subsequent ED use, hospital admissions, and primary care use among publicly insured or Medicaid-eligible high ED utilizers. During the six months after the B2C intervention was completed, participants had significantly fewer ED visits (a reduction of 27.9 percent) and significantly more primary care visits (an increase of 114.0 percent), compared to patients in the control group.”

    “In this article we compare participants in the B2C program with patients who received standard care (the control group) with respect to three outcomes: ED use, hospital admission, and primary care use.”

    “B2C, a multidisciplinary program based on the Camden Coalition model, was developed collectively by the community and health care provider stakeholders and the Innovation Center project sites. It provides intensive medical, behavioral health, and social care coordination services, with up to eight home visits within sixty days of an ED visit or hospital discharge from a team comprising a primary care provider, care coordinator, health coach, behavioral health evaluator, and community health worker (all of whom are employed by the local federally qualified health center).”

    “The B2C intervention begins with enrollment, a brief assessment, and scheduling of home visits while the patient is still in the ED or hospital. The first home visit occurs 24–72 hours after the enrollment date and is conducted by the community health worker and the care coordinator to complete the enrollment forms, provide the patient with B2C contact information, and talk about the patient’s goals.”

    “The most common comorbidities were hypertension, mental health disorder, asthma, and diabetes. We note that 27.6 percent of enrollees did not complete the sixty-day program.”

    “We believe that the program’s success stems from bringing together different health care systems (hospitals, federally qualified health centers, and others), breaking down silos between disciplines, and focusing on continuity of care in the outpatient setting.”

    “This study has several implications for policy and health care practice. Some experts argue that an intervention program should reduce ED utilization by 40–50 percent, but we believe that the reductions we found in ED use and hospital admissions (of 28 percent and 16 percent, respectively) are more realistic—and replicable, given that our study had a control group. In addition, building and implementing an intensive, community-based, transition-of-care program such as B2C requires an up-front financial investment, with a delayed return on investment. Also, no billable codes exist for providing ED care transitions, where programs such as this could be funded in the future. We learned that for B2C to reduce the use of acute care, outreach to and enrollment of high utilizers had to happen in real time in the ED.”

  • 2 Oct 2017 3:47 PM | AIMHI Admin (Administrator)

    If you pull a fire alarm in any large U.S. city, it’s likely that paid firefighters waiting at a nearby station will quickly respond. But seven out of 10 American firefighters are actually volunteers. They cover vast sections of the country, making up an aging network that is increasingly understaffed and overworked.
    On a blazing hot day recently in western Kansas, two men have rushed from their jobs to douse a grass fire, for free.

    “If somebody wasn’t here to do it, this could get out of hand real quick,” says Jason Lonnberg, with the Jetmore Volunteer Fire Department.

    Volunteers keep fires from getting out of hand in most rural communities, and many of these departments are barely hanging on.

     

    It’s not uncommon these days to find rural firefighters in their 60s or 70s. According to the National Volunteer Fire Council, about a third of small town volunteer firefighters are now over 50. That’s double the number in the 1980s.

    And while volunteer firefighters are trending older, they are answering many more calls.

    In tiny Cedar Vale, Kan., for instance, the fire barn is full of old fire trucks, but finding people to operate them is a challenge. Like many remote, rural towns, Cedar Vale is in steep decline, and volunteer Dwight Call says that undermines recruiting efforts.

    “There’s no jobs here,” says Call, who sports a dirty work shirt and a huge white mustache.

    “So if you live here and you’re working age, you’re probably driving someplace to work,” he says. “Or, you’re working one of two places in town that probably aren’t going to let you take off to fight fire.”

    Call says that 50 years ago, when Cedar Vale had lots of small businesses, the volunteer fire department was well-staffed. Now many area residents have a harder time piecing together a living.

    “I work days and nights, and hours that are just ridiculous,” says Isaac McNown, as he stops in Cedar Vale for gas. McNown says he works nights, plus two days a week at a livestock feed mill. The rest of his time he devotes to his own tree trimming business.

    The volunteer shortage has pushed Cedar Vale, like many other rural fire departments, to turn increasingly to people like 62-year-old Montra Beeler.

    “I’m a firefighter. I drive trucks, fight fires,” states Beeler. “I’m kind of the momma of the fire barn.”

    Beeler, who barely clears 5 feet, says she has a hard time seeing over the hood of these big old firetrucks, but she is a crucial first responder here.

    “Right now, the three of us that respond most of the time are me, my son Marshal, and Zeke,” explains Beeler. “We’re the three that usually show up to go to car wrecks, to motorcycle wrecks, to fires.”

    Jeff Mortimer, who’s with the volunteer fire department in Mayfield, Kan., says the workload keeps mounting.

    “When I first started all we did was fires,” recalls Mortimer. “Now we’re power line arcing, to accidents, hazmat, technical rescue. You know, all of the above.”

    Not to mention medical emergencies. Across the country, calls to volunteer fire departments have tripled in the past three decades. And that’s slammed volunteer EMS services like the one Chrissy Bartell runs in Norwich, Kan.

    The only doctor in town, whose office used to take up a whole building, left several years ago, Bartell says.
    Now, this volunteer ambulance service is the only medical provider in Norwich, and it covers nearly 300 square miles.

    “Call volumes are up tremendously, and I don’t see that changing, except to increase,” frets Bartell.

    There’s no easy solution. Going to paid fire and EMS everywhere would cost a fortune. A National Fire Protection Association study figured that volunteer firefighters donate about $140 billion worth of labor each year. Even so, many departments have a hard time affording basic equipment, according to Kimberly Quiros with the National Volunteer Fire Council.

    “Time and again you hear stories of departments that, you know, are using old gear, that’s not necessarily the safest, or old fire trucks and old equipment, or not able to afford the resources that they really need,” says Quiros.

    And that can affect most anybody. Though bigger cities have paid fire service, volunteers cover most of the country. So if you have a wreck on a rural stretch of highway, say Interstate 70 in Gove County, Kan., Steve Hirsch says you’d better hope it happens near the county’s one well-equipped fire department.

    “Three of the four do not have any rescue equipment whatsoever. So you can go 30 miles through there, and there’s no rescue equipment,” says Hirsch.

    Hirsch is first vice-chair of the National Volunteer Fire Council, and he serves on the volunteer fire department in tiny Hoxie, Kan. Which, Hirsch boasts, is fully staffed.

    “There are some departments that are just begging to get volunteers. Out here, we don’t have that much of a problem. Recruiting is one of those 24/7/365 [days a year] deals. We just never stop recruiting.”

    Like many volunteer firefighters, Hirsch is deeply committed to what he’s doing. Because without volunteers and departments like his, he says, huge swaths of America would just burn up.

  • 2 Oct 2017 10:30 AM | AIMHI Admin (Administrator)

    Used to be, emergency medical services, or EMS, was primarily a mode of transporting critically ill or injured people to the hospital in a hurry. That’s still a key part of its mission. But today, with advanced technology, greater capabilities of emergency medical technicians and paramedics, and the overarching need to improve care while lowering costs, EMS is increasingly being viewed as part of the care continuum.

    In fact, through an initiative called integrated mobile healthcare or community paramedicine (IMH/CP), EMS professionals may find themselves spending more time in the community, supporting post-discharged patients and homebound people with chronic illnesses.

    The EMS professional
    Today’s EMS professionals are up to the task, according to those with whom Repertoire spoke.

    “EMS providers have become increasingly proficient over the past decade performing many procedures unheard of decades ago, such as rapid sequence induction, intubation, intraosseous infusions and pericardiocentesis,” says Debra Perina, M.D., MS FACEP, FAEMS, division director, prehospital care, University of Virginia, and a board member of the American College of Emergency Physicians. “They are much more adept at critical thinking and resuscitation, of both trauma and cardiac patients, from continual education programs and quality improvement program feedback. Physicians have come to rely on paramedic assessment to mobilize trauma, STEMI [ST-Elevation Myocardial Infarction], and stroke teams, as well as to begin proper treatment during transport.”

    Says Jonathan Washko, MBA, NREMT-P, AEMD, assistant vice president, Center for EMS, Northwell Health (and a board member of the National Association of Emergency Medical Technicians), “In the past five years, EMS has transitioned from a transportation commodity to a recognized clinical provider, able to deliver healthcare services in the out-of-hospital environment. We are seeing EMS providers entering the industry with associate, bachelor’s and master’s degrees.” More females and minorities are entering the industry as well, he adds.

    EMS professionals have kept pace with the latest breakthroughs in life-saving medications, says Washko. As technology has improved (and shrunk in size), they are able to perform point-of-care lab testing, ultrasound and other procedures, and they communicate with hospital-based caregivers via telemedicine and video conferencing.

    Most likely, the EMS profession will eventually move from a certificate licensure to a full degree, notes Christine Ford, senior market manager, EMS/Fire, Moore Medical, an affiliate of McKesson Medical-Surgical.

    Today’s EMS professional “is more familiar with new, advanced technologies now available in prehospital care, or more open to learning about them,” she says. Those include:
    • Mobile blood analyzers, which can deliver lab-quality results in minutes.
    • Handheld ultrasound units, which can be used to detect heart action and validate continued resuscitation, as well as pinpoint location of internal hemorrhages and cerebral blockages, and to share those images – with Wi-Fi and DICOM capabilities – with the hospital.
    • Video laryngoscopy, enabling high intubation success for difficult airways, with recording capabilities and Wi-Fi.

    “Expect revised definitions of the EMS Scope of Practice Model (SoPM), with evidence that supports improved patient outcomes with the use of new skills and interventions,” continues Ford. “These include therapies such as hypothermia in cardiac arrest, naloxone administration options, and hemorrhage control.” Other potential advances may include:
    • Upgraded seating options in ambulances for improved safety and patient access, as Moore Medical is seeing in European emergency vehicles.
    • Continued changes in immobilization protocols, including increased use of vacuum mattresses versus backboards.
    • Increased use of mechanical CPR systems
    • Advanced procedures similar to what Moore Medical is starting to see in European prehospital care, including therapeutic hypothermia (body cooling) treatment and use of body pressure, ECMO (extracorporeal membrane oxygenation) and REBOA (resuscitative endovascular balloon occlusion) of the aorta.

    Community paramedicine
    “One change that we’ve seen in the last 10 years is the growth of community paramedicine or mobile integrated healthcare,” says Ford. “This permits paramedics and EMTs [emergency medical technicians] to operate in expanded roles to provide more routine healthcare services within their community. This role helps keep patients from returning to the hospital unnecessarily, resulting in reduced overall healthcare costs and hospital readmission penalties for chronically ill patients.

    “In the next five years, as more pilot project data becomes available and agencies determine the best models that will work for their communities, community paramedicine programs will continue to develop,” says Ford, who participates in a community paramedicine task force of the National Association of State EMS Officials. “As the cost of healthcare services continues to rise and hospitals seek options to reduce their readmission penalties, the economics of these programs should become more and more practical. For agencies and regions that do not currently have a mobile integrated healthcare program in place, many report that they are currently discussing these models for future implementation.

    “In addition to community paramedicine, we expect to see more specialized mobile transport units such as bariatric, NICU and critical care ambulances.”

    In 2016, the Mobile Integrated Healthcare/Community Paramedicine Task Force of the American College of Emergency Physicians issued an Information Paper on the topic. “ACEP has long been interested in EMS practice, and MIH/CP is one facet of EMS care,” says Perina.

    Several years ago, the association felt a need to inform its members about trends in mobile integrated healthcare and community paramedicine, and how emergency physicians should expect to interact with these programs, says Perina, who chaired a task force on the issue. “Our charge was to help our members understand the impact and what they should expect in practice.”

    In its Information Paper, ACEP defines MIH/CP as “a term applied to a new model of community-based healthcare service delivery that often primarily uses emergency medical services (EMS) personnel and systems to provide acute medical care, coordination of services, healthcare maintenance, post-acute care, and prevention services to patients outside of routine EMS transport service to hospital destination care.”

    “MIH/CP is the natural next step for evolution of paramedicine as a profession,” says Perina. Initially targeted at rural communities, the concept has expanded, so that at least one program exists in the majority of states, she says. Driving that growth is today’s emphasis on prevention of illness and the need for cost-savings.

    “These programs are only a couple of years old, and as such, only a few have reported results. What little data is out there appears to show value, but additional results of such programs need to be analyzed. I think that as these programs grow, EMS will take on even more roles as the interface between patients and the healthcare system.”

    And EMS professionals are likely to embrace the opportunity. “It creates a career ladder for medics, and a way to continue growth in the profession,” says Perina.

    Career ladder
    Mobile integrated healthcare, or community paramedicine, does call for an entirely different skill set than responding to 9-1-1 calls, says Perina. That might call for anywhere from 18 months to two years additional training, including precepting with a physician. “But it allows the medic to grow in paramedicine, and it provides them an additional opportunity to provide direct patient care in the home.”

    Veteran EMS professionals who may be on the verge of burning out may find community paramedicine a suitable alternative to 9-1-1 response, Perina continues. “Working in a high-volume, large urban emergency system is really a young man’s game, because of the stress and physical activity,” she says. Still, challenges remain for MIH/CP programs, including:
    • State regulations. In some states, regulations prohibit EMS practice outside of traditional 9-1-1 response, or care that is designed to stabilize patients for transport to a healthcare facility. (With current reimbursement requirements, if the patient is not brought to a hospital, the ambulance service is not reimbursed.)
    • Funding. Most pilot programs are financed with grants or short-term funds. A more stable source of funding is needed.
    • Training. Time and money are needed to create and operate training programs for community paramedicine.
    • Evidence. The results of pilot projects need to be gathered to document outcomes and cost-savings.

    For more information:
    “Mobile Integrated Healthcare/Community Paramedicine Primer, American College of Emergency Physicians, 2016, https://www.acep.org/search.aspx?searchtext=MIH/CP

    ________________________________________

    Who’s who in EMS?
    EMTs, or emergency medical technicians, usually complete a course that is about 120-150 hours in length. EMTs are educated in many skills, including CPR, giving patients oxygen, administering glucose for diabetics, and helping others with treatments for asthma attacks or allergic reactions. With few exceptions, such as in the case of auto-injectors for allergic reactions, EMTs are not allowed to provide treatments that require breaking the skin.

    Paramedics are advanced providers of emergency medical care and are highly educated in topics such as anatomy and physiology, cardiology, medications, and medical procedures. Paramedic courses can be between 1,200 to 1,800 hours. They build on their EMT education and learn more skills, such as administering medications, starting intravenous lines, providing advanced airway management, and learning to resuscitate and support patients with significant problems, such as heart attacks and traumas. Paramedic education programs may last six to 12 months.
    Source: UCLA Center for Prehospital Care

    ________________________________________

    EMS Q&A
    Repertoire thanks Christine Ford, senior market manager, EMS/Fire, Moore Medical, for answering the following questions.
    Q: Who typically mans EMS vehicles?
    A: The personnel manning EMS vehicles depends largely on the type of service the agencies provide. For those providing non-emergency transport service, you may see an ambulance attendant, or CPR Ambulance Driver (trained in cardiopulmonary resuscitation). For agencies that offer BLS (Basic Life Support) services, the vehicles are typically manned by emergency medical technicians (EMTs), usually two per vehicle. ALS (Advanced Life Support) service agencies add a paramedic onboard to assist with more complex procedures, depending on the nature of the emergency call. In some regions, the paramedic may drive a separate vehicle – a First Response Chase Vehicle – which follows the ambulance.

    Q: How are EMS services reimbursed?
    A: The Affordable Care Act provided more access to patients who may have previously been uninsured. Even though reimbursement rates in most states don’t cover the actual cost of transporting a patient to a hospital, a little is better than nothing. As part of the healthcare reform act, the consumer price index (CPI) and ambulance inflation factor (AIF) was adjusted downward for EMS when it was grouped in with private, nonfarm business multifactor productivity (MFP). The Regional/National Fee Schedule also expired in 2009, so that all EMS providers now receive the same reimbursement formula, except for the Geographic Practice Cost index (GPCI) and urban versus rural adjustments. Each year, Congress reapproves the Medicare base rate modifier, which defines increases in the fee schedule for ambulance transport in rural and super rural states. These variances are driven by population. In the future, there is talk about reimbursement being more closely tied to qualitative patient care, but reimbursement models in EMS have been slow to change.

    Q: Who makes purchasing decisions regarding EMS products, equipment and services?
    A: The emergency medical service field is largely driven by protocols. These protocols can vary by state, as well as specific regions within a given state. Protocol changes usually occur at the level of a medical director. As field technology options advance in prehospital care, the role of the medical director has increased. Many protocols spell out a general type of device or pharmaceutical product that should be used in various scenarios. In these cases, an EMS chief or operations director often decides which option their crew will use. When substitute products are introduced, the training of the crew needs to be considered to ensure quality patient care. After standards have been set for the agency or region, a purchasing director, EMS supervisor, operations staff or supply personnel may handle day-to-day purchases.

    Q: Has consolidation affected the EMS market?
    A: The emergency medical service industry is highly fragmented, with hospital-based services representing only one of the many different models one will find throughout the country. [That said], consolidation has also continued in the EMS industry, with larger private ambulance services/agencies joining up with smaller services. Expect to see this trend continue, with smaller agencies or municipalities contracting out their ALS or BLS transport needs, and larger private agencies purchasing smaller private agencies for improved economies of scale.

    ________________________________________

    Health systems and EMS
    Given today’s emphasis on the continuum of care and value-based reimbursement, it’s no surprise that EMS and health systems are growing closer.

    “Many hospitals have partnered with emergency medical service agencies to provide mobile integrated healthcare services targeted at chronically ill patients and ‘frequent fliers,’ who overuse traditional EMS services,” says Christine Ford, senior market manager, EMS/Fire, Moore Medical. “The hospitals are largely interested in these models in an effort to help reduce their readmission penalties.

    “We also see a lot of collaboration for mass casualty training between hospitals and EMS agencies,” she adds.

    Says Jonathan Washko, MBA, NREMT-P, AEMD, assistant vice president, Center for EMS, Northwell Health (and a board member of the National Association of Emergency Medical Technicians), “As healthcare consolidates and becomes integrated across the spectrum of services, EMS can be an extremely beneficial tool in the healthcare arsenal, especially in hub-and-spoke models of care or when coupled with population management efforts. Some healthcare systems are recognizing this and are either getting into the ground and air EMS business or are expanding existing services.”

    But hospitals’ participation in EMS is dependent on size and funding, he adds. “If the hospital is not part of a larger healthcare system or it cannot derive value from EMS in its marketplace, we are seeing some hospitals shed EMS services, especially in markets where the EMS agency operates in the red and the parent hospital can no longer afford to subsidize their EMS efforts.”
    Debra Perina, M.D., MS FACEP, FAEMS, division director, prehospital care, University of Virginia, and a board member of the American College of Emergency Physicians, says that hospital systems’ participation in mobile integrated healthcare services or community paramedicine varies. “Some are partnering in various outreach programs or in accountable care organizations,” she says. “Some target frequent utilizers who may need more in-home contact, and others chronic disease management to prevent multiple visits. Some are using them for specific services, such as injury prevention efforts and home inspections.”

    ________________________________________

    EMS 3.0
    EMS 3.0 is an EMS industry initiative to help EMS agencies and practitioners understand the changes that are needed in EMS to fully support the transformation of the nation’s healthcare system, and to provide tools and resources to help them implement these changes. Following are some basic tenets of the initiative, from the National Association of Emergency Medical Technicians, or NAEMT.
    • America’s healthcare system is broken and needs fixing. The best way to fix it is by changing the way care is delivered and coordinated across all spectrums of healthcare providers and facilities.
    • EMS must be a part of the solution.
    • Today, EMS operates in communities across the country as a trusted and expected medical provider. EMS providers administer care in homes and throughout the community, delivering rapid and reliable medical assessment, care and transportation.
    • Many of the patients to whom EMS provides care are not in need of emergent medical interventions, but rather have medical needs that can be better addressed through actions other than transporting these patients to an emergency department. Some examples of these actions can include care coordination, community resource acquisition, and facilitation of transportation to appropriate healthcare facilities.
    • EMS is transforming to fill needs in the healthcare system that improve patient outcomes and satisfaction while also providing additional value to the healthcare system. EMS has demonstrated that it can assess, treat, and navigate patients to the most appropriate and convenient location for their medical needs. This may mean that patients receive their treatment in locations other than a hospital emergency department, including in their own home.
    • Transformed EMS agencies have proven significant savings in healthcare costs, while also improving the quality of care.

    Source: National Association of Emergency Medical Technicians, http://www.naemt.org/docs/default-source/advocacy-documents/ems-transformation/what-is-ems-3-talking-points-final.pdf?sfvrsn=0

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