News & Updates

  • 25 Jun 2019 8:43 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments courtesy of Matt Zavadsky

    Nice summary from the Health Affairs on yesterday’s Executive Order…  Much to unpack in the near future as the rules are proposed….

    Unpacking The Executive Order On Health Care Price Transparency And Quality

    Katie Keith

    JUNE 25, 2019

    On January [June] 24, 2019, President Donald Trump issued a highly anticipated executive order on health care price and quality transparency. The White House also posted a fact sheet alongside the order. The goal of the executive order is to help consumers know the prices and quality of a good or service and to make informed decisions about their health care. The executive order is consistent with recent rules to, for instance, require drug manufacturers to disclose list prices in their advertisements or require hospitals to publish list prices on their websites.

    Generally speaking, the executive order directs an array of federal agencies to adopt rules, issue guidance, or develop reports with the goal of increasing the transparency of health care price and quality information.


  • 24 Jun 2019 6:08 PM | AIMHI Admin (Administrator)

    JAMA Network source article | Comments courtesy of Matt Zavadsky

    Special thanks to Dr. Munjal, Dr. Margolis and Dr. Kellerman for this editorial in the JAMA Network!

    Tip of the hat to Dr. Margolis for sharing this link!


    Realignment of EMS Reimbursement Policy

    New Hope for Patient-Centered Out-of-Hospital Care

    Kevin G. Munjal, MD, MPH, MSCR1Gregg S. Margolis, PhD, NRP2Arthur L. Kellermann, MD, MPH3


    June 21, 2019


    Substantial efforts have been made over the past decade to move the US health care system away from fee-for-service reimbursement toward alternative payment models, with the goals of expanding access, improving quality, and reducing medical costs. However, financing for emergency medical services (EMS) continues to incentivize transport to the emergency department (ED), regardless of the needs or desires of patients. In 2016, EMS agencies in the United States responded to an estimated 22.0 million 911 calls and transported an estimated 14.6 million patients to a hospital. Of those transports with complete billing information, 33% were billed to Medicare, 31% to private insurers, 20% to Medicaid, and 15% were self-pay.1

    Experts have long called for realigning reimbursement policy to support a more patient-centered approach to out-of-hospital emergency care. On February 14, 2019, the Center for Medicare & Medicaid Innovation (CMMI) announced the Emergency Triage, Treat, and Transport (ET3) model.2 This voluntary, 5-year payment model will allow EMS agencies to be reimbursed for handling 911 calls with dispositions other than transportation to an ED, including nurse triage, treatment by a qualified health care practitioner either on scene or via telehealth, or transporting patients to an urgent care center, or primary care physician office.

    The decoupling of EMS assessment and treatment from ED transport is a major development for out-of-hospital care. This approach is consistent with a 2007 Institute of Medicine recommendation “to evaluate the reimbursement of emergency medical services” and follows the recent release of the EMS Agenda 2050 document, commissioned by the National Highway Traffic Safety Administration, which articulated a future in which EMS is safe, reliable, efficient, equitable, innovative, and seamlessly integrated into health care.3 Together, these developments have the potential to promote significant innovation within the EMS community.

    Moving Beyond Transport

    EMS services are generally underfunded and have historically lacked financial motivation to invest in approaches that could help determine the most appropriate level of care. The CMMI announcement does not indicate an intended reduction in Medicare’s annual ambulance expenditures of $5.5 billion, but rather cites a projected $560 million in annual savings from reduced ED expenditures if 15.6% of Medicare ambulance transports could be managed outside a hospital ED.4

    With the ET3 model, incentives are now better aligned for EMS to pursue new communications technologies, decision-support applications, and point-of-care laboratory testing that could enable more patient-centered care to help avoid transport. The ET3 model is also likely to promote new collaborations between EMS and various community resources, including federally qualified health centers, dialysis centers, and substance abuse treatment programs. Other partnerships, such as with traditional taxi services or app-based ride services, may develop and could give patients more affordable transportation options.

    In rural and remote areas, EMS services could potentially manage an array of problems on scene with telehealth support, rather than transporting every patient (often requiring a lengthy ambulance ride) to a hospital ED. Likewise, patients receiving hospice care or palliative care may be treated more humanely in their home rather than in the hospital ED.

    EMS systems participating in the ET3 model also may be able to expand their efforts to promote injury and disease prevention. Because EMS personnel already make “house calls” and regularly encounter vulnerable populations, they are ideally positioned to identify health hazards and connect patients to community-based resources such as home health, housing assistance, and food delivery programs.

    Remaining Barriers

    Despite the potential for the ET3 model to transform EMS, several issues must be addressed to ensure that the concept moves from demonstration project to established policy.

    Patient Safety

    While the ET3 model is designed to unlock potential savings opportunities through reduced ED utilization, EMS agencies must ensure that patients who require ED care receive that service. It will, therefore, be important to demonstrate that EMS professionals can safely and consistently identify patients with nonemergency conditions. A 2009 meta-analysis of paramedic accuracy in determining medical necessity from 13 studies calculated negative predictive values of 91% for ambulance transport and 68% for ED evaluation.5 A more recent analysis involving 503 patients and 45 paramedics found a similar under-triage rate of 19.3%.6

    With additional education, greater use of evidence-based algorithms, clinical decision support, and online medical control, it should be possible to improve paramedics’ decision-making. A study performed by Wake County EMS demonstrated that a validated clinical protocol avoided transport for 65.8% of 840 low-acuity falls among older adults and achieved a negative predictive value of 98% for a time-sensitive condition.7 This same group created another protocol that triaged 226 patients with minor behavioral health symptoms, such as substance use disorders and depression, to a specialty center, with only 5% requiring secondary transport from the specialty center to the ED.8

    In another study, Houston EMS demonstrated safer decision-making using physicians via telehealth. Based on an analysis of 5570 patients treated by EMS in 2015, the project achieved a mean 44-minute reduction in EMS call time (from 83 to 39 minutes), and 75% of patients were safely transported by taxi (3751 patients) or treated on scene without transport (419 patients).9

    Measuring and Ensuring Quality

    Within the ET3 model, the Centers for Medicare & Medicaid Services includes a 5% upside-only incentive based on as-yet unannounced quality metrics. This represents one of the first pay-for-performance initiatives for EMS and will hopefully help to ensure safety of the new initiative. Measures will be needed to assess 911 call handling, nurse triage, treat-and-release policies, alternative destination management, and telehealth. However, quality measurement in EMS remains underdeveloped. With the exception of a few well-funded disease-specific registries, it has proven difficult for EMS services to obtain data on patient outcomes.

    EMS agencies will more likely succeed in the ET3 model if they can access and send electronic health information to other health care entities. This could serve to improve triage, treatment, and transport decisions, and could enable notification of the patient’s primary care physician, care manager, or both of the EMS encounter and needed follow-up.

    States, Municipalities, and Other Payers

    EMS is primarily state-regulated with substantial variation in system design and clinical protocols. As a result, the ET3 model may prove more feasible in some jurisdictions than others. In highly restrictive regulatory environments, this model may provide political impetus for reform. However, some hospitals and EDs may oppose giving EMS the flexibility to manage patients in less costly ways.

    Medicare officials are encouraging multi-payer arrangements so that EMS agencies can service all patients in a region. While most patients will benefit from more coordinated, patient-centered out-of-hospital care, Medicaid beneficiaries have particularly high EMS utilization rates, thus giving state governments the greatest opportunity to benefit from reduced health care spending.

    Local governments often operate local 911 centers, making them eligible to apply for ET3 model funding to support a medical triage function. Despite having substantial influence over the provision of EMS, many communities currently do little more than monitor EMS response times. The 5% quality incentive may encourage more meaningful priorities, such as improving patient experience and measuring clinical outcomes.

    Unintended Consequences

    The ET3 program only applies to patients who access the 911 system, as opposed to directly contacting a health system call center. As a consequence, innovative programs that are virtually identical to the ET3 model will be ineligible for reimbursement despite having demonstrated substantial savings. A future refinement of the ET3 program might reimburse all EMS systems providing care, regardless of how the call for out-of-hospital emergency care is first placed.

    Another concern is the potential for abuse of 911 services to secure convenient treatment at home, taxi vouchers to an ED or urgent care center, or quicker appointments. EMS systems will need to monitor call volumes to determine if the ET3 program incentivizes increased utilization of 911 for low-acuity conditions. If this proves to be problematic, additional measures may be required to deter misuse of the system. However, recognizing human behavior, some increase in call volume may need to be accepted, if offset by increased efficiency and therefore increased availability of 911 resources for life-threatening emergencies.


    The recent CMMI announcement represents an important development for EMS. This is a first step toward the financial and delivery system reforms needed to allow out-of-hospital care systems to deliver higher-quality, patient-centered, coordinated health care that could lower costs. If CMMI and the EMS community can successfully address patient safety, quality, and local and state regulation and mitigate unintended consequences, the ET3 model experiment could help EMS realize its full potential.

  • 24 Jun 2019 6:01 PM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Interesting perspective…


    Conservative legal expert calls surprise bill proposals unconstitutional

    June 21, 2019


    A prominent conservative legal expert is warning that congressional moves to regulate surprise out-of-network billing by physicians are unconstitutional and could be challenged in court.

    In a new legal brief, Paul Clement, a former Republican solicitor general who led the unsuccessful effort to overturn the Affordable Care Act in 2012, said bipartisan congressional proposals to cap out-of-network rates would violate the takings clause of the Fifth Amendment as well as the First Amendment right to freely associate.

    Other legal experts said Clement's arguments are dubious but could convince lawmakers to back off or water down legislation.

    "These are extremely weak constitutional claims—the sorts of claims that, if accepted, would threaten the constitutionality of any kind of legislative price controls," said Nicholas Bagley, a health law professor at University of Michigan.

    Nevertheless, Clement's brief may foreshadow a court challenge by provider groups or conservative legal groups if Congress passes legislation to protect consumers from surprise out-of-network bills and cap the rates insurers pay for out-of-network services.

    The Senate health committee is planning to vote next week on a bipartisan bill that would cap payment for out-of-network care at a regional insurer's typical negotiated rate. House Energy and Commerce Committee leaders have offered a similar proposal.

    With public outrage growing over surprise bills, President Donald Trump and lawmakers of both parties have called for protecting patients from these bills. "A very unpleasant surprise," Trump said last month. "So this must end."

    Clement, a partner at Kirkland & Ellis who has argued nearly 100 cases before the U.S. Supreme Court, said the proposed legislation "threatens to take property from healthcare providers without just compensation" and "threatens to infringe on providers' associational activity."

    He argued that any legislation should at least ensure that out-of-network providers who treat patients during an emergency or at an in-network facility receive the prevailing market rate as soon as possible after providing the service. In addition, he said Congress also should require a baseball-style arbitration process as an alternative.

    Clement's office did not respond to a question about whether he wrote the brief on behalf of a particular client.

    Physician and hospital groups strongly oppose the Senate health committee's "benchmarked cap" proposal as well as proposals to require hospitals to bring all their physicians into their insurance networks.

    Provider groups didn't immediately indicate whether they agreed with Clement's legal analysis or would sue to block legislation. But the American College of Emergency Physicians echoed his arguments.

    "While we can't speak to the legal or constitutional implications of the benchmarking approach of the Senate (health committee) bill, we have very strong concerns about the damaging impact that capping out-of-network reimbursement at the median in-network rate would have on patient access to care," said Laura Wooster, the association's associate executive director for public affairs.

    Clement wrote that capping or eliminating balance billing would rob providers of the negotiating leverage they have with health plans, forcing them to accept unreasonable network rates. Over time, he said, rates would decline and physician practices would become economically non-viable for both network and out-of-network providers.

    But those arguments are unlikely to hold up in court, said Tim Jost, an emeritus health law professor at Washington and Lee University.

    "It seems to me a real stretch to say that requiring providers to accept a median in-network rate would be a taking prohibited by the Constitution or a violation of freedom of association," he said. "Government action has to be pretty extreme to constitute a taking."

    Still, Clement's arguments "may give cover to politicians who are otherwise opposed to addressing surprise medical billing," he added.

  • 18 Jun 2019 1:15 PM | AIMHI Admin (Administrator)

    Kaiser Health News source article |Comments courtesy of Matt Zavadsky

    This article was produced by Kaiser Health News and published in Governing Magazine…

    In Fight Against Surprise Medical Bills, Lawmakers Miss High Air Ambulance Costs


    JUNE 18, 2019

    In April 2018, 9-year-old Christian Bolling was hiking with his parents and sister in Virginia’s Blue Ridge Mountains, near their home in Roanoke. While climbing some boulders, he lost his footing and fell down a rocky 20-foot drop, fracturing both bones in his lower left leg, his wrist, both sides of his nose and his skull.

    A rescue squad carried him out of the woods, and a helicopter flew him to a pediatric hospital trauma unit in Roanoke.

    Most of Christian’s care was covered by his parents’ insurance. But one bill stood out. Med-Trans, the air ambulance company, was not part of the family’s health plan network and billed $36,000 for the 34-mile trip from the mountain to the hospital. It was greater than the cost of his two-day hospitalization, scans and cast combined.

    “When you’re in that moment, you’re only thinking about the life of your child,” said Christian’s mother, Cynthia Bolling, an occupational therapist. “I know that I am being taken advantage of. It’s just wrong.”

    The rising number of complaints about surprise medical bills is spurring efforts on Capitol Hill and at the White House to help consumers. Over and over again, the high cost associated with air ambulance service gives patients the biggest sticker shock — the subject has come up at nearly every Capitol Hill hearing and press conference on surprise medical bills.

    Yet air ambulance costs are not addressed in any of the proposals introduced or circulating in Congress. Even a congressional decision last year to set up a panel that would study air ambulance billing hasn’t gotten off the ground.

    “We’re doing a disservice to patients if we protect them from hospital bills but bankrupt them on the way there,” said James Gelfand, senior vice president for health policy for the ERISA Industry Committee, known as ERIC, a trade association for large employers.

    The issue came up again Wednesday at a House Energy and Commerce subcommittee hearing where Rick Sherlock, president and CEO of the Association of Air Medical Services, the industry group for air ambulances, was among eight witnesses.

    Rep. Ben Ray Luján (D-N.M.) sharply questioned Sherlock why costs for air ambulance services have risen by 300 percent in his state since 2006.

    “I’m trying to get my hands around why this is costing so much and why so many of my constituents are being hit by surprise bills,” Luján said.

    Sherlock said that reimbursements from Medicare and Medicaid do not cover the cost of providing services, so charges to private patients must make up that difference.

    Air ambulances serve more than 550,000 patients a year, according to industry data, and in many rural areas air ambulances are the only speedy way to get patients to trauma centers and burn units. As more than 100 rural hospitals have closed around the country since 2010, the need has increased for air services.

    More than 80 million people can get to a Level 1 or 2 trauma center within an hour only if they’re flown by helicopter, according to Sherlock.

    The service, though, comes at a cost. According to a recent report from the Government Accountability Office, two-thirds of the more than 34,000 air ambulance transports examined were not in the patients’ insurance networks. That can leave patients on the hook for the charges their insurers don’t cover, a practice known as “balance billing.”

    In 2017, GAO found that the median price charged nationally by air ambulance providers was around $36,400 for helicopter rides and even higher for other aircraft. The total generally includes the costs for both the transportation and the medical care aboard the aircraft.

    Additionally, the ongoing “Bill of the Month” investigative series by Kaiser Health News and NPR has received more than a dozen such bills, ranging from $28,000 to $97,000.

    Cynthia Bolling said her insurance company paid about a third of Christian’s air ambulance bill and the family settled this week with Med Trans by agreeing to pay $4,400 out-of-pocket.

    Reid Vogel, director of marketing and communications for Med Trans, said the company cannot talk about a private patient because of privacy rules. But he added that the company works with patients to find “equitable solutions” when their bills are not covered by insurance.

    Since nearly three-quarters of flights are for patients insured by low-paying Medicare, Tricare and Medicaid, he said, “providers must shift costs to insured patients.”

    Private insurers usually will pay only an amount close to what Medicare reimburses, which is around $6,500. That gives air ambulance companies an incentive to remain out-of-network, according to a 2017 GAO report.

    “A representative from a large independent provider noted that being out of network with insurance is advantageous to the provider because a patient receiving a balance bill will ask for a higher payment from the insurance company, which often results in higher payment to the air ambulance provider than having a pre-negotiated payment rate with the insurer,” the GAO said.

    In an interview, Sherlock, of the trade association, disputed the report’s findings, saying his members are actively trying to be in-network in more places, although he couldn’t provide any specific numbers.

    “I think that everywhere they can, they’re incentivized to be in-network,” he said.

    States are hampered in their efforts to ease the strain for residents.

    The Airline Deregulation Act of 1978, which was intended to encourage more competition, forbids states to regulate prices for any air carrier, which applies to air ambulances. What’s more, many large employers’ health insurance is not governed by states but regulated by the federal labor law, known as ERISA.

    So a remedy likely has to come from Congress. And it’s proven to be a heavy lift.

    For example, the committees that deal with regulation of the air industry — the Commerce Committee in the Senate and the Transportation Committee in the House — don’t make health policy or regulate health insurance.

    Last year, some lawmakers sought to let states regulate air ambulances with a provision in the bill reauthorizing the Federal Aviation Administration.

    But that measure was ultimately eliminated. Instead, the bill called for the creation of an advisory committee to study air ambulance prices and surprise bills.

    “The air ambulance lobby did a very good job playing defense during FAA authorization,” said ERIC’s Gelfand.

    The panel, which was supposed to be formed within 60 days of the law’s enactment date — Oct. 5 — still has not been created.

    Representatives from the air ambulance industry don’t think congressional action is necessary, although they are calling for higher reimbursements from Medicare.

    Chris Eastlee, vice president for government relations for the Association of Air Medical Services, said his group does not favor more congressional regulation of prices but would support mandatory disclosure of costs to the secretary of Health and Human Services. The organization argues that greater transparency will help companies negotiate more in-network contracts.

    A fix for surprise bills supported by some researchers and advocates would require every provider within a medical facility to accept any insurance plan that contracts with that hospital. It might also help bring down air ambulance bills, said Loren Adler, associate director of USC-Brookings Schaeffer Initiative for Health Policy.

    It would avoid the situation where someone picks an in-network hospital only to find out that a surgeon or anesthesiologist at that hospital doesn’t take their insurance. Air transport should also be included in the rule, he said.

    “It’s the exact same situation as with the out-of-network emergency facility rates,” Adler said. “The same solutions should apply.”

    Gelfand suggested also that the House Ways and Means Committee mandate that air ambulance companies seeking to participate in Medicare must charge in-network rates.

    That would require only a small tweak of the legislative language, as he sees it. “Every proposal that includes something to address surprise bills for emergency care, all you have to do is add in the words ‘air ambulances,’” Gelfand said.

    Right now, the closest any surprise billing proposal has come to addressing air ambulances is a draft legislative plan on medical costs from Sen. Lamar Alexander (R-Tenn.) and Sen. Patty Murray (D-Wash.). They would require bills for air ambulance trips to be itemized to show both medical charges and the transportation charges so patients and health plans can understand them better.

  • 18 Jun 2019 7:35 AM | AIMHI Admin (Administrator)

    Axios Source Article | Comments Courtesy of Matt Zavadsky

    Interesting – From Axios

    Surprise billing proposals don't address ambulances

    Caitlin Owens


    None of Congress' proposals to rein in surprise medical bills address ambulances — which are expensive and often aren't covered by insurance.

    Why it matters: More than half of ambulance rides, and two-thirds of air ambulance transports, aren't covered by private insurance. Patients are often billed more than $10,000 for what insurance won't cover.

    What we're watching: Energy and Commerce Committee Chairman Frank Pallone has said that the committee plans to address air ambulances in its final bill. But it's less clear what will happen with ground ambulances.

    What they're saying: "Ground ambulances are arguably the screwiest market of any that comes up in this context," said Brooking's Loren Adler.

    • "Neither side has much incentive to contract because the insurer knows the ambulance has to pick up anyone who calls 911 and the ambulance doesn’t want to take less money from the insurer than they could get balance billing people," he added.

    The other side: Air ambulances say that the government reimburses below the cost of the service. That means that they have to charge privately insured patients higher rates, but insurers often refuse to cover their services.

  • 17 Jun 2019 7:51 AM | AIMHI Admin (Administrator)

    Health Affairs Source Article | Comments Courtesy of Matt Zavadsky

    This is a very comprehensive, (i.e.: long) interpretation of the new HRA regulations. 

    Seems that these changes could have significant impact on both employers and employees.


    Final Rule On Health Reimbursement Arrangements Could Shake Up Markets

    Katie Keith

    JUNE 14, 2019

    On June 13, 2019, the Departments of Health and Human Services, Labor, and Treasury issued a new final rule to expand the use of health reimbursement arrangements (HRAs) by employers to fund premiums for their employees in the individual health insurance market. The final rule reverses prior federal guidance by allowing HRAs to be used to fund both premiums and out-of-pocket costs associated with individual health insurance coverage. The Departments also released new frequently asked questionsmodel attestations, and model notices.

    The final rule is largely similar to the proposed rule, which received more than 500 comments from a stakeholders that include state regulatorsinsurers, and employers, brokers, and benefit advisors. The final rule’s major significant changes focus primarily on new “integration requirements” for HRAs. The rule also allows a new “excepted benefit HRA” option that employees can use to pay premiums for excepted benefits and short-term coverage. Individuals who gain access to an HRA or qualified small employer health reimbursement arrangement are eligible for a special enrollment period in the individual market.


  • 16 Jun 2019 8:39 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Interesting approach for providers in states that have a state income tax. 

    Wonder if this option could be used for federal income tax refunds – that would help everyone, including providers in states without a state income tax.

    Note Allina EMS’ use of the program to collect ambulance bills from patients who don’t pay, but do not quality for charity care.

    Allina Health, which reported revenue of $4.3 billion in 2018, uses a provision of the Minnesota revenue recapture law allowing licensed ambulance services, public or private, to seize refunds for unpaid bills. It’s garnered nearly $5.7 million from more than 15,000 claims over the past five years.

    Mark Anderson, director of finance for Allina Health Emergency Medical Services, acknowledged that the statutory provision originally was written to help struggling volunteer ambulance services in rural parts of the state. Still, Allina has used the system in its Minneapolis-St. Paul service area.

    Allina only seeks a patient’s tax refund after repeated letters and at least one phone call to the patient to try to work out a payment arrangement, he said. It first makes sure the person doesn’t qualify for charity care or financial assistance and has the ability to pay. Anderson wasn’t sure if the letters specifically warn people that their tax refunds may be seized.

    “The typical ambulance bill is about $2,000, and taking people to court isn’t very cost-effective,” he said. “No one wants to create hardships for anyone, but some individuals just don’t cooperate.”

    When collection efforts fail, some hospitals seize patients' tax refunds

    June 15, 2019

    Duluth, Minn.-based Essentia Health collects only about 20% of the $125 million its patients owe for self-paid services, deductibles and cost-sharing.

    To boost those collections, the 11-hospital, not-for-profit system takes advantage of a Minnesota law allowing it to seize state tax refunds from people who have unpaid bills. Under the law, five of its rural hospitals can use the “revenue recapture” program since they lease facilities from state or local governments.

    In 2018, the tax refunds it intercepted totaled more than $500,000, a small percentage of Essentia’s nearly $4 billion in total patient revenue.

    “We get excited about anything we recover,” said Melanie Wilson, Essentia’s vice president of revenue services. “We invest a lot of money to serve those communities. This is just a small way to balance our commitment with their commitment back to us.”


  • 14 Jun 2019 9:11 AM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    If these provisions make it all the way through the legislative and fiscal process, there is good news for the healthcare system and the patients we serve. 

    • Having a unique national patient ID number would make care coordination, quality assurance, outcome measures and EMS/MIH partnerships much more effective.
    • Enhancing surge capacity for large scale emergencies would be very helpful.
    • Funding for rural and critical access hospitals would help with access to healthcare in rural areas.


    House votes to overturn ban on national patient identifier

    Susannah Luthi and Jessica Kim Cohen

    June 13, 2019

    The U.S. House of Representatives passed a $99.4 billion HHS appropriation bill with several amendments including reversing a longtime ban on developing a national patient identifier, money for hospital emergency departments dealing with opioid overdoses, and a nod to the anti-vaccination controversy.

    For decades, Congress has prohibited HHS from funding the development or promotion of any national program where patients would receive permanent, unique identification numbers.

    Lawmakers previously argued such a program could violate privacy issues or raise security concerns, while the medical community and insurers claimed the ban kept them from properly matching patients with the correct medical information.

    The measure by Rep. Bill Foster (D-Ill.) to overturn the ban passed late Wednesday with the first tranche of amendments to the appropriations bill.

    Several amendments focused on the opioid epidemic, including a measure by Reps. David McKinley (R-W.Va.) and Mike Doyle (D-Pa.) that would deploy $10 million to set up a coordinated-care model for overdose cases in emergency rooms, according to a provision of last year's major opioid legislation.

    Others focused on the impact of addiction on children, with one measure to shift $2 million for research on neonatal abstinence syndrome. A second boosts funding for the National Survey of Child and Adolescent Well-Being by another $2 million to look at children affected by a parent's addiction.

    Rep. Adam Schiff (D-Calif.) secured his amendment that essentially tells HHS to prioritize its national campaign to encourage vaccines and counter the anti-vaccination rhetoric that has increasingly raised worry in Washington amid measles outbreaks across the country.

    The full legislation incorporates provisions to boost rural hospitals and rural healthcare access.

    The final report adds $10 million to the previous year's budget for state surveys and certification reviews of nursing homes, home health agencies and hospice facilities.

    It also increases funding for the Hospital Preparedness Program by $52 million. The initiative coordinates state, local and territorial health departments to get ready for patient surges during public health emergencies.

    House appropriators suggested that federal agencies should follow the enhanced reimbursement model offered for the academic health centers that treated Americans with Ebola for other serious communicable diseases.

    "Given the significant cost of preparedness and care associated with any serious communicable disease, when any federal agency refers any highly contagious individuals to a designated treatment center, the committee encourages the use of the previously developed reimbursement model for Ebola to be applied," appropriators wrote in the bill.

    While the House wrapped up a chunk of its appropriations work this week, Senate appropriators have yet to mark up their own bill as Congress prepares for a battle to lift the spending caps and then the debt ceiling later this year.

  • 12 Jun 2019 10:20 PM | Matt Zavadsky (Administrator)

    Top 7 Reasons That Mobile Integrated Healthcare-Community Paramedicine Programs Benefit Everyone

    Kevin Amell

    May 30, 2019

    A new model of healthcare has arrived in the form of mobile integrated healthcare community paramedicine (MIH-CP).

    You’ve heard all the buzz about these programs and partnerships with local EMS and ambulance companies. You’ve heard about how specially-trained paramedics can visit the homes of selected residents. You’ve heard about how it’s supposed to help EMS agencies to create patient-centered, mobile resources in an out-of-hospital environment. Do MIH-CP programs live up to the hype? In today’s post, we’ll look into seven reasons that MIH-CP programs benefit everyone.

    1. Lowering super-utilizers

    In Milwaukee, Wisconsin, a 2015 review of more than 60,000 annual 911 calls found that 7 percent, or 4288 calls, came from the same 100 people. California’s Alameda County has a list of the top 25 “frequent fliers” who call 911 regularly; in just two years, 25 people had collectively called the 911 line 4,291 times. A 2009 MedStar study found that in the Fort Worth, Texas area, 21 patients had been transported to local EDs a total of 800 times over a 12-month period, generating over $950,000 in ambulance charges and even more significant ED expenses. Most of these individuals did not have health insurance and relied on EMS and local EDs for health services. The Tucson Fire Department had been able to identify 50 individuals who accounted for more than 300 non-emergency 911 calls over a 12-month period.

    This is no surprise. All EMS workers know this: super-utilizers and “frequent flyers” are prevalent everywhere across the country.

    This certainly isn’t ideal. It’s a waste of EMS services, time, effort, and money, especially when most of the problems that these frequent flyers have, and this system abuse seems only to be getting worse. How can communities combat this?

    The answer is not to limit people’s access to 911, of course. Instead, MIH community paramedicine is an answer. MIH-CP programs aim to solve this by attacking the underlying causes of these many 911 frequent flyers, or at least mitigate the load and give these patients the proper care. MIH-CP can improve the health and wellness of underserved populations — especially those with chronic conditions who use the ER as their primary source of healthcare. People needing mental health care can be directed to the proper facilities through proper transportation. Slowly, they’ll learn to better take care of themselves instead of using 911 as their catch-all. By helping patients in the community improve mental and physical health, the frequent flyer and super-utilizer phenomenon decreases.

    2. Relieve the EMS system in 911 Calls

    The community paramedicine program in North Memorial, Minnesota, is seeing a decline in 911 calls after implementing an MIH-CP program. For the first half of 2018, North Memorial found no cost savings during that time period, but in the second half of 2018, the costs of patients who had received those visits declined by $1,969 per member per month.

    Fort Worth, Texas, saw similar results as well. Between July 2009 and August 2011, the Texan community saw the volume of 911 calls fall by 58 percent, from an average of 342.3 monthly calls during the 6-month period before enrollment to 143.3 monthly calls afterward. Unsurprisingly, the decline in calls corresponded to a drop in wasted money; the annualized EMS transport costs for these patients decreased by over $900,000 (from $1,577,472 to $660,128) and charges falling by over $2.8 million ($4,929,600 to $2,062,899).

    An EMS1 article wrote that “81 percent of [MIH-CP] programs in operation for two or more years reported success in lowering costs by reducing 911-call use and emergency department visits for defined groups of patients.”

    Give the EMS and emergency room workers a break — and let them focus on the emergencies they need to focus on.

    3. Educate and help the underserved populations

    When community paramedics can visit underserved populations, it saves time for everyone. MIH-CP programs allow paramedics and emergency medical technicians (EMTs) to operate in expanded roles by assisting with public health and primary healthcare and preventive services to underserved populations in the community. Ultimately, allowing EMS workers to do this helps improve access to care, as many populations currently don’t know how to access that care. Instead, community paramedicine brings that care to them.

    By focusing on medically or socially underserved populations, which are the ones who tend to have a higher risk of using emergency departments, MIH-CP programs become first responders with community health worker skills.

    Healthy Hennepin, a publication managed by Minnesota’s Hennepin County Public Health Department reported the following story: “A community paramedic was on-site when an asthmatic shelter resident, who had recently been discharged from the hospital, began wheezing. ‘Normally someone would have called 911 about him,’ the paramedic remembers. ‘Instead, they called me.’ After showing the resident how to properly use his nebulizer and inhaler, his wheezing subsided. Crisis averted. Calm achieved. Costs contained.”

    In a California study of MIH-CP in over five counties, patient self-assessments after receiving community paramedic visits showed several improvements: a 16% increase in their rating of overall health, 11% in their understanding of discharge instructions, 4% in their understanding of when to take medications, and 9.5% in their understanding of medication side effects.

    4. Provide the proper care for the caller

    The point of community paramedicine is to outgrow the outdated system currently in place. Anyone working in EMS knows that the 911 calls they receive are often for non-urgent needs or those that a hospital emergency room is not equipped to handle. Research has shown that 11 to 52 percent of 911 calls aren’t from people in serious health emergencies.

    Additionally, many visits are made for patients with conditions that are better treated in a primary care setting. Going to an emergency room for acute upper respiratory infections, viral infections, otitis media, and acute pharyngitis is often worse off for the patient because the emergency room is already so busy that the doctors and nurses don’t have enough time to explain the patient’s condition to them adequately, nor how to properly take care of themselves during the recovery process.

    Importantly, the real underlying problems of many 911 callers, especially for frequent flyers, are psychosocial problems that cannot be effectively treated in the emergency room. An emergency room doctor or surgeon cannot fix someone’s alcohol or drug dependency problem, nor can they do much to help a patient with depression. With community paramedicine programs, paramedics will be allowed to transport a person experiencing a behavioral health problem directly to a crisis care center instead of the emergency room first, which will enable patients to get the help they need much faster. Inebriated individuals can be sent to sobering centers.

    Although some might argue that this could lead to the under-triaging of patients, but it’s already been well established that a hefty portion of 911 calls don’t require emergency room treatment. It makes more sense to paramedics to transport patients to the most appropriate location for their condition instead of trying to funnel all patients through a more-likely-than-not costly and crowded emergency department.

    Many callers use 911 because they don’t know where else to go for healthcare-related problems. By allowing paramedics to transport them (or suggest that idea to the patient), patients can slowly learn about the available solutions to their problems.

    5. Reducing hospital readmissions

    One specific subset of also routinely call 911 and visit the emergency room with exacerbations of chronic conditions that could be avoided with proper condition management. Community paramedics aim to help those with complex chronic conditions improve their health and wellness at home. Through home visits, community paramedics teach patients how to use and why they should use their medication. Additionally, these paramedics can assist in filling prescriptions, sorting medications, and explaining how to take them as prescribed. They can supplement information by providing counseling on hospital and clinic discharge instructions.

    Community paramedics can assess the patient’s lifestyle — often the culprit of hospital readmissions, especially in those with chronic conditions — and educate them on how or why they should change certain things. This allows healthcare providers insight into a part of the patient’s life that even doctors don’t get to see and has had proven benefits in reducing the number of hospital admissions.

    In a 2017 California MIH-CP study in the Alameda, Glendale, San Bernardino, Solano counties, hospital readmissions rates decreased by about 10%. Other studies have shown up to a 50% decrease in readmissions

    6. Build more trust with the community

    Since MIH-CP programs aim to solve everyone’s problems, having an effective MIH-CP helps people have more confidence in their EMS and network of healthcare providers in the area. By making routine visits to patients’ homes, paramedics not only help improve patients’ physical health but also feel more cared-for and supported. Relations between all network healthcare providers would be improved, especially given the logistical and financial benefits for everyone involved. When people know that their community healthcare providers can provide them with the support that they need, the community inherently will learn to trust them more.

    Additionally, everyone in the community will be in better shape. Emergency room doctors see fewer non-emergency cases, and hospital charges decrease, urgent care centers get better access to the people who need them, and the patients get the care they need.

    7. It’s easier than ever to do this

    The good news is that the technology is finally where it needs to be. Implementing an MIH-CP program is easier than ever because software and systems that bring entire local healthcare provider workforces together to effectively collaborate finally exist. With Julota, for example, a community’s health systems, EMS, law enforcement, social services, mental health, and all other community care organizations can benefit from more collaboration, better health, and lower overall costs. As comprehensive HIPAA-/mental health (42 CFR part 2)-/Criminal Justice Information System-compliant solution that manages secure multidirectional sharing of consented information, Julota helps patients get better and more appropriate treatments that they would otherwise lack.

  • 12 Jun 2019 10:17 PM | Matt Zavadsky (Administrator)

    Kudos to the folks in Lexington, Kentucky for this program!!

    Tip of the hat to NAEMT’s Melissa Trumbull for the heads up on this news story…


    Community Paramedicine Program helps hundreds in Lexington, saving taxpayers millions

    By Miranda Combs

    May 29, 2019


    LEXINGTON, Ky. (WKYT) - At last count, the number of homeless people living in shelters and on the street had dropped drastically in the past few years -- by almost half.

    In the last couple of years, a new program in Lexington called the Community Paramedicine Program has helped connect the homeless and the people who regularly visit Lexington's emergency rooms with resources in the community to keep them off the streets and out of the ER.

    Cecil Brown was a man who did both. He was homeless, and he'd show up at UK Good Samaritan emergency room regularly. So often, that Physician Assistant Julie Stumbo took an interest in his life.

    "He had told me a lot about his family. Just bits and pieces through the time that I saw him," Stumbo said.

    Stumbo said she'd see him so much, that if time went a few months without showing up, she'd worry.

    "He was respectful and never rude and was grateful for everything we gave him," she said.

    Cecil's visits with Stumbo went on for seven and a half years. He'd been hit by three cars over his lifetime. The last time landed him in the hospital for 22 days.

    "I'm so grateful for the car that hit him," Stumbo said of what would be a life-altering moment.

    "I just said, 'I'll never drink again God, for the mercy that you've shown me," Cecil said.

    He headed to rehab after the hospital, and when he got out, the community paramedicine program hooked him up with a group that provided housing for free.

    Cecil said his friends from UK Good Samaritan Hospital showed up to make the apartment home.

    "When they found out I had an apartment, I didn't ask for nothing. They come with this stuff," Cecil said.

    "We never set out to furnish his apartment. I just wanted him to have a bed. There's truly more good in the world than evil," Stumbo said.

    The Community Paramedicine Program director said the program has had at least 290 unique individual cases since July 2018.

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