Author: Matt Zavadsky

Special thanks to EMS1 for sharing this information as the RHTP grant deadline approaches.
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𝐏𝐚𝐫𝐭𝐧𝐞𝐫𝐢𝐧𝐠 𝐟𝐨𝐫 𝐢𝐦𝐩𝐚𝐜𝐭: 𝐒𝐞𝐜𝐮𝐫𝐢𝐧𝐠 𝐑𝐇𝐓𝐏 𝐠𝐫𝐚𝐧𝐭𝐬
How EMS agencies can work with states to obtain Rural Health Transformation Program funding
October 15, 2025

https://www.ems1.com/ems-grants/partnering-for-impact-securing-rhtp-grants

Rural America faces a growing health access crisis. Declining hospital resources, limited behavioral health services and workforce shortages are placing tremendous strain on already fragile rural health systems. At the same time, EMS remains a trusted and reliable point of access for millions of rural residents — often serving as the front door to care when no other options exist.

But rural EMS agencies are in a crisis of their own, due largely to funding, staffing and geography. Grant opportunities available through the Rural Health Transformation Program (RHTP) may perfectly align state and rural EMS agency goals.

RHTP grant guidance from CMS includes several references to EMS and community paramedicine, and a recently published commentary from the National Governors Association also suggests states consider including EMS in their grant applications.

EMS leaders should use these references as a springboard to ensure they are communicating with their state agencies who are developing grant applications.

It’s encouraging to see more communities transforming their EMS delivery systems using evidence-based research.

While the concept of triaging 911 EMS requests based on effective emergency medical dispatch (EMD) processes, with appropriate medical oversight and quality assurance, using evidence-based protocols is not new, it’s encouraging to see more agencies beginning to use these tools to send the right resource, to the right patient, in the right time – keeping ALS resources available for high acuity calls.

Programs like these also help enhance clinical performance for ALS and BLS clinicians, improve operational effectiveness, and help make EMS systems more financially sustainable!

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Sterling Heights launches first-of-its-kind EMS program to improve emergency response times

The Peak Demand program uses a color-coded priority system to ensure appropriate resources respond to 911 calls, taking pressure off paramedics for critical emergencies

By: Peter Maxwell

Oct 07, 2025

https://www.wxyz.com/news/region/macomb-county/sterling-heights-launches-first-of-its-kind-ems-program-to-improve-emergency-response-times

STERLING HEIGHTS, Mich. (WXYZ) — The Sterling Heights Fire Department has launched a new technology-driven emergency response program designed to save lives by ensuring the right resources reach emergencies faster.

The EMS Peak Demand program is the first of its kind in metro Detroit and comes in response to a sharp increase in 911 calls throughout the area.

The new system has already shown promising results since launching eight days ago.

“This program has been up and running for 8 days. They took about 39 calls in those 8 days, and that equates to 8 percent of the call volume,” said Kevin Edmond, Sterling Heights Fire Department chief.

The EMS Peak Demand units are staffed with four newly hired EMT firefighters and are designed to take pressure off Sterling Heights Advanced Life Support units.

“By sending these people out on the low basic calls, we keep our paramedics available for the heart attacks, strokes, trauma, and breathing difficulties,” Edmond said.

The system determines which EMS unit responds based on information provided to dispatchers, with the goal of alleviating strain on critical resources.

“It’s helping our call takers determine what response unit to deploy to that call,” said Angela Elsey, Macomb County dispatch director.

Dispatchers assess calls through a color-coded priority scale using red, blue, yellow, and green classifications. Red and blue calls are reserved for the most critical emergencies and Advanced Life Support units, while yellow and green calls are handled by Peak Demand EMS units.

Macomb County Executive Mark Hackel called the new program a game-changer.

“It cuts down in deficiency and the unnecessary nature of some vehicles going that don’t need to be there by making sure it’s the right vehicle that’s going,” Hackel said.

Sterling Heights resident Bashar Metti supports the new program and believes it will benefit the entire community.

We often look to EMS systems ‘across the pond’ for innovations. This one seems to make a lot of sense!
 
We just need an economic model that supports NOT sending an ambulance on every 911 call.
 
Side Bar: Imagine deploying 400 ambulances to cover 4,000 DAILY responses… 

Ambulance triage is a ‘game-changer’ – paramedic
Kate Baldock, BBC Shropshire
September 1, 2025

https://www.bbc.com/news/articles/cn02j3gxzdgo

“Our peak across the West Midlands area every day is 400 ambulances, the demand will always be high.”

Jamie Breen, a West Midlands Ambulance Service (WMAS) paramedic who has been in the role for six years, has told how the introduction of a Clinical Validation Team (CVT) in 2021 has been a “game-changer for the service”.

The team calls patients back and where possible speaks to them to determine next steps, which could be advice, referral to a GP, pharmacist, hospital or urgent care team, or sending an ambulance.

Mr. Breen was giving BBC Shropshire an inside view of the pressures, challenges and highlights faced by ambulance crews.

He explained how the CVT worked to “see if they can triage them over the phone, so they don’t have to resource it with an ambulance”.

“Patients are getting the right care -and they’re getting referred on to specialist services such as specific wards, their GP or district nurses or things like rapid response,” he said.

Rob Till, head of integrated urgent care services at WMAS, said the triage service meant life-threatening cases were prioritised and responded to as quickly as possible.”

“At the same time, patients whose conditions are less urgent are safely referred to alternative services better suited to their needs,” he said.

WMAS receives about 4,000 emergency 999 calls a day and serves a population of about six million people.

The ambulance trust said it clinically triaged 723 patients each day through the CVT last month.
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From the CVT Website:
“Not all calls require an ambulance; some 999 calls can be dealt with by our Clinical Validation Team (CVT) in our Emergency Operations Centre, who can discuss the patient’s condition further.

CVT is a team of paramedics and nurses specially trained to help patients who have called 999 needing medical help.

Around a quarter of all 999 calls we receive go to CVT.

Out of those, 60% of patients do not require an ambulance.

Instead CVT is able to find alternative care pathways, ensuring patients are given the right help, at the right time and in the right place.”

This recent article (excerpted below for length) explains that the Hospital At Home model is an innovation that seems to be demonstrating value for America’s healthcare system.

Under the CMS waiver that expanded this model, Mobile Healthcare Paramedics are approved members of the healthcare team supporting this model.

Some EMS systems have partnered with local hospitals to be part of this model, but the CMS waiver that enables the intervention is due to expire on September 30, 2025.

EMS advocacy groups should include the continuation of this waiver as part of their legislative educational efforts, along with the waivers that enable telehealth services available that some EMS systems are using to provide patient-centered patient navigation.

How Health Systems Are Turning Living Rooms Into Hospital Rooms
By Alexis Kayser, Healthcare Editor
Sep 10, 2025

https://www.newsweek.com/2025/09/19/how-health-systems-are-turning-living-rooms-hospital-rooms-2126557.html

How Do Hospital at Home Programs Work?
Demand for hospital beds skyrocketed during the pandemic. To alleviate some of the pressure on inpatient wards and emergency departments, the U.S. Centers for Medicare and Medicaid Services launched the Acute Hospital Care at Home initiative in November 2020. The new rule permitted certain Medicare-certified hospitals to provide inpatient-level care in patients’ homes.

While this wasn’t the first test run for hospital at home—the model is popular around the world and had been piloted in the U.S. for specific disease cases—the legislation sparked unprecedented interest. People over the age of 65 represent a large portion of hospitalized patients, so it was tough for health systems to justify this kind of treatment without a reimbursement route for Medicare, the federal health insurance program for seniors.

By July 2025, 400 hospitals across 39 states were participating in the AHCAH program. Many of them use a combination of remote patient monitoring technology, in-home nursing and rehabilitation visits and virtual doctors’ appointments to provide hospital-level care in the comfort of patients’ own homes. Often, the remote monitoring devices can be operated with the click of a button and automatically send readings to hospitals’ data dashboards—reducing pressure on the less technologically savvy. Patients with respiratory, circulatory, renal and infectious diseases are common candidates for this type of care.

The success is not just anecdotal. Medicare beneficiaries who received care under the AHCAH initiative had lower mortality rates, according to a September 2024 CMS report. And a June 2024 research analysis published in the journal BMC Medicine found a 25 percent reduction in mortality rates for patients who had been discharged early from an inpatient hospital stay into a hospital at home program.

In the 30 days after a patient was discharged from the hospital, Medicare spending was significantly lower in the hospital at home group than in the traditional hospital group as well.

Hospital CEOs are worried about a “triple threat” to their budgets, DiLullo said: People need more health care services than ever, and need them for longer as life expectancies go up, yet the industry doesn’t have enough staff to meet demand. As health care costs rise at a quicker pace than inflation, industry leaders are feeling the pressure to make care more affordable without sacrificing quality. He believes that virtual and hospital at home programs could be a solution.

What are the Challenges Facing Hospital at Home Programs?
OSF Healthcare has generally seen “incredibly high” satisfaction scores for hospital at home, according to Moots. But the model is far from perfect. Caregivers lose the solace and privacy that once marked their space. Oftentimes, they’re also tasked with providing medical care, making sure equipment is up to date, medications are filled and nurses show up to their shifts.

But that momentum is tempered by the uncertain policy environment. When CMS launched the AHCAH initiative in 2020, they did not promise that it would be permanent. The program has been extended by Congress three times, most recently in 2025 for six months. The current waivers are set to expire on September 30, 2025—which would end hospitals’ ability to provide care in the home.

Health systems and House representatives—from both parties—have been working to keep hospital at home programs alive. The Hospital Inpatient Services Modernization Act, which would extend the AHCAH program through 2030, was introduced in the House in July. Backed by professional organizations like the American Hospital Association and the Association of American Medical Colleges, the legislation also calls for a formal evaluation to compare home-based to traditional hospital care, and help CMS set standards.

On September 3, a group of 140 health care stakeholders—including health systems, digital care companies and advocacy organizations—wrote a letter to Congress, urging them to include the waiver extension in the September government funding package. If the legislation passes, it would benefit systems like OSF HealthCare that have spent much of the past five years in a waiting game.

“Our CMS waiver has been unevenly renewed, and that’s been a real struggle,” Moots said. “If you’re living six months to six months in a program that requires a lot of capital investment, that’s really tough to do.” A longer extension would also incentivize more hospitals to invest. Many have been holding off because they’re unsure of the AHCAH’s future, according to the American Hospital Association.

“We always have to make sure that Medicare extends the [AHCAH waiver],” Banos said when asked about the greatest challenges facing hospital at home programs. “We want to focus permanently on Medicare.”

Readmission prevention continues to be a valuable offering by EMS-Based MIH programs. This recent news may spur even more interest, especially considering the likelihood of additional financial pressures on hospitals in the near future.

We will provide an update once the CMS data is officially published. CMS offers a site where you can view/compare hospital readmission percentages (as well as other quality metrics) at their ‘Care Compare’ site here.

Upon accessing the site, find the hospital that interests you, click on ‘Unplanned Hospital Visits’ to see the hospital’s readmission rate.

More hospitals to face high readmission penalties in fiscal 2026
By Diane Eastabrook
September 22, 2025

https://www.modernhealthcare.com/providers/mh-cms-hospital-readmission-penalties-2026/

The number of hospitals faced with readmissions penalties of at least 1% come Oct. 1 is set to rise to the highest number since fiscal 2022.

Prior to fiscal 2026, the number of hospitals facing readmissions penalties of 1% or more had dropped for five consecutive years. But preliminary data released Friday by the Centers for Medicare and Medicaid Services showed the number of hospitals set to pay penalties of 1% or more under the Hospital Readmissions Reduction Program will increase to 8.1%, or 240 hospitals, in fiscal 2026 compared to 7%, or 208 hospitals, in fiscal 2025.

However, the number of hospitals facing no readmissions penalties next fiscal year, which starts Oct. 1, remained relatively flat compared to fiscal 2025, rising to 21.8%, or 641, from 21.4%, or 638.

For the upcoming year, 70.1% of hospitals will be charged penalties of less than 1%, compared to 71.6% in fiscal 2025.

The average fiscal 2026 readmission penalty for hospitals with the highest proportion of Medicare-Medicaid dual-eligible patients is 0.33%. For hospitals with the lowest number of dual-eligible patients, the average penalty is 0.35%.

During fiscal 2025, those two groups had penalties of 0.31% and 0.32% respectively.

CMS will release the final data Oct. 1.

The Hospital Readmissions Reduction Program is a Medicare value-based purchasing program that began over a decade ago to encourage hospitals to better communicate and coordinate care with patients and caregivers to avoid hospital readmissions. Penalties reduce fee-for-service Medicare payments CMS makes to hospitals.

The hospital readmissions performance period for fiscal 2026 pulls in claims from July 2021 through June 2024. The report is based on a rolling three-year time period. The most recent period included data generated during the tail-end of the COVID-19 pandemic.

Akin Demehin, senior director for quality and patient safety policy at the American Hospital Association, said the increase in the number of hospitals receiving higher penalties could be partly attributed to CMS reinstating data on pneumonia patients, which it excluded from the previous period because the illness overlapped with COVID-19. “That could potentially be part of the explanation of why there was some change. I think what we are seeing is some of the normal year to year fluctuations,” he said.

However, he also warned hospitals could soon start seeing rising penalties as CMS begins looking at Medicare Advantage enrollees, as well as those in traditional Medicare, when considering hospitals’ performance in fiscal 2027, Demehin said.

Demehin estimates between 75% and 82% of hospitals will see some penalties in fiscal 2027, with an average penalty of .44%.

The inclusion of Medicare Advantage patients in future performance calculations is a concern for hospitals, because prior authorizations used by private insurers can result in delayed or denied post-acute care, Demehin said.

“We know that timely access to post-acute care can be a key determinant in how patient recovers and, therefore, the likelihood of readmission,” he said. “We do worry about how that will show up in readmissions for hospitals so we are going to be watching that very closely.”

This is an example of the types of EMS delivery transformations that communities are considering to enhance clinical proficiency, improve operational effectiveness, and increase fiscal efficiency in EMS delivery.

The economic model for transformations like this are a bit challenging. The Q2 PWW|AG Financial Index revealed that nationally, 39% of ambulance Treatment in Place (TIP) claims are paid, with an average reimbursement per paid claim of $398.

There is limited reimbursement opportunity for a non-ambulance response TIP claim.

However, there may be cost savings by not needing to hire additional staff to respond ambulances to these types of calls, which could be modeled as a cost savings to the community.

Kudos to Onslow County Emergency Services for implementing this change!

County launches new paramedic dispatch program
By Daily News staff
Sep 22, 2025
 
https://www.jdnews.com/news/local/county-launches-new-paramedic-dispatch-program/article_e4d4b628-7199-5e0f-a6d4-25b4c0698ec5.html
 
Onslow County Emergency Services has implemented a new innovative dispatch method for calls requiring a paramedic response.
 
Under the new system, paramedics will have greater flexibility to respond to calls that may not require an Emergency Medical Services unit with an ambulance, county officials said.
 
Previously, EMS units responded to all six levels of emergency medical dispatch. Paramedics are now automatically dispatched to the lowest-level calls, as well as fall calls without injury that only require a lift assist.
 
Low-level calls typically involve nonemergent conditions, like fevers, sore throats, flu-like symptoms, rashes or minor injuries, county officials said.
 
When a paramedic arrives on scene, they conduct a full patient assessment, which helps determine whether an emergency room visit is needed or if the patient can be served by other resources, such as an urgent care or primary care provider.
 
Bradley Kinlaw, Onslow County Emergency Services director, said the changes will make EMS response more agile and focused.
 
“Not every medical call needs an ambulance,” Kinlaw said. “Now when someone calls 911 for something like lift assistance or other minor issues, we can send a community paramedic, which ensures that ambulances are available for the most serious calls.”
 
The improvements being made to EMS dispatching represent Onslow County’s commitment to the recently adopted strategic plan, county officials said.
 
One of the focus areas, Healthy and Safe Community, prioritizes investment in first responder services to ensure the safety of citizens.