News & Updates

CBS News Source Article | Comments Courtesy of Matt Zavadsky

Scary statistics from the National Safety Council:

• 71% of drivers admitted to taking photos and texting while driving by emergency workers.
• Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road.
• Forty first responders were killed on the side of the road last year, up 60% from 2017.
• So far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

Please help keep our First Responders safe as they try to keep others safe!

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Distracted drivers an increasing threat to first responders

CBS NEWS May 27, 2019, 7:40 AM

New research shows that many drivers are profoundly distracted by their phones when they're going past first responders working accidents on the roadways.

New research from the National Safety Council found 71% of drivers admitted to taking photos and texting while driving by emergency workers; that's nearly triple the 24% who admitted to doing it under normal driving conditions. Sixty percent admitted to posting to social media; two-thirds have emailed about what they're driving by.

And the results are increasingly deadly. Sixteen percent of drivers say they've struck or nearly struck an emergency vehicle or first responder on the side of the road. Forty first responders were killed on the side of the road last year, up 60% from 2017. And so far this year, 21 have died, including 10 police officers; 14 officers were hit and killed in all of 2018.

"What surprised us most about this study was the magnitude of people who are really exercising very dangerous behavior," said Kelly Nantel of the National Safety Council. "They're adding another level of exposure to these first responders."

Last December, Florida Highway Patrol Trooper Mithil Patel was on the shoulder of interstate 95 working an accident when, despite a traffic lane being closed as a safety buffer, a suspected distracted driver was the cause of a car losing control and swerving towards him.

Video captured Patel throwing another man to safety right before being hit by the car himself.

"It's a different feeling definitely, seeing where I almost got killed – definitely a weird feeling,' Patel said.

"Do you feel lucky to have survived that?" Van Cleave asked.

"I feel extremely lucky," Patel replied. "I have seen people, you know, pretty much die from this."

Patel admitted to some nerves as he hit the road in his patrol car for the first time since the accident. "I still have the butterfly in my belly," he told Van Cleave. "Whenever you see the brakes squeeze really hard, you're always going to be back to be, like, is he coming toward my way or not?"

Patel hopes to be back to full duty and working calls on the side of the road in the coming months.

In Miami, Fire Captain Steve Perez, heading to a traffic accident, said as soon as they flip on the lights and sirens, drivers behave differently.

Van Cleave asked, "Every call you see people paying more attention to their phones than the road? Is it that common?"

"Sure, I'll venture to say it's very common to see somebody either on their phone or taking their phone out to try to videotape or get a snap of what's going on," said Captain Perez.

Patel said, "I have seen it where they pull out the phone outside the window and take start taking pictures, not paying attention to the road."

All 50 states have a "move over" law that requires drivers to give first responders room to work, but police say it's about 50-50 if people actually do it.

Trooper Patel says, bottom line, put down the phone.

While many excellent nominations were received, the following were selected by the AIMHI Board and Education Committee as the 2019 Excellence in EMS Integration Award winners.

2019 Winners List

Click each winner for a comprehensive look at their programs.

Excellence in EMS Integration Award (Tie)

• John Peter Smith Health Network
• Northern Nye County Hospital District

Excellence in Public Information or Education Award

• Pinellas County 911—Prevent the Fall, Prevent the Call

Excellence in Value Demonstration or Research

• Northwell Health House Calls 

Leadership in Integrated Healthcare Award

• Doug Hooten, Medstar Mobile Healthcare

TimesUnion source article | Comments courtesy of Matt Zavadsky

Congrats to our Montana team, especially Justin Grohs of Great Falls Emergency Services and Jim DeTienne, EMS lead for Montana in getting this legislation passed.

Legislation text►

New law allows emergency care providers to offer other aid

By AMY BETH HANSON, Associated Press

May 2, 2019

HELENA, Mont. (AP) — Montana Gov. Steve Bullock has signed a bill allowing emergency care providers to offer non-emergency medical assistance in their communities to reduce noncritical calls to 911, especially in rural areas.

The providers could fill gaps in the current medical system by helping people manage their medicine or chronic illnesses, giving them a ride to their doctor's office or home from a hospital, or connecting them with other medical or mental health services, supporters said.

The bill, sponsored by Democratic Sen. Margie MacDonald, allows the Board of Medical Examiners to create rules detailing changes and a training program for paramedics and emergency medical technicians. It does not require volunteer emergency agencies to offer the services.

Supporters said the measure, which Bullock signed Wednesday, will reduce the number of 911 calls from people who could have been helped earlier and less expensively.

Hundreds of programs around the country are using emergency care providers to fill similar community medical needs. Montana has successful pilot programs in Cut Bank and Red Lodge, said Jim DeTienne, supervisor of the state health department's Emergency Medical Services and Trauma Systems section.

Medicaid pays for similar programs in other states, and the department is talking with health insurers about covering the service. However, insurers wanted to see it credentialed and regulated, DeTienne said.

Supporters said the program may draw volunteers who don't want to be on-call for emergency situations but would be willing to help with scheduled visits.

The state has funding for six pilot projects that would gather data about the effectiveness of the programs, said Jon Ebelt, spokesman for the Department of Public Health and Human Services.

Officials with fire and rescue services told lawmakers about 911 calls that could have been avoided if the callers had someone to help them manage their medication or give them a ride to a doctor instead of an emergency room if that would better serve them.

The legislation gives emergency responders the ability to sit down with patients and get to the reason for repeated 911 calls, said Bob Drake, chief of the Tri-Lakes Volunteer Fire Department, northeast of Helena.

Drake told lawmakers a resident, despite being in a wheelchair, kept falling and calling 911. He said he finally asked the man why he was falling so much and the man said the brakes on his wheelchair were broken and it kept rolling out from under him as he moved in or out of the chair.

Drake said the man was a patient of the Department of Veterans Affairs, so he called the VA, but they said it would take a few weeks to get him a new wheelchair.

Drake said he went home and got his late father's wheelchair and took it to the man.

"The 911 calls stopped for three weeks," he said.

HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

There has been much discussion about surprise medical bills over the past few years.  The House Energy and Commerce committee released a discussion draft of a proposed Bill and today, requested formal feedback from industry stakeholders.

The email to stakeholders and the supporting documents to the email are below and attached.

Here is an interesting analysis of the Bill released by the Energy and Commerce Committee.

Analyzing The House E&C Committee’s Bipartisan Surprise Out-Of-Network Billing Proposal

Loren Adler, Paul B. Ginsburg, Mark Hall, Erin Trish

MAY 14, 2019

10.1377/hblog20190514.695693

A new bipartisan discussion draft to address surprise out-of-network billing was released today, introduced by the Chairman and Ranking Member of the House Energy and Commerce Committee. This bill follows two Senate proposals released late last year, one from a bipartisan group composed of Senators Bennet, Carper, Cassidy, Grassley, McCaskill, and Young, and another from Senator Hassan.

Surprise out-of-network bills can occur when a patient receives care from an out-of-network provider in situations they cannot reasonably avoid, typically when there is no real choice of provider. These surprise bills can arise both from emergency care (whether the facility itself is out-of-network, the ambulance that transports the patient is out-of-network, or a physician providing emergency treatment is out-of-network) and out-of-network nonemergency care received at an in-network facility (typically a hospital or ambulatory surgery center).

Energy And Commerce Draft Approach

The Energy and Commerce draft would eliminate surprise out-of-network billing for both emergency and non-emergency services (with the notable exception of ambulance services) and across different sites of care (e.g., hospitals, ambulatory surgery centers (ASCs), freestanding emergency departments). Importantly, the legislation would do so for all commercial insurance plan types, including self-insured health plans that can only be regulated by the federal government. The legislation achieves this objective by combining the following three components:

• Require the health plan to treat the out-of-network service as if it were in-network for purposes of enrollee cost-sharing, deductibles, and out-of-pocket limits;
• Set a minimum payment amount that the health plan must pay to the out-of-network provider; and
• Prohibit out-of-network providers from “balance billing” patients -- that is, from billing the patient any amount above the patient’s in-network cost-sharing.

These protections would apply to all out-of-network emergency services and to all out-of-network nonemergency services received at an in-network facility from “facility-based providers,” which the bill defines to include anesthesiologists, radiologists, pathologists, neonatologists, assistant surgeons, hospitalists, intensivists, and any additional provider types specified by the Secretary of Health and Human Services (HHS). Other provider types would still be allowed to treat patients on an out-of-network basis in nonemergency situations if they met the strong notice and consent requirements detailed in the discussion draft. Limiting notice and consent exceptions to physician specialties that patients typically actively choose strikes a sensible balance. It preserves patients’ ability to seek out-of-network care in circumstances where it is appropriate, while mitigating the risk that the flood of paperwork involved in seeking medical care will result in some patients consenting to out-of-network billing without understanding what they are consenting to or whether they have a reasonable alternative.

Payment Standard

By prohibiting balance billing by out-of-network emergency and facility-based providers, the Energy and Commerce draft addresses the market failure that allows these specialties to receive what appear to be very high in-network payment rates, relative to what specialties facing more typical market forces earn. In addition, to help providers, the draft requires health plans to pay out-of-network emergency and facility-based providers their plan-specific median contracted rate for the relevant service in that geographic area. Existing state laws that provide methods for determining out-of-network payment for surprise bills would remain for fully insured plans and would not be pre-empted.

Notably, given that the threat of surprise billing allows emergency and ancillary physicians such as anesthesiologists to garner very high in-network rates today, tying a payment standard to current median contracted rates may fail to bring rates down to what normal market rates would be in the absence of the market failure. However, because median contracted rates for the specialties most commonly associated with surprise billing are typically considerably below the mean (due to the typical presence of a minority of physician groups garnering especially high rates), this bill represents a clear improvement over the status quo. For example, in one study of commercial claims data, mean reimbursement for the highest-level emergency physician service was 306 percent of Medicare’s payment for the same service, whereas median reimbursement was 257 percent of the Medicare rate.

Therefore, the Energy and Commerce draft likely would result in lower insurance premiums in most markets and hence reduced federal deficits (from reducing loss of revenue from tax subsidies to health insurance), in addition to eliminating the scourge of surprise bills to patients. We also believe that a decision by Congress on an out-of-network payment standard is preferred to arbitration, which could be unpredictable, lacks transparency, and could involve significant administrative costs. While it may fall short of fully unwinding the increase in health care spending stemming from today’s market failure, the Energy and Commerce draft legislation represents the strongest proposal to date on the dual fronts of protecting consumers and reducing health care costs. The bill’s structure is most similar to state laws in California and Oregon.

Areas For Further Consideration

The Energy and Commerce Committee should be applauded for a serious bipartisan proposal to address surprise out-of-network billing. As is, the proposal would reduce system wide health costs and provide valuable protection from surprise bills to patients.

The rest of this post discusses a few areas that Members should consider as they revise this discussion draft.

How To Determine The Median Contracted Rate

There are important considerations relating to the payment standard being tied to an insurer’s own median in-network rate for the relevant service in a geographic area. First, this approach gets around the technical challenge of setting different payment standards by geography from the federal perch, without sufficient data available to calculate median contracted rates by geographic market. Second, it leaves in place insurer-specific dynamics based on the rates they have negotiated for emergency services and “facility-based providers,” which may not be desirable to the extent that those rates largely reflect a plan’s current willingness to shield their enrollees from surprise bills.

Third, over time this approach may allow health plans to drive down in-network payment rates toward normal market rates if the plan is able to undo contracts with physician groups earning especially exorbitant rates today and rachet down their plan-specific median contracted rate to more reasonable levels. And because the draft legislation requires the plan to make this payment directly to the provider and prohibits the provider from billing the patient any more than their in-network cost-sharing amounts, the distinction between these provider types technically being in- or out-of-network becomes meaningless from the patient’s perspective.

Still, relying on insurer’s own median rates may lead to out-of-network payment rates being unpredictable for providers, although the HHS Secretary is tasked with determining a methodology for guaranteeing accurate and fair reporting by insurers, which may address this concern. States with all-payer claims databases could also be allowed to use those to determine a market-wide median rate.

In the context of a relatively high payment standard such as median contracted rates, the insurer-specific median approach may be preferable. However, there would be value to pursuing a more transparent approach utilizing a payment standard tied to a lower rate set across a market or tied to a percentage of Medicare rates, which vary by geography.

Lower Payment Standard

For emergency physicians and ancillary clinicians (anesthesiologists, certified nurse anesthetists, radiologists, and pathologists), the natural market negotiation is between them and the facility at which they practice (that’s where the price-volume trade-off exists). To fully ameliorate the current market failure, an out-of-network payment standard would need to be set at or below the normal market rate for that specialist (that is, the rate that would be negotiated with the hospital in the absence of the ability to surprise bill patients).

Fortunately, there is little risk to setting the payment standard below market rates because facilities would then have to step in to demand market rate payment from insurers in order to ensure adequate staffing – or, alternatively, pay these specialists more money directly. (See here for a more detailed discussion of the considerations in setting an out-of-network payment standard.) Given the difficulty of determining this normal market rate, we recommend setting an out-of-network payment standard at a percentage of the relevant Medicare payment rate equal to the ratio of average contracted rates to Medicare rates for other specialists (ones that patients do choose) in the same geographic region.

Ambulances

Similar to the two Senate bills last year, today’s draft does nothing to prevent surprise out-of-network bills from ground or air ambulances, despite ambulance services frequently being delivered out-of-network. Very similar market dynamics characterize ambulance services, and federal law prevents states from addressing this market failure for air ambulances in particular.  Federal legislation addressing surprise billing should incorporate ambulance services within the emergency service protections. The same approach, including a payment standard, could apply.

Non-Physician Providers

Non-physician providers often involved in surprise billing, such as certified nurse anesthetists (CRNAs), should be included in the draft’s list of “facility-based providers” that are subject to the law. Lab services are also a common source of surprise bills. While the draft includes laboratories in its list of health care facilities, it’s not clear that a patient would be protected from a surprise bill if their labs are sent to a non-participating facility.

State Preemption

As drafted, the Energy and Commerce bill appears to allow all existing state surprise billing laws that include a payment standard or arbitration process to supersede the new federal law, for the fully insured plans that states can regulate. This approach, however, allows for state laws that are worse for consumers to continue. One option to address this risk while still allowing for state flexibility would be to rely on the approach already built into the Public Health Service Act -- to allow states to maintain laws that are at least as protective as the federal one. The federal legislation could then include language clarifying that to be considered at least as protective, state protections must not increase premiums or include a payment standard tied to amounts greater than median contracted rates (or an arbitration process in which arbiters are, on average, selecting rates above the relevant median contracted rate).

There is also a narrower question to be resolved regarding how preemption would function for state laws that have a method for determining out-of-network payment but exempt surprise bills below a certain dollar amount, such as in New York or Arizona. A federal law should at least serve as the default for the surprise bills currently not protected against by such state laws. Similarly, certain state surprise billing laws only apply to specific physician specialties, and it should be clarified that the federal default would then apply to other specialties providing out-of-network services for enrollees in state-regulated, fully insured plans.

Post-Stabilization Protections

While the draft legislation clearly protects consumers from surprise out-of-network bills for emergency services, there may remain a risk of patients receiving surprise bills for post-stabilization services performed at an out-of-network facility. One approach to ameliorate this concern is to extend protections from surprise out-of-network facility bills to 24 hours after stabilization from an emergency and require that the facility offer transfer to an in-network facility for continued care.

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Body of email from E & C:

Dear Stakeholder:

 

Last week, Energy and Commerce Committee Chairman Pallone and Ranking Member Walden announced their commitment to crafting a bipartisan solution to address the problem of surprise medical bills that are leaving families across the country with crippling amounts of financial debt.  As the Committee leaders said last week, no family should be left in financial ruin through no fault of their own.

 

Today, Chairman Pallone and Ranking Member Walden are releasing a bipartisan discussion draft, the No Surprises Act, which would protect consumers from surprise medical bills and increase transparency in our health care system.  Attached you will find legislative text and a summary of the discussion draft, which the Chairman and Ranking Member are requesting your constructive feedback on.  Specifically, the Committee requests feedback on the following areas:

 

·        Increasing Transparency for Consumers.  Our health care system is confusing for even the most educated consumers.  The Committee is interested in feedback on ways to help consumers better understand their health plans and which providers are in their network.    

·        Ensuring Network Adequacy.  Consumers deserve adequate networks that offer the right care at the right time.  The Committee seeks feedback on ensuring that networks are sufficiently meeting the needs of individuals.    

·        Encouraging the Development of State All-Payer Claims Databases.  All-payer claims databases have the potential to bring greater transparency to health care costs and spur innovative policy solutions.  The Committee requests feedback on how to aide states in developing robust all-payer claims databases. 

·        Protecting Consumers from Surprise Bills from Air and Ground Ambulances.  While the No Surprises Act does not address the issue of surprise medical bills from ground or air ambulances, the Committee recognizes the need for solutions in these areas and seeks feedback on how to provide relief to consumers burdened with unexpected ambulance bills. 

·        Establishing a market-based benchmark to resolve out-of-network payment disputes between providers and insurers.  Payment disputes between providers and insurers must be resolved in a manner that takes the patient out of the middle, is transparent and does not increase federal healthcare expenditures.  The Committee requests feedback on how to adequately provide payment in these situations through a transparent, non-inflationary mechanism.

 

The Committee requests your written feedback by May 28^th and upon receiving your feedback welcomes the opportunity for further discussion.  We look forward to working with you to solve this critical issue for consumers.

 

Vox Source Article | Comments Courtesy of Matt Zavadsky

Interesting perspective…  Tip of the hat to Don Jones for sending this article along.

“Am I a bad person?” Why one mom didn’t take her kid to the ER — even after poison control said to.

The emergency room bill I can’t stop thinking about.

By Sarah Kliffsarah@vox.com  

May 10, 2019

Two years ago, 36-year-old Lindsay Clark was facing a terrible decision.

Her 2-year-old daughter Lily had gotten into a small bottle of the anti-nausea drug Dramamine.

“It had a child lock on it, but I caught her sitting there with a bunch of white stuff in her mouth,” Clark says. “I immediately swept her mouth with my finger, but I wasn’t sure how many pills she ate.”

Clark had to decide: Should she take Lily to the emergency room?

She called a poison control hotline and the answer was yes: A Dramamine overdose could lead to seizures. The little girl should be monitored. When Clark asked what doctors would likely do, she was told they would likely give her activated charcoal and possibly pump her stomach.

Read the rest of the article on Vox►

Milwaukee Journal Sentinel Source Article | Comments Courtesy of Matt Zavadsky

Huge Kudos to Captain Wright and his team at Milwaukee Fire!  Even re-opened a closed fire station to serve as a home-base for their MIH program!

Nice work, Michael!

New effort to stem overdose deaths, streamline access to treatment announced in Milwaukee

Alison Dirr, Milwaukee Journal Sentinel

May 3, 2019

Milwaukee officials announced a data-driven effort Friday to help stem the opioid crisis by following up with people who have overdosed and streamlining access to treatment.

"We are here for one reason: We want to change the outcomes of what we see in this city, this county and this country, and it's all about partnerships," Ald. Michael Murphy told those gathered for the announcement Friday at Milwaukee Fire Department Station 31, 2400 S. 8th St. 

He said there remains a stigma around addiction that enforces the idea that people who are addicted got themselves into the situation they're in and should, therefore, pull themselves out of it.

That's not true, he said.

The program is expected to roll out in June on Milwaukee's south side, in Ald. José Pérez's 12th aldermanic district.

"This district has been hit severely by this opioid crisis," Pérez said.

Dubbed the Milwaukee Overdose Response Initiative, the effort puts into practice the recommendations of the Milwaukee City-County Heroin, Opioid, and Cocaine Task Force. It aims to save lives by finding trends in data while also providing more direct avenues to treatment and providing in-school education.

The effort is led by the Milwaukee Fire Department and the Milwaukee Health Department.

More specifics about the program will be available after a May 9 meeting.

The data shows that substance use disorder is still widespread, but innovations in treatment, prescribing and awareness are helping. 

How the program works

The program allows data to be used proactively, Milwaukee Fire Department Capt. Mike Wright told those gathered for the announcement. Under the program, he receives a report each morning that details what happened in the last 24 hours. That includes the narrative of each case, the person's age and whether opioid overdose-reversing drug naloxone was used. 

"All this data has never been at our disposal in such a ready fashion," he said. 

A packet is produced on each patient. Then, paramedics and a peer-support person from Community Medical Services, a service for people who struggle with addiction, head out to follow up with the person who overdosed.

They will first ask if that person needs clean needles, Wright said. If so, the AIDS Resource Center of Wisconsin also responds.

The response team then would offer ongoing assistance to the person who overdosed and their loved ones.

"At any time the patient is ready for treatment, we will go out," Wright said. "And then if they say we are ready to go, we stay with them" as they go to a facility.

It's critical, he said, to respond quickly when a person with an addiction wants treatment.

The program will be implemented by the Milwaukee Fire Department Mobile Integrated Healthcare Program, which aims to proactively address the chronic health issues that cause residents to repeatedly call 911.

The Mobile Integrated Healthcare Program on Friday also celebrated its continued expansion. Station 31, one of six that closed in 2018 under Milwaukee Mayor Tom Barrett's 2018 budget plan, has reopened for the program.

"It's an amazing program, and it's growing," Fire Chief Mark Rohlfing told those gathered.

Its first paramedics were trained in 2015.

The department has seen reductions in repeat 911 calls among the people who participated in the program since it launched, he said. Those calls fell by 56% in 2016, by 62% in 2017, and by 55% in 2018, he said.

What they're doing is working, Rohlfing said, and other agencies have come on board.

"We're reaching more patients than ever, and the important thing is we really are meeting them where they are — and where they are in their life, in their health situation but where they are in the community," he said.

FierceHealthcare Source Article | Comments Courtesy of Matt Zavadsky

Several folks have asked opinions on what a “Medicare for All” option may actually entail, and how it might impact EMS and other healthcare agencies.  This is a nice ‘primer’ on the various issues.

One exercise to dabble with is to take your average Medicare/Medicaid reimbursement amounts and apply that to all the FFS services you provide, including a majority of the typically low/no payments generated from ‘bill patient’ (uninsured) patients, since ‘uninsured’ patients would be dramatically reduced.  That may give you a glimpse into the potemtial revenue side.

Lots of variables on the expense side, like what would an employer contribute (if any) to a single payer, in addition to what may be taxed to the employee.

$35 Trillion over ten years ($3.5 Trillion annually) seems like a lot, but estimates of the expenditures for our current system in 2017, are exactly that, …  https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html

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The CBO analyzed what it would take to shift to a single-payer system. Here are 5 takeaways

by Paige Minemyer | 

May 1, 2019

As chatter about "Medicare-for-All" ideas heats up—at least among the field of Democratic presidential hopefuls—the Congressional Budget Office decided to offer its own take.

Well, sort of.

Wednesday, the CBO issued a report that dove into the key considerations policymakers might want to think about before they overhaul the U.S. healthcare into a single-payer system. Putting it mildly, they said, the endeavor would be a "major undertaking."

They don't actually offer up specific cost estimates on any of the Medicare-for-All bills floating around, though other researchers put Bernie Sanders’ Medicare-for-All plan at between $32.6 trillion and $38.8 trillion over the first decade.

But the CBO analysts did weigh in on a slew of different approaches to financing, coverage, enrollment and reimbursement that could be built into a single-payer plan.

“Establishing a single-payer system would be a major undertaking that would involve substantial changes in the sources and extent of coverage, provider payment rates and financing methods of healthcare in the United States,” the CBO said.

So what exactly did the CBO have to say about what it would take to create a single-payer system? Here are some key takeaways:

1. There could be a role for private insurance—or not 

There has been plenty of heated debate around Medicare for All focused on the role that existing private coverage could—or could not—play in that system. Most insured Americans are enrolled in a private plan today, including about one-third of Medicare beneficiaries. 

If they’re allowed, commercial plans could play one of three roles in a single-payer system, according to the report: as supplemental coverage, as an alternative plan or to offer “enhanced” services to members in the government plan. 

Allowing private insurers to offer substitutive plans is unlikely, because they could potentially offer broader provider networks or more generous benefits, which would draw people into them. A solution to this issue could be mandating that providers treat a minimum number of patients who are enrolled in a single-payer plan. 

Private payers could also offer coverage for care that is traditionally outside of the purview of government programs, such as dental care, vision care and hearing care.

Supplemental plans like these are offered in the existing Medicare program, and several countries with single-payer systems allow this additional coverage. 

For example, in England, private plans offer “enhancements” to members of the government plan, including shorter wait times and access to alternative therapies, but members of these plans must pay for it in addition to tax contributions to the country’s National Health Service. 

2. Other government programs could stick around 

In addition to Medicare and Medicaid, the federal government operates several health programs targeting individual populations: the Veterans Affairs health system, TRICARE and Indian Health Services.

A single-payer system could be designed in a way that also maintains these individualized programs, the CBO said. Canada does this today, where its provinces operate the national system while it offers specific programs outside that for indigenous people, veterans, federal police officers and others.

There could also be a continuing role for Medicaid, according to the report.  

“Those public programs were created to serve populations with special needs,” the CBO said. “Under a single-payer system, some components of those programs could continue to operate separately and provide benefits for services not covered by the single-payer health plan.” 

On the flip side, though, a single-payer plan could choose to fold members of those programs into the broader, national program as well, the office said. 

3. A simplified system could also mean simplified tech 

Taiwan’s government-run health system has a robust technology system that can monitor patients’ use of services and healthcare costs in near real-time, according to the report.  

Residents are issued a National Health Insurance card that can store key information about them, including personal identifiers, recent visits for care, what prescriptions they use and any chronic conditions they may have.  Providers also submit daily data updates to a government databank on service use, which is used to closely monitor utilization and cost. Other technology platforms in Taiwan can track prescription drug use and patients’ medical histories. 

However, getting to a streamlined system like this in the U.S. would be bumpy, the CBO said. It would face many of the same challenges the health system is already up against today, such as straddling many federal and state agencies and addressing the needs of both rural and urban providers.  

But the payoffs could be significant, according to the report. 

“A standardized IT system could help a single-payer system coordinate patient care by implementing portable electronic medical records and reducing duplicated services,” the agency wrote. 

4. How to structure payments to providers? Likely global budgets 

Most existing single-payer systems use a global budget to pay providers, and may also apply in tandem other payment approaches such as capitation or bundled payments according to the report. 

How these global budgets operate varies between countries. Canada’s hospitals operate under such a model, while Taiwan sets a national healthcare budget and then issues fee-for-service payments to individual providers. England also uses a national global budget. 

Global budgets are rare in the U.S., though Maryland hospitals operate under an all-payer system. These models put more of the financial risk on providers to keep costs within the budget constraints. 

Many international single-payer systems pay based on volume, but the CBO said value-based contracting could be built into any of these payment arrangements. 

5. Premiums and cost-sharing are still in play, especially depending on tax structures 

A government-run health system would, by its nature, need to be funded by tax dollars, but some countries with a single-payer system do charge premiums or other cost-sharing to offset some of those expenditures. 

Canada and England operate on general tax revenues, while Taiwan and Denmark include other types of financing. Danes pay a dedicated, income tax to back the health system, while the Taiwanese have a payroll-based premium. 

The type of tax considered would have different implications on financing, according to the CBO. A progressive tax rate, for instance, would impose higher levies on people with higher incomes, while a consumption tax, such as one added to cigarettes, would affect people more evenly.  

Policymakers will also have to weigh when to impose new taxes, shifting the economic burden between generations. 

The CBO did not offer any cost estimates in terms of the amount the federal government would need to raise in taxes to fund a single-payer program.

StarTribune source article | Comments courtesy of Matt Zavadsky

Nice story about North Memorial’s program.  Interesting that their finding in medication inventories is very similar to those we hear from multiple programs across the country…

Visiting medics prevent problems

Community paramedics are often dispatched after colleagues on emergency scenes notice that patients have problems beyond their immediate injuries.

By Jeremy Olson Star Tribune  APRIL 27, 2019

North Memorial’s community paramedic program is expanding to provide more at-home, nonemergency support to people who might otherwise call 911 for costly and avoidable ambulance rides.

A UCare health plan grant is extending the reach of the Twin Cities program to include Faribault, Forest Lake and Princeton. Leaders said the program in its first six years has produced measurable results, including lower costs by helping people avoid intensive medical services they don’t need.

Many patients with nonemergency concerns call 911 because the health care system doesn’t present them with obvious alternatives, said Dr. Peter Tanghe, medical director of the program. “That’s part of the problem we’re trying to solve. We have had sort of one solution for a thousand problems.”

Community paramedics are often dispatched after colleagues on emergency scenes notice that patients have problems beyond their immediate injuries. Doctors and nurses might request visits as well if they suspect patients have problems at home that are worsening their medical conditions.

The state Medicaid program pays for visits to its poor and disabled members. Visits generally aren’t covered by private health insurance, though, so North EMS has used its own investments and UCare grants to keep the program running.

North EMS leaders said the investment will hopefully pay off in the future, as health insurance plans switch from paying per procedure to paying for efficient care that improves patient health while lowering costs.

Studying community paramedic visits in 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. North EMS leaders said this might reflect less usage of the ER because medics referred these patients to primary care doctors and instructed them on how to safely take their medications.

“We find a medication error on almost every visit that we go out on,” Tanghe said.

Medics have eagerly sought to join the program, completing the required additional training and then alternating shifts between traditional ambulance runs and community visits, said Shannon Gollnick, North Memorial’s director of ambulance operations.

The change of pace gives medics a chance to help people beyond stabilizing them in emergencies and running them to hospitals, he said. “They like to take care of people.”

Governing source article | Comments courtesy of Matt Zavadsky

Interesting….  Law enforcement officers trained to do blood draws…

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A New Way for Cops to Catch Impaired Drivers: Draw Blood

BY STATELINE | APRIL 18, 2019 AT 7:10 AM

By Jenni Bergal

It was about 6:30 on a Friday night in January when Phoenix Police Det. Kemp Layden pulled over a white Jeep Cherokee that was speeding and weaving in and out of its lane.

The 47-year-old driver spoke slowly, his eyes were red and watery, and his pupils were dilated. The inside of the Jeep reeked of marijuana, and the driver failed a field sobriety test, which includes walking heel-to-toe and standing on one leg.

He told the officer he had smoked marijuana a few hours earlier and taken a prescription sedative the night before, police say. The man passed a portable breath test — he wasn’t drunk. But Layden suspected he was impaired by drugs, which the test can’t detect.

A DUI police van equipped with a special chair and table for blood testing pulled up. The man refused to submit to a blood draw. So Layden grabbed his laptop and filled out an electronic warrant, or e-warrant, which was transmitted directly to a judge.

Within 10 minutes, Layden had a search warrant. Another officer drew the man’s blood. A lab report later confirmed he had active THC and a sedative in his blood.

Police photographed and fingerprinted the driver and issued him a citation for DUI. It took 79 minutes from the time he was stopped until he was picked up by an Uber.

Drugged driving is a growing concern as more states legalize marijuana and the opioid epidemic rages on. To fight it, more communities are training police officers to draw drivers’ blood at police stations or in vans, as in Arizona. And on-call judges are approving warrants electronically, often in a matter of minutes at any time of day or night.

Together, the blood tests and e-warrants “could be a game-changer in law enforcement,” said Buffalo Grove, Illinois, Police Chief Steven Casstevens, the incoming president of the International Association of Chiefs of Police.

While it’s easy for police to screen drivers for alcohol impairment using breath-testing devices to get a blood alcohol concentration level, there’s no such machine to screen for drug impairment.

That’s why blood tests are so important, traffic safety experts say. And alcohol and drugs such as heroin and the psychoactive compound in marijuana are metabolized quickly in the body, so the more time that elapses, the lower the concentration.

Having an officer draw the suspect’s blood soon after he is stopped gives a truer picture of his impairment because he doesn’t have to be taken to a health center for a blood draw after he is arrested, they say. Police departments also save money because they don’t need to pay phlebotomists and hospitals for blood draws.

And having a system in which a judge can sign off quickly on an electronic warrant for a blood test streamlines the process.

Whether or not a state has legalized marijuana for medical or recreational use, you can’t get behind the wheel while you’re impaired. Police make that determination based on your driving pattern, physical appearance, interaction with the officer and roadside sobriety tests. The blood test identifies which substances, if any, are causing that impairment.

A 2016 U.S. Supreme Court ruling found that police don’t need a warrant if a driver suspected of impairment refuses to take a breath test, but they do for a blood test, which pierces the skin. But critics say blood draws outside of a traditional medical setting are unhygienic and that e-warrants could infringe on an individual’s rights.

“There’s an absolute potential for a dilution of a citizen’s constitutional protections against unreasonable search and seizure when it’s done that way,” said Donald Ramsell, a Wheaton, Illinois, DUI attorney and Illinois Association of Criminal Defense Lawyers board member. “A judge can just wake up in his bedroom and hit ‘accept’ [on his device] and go back to sleep.”

 

Deadly Crashes

Impaired driving kills and injures thousands of Americans every year. Alcohol-related crashes claimed 10,874 lives in 2017, according to the National Highway Traffic Safety Administration.

There isn’t comparable fatality data for drugged driving because reporting requirements differ from state to state and not all of them test fatally injured drivers for drugs. But a report from the Governors Highway Safety Association found that in 2016, about 44 percent of fatally injured drivers who were tested for drugs had positive results, up more than 50 percent compared with a decade earlier. The data does not specify how many were at fault.

Police blood-draw programs and e-warrants speed up the investigative process.

“It especially helps with drug-impaired driving by getting a blood sample as close to the time someone is operating the vehicle, versus two hours later,” said Jake Nelson, AAA’s traffic safety advocacy and research director.

It’s not only quicker for a certified phlebotomist officer to take the blood, he said, but it also helps with the chain of custody because fewer people are handling the evidence.

“That helps tie it up in a nice bow,” said Nelson, whose organization is advocating for more law enforcement phlebotomy and e-warrant programs. “It protects the suspect and it’s stronger in a court of law.”

 

Drawing Blood

Police who draw blood from suspected impaired drivers must be trained and certified before they can pull out a needle.

At least nine states have law enforcement phlebotomy programs: Arizona, Indiana, Maine, Minnesota, Ohio, Pennsylvania, Rhode Island, Utah and Washington state, and Illinois is starting one, according to the national highway safety agency.

Police phlebotomist training varies. In Arizona, for example, officers take 100 hours of training, during which they do 100 clinical blood draws. They also get eight hours of refresher training every two years.

In Phoenix, where police use blood draws as the primary testing method, 49 officers and three police assistants are phlebotomists, according to Layden. They wear gloves when they draw blood, and work in a clean environment, following Occupational Safety and Health Administration standards and sanitizing the chair and table.

But Ramsell, the Illinois DUI lawyer who also practices in Arizona, questions whether blood draws should be done outside of a medical facility, saying it’s “ripe for infection and disease.”

And since officers aren’t in the healing profession, Ramsell said, they’re not concerned about pain reduction or hitting a vein. He cited the case of a client arrested in Arizona who had a blood draw in a police DUI van.  “The officer poked him at least 15 times, and because he has a medical condition it was next to impossible to draw enough blood to fill a 10-cc tube,” he said, referring to the size of the tube in cubic centimeters. “Those knuckleheads just kept poking the hell out of him. They only got 3 ccs.”

Electronic Warrants

Forty-five states have legislation, court rules or a combination that allow the issuance of warrants by telephone, video or electronic affidavits, according to a 2018 study by Responsibility.org, a Virginia-based nonprofit funded by distillers that aims to eliminate impaired driving. Twenty-one states and the District of Columbia specifically allow electronic transmission.

But having a law or rule doesn’t mean court systems are using e-warrants for DUI cases. Nor does it mean they need one to do so.

The study examined five states that use e-warrants — Arizona, Delaware, Minnesota, Texas and Utah. Delaware has neither a law nor a court rule specifying requirements for transmitting warrants.

In Utah, where more than 400 officers are trained phlebotomists, police submitted 2,219 DUI blood draw e-warrants last year, according to Highway Patrol Sgt. Nick Street. He said the vast majority came back positive.

According to Utah Highway Patrol Trooper Janet Miller, a certified phlebotomist, “It’s been a great tool not only for law enforcement but for the individual placed under arrest.

“Instead of spending three to six hours with the officer, it’s been cut down to one to two,” she said. “They can get to the jail sooner and get out sooner.”

But critics worry that the e-warrant process for DUI blood draws can end up being the electronic version of a rubber stamp.

“It’s primarily a question of whether judges are actually reading the warrants with the degree of attention that one would expect,” DUI attorney Ramsell said.

Money Magazine Source Article | Comments Courtesy of Matt Zavadsky

This article is from October of 2018, but not sure how widely it was widely circulated… 

This is essentially an economics 101 “chicken and the egg” discussion.  Wages are typically tied to the perceived value of the position (NFL Quarterback vs. EMT).  As a profession, if we articulate and demonstrate higher value, it’s likely we’ll be compensated differently, and could pay differently.

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'The Pay Is Just Not Enough.' EMTs Are Working Multiple Jobs Just to Make Ends Meet

And the complexities of the job are often misunderstood.

KRISTEN BAHLER

October 31st, 2018

If the thought of being rushed to the hospital in a speeding ambulance gives you goosebumps, here’s something that will really make your skin crawl.

Chances are, the person behind the wheel — and the one administering life-saving care in the back — are both tired, overworked, and underpaid.

Paramedics and Emergency Medical Technicians (EMTs) make an average of $16.05 an hour, according to the Bureau of Labor Statistics. That’s about 40% less than the average employed American earns, and one of the worst-paying medical jobs out there. And thanks to grassroots organizing efforts like the “Fight For $15,” some service industry jobs nearly match that pay now.

Wages vary by state and municipality, but in many parts of the country, the going rate for an EMT or paramedic job is well below the threshold needed to meet the cost of living. As a result, many have to work multiple gigs; often hopping off one ambulance, only to start another route immediately after.

“These are the people assigned to the front lines, whether someone has a heart attack in their living room or there’s a terrorist attack,” says David Fifer, a paramedic and educator. “And they’re having to keep a lot of balls in the air.”

Moonlighting to make ends meet is a burden facing much of the U.S. workforce — the plight of teachers, who sometimes work side jobs on nights and weekends to provide for their families, have dominated news cycles this year. But the challenges facing Emergency Medical Services (EMS)—the umbrella term for EMTs and paramedics—are rarely discussed outside of hospital break rooms. And the implications are dire.

“You get what you pay for,” Fifer says. “If you’re only willing to fund EMS agencies to a level that results in a minimum wage, you’re unlikely to get the type of EMTs you would like to have.”

Undervalued and Overworked

One of the most stable jobs Amy Eisenhauer ever took as an EMT paid about $450 a week, after taxes.

It wasn’t a lot — barely enough to cover her bills, groceries, and car payments. But it came with benefits, and a set schedule: Wake up, work a 14 hour shift, fall into bed, repeat.

At previous EMT jobs, Eisenhauer had been hired on a per-diem basis, so she took whatever hours she could get, even if it meant working overnights, weekends, and back to back shifts. For awhile, she worked a part-time job at Starbucks, too. Eisenhauer drinks a lot of coffee, and if she picked up enough hours, she qualified for the chain’s health insurance plan.

It’s never been an easy job: The EMT profession is threaded with hazards that range from injury to infectious disease to a host of mental health issues (the suicide rate of EMS personnel is 5 times greater than the general population, according to research from Eastern Kentucky University).

For some, it’s a stepping stone to a more lucrative medical career; an entry-level job you can put on a med school resume. Others fall into the occupation, and end up making decades-long careers out of it.

Eisenhauer, for her part, started on a volunteer squad in high school, and has worked in a variety of paid EMT jobs throughout New Jersey in the years since. Today, she’s an EMS consultant and educator, and picks up about 5 to 6 EMT shifts a month to keep her skills relevant.

There’s a certain vigilantism baked into the profession — nobody becomes an EMT to make money. But while compassionate, community-minded employees flock to this field in droves, the turnover rate—about 20%—is higher than most industries.

“You have to work two or more jobs to be able to live, and each comes with a multitude of regular workplace stressors,” Eisenhauer says. “[The pay] is just not enough.”

Why There’s No Money (and Why That’s a Big Problem)

The complexities of EMS roles are largely misunderstood, experts say.

These are jobs that require employees to be clear-headed in high-stress environments, and have core competencies in everything from CPR to mental health training. But most people don’t have a clue as to what goes on in the back of an ambulance. And neither do regulators.

“The average person thinks that, in an emergency situation, we come running, we take them to the hospital, and then something is done,” says Dennis Rowe, president of the National Association of Emergency Medical Technicians (NAEMT). “We’re not defined as an ‘essential service.’”

You can look to your local government’s budget to see how this plays out in the policy world — EMS departments usually get a fraction of the funds earmarked for police and fire squads. New York City, which employs more than 3,000 EMTs and paramedics, and has allotted $321.1 million to its EMS department for the coming year. “Fire Extinguishment/Emergency Response,” gets four times that amount. Smaller cities, like Austin and Seattle, also tend to allocate at least twice as much to their fire departments as they do to EMS.

Insurance is another pain point. Medicaid and Medicare cap reimbursement rates for ambulance rides; in many cases, experts say, it’s lower than the actual cost of service. Patients sometimes stiff the bill, too. In cities like North Lauderdale, Florida, unpaid ambulance bills have cost taxpayers millions in debt. And since ambulance services, like the rest of the healthcare industry, operate like a business, salaries suffer when bills go unpaid.

There are other reasons EMS pay is so low.

Certification is minimal — it only takes 120 to 150 hours of training to become an EMT (paramedics require significantly more). Ambulances in rural communities are often staffed by volunteers, which depresses wages for those who do pursue the role as a career. And there’s little opportunity for advancement.

“In a police department, you can be a patrol officer, and be promoted to a shift supervisor, and then captain, and then division chief, and then assistant chief, and then, chief,” says Greg Friese, an industry veteran and editor of EMS1.com. “EMS agencies don’t have that promotion pathway. You’re either an EMT or you’re running the agency, with very little in between.”

‘A Pillar of Public Safety’

The world is changing in ways that impact every facet of healthcare. Our population is aging — the number of Americans ages 65 and older is expected to more than double by 2060. And the opioid crisis, now responsible for more than 40,000 overdoses a year — is complicating patient care even further.

EMS workers, often the first line of defense in keeping these populations alive, will be even more important in the coming years. But unlike most medical professions—including those that don’t require a college degree, like medical health technicians and Licensed Practical Nurses (LPNs), EMS pay remains stagnant.

Advocates have floated several solutions, though most require insurance reform, a redistribution of taxpayer money, and a level of advocacy that is unlikely to catch hold anytime soon.

Looking towards academia, one solution is gaining steam.

As of now, communities have an uneasy (and unbalanced) relationship with the EMS departments that serve them. The low barrier to entry makes it difficult to value those professions the same way we do nurses, firefighters, and police officers. More extensive schooling, and degree programs for advancement, could change that. And it would probably drive up wages, too.

Already, schools like the University of South Alabama and George Washington University in D.C. have added bachelor’s degrees in EMS studies to their rosters.

So has Eastern Kentucky University, where David Fifer teaches.

Fifer says he hopes this becomes a national trend — and soon.

“These are individuals tasked with administering critical healthcare across the nation,” he says. “They’re a pillar of public safety, and they’re not making livable wages.”