News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,990 news reports have been chronicled, with 40% highlighting the EMS staffing crisis, and 40% highlighting the funding crisis. Combined reports of staffing and/or funding account for 79.6% of the media reports! 247 reports cite EMS system closures/takeovers, or agencies departing communities, and 94% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals 5-31-25.xlsx

  • 30 Oct 2024 2:44 PM | Matt Zavadsky (Administrator)

    As the period for Medicare Ground Ambulance Data Collection System (GADCS) submissions starts to wind down, the Academy of International Mobile Healthcare Integration (AIMHI) is interested in doing a cost and revenue analysis, using data submitted to Medicare, in advance of Medicare finalizing their assessment. We believe this advance assessment will serve two key purposes for the industry:

    • Provide valuable information to the EMS profession about costs and revenues for service delivery that can be used to advocate for reimbursement changes.
    • Provide a 'gut check' on what the data shows so that when Medicare does release their analysis, the industry will have some 'ground truth' on pre-assessment of the same data submitted to Medicare.

    We commit to releasing an only aggregated data, without any agency identifiers. However, for additional assurance, agencies can either 'stamp' their PDF with 'Confidential', or include 'confidential' in the file name.

    The secure link to upload the PDF files is: https://pwwemslaw.sharefile.com/i/i97ecb1d33dc479d9

    Thank you!
    Chip Decker, President

    Below are the instructions for the secure file upload. If you have any questions, or would like support setting this up, feel free to contact Matt Zavadsky at Matt.Zavadsky@pwwadvisorygroup.com, or by phone/text at 817-991-4487.
    -----------------------
    Click on the link below: https://pwwemslaw.sharefile.com/i/i97ecb1d33dc479d9 You'll be prompted to set up a login:

    Once created, you'll be prompted confirm your email and create a password - once completed, you'll be navigated to the link to upload your GADCS file.



  • 21 Oct 2024 9:08 PM | Matt Zavadsky (Administrator)

    CMS Transmittal: 12896

    https://www.cms.gov/files/document/r12896cp.pdf 

    Full transmittal here: 2025 CMS AFS AIF Memo.pdf


  • 15 Oct 2024 9:30 AM | Matt Zavadsky (Administrator)

    The CDC released a series of reports on 10/9/2024 highlighting EMS delivery challenges.

    The reports are summarized below, and there are links to PDFs of the full reports at the end of the summary.

    ------------------------- 

    Emergency Medical Services (EMS): A Look at Disparities in Funding and Outcomes

    https://www.cdc.gov/ems-community-paramedicine/php/us/disparities.html

    Key points

    • Substantial geographic disparities in emergency medical services (EMS) exist based on urbanicity—for example, in rural areas more staff volunteer or work part time, response times are longer, paramedics typically have lower levels of certification, and EMS relies heavily on fee for service funding.
    • EMS response times for patients with cardiac arrest are 10% longer in low-income neighborhoods than in high-income neighborhoods.
    • Studies find substantial disparities in the provision of EMS based on race and sex.
    • In a case study of eleven counties in California, local EMS agencies that served rural counties had lower per capita EMS funding and lower percentages of cases that met established quality standards.

    Nationwide EMS challenges

    Despite widespread popular support for additional EMS funding, limited EMS resources contribute to service-related challenges throughout the nation. Recruiting qualified emergency medical technicians (EMTs) can be difficult because of:

    • Low salaries (national average: $34,320)
    • High turnover
    • Lack of racial equity among staff (in 2019, 86.6% of EMTs were White)
    • Insufficient operations support:
      • Reports of ambulances held together with duct tape
      • Reports of bake sales to raise money for fuel
    • Little recognition of EMS role in public health
    • Poor opportunities for staff training

    Geographic disparities in EMS

    Geographic disparities in EMS based on urbanicity have been identified nationwide. Specifically, rural areas have:

    • Greater reliance on volunteers and/or part-time staff
    • Paramedics with basic, rather than advanced, life support certification
    • EMS paramedics who are less likely to receive prearrival instructions
    • Heavier reliance on fee-for-service funding
    • Longer prehospital response and transport times
    • EMS systems that lack consistent medical oversight, which affects outcomes
    • Higher rates of patients who require EMS transport
    • Substantially higher costs for pregnant women with preterm labor


    Emergency Medical Services (EMS): Local Authority, Funding, Organization, and Management

    https://www.cdc.gov/ems-community-paramedicine/php/us/local-authority.html

    Key points

    • Unlike police and fire services, emergency medical services (EMS) are rarely classified and funded as "essential services."
    • EMS are primarily funded at the local level and often severely underfunded.
    • Administration, management, and oversight of EMS systems vary greatly but typically involve collaboration among multiple sectors.
    • Local government autonomy may play a crucial role in giving local governments the flexibility to create and fund EMS with limited local resources.

    Emergency Medical Services (EMS)_ Local Authority, Funding, Organization, and Management _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Equity in U.S. Emergency Medical Services (EMS)_ A Case Study in California _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Table 2b_ State Laws for Mutual Aid Contracts, Bonds, and Fees in Effect as of January 31, 2022 _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Table 2a_ State Laws Related to Statewide Local Government Autonomy in Effect as of January 31, 2022 _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Table 1_ Summary of Laws Pertaining to Local Government Autonomy and Local EMS Funding Mechanisms, in Effect as of January 31, 2022 _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Emergency Medical Services (EMS) Home Rule State Law Fact Sheet _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Appendix_ Detailed Methodology and Data Sources _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf

    Emergency Medical Services (EMS)_ A Look at Disparities in Funding and Outcomes _ Emergency Medical Services (EMS) and Community Paramedicine _ CDC.pdf



  • 14 Oct 2024 5:05 AM | Matt Zavadsky (Administrator)

    EMS on Life Support_Expectations vs Reality.pdf

    EMS On Life Support: The Alarming Gap Between Expectations and Reality

    What should you expect when you call 911 for an ambulance? For decades, the expectation has been to see an ambulance racing down the street with lights flashing and sirens blaring as Paramedics and Emergency Medical Technicians (EMTs) rush to the scene of a medical emergency. In reality, time is a factor in a small percentage of the calls EMS respond to and a large portion of calls to 911 today aren’t for medical emergencies. The idea fast equates with quality was pushed by the Emergency Medical Services (EMS) profession as some emergencies, such as cardiac arrests and strokes, depend on rapid responses for the best outcomes. While time is a factor for these emergencies, they make up a small number of EMS responses. Still, EMS response times are what many localities look to as the key measure of the success of their EMS system with the expectation that all calls to 911 are emergencies and need a quick response. EMS today plays a larger role in healthcare and emergency preparedness, often providing services for which there is no compensation. The gap between expectations and reality has strained EMS systems nationwide, impacting response times, financial sustainability, staffing and patient care. If the gap between expectations and reality isn’t closed, the problems facing EMS and the essential service it provides to the public could hit a breaking point. In some places, it already has. 

    Recently, a joint statement from national and international healthcare and civic organizations called on localities to modernize how they measure an EMS system’s success beyond response times. While speed is helpful in some cases, in most responses it can do more harm than good. A 2020 study published in the National Library of Medicine, looking at nearly 6 million calls from almost 1,200 agencies across the country, showed less than 7% of 911 calls for EMS dealt with potentially life-saving interventions even though lights and sirens were used to respond to calls 86% of the time. Another study published by the National EMS Quality Alliance found it was more dangerous to the crews, patients and the public to use lights and sirens that often. In reality, fast does not equate with quality for most 911 calls. EMS systems are being evaluated and sometimes replaced because of an outdated metric. We must ask ourselves, are we doing what’s best for patients or changing for the sake of change in hopes ambulances will arrive more quickly? We should be measuring patient outcomes, how successfully staff are providing appropriate treatment according to the latest research and guidelines and when it is truly a factor, response times.

    At its inception, the expectation was EMS would be used for medical emergencies. In today’s reality, EMS is a catchall. Many EMS responses aren’t for emergencies and sometimes do not require any medical assistance at all. At times, patients could be better served with a visit to an urgent care facility, a virtual visit with a doctor, or a response from a behavioral health professional or social services. Research published earlier this year, looking at nearly 2 million EMS responses, found 27% of the responses fell into this category. As call volume for these types of calls has increased, many EMS agencies have been stretched thin. As a result, callers get angry when an ambulance doesn’t arrive in minutes.

    What is most troubling, is sometimes it is the patients who are suffering a life-threatening emergency that are having to wait longer. If we aren’t amplifying and using options more appropriate for patients than a call to 911, we are putting those who need lifesaving help at risk.

    In February, a bipartisan group of legislators in Minnesota declared an “EMS Emergency,” asking for a $120 million infusion to address short-term funding challenges and strain on current EMS systems, with providers saying EMS in the state was on the brink of collapse. An industry media tracker has identified thousands of media reports on the economic crisis in EMS nationwide.

    The reimbursement and funding models for EMS need to be restructured so agencies have access to consistent federal, state and local funding and are paid for services beyond the transportation of patients.

    Additional funding is essential but we must also reset expectations so they’re more in line with reality. Failure to change will lead to more expensive alternatives, could result in lower quality care and could drive any current and future EMS employees away from the profession. That’s where we are headed if we do not close the gap between expectations and reality. We know the problems, now is the time for all of us to have an honest conversation about the solutions.

    Richard (“Chip”) H. Decker, III

    President, AIMHI


    About the author:

    Chip Decker serves as the CEO of the Richmond Ambulance Authority (RAA) located in Richmond, VA.  His duties extend to administering the high-performance system design to deliver clinical excellence in the most economically efficient way possible.  He currently serves as the Board President for the Academy of International Mobile Healthcare Integration (AIMHI) and is an Affiliate Professor with Virginia Commonwealth University’s (VCU) Department of Health Administration, School of Allied Health.  He currently serves as a member of the Virginia Public Safety Foundation’s Board of Directors and remains an active member of the Virginia Association of Governmental EMS Administrators (VAGEMSA).

    He was a member of the Virginia EMS Advisory Board, past-Chairman of the Advisory Board’s Transportation Committee and also served on the Old Dominion EMS Alliance (ODEMSA) Board of Directors and the Richmond Metro Council.    His experience in EMS spans over 40 years and includes both volunteer and career positions. 

    Chip is the recipient of a number of awards in recognition of his dedication to the EMS field.  These include an ODEMSA Award for Excellence in EMS, recognition for outstanding service from the Virginia Attorney General for his work in response to the Pentagon following the 9/11 attacks, and a commendation from the Virginia Office of EMS.  He is a life member of the Tuckahoe Volunteer Rescue Squad and received Henrico County’s Division of Police Meritorious Unit Citation for his service as Senior Volunteer Medic and member of their S.W.A.T. team.


    About the Academy of International Mobile Healthcare Integration

    The Academy of International Mobile Healthcare Integration (AIMHI) represents high performance emergency medical and mobile healthcare providers in the U.S. and abroad. Member organizations employ business practices from both the public and private sectors.  By combining industry innovation with close government oversight, AIMHI affiliates are able to offer unsurpassed service excellence and cost efficiency. www.aimhi.mobi | hello@aimhi.mobi | @AIMHI_MIH | www.fb.me/aimhihealthcare


  • 10 Oct 2024 8:27 AM | Matt Zavadsky (Administrator)

    This is interesting news, as many EMS providers have struggled with payers complying with outcomes of arbitration or mediation when an Independent Dispute Resolution (IDR) processes used. Some of the state-level patient protection from balance billing laws also include this provision.  The report also highlights one of the many challenges with the current No Surprises Act, likely a factor in the Ground Ambulance Patient Billing Advisory Committee's (GAPBAC) recommendation that ground ambulance providers NOT be included in the act.

    It's nice to see the coalescence of associations and federal agencies about the challenges with the No Surprises Act.

    Click here for an overview of the GAPBAC recommendations to Congress. 

    ----------------------------- 

    Federal departments, provider groups oppose HCSC in unpaid surprise billing lawsuit

    By Noah Tong 

    Oct 8, 2024

    https://www.fiercehealthcare.com/payers/vocal-opposition-hcsc-arises-unpaid-surprise-billing-lawsuit

    Major medical associations and the federal government are voicing their opinions in a controversial No Surprises Act lawsuit.

    The Department of Labor (DOL), Department of Justice (DOJ), American Hospital Association, American Medical Association, Federation of American Hospitals and the Texas Medical Association are all supporting air ambulance providers against Health Care Service Corporation (HCSC), under the Blue Cross Blue Shield Association umbrella.

    Insurers are required under federal law to cover emergency services, even if the care is out-of-network, as is often the case in emergency situations. Health plans are often required to reimburse providers at a fair rate after going through a lengthy independent dispute resolution (IDR) process.

    In the lawsuit before the Fifth Circuit of Appeals, provider Guardian Flight underwent the IDR process with HCSC for 33 air transports, but the insurer never paid up. A district court previously ruled in favor of HCSC, saying patients are not hurt by insurers’ inaction. The court said HCSC did not violate the Employee Retirement Income Security Act (ERISA) or No Surprises Act.

    HCSC did not immediately respond to a request for comment. The insurer owed nearly $1 million in payments if it followed the IDR ruling.

    “Truly an awful decision,” said Julie Selesnick, senior counsel at Berger Montague, in a LinkedIn post in August. “Why would an insurer ever pay an IDR award now?”

    But on Oct. 4, the DOL and DOJ argued in an amicus brief that protecting a provider's ability to recoup payments is instrumental in protecting patients against surprise medical bills, as intended by Congress when it enacted the law. The agencies said because payment following the IDR process is “tantamount to mandatory plan benefits” plaintiffs should be allowed to invoke ERISA.

    Last month, Rep. Greg Murphy, R-N.C., introduced the No Surprises Act Enforcement Act. The proposed bill enforces non-compliance penalties on health plans that already exist for providers.

    No payments were made after the conclusion of the IDR process 52% of the time, a survey (PDF) of 48,000 physicians from the Americans for Fair Health Care found. In the other instances, 49% of payments were not made within the required 30-day window and 33% of payments were incorrect.

    CMS previously said providers are winning (PDF) No Surprises Act arbitration cases against health plans at a 77% clip.

    “As argued by the DOJ, the ability to enforce IDR determinations in court is but one more necessary ‘tool in the toolbox’ for clinicians to force the health plans to comply with the law,” said Ed Gaines, vice president of regulatory affairs and industry liaison for Zotec Partners, in a statement to Fierce Healthcare.

    Leading provider organizations—the American Hospital Association, American Medical Association, Federation of American Hospitals and the Texas Medical Association—agreed with the government, arguing providers’ existence would be threatened.

    “It gives insurers significant leverage to demand confiscatory discounts from out-of-network providers, as well as to exact across-the-board rate cuts from in-network providers, lest they be kicked out of network and not paid at all,” the organizations said in a joint amicus brief. “Both in- and out-of-network providers will thus find themselves perpetually underpaid or even uncompensated for their valuable services, and patients will lose providers and critical care as a result.”


  • 2 Oct 2024 3:10 PM | Matt Zavadsky (Administrator)

    A very comprehensive report on this nagging issue. The linked article has some descriptive inter-active charts that are very informative.

    AIMHI hosted an insightful webinar on this topic, with tips from leading EMS and hospital experts. You can access the recording of that webinar here: https://aimhi.mobi/ondemand/11002833.




    On Hold: Dire delays at hospital ERs create long waits for ambulance crews, put patients at risk

    National data shows delayed EMS crews frequently wait an hour or more before returning to service

    September 30, 2024

    By Emily Featherston and Chris Nakamoto

    https://www.wifr.com/2024/09/30/hold-dire-delays-hospital-ers-create-long-waits-ambulance-crews-put-patients-risk/

    Sandy Edlein had just finished reading a chapter in a book and was preparing to go to bed when a sharp pain shot across his upper body — turning his quiet evening into a night spent fighting for his life.

    “I stood up, and as soon as I stood, it was like somebody hit me across the chest with a baseball bat,” Edlein said. “I never felt anything like it before.”

    Edlein, 80, recalled his wife Rita telling him he was having a heart attack.

    “She said, ‘You need to get to the front room because I’m calling 911,’” Edlein said. “The front room would give us immediate access to somebody coming in. I laid on the bed with my face down, writhing back and back and forth.”

    Edlein and his wife said the first fire truck arrived in minutes, bringing with it emergency medical technicians who were able to assess his situation and start an IV.

    A second truck arrived four minutes after that, but the ambulance needed to transport Edlein the three miles from his house to the University of Tennessee Medical Center was nowhere to be found.

    As precious minutes ticked by, Edlein said the first responders kept asking 911 dispatchers about the ambulance.

    “They were calling every single minute,” Edlein said. “They were exasperated beyond belief.”

    All told it was 55 minutes before the ambulance crew arrived.

    “My wife had indicated, you know, to the firemen, ‘Let’s just put him in my car,’” Edlein remembered. “They were not agreeable with that, because I had the line in me. I had the PICC line in me, and I was hooked up to the machines.”

    Edlein learned later there were no available ambulances to immediately respond to his emergency, in large part because crews were tied up at the hospital, waiting to drop off another patient.

    InvestigateTV analyzed national data and found emergency medical service crews reported being delayed returning to active service due to emergency room backups more than 890,000 times in 2023.

    One in five of those delays lasted an hour or more.

    Not only is that idle time frustrating for crews, but — as in Edlein’s case — it means there is one fewer ambulance able to respond when someone needs help.

    Despite federal regulations indicating hospitals are responsible for patients as soon as they arrive, there is little direct oversight by federal or state governments over how long it takes to offload an ambulance.

    And experts warn the consequences of continued long delays could be severe.

    “If we don’t do something, the hospital offload times are going to crush the EMS system,” said Dr. Clayton Kazan, the emergency medical director for the Los Angeles County Fire Department. “It’s going to impact people in their homes, who are having the acute, life-threatening emergencies like cardiac arrest, seizures, or major trauma patients in the street, and there’ll be no ambulance to respond to them.”

    ‘Waiting on the Wall’

    Contrary to portrayals in popular television medical dramas, the transfer of a patient from an ambulance into the emergency room is not instantaneous.

    EMTs and paramedics must officially transfer the patient’s care, and those transfers are prioritized by how critically each patient needs care.

    When an emergency room is full and there are no beds available for that patient, crews end up “waiting on the wall” — either literally along a wall in a hospital hallway, or outside in an ambulance bay — with patients whose care needs are not immediately critical.

    Patients experiencing things such as severe traumas or having significant cardiac symptoms are triaged first, Kazan said, whereas a patient with a broken hip may have to wait.

    As a result, an extended period between when an ambulance arrives at a hospital and when that patient is officially transferred, and the ambulance can return to service is commonly referred to as a “wall time.”

    To look at the scope and severity of wall times nationwide, InvestigateTV obtained data from the National Emergency Medical Services Information System (NEMSIS), a program run through the National Highway Traffic Safety Administration and the University of Utah that provides a standardized method of recording and reporting information about 911 calls involving EMS.

    The data, which local EMS agencies report to their respective states that in turn submit it to the national database, documents all aspects of the call, including if the ambulance crew experienced any kind of delay.




    According to data from 2023, in cases where crews noted a wall time delay, the median time between arriving at the hospital and getting back into service was just over 40 minutes — double the median amount of time needed in calls with no delay reported.

    In 21% of those cases, the ambulance was out of service for an hour or more.

    In the worst cases, hours turn into days.

    “The longest wall time in Los Angeles County was 25 hours,” Kazan said.

    That 25-hour case, Kazan said, was during the COVID-19 pandemic, which pushed times up even higher.

    “So, I wouldn’t say 25 hours is typical, but every day in our system, there are ambulances that are held for more than three hours,” Kazan said.

    InvestigateTV’s analysis of the 2023 NEMSIS nationwide data found nearly 5,600 reported cases of wall times of three hours or more, and more than 300 where the reported delay was 12 hours or longer.



    “This is a problem that we have everywhere across the country,” Kazan said.

    Widowmaker

    “I’m the luckiest guy in the world, to be honest with you, you know, for all practical purposes,” Edlein said.

    More than an hour after the first call to 911 was made, Edlein finally arrived at the Knoxville hospital, where he underwent immediate surgery to alleviate the blockage causing him to suffer a “widow maker” — a type of heart attack that only 12 percent of patients survive.

    Still, he said as he recovered, he was determined to uncover what caused the lengthy ambulance delay.

    When he questioned the ambulance company, American Medical Response, Inc. (AMR), he said he was told there were several ambulances waiting on the wall at the hospital at the time, and therefore unable to render aid.

    Edlein’s quest for answers led him to reach out to the county and the city. He wrote letters to respective mayors asking them about accountability and raised questions in public to call attention to this issue. He said the situation started receiving much-needed attention after going to the local media in Knoxville.

    “As long as I can breathe, and I know there are people that have interest, I’ll show up at a commissioner’s meeting or a city council meeting, you know, and I have no… compunction whatsoever to ask pointed questions to the people that we elect that are supposed to be there for the benefit of their constituents, not for themselves,” Edlein said.

    Edlein’s case is not unique — AMR, one of the largest private ambulance companies in the country — has blamed long wall times for response delays in other instances as well.

    In Jackson, Mississippi, Donna Echols had just returned from a trip in late April 2023 when her ex-husband Jim Mabus, who had been house sitting for her, suffered a stroke.

    It took 90 minutes from Echols’ first 911 call for an ambulance to arrive.

    “I called them five times that night,” Echols’ told Jackson’s WLBT in a June 2023 interview.

    Echols said by the time the ambulance arrived, it was too late.

    “I went back into the living room, and he was on the floor unresponsive making some God-awful sounds and was flailing his arms and his legs,” Echols said. “We live in a civilized country. To wait an hour and a half for life saving ambulance services is inexcusable.”

    Mabus died at the hospital a few days later.

    Amid her family’s grief, Echols, like Edlein, took her outrage to local officials, demanding they investigate. The family has since filed a lawsuit against the ambulance company.

    “The trauma involved in that, just somebody watching a loved one, a friend, go through that... It’s just emotional beyond belief to know that my children now had to hear that story,” she told WLBT. “And, God forbid, I don’t even what to think what Jim may have been thinking on that floor.”

    In the months that followed Mabus’ death, WLBT uncovered through public records requests that AMR had not been meeting its contractual obligations with Hinds County, where Jackson is located, to respond to the majority of emergencies within acceptable time frames.

    AMR’s operations manager for Central Mississippi Ryan Wilson acknowledged the complaints and frustrations in an interview with WLBT at the time.

    “What the numbers say, we don’t dispute them, and we know there needs to be improvement,” Wilson said.

    AMR did not grant InvestigateTV’s requests for an interview, but a spokesperson provided a lengthy emailed statement.

    [Read the full emailed response from AMR below]

    “Due to patient privacy laws, we cannot provide details regarding a specific episode of care. However, based on previous news coverage, we can say that at the times in question, all ambulances in each area were actively responding to other calls,” the spokesperson said.

    In response to InvestigateTV’s inquiry about Edlein’s case specifically, the statement added: “In fact, in Knox County [where Edlein lives] at that time, five of the ambulances in service were at hospital emergency departments (ED), waiting for the hospital to accept our patients, and three had been at the ED for over an hour.”

    Regional AMR representatives interviewed in late 2023 by WLBT in Jackson and WVLT in Knoxville also blamed long wall times for the chronic delays.

    Ambulance industry representatives have pointed to emergency department backups as well.

    “It’s a bad situation to be in,” Mississippi Ambulance Alliance President Julia Clarke said in a September 2023 interview.

    “We don’t have just a bank of people that we can call in and say, ‘Hey, we’ve got four ambulances on the wall, come in and help us,’” she said. “And we have to figure out, between EMS and the hospitals, we have to figure out as partners how to fix that.”

    Supply and Demand

    Kazan, the Los Angeles EMS director — who himself is an emergency room physician as well — couldn’t agree more.

    “The reality is, the longer you park patients on the wall, the more likely we’re going to have bad outcomes result,” he said. “It has clearly happened everywhere, and it certainly has happened here in LA County.”

    Kazan oversees the 1,000 calls for assistance that come in each day in America’s most populous county with nearly ten million people.

    State data indicates approximately 70,000 California patients get stuck on the wall each year after being transported to a hospital by an ambulance.

    Kazan said it’s been that way for years, but that the condition has grown more acute as emergency medicine faces a growing staffing crisis.

    “If you don’t have staff, particularly in a state like California where we have mandatory staffing ratios, if I’m down a nurse I’m automatically down four beds in my emergency department,” he said. “And when that adds in across the system, we just have fewer emergency department beds to offload patients to.”

    When InvestigateTV visited one Los Angeles County hospital in June, at least six ambulances could be seen parked outside.

    Several of those units were from Falck Mobile Health, the largest provider of emergency medical transportation in Southern California.

    A spokesperson for Falck said such a sight is not uncommon — that in August alone their crews were stuck on the wall for at least an hour more than 1,500 times, roughly one out of every eight calls.

    “Our ability to provide essential emergency medical response to our community has long been hindered by extended “wall times” at hospital emergency departments,” the spokesperson said in an emailed statement. “Hospital delays can cause backups in the entire 911 system; when our units are kept out of service for extended periods because they are unable to transfer patient care at a hospital, response times for 911 calls increase. We applaud the hospitals that have taken proactive and innovative steps to accept ambulance patients without delay and return our crews to service.”

    The American Ambulance Association has expressed similar sentiments in online publications.

    Combine those delays with ever-increasing call volumes for emergency services, Kazan said, and you get ambulance crews stuck for hours on end.

    “So the supply and demand is just not working. You have more patients coming in fewer places to offload them, and eventually the end result is we just park them on the wall,” Kazan said.

    “That’s not to say that there aren’t strategies that we can do to try to improve throughput through the emergency department and through the hospital to try to create those vacant beds and have other solutions, but unfortunately, the pace of those solutions has not kept up with the pace of the growing problem.”

    Neither, he said, has accountability.

    Under the Emergency Medical Treatment and Labor Act enacted by Congress in 1986, hospital emergency departments are required by law to provide evaluation and treatment to anyone who seeks it regardless of their ability to pay — and that this federally-mandated responsibility begins the moment any patient arrives on hospital property.

    Federal health officials have outlined in the past that excessive wall times are a problem, including in a 2006 memo from the Centers for Medicare and Medicaid Services (CMS) that noted the practice could put patients at risk and may result in an EMTALA violation.

    “Federal law says that the hospitals have ownership of those patients from the time they get to the door,” Kazan said. “[Wall times have] just been this delay in allowing us to turn over the patient to the hospital.”

    As an emergency physician, he said he understands the supply and demand challenge hospitals are facing, but that they still need to be held accountable.

    “We don’t want to be antagonistic with the hospitals, we just want the hospitals to step up and don’t crush the EMS system,” Kazan said.

    Calls for change

    In California, the problem has grown so severe it caught the attention of state lawmakers. In 2023, the state passed legislation that aims to reduce wall times.

    The law required every local EMS agency in the state to develop by July 1 a standard to ensure patient offload times at hospitals do not exceed 30 minutes at least 90% of the time.

    By Sept. 1, all hospital emergency departments were required to develop protocols to reduce offload times.

    The law’s author, Assembly member Freddie Rodriguez, is a paramedic.

    He said in his decades-long career in emergency response, he has experienced long waits on the wall for himself.

    “I told folks, you don’t need to tell me, I’ve worked the field,” Rodriguez said. “I’ve seen it firsthand. I’ve seen the delays. I’ve been delayed to 911 calls because hospitals were tied up.”

    He said in one case 20 years ago he spent 12 hours waiting in a hospital hallway with a patient.

    “That stayed with me to this day,” he said.

    Frustrated that nothing had changed in two decades, Rodriguez pursued his legislation — successfully making California one of the first states in the nation to attempt to regulate wall times.

    Kazan said in many ways, it’s an issue of awareness.

    “Ambulance wall time is largely invisible to the public,” Kazan said. “I think to some extent, that’s why the public has not been outraged by it because nobody would want this for themselves or their loved ones.”

    But even when there are rules in place, enforcement is limited.

    Mississippi code specifically notes that failing to abide by its 30-minute rule cannot be grounds for an EMS agency losing its license.

    Rodriguez said California’s law, which took effect earlier this year, in many ways doesn’t have the “teeth” it really needs, because there are no consequences for times that exceed the 30-minute limit.

    “My bill doesn’t do any penalties or fines,” Rodriguez said. “It’s just coming up with the 30-minute offload time. But I’m sure that if people violate it ... that may be another bill idea that if people ... violate this, that there could be fines or penalties.”

    Largely unknown to the public

    In the meantime, Kazan’s department is working in other ways to reduce the burden on the emergency medical system — and in so doing reduce wall times. A pilot program called the Advanced Provider Response Unit was rolled out in February 2023 to help reduce hospital wall times. It is expected to run through June of 2025.

    The program acts as an urgent care facility on wheels, responding to 911 calls dispatchers think may not actually require transportation to a hospital.

    The responding paramedic and nurse practitioner assess patients in the field to determine the level of care they need. If the patient can be treated on scene, it eliminates a need for a trip to the hospital — eliminating by at least one bed the likelihood of another crew getting stuck on the wall.

    So far, Kazan said the program has responded to around 18,000 calls and alleviated the need for ambulance transports for 7,000 patients.

    “A lot of the patients that present to the emergency department really don’t need to be there. They can receive adequate levels of care in other venues,” he said.

    However, because health care revenue is primarily driven by the volume of patients treated, Kazan said efforts to redirect emergency care on a large scale often face an uphill battle.

    “We have this misalignment right now, which is emergency departments don’t want patients to go elsewhere, but EMS cannot continue to keep bringing unnecessary patients to emergency departments where our ambulances get trapped,” he said.

    Back in Knoxville, Edlein said he thinks government officials at all levels need to take stronger ownership of emergency medical response as a matter of public safety.

    “We’re not talking about conservative, liberal, Democrat, Republican issues,” he said. “We’re talking about the health and welfare of entire communities and cities in the nation, nation at large.”

    Edlein said he lost so much faith in the system because of his ordeal, he doesn’t plan to ever call for an ambulance in Knoxville again.

    “No way. No way,” he said.

    And he’s followed up on that ultimatum — six weeks after his heart attack he collapsed in his driveway from a related blood-pressure episode, but instead of calling 911, his wife ran to a neighbor’s house for help getting him in the car to drive him herself.

    Between the moment he collapsed and when he arrived back in the emergency room, only 12 minutes passed.

    The drive took just four.

    “Took four minutes to get from our house to the same place that it took the ambulance company 55 minutes,” Edlein said.

    While he said he understands that the balance between hospitals, EMS crews and the government officials charged with overseeing them is a difficult one to strike — it’s literally a matter of life and death.

    “If all three parties are not on the same page and they’re not whistling in the same tune, you got a sour note.”

    ----------------------

    Full statement from AMR

    Due to patient privacy laws, we cannot provide details regarding a specific episode of care. However, based on previous news coverage, we can say that at the times in question, all ambulances in each area were actively responding to other calls. In fact, in Knox County at that time, five of the ambulances in service were at hospital emergency departments (ED), waiting for the hospital to accept our patients, and three had been at the ED for over an hour.

    About Wall Times

    “Wall time” is the waiting period between the time an ambulance crew arrives to deliver a patient into a hospital ED and the time the hospital staff accepts the patient. Increasing and extended wall times are impacting communities across the U.S. and our ability to meet emergency medical needs in many areas. While we stay with these patients in the ED to ensure a smooth transition and share our clinical knowledge with the next care provider, these extended wait times are hindering our ability to serve the broader community effectively.

    Experts Agree: Wall Times are a Serious Healthcare Issue

    In recent years, the healthcare industry has seen a steep increase in wall times nationwide. Extended wall times have been a problem since before the COVID-19 pandemic, with the Centers for Medicare and Medicaid Services (CMS) identifying the issue as early as 2006. CMS also indicated that extended wall times “may result in a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and raise serious concerns for patient care and the provision of emergency services in a community.” According to the Texas Department of State Health Services, extended wall times are not an EMS issue, but rather a systemic healthcare issue.

    The same agency also agreed that “EMS unit availability across a community is dependent upon the EMS agency being able to turn units around reliably in a reasonable amount of time.”

    Editor's Note: After publication of this story, a spokesperson from the Texas Department of State Health Services clarified that while the text quoted in AMR's statement can be found in a document linked on the agency's website, "the paper itself was authored by a task force of the Governor’s EMS and Trauma Advisory Council. It was then provided to EMS providers and healthcare facilities in Texas. The comments were not authored by Texas DSHS."

    AMR Statement Continues Below.

    California recently passed AB 40, which set a standard of 30 minutes for the time when an EMS agency arrives at the hospital with a patient to when the hospital staff accepts the patient is documented. It also requires EDs to develop an ambulance patient offload time reduction protocol.

    Working Together to Address Wall Times

    American Medical Response (AMR) fully understands that the reasons for increasing wall times are multifaceted and driven by unique local challenges, including people utilizing the ED for low acuity needs. While we cannot solve this problem on our own and partnerships with local hospitals are imperative to improving wall times, AMR is continually adjusting our own processes to keep up with the everchanging demands of the strained EMS system. In a 2023 study completed by Fitch and Associates (FITCH) for Knox County, Tennessee, the group identified current hospital wall times as “excessive.” In analyzing county data, FITCH found that “current wall times are comparable to having 6.662 12-hour shift ambulances waiting idly and unable to respond,” later reporting that 29,004 hours are spent waiting at hospitals a year. In Hinds County, AMR has spent 14,716 hours January 1 – September 11, 2024 waiting to transfer patient care at local hospitals.

    Considering these findings, AMR Knox County and AMR Central Mississippi engaged local stakeholders to identify collective initiatives to improve wall times, such as:

    • standardized waiting room triage
    • inpatient discharge improvements
    • staffing emergency medical technicians (EMTs) to assist with ED triage
    • real-time communications among ED managers and AMR supervisors to communicate which hospital(s) have the longest wall time(s) and make destination suggestions for stable patients
    • Shared protocols with hospitals that allow AMR to assist the patient in getting registered and seated in the ED waiting room
    • EMS Waiting Areas with beds that crews can transfer stable patients to, staffed by hospital personnel to monitor multiple patients, allowing crews to respond to their next request
    • In conclusion, AMR is committed to our patients and our communities. It’s why we’ve chosen this profession, why we continue to serve, and why stay with them in the ED until they have another healthcare expert to provide continuing care. However, addressing wall times requires local solutions as well as a real commitment to partnership from the entire healthcare system.


  • 23 Sep 2024 1:09 PM | Matt Zavadsky (Administrator)

    As forward thinking EMS agency leaders consider the value of transforming their service delivery model, this report from Becker's highlighting the findings from the Commonwealth Fund's most recent report "Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System" might provide some insight on services that EMS Agencies can provide that may bring more value than simply responding to EMS requests and taking people to a hospital.

    There are numerous excellent examples of EMS systems making a difference in their local community by implementing innovative programs designed to increase access to care, avoid preventable acute care utilization, and improve health equity.

    ------------------- 

    US health system falls short: 6 takeaways from new global report card

    Molly Gamble

    September 23, 2024

    https://www.beckershospitalreview.com/rankings-and-ratings/us-health-system-falls-short-6-takeaways-from-new-global-report-card.html

    Health system performance in the U.S. is dramatically lower than that of nine other countries in a new assessment from the Commonwealth Fund.

    In Commonwealth Fund's "Mirror, Mirror 2024" report, the foundation analyzed 70 health system performance measures in five areas — access to care, care process, administrative efficiency, equity and health outcomes — for Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom and the United States. 

    In its eighth report comparing countries' health systems, the Commonwealth Fund finds that no single country ranks at the top or bottom across all performance areas. However, the report notes:

    "Nevertheless, in the aggregate, the nine nations we examined are more alike than different in terms of their higher and lower performance across various domains. But there is one glaring exception — the U.S."

    Americans have the shortest life expectancy and the highest rates of avoidable deaths among the 10 countries, placing the U.S. last for health outcomes. Notably, this year's report accounts for the impact of COVID-19 on health system performance, using data collected since the pandemic began and excluding data from before 2020.

    Here are six key takeaways from the foundation's latest global report, which can be accessed in full here

    1. The U.S. ranked last overall, dropping to 10th place for access to care and health outcomes, and ninth for equity and administrative efficiency. The only area where the U.S. performed well was care process, where it ranked second.
    2. Care process evaluates health system prevention, safety, coordination, patient engagement and sensitivity to patient preferences. It does not evaluate quality of care for acute care conditions, especially in hospitals. The U.S. ranks second in this area, driven by its chronic care management, preventive services like mammograms and flu vaccinations, as well as a focus on patient safety, which has led to reductions in adverse events during hospital stays. The Commonwealth Fund describes this high performance as "particularly interesting" for the U.S., suggesting that value-based care reimbursement models may contribute to these results, although they do not translate into improved health outcomes for the country.
    3. In terms of access to care, the U.S. ranks lower than the other nine countries, scoring last in affordability and low for availability. U.S. patients are more likely than their peers in most other countries to report they don't have a regular physician or place of care and face limited options for getting treatment after regular office hours. Shortages in primary care services exacerbate these availability issues, occurring against a backdrop of fragmented insurance coverage, with 26 million Americans uninsured and cost-sharing requirements that prevent patients from seeking medical attention when needed. By contrast, the Netherlands, the United Kingdom, and Germany perform best on access overall. 
    4. Australia and the United Kingdom virtually tied for the best performance on administrative efficiency, while Switzerland and the U.S. performed worst on most of these measures. The complex system of public and private payers in the U.S. works against this category, with the country receiving the worst score for providers spending time on paperwork or disputes related to medical bills. 
    5. New Zealand and the U.S. rank last in equity, which assesses disparities in access to care and patient experiences between individuals with below-average and above-average incomes. The U.S. struggled with particularly low scores related to patients forgoing care due to financial reasons and difficulties accessing after-hours medical services. A high percentage of patients in both countries reported feeling unfairly treated or having their health concerns dismissed during healthcare encounters.
    6. The U.S.'s bottom ranking for health outcomes is driven by poor performance in four of five outcome measures.  Life expectancy is more than four years under the 10-country average, and the U.S. leads in preventable and treatable deaths across all ages, as well as excess deaths from the pandemic for those under 75. 

    High rates of substance use and gun violence significantly worsen outcomes, with over 100,000 overdose deaths and 43,000 gun-related deaths in 2023 — figures far higher than in other high-income countries.

    "To create a health system that truly safeguards the well-being of Americans, the U.S. will need interventions besides those directly related to healthcare services," the report notes.


  • 12 Sep 2024 10:27 AM | Matt Zavadsky (Administrator)

    Good summary of the issues from the writers at Axios.

    The full report is here: gapb-advisory-committee-report-2024-final-508.pdf

    For a summary of the GAPBAC report, click below.

    Zavadsky - 2024 EMS Leaders Discussion - GAPBAC Update.pdf

    1 big thing: A map to end surprise ambulance bills

    Maya Goldman

    September 12, 2024

    https://www.axios.com/newsletters/axios-vitals-fcd178b0-7047-11ef-8090-5ff6eec84f57.html


    Patients could be spared huge, unexpected bills for ambulance rides under a new plan aimed at closing a gap in the surprise billing law.

    Why it matters: Many Americans avoid calling 911 when they're having a medical crisis because of cost concerns. Others get stuck with massive unanticipated bills that are a major driver of medical debt in the U.S.

    • Ambulances are "the backbone of saving lives," said Patricia Kelmar, a director at Public Interest Research Group and a member of the federal ambulance billing advisory committee.
    • But the country's emergency response system is dysfunctional. "Unfortunately, patients who need emergency services have really been carrying a lot of the cost of those services," she added.
    • Congress decided to exclude ambulance rides from the landmark 2020 surprise medical billing legislation and instead charged an advisory committee with recommending a policy fix specific to the ambulance industry.

    Driving the news: A committee of ambulance providers, patient advocates, insurance experts, and other advisers is recommending Congress adopt a tiered payment system for reimbursing out-of-network ambulance rides.

    • Under the proposed policy, insurers would pay ambulance providers either an amount set in state law, if one exists, or locally set ambulance rates.
    • If local rates also don't exist, insurers would pay a congressionally-determined rate that's higher than Medicare reimbursement.
    • Advisers also suggested a $100 cap on patient costs for out-of-network ambulance rides. This could keep insurers from passing costs along to patients if local governments set high rates for ambulance rides, Kelmar said.
    • The advisory committee's report was released publicly at the end of August, though the committee adopted the recommendations earlier this year.

    The big picture: Nearly 60% of ground ambulance rides were out of network in 2022, according to FAIR Health.

    • Unlike some other forms of care, patients typically don't have the luxury of shopping around for an ambulance provider. Non-emergency transportation between hospitals often ends up generating surprise out-of-network bills, too.
    • Some municipalities run their own ambulance fleets, while other communities rely on companies or hospitals to operate the vehicles.
    • More than 15 states have passed their own surprise ambulance billing restrictions in the absence of federal policy.

    What they're saying: "It's very exciting to see that there's a chance to get the patient out of this uncomfortable spot in the middle between us and their insurer," said Shawn Baird, advisory committee member and CEO of Metro West Ambulance.

    Between the lines: The federal government is already struggling to implement existing surprise billing protections. The law's process for hashing out billing disputes between insurers and providers has been tied up in litigation.

    • The advisory committee narrowly voted against recommending a similar dispute resolution process for ambulance bills.
    • The arbitration process in the surprise billing law has "proven in the years since to be an abject failure," committee member Adam Beck, a senior vice president at the insurance trade association AHIP, said during the meeting.
    • "Setting up any [dispute resolution] system is ill-advised," he added, according to the report.

    What to watch: Patients wouldn't benefit from the committee's recommendations unless Congress opts to pursue legislation — a long shot this year.

    • Aside from protecting patients from surprise ambulance bills, Congress could also explore requiring Medicare and private insurers to pay higher rates to rural ambulance providers and enabling community paramedics to take on increased health care delivery responsibilities, the report suggested.


  • 11 Sep 2024 8:17 AM | Matt Zavadsky (Administrator)

    Collaboration with healthcare providers and agencies to reduce preventable acute care utilization is the hallmark of effective EMS-based MIH programs. Hospice and palliative care agencies are logical collaborative partners. This study illustrates the value of these partnerships.

    ----------------- 

    CPAC-HEC program to support at-home palliative care by paramedics saved money, time and trips to emergency rooms
    Study demonstrates economic benefits in equipping paramedics to support patients with palliative care needs in their homes, when appropriate.
    CNW Group
    Tue, September 10, 2024
     
    https://ca.finance.yahoo.com/news/cpac-hec-program-support-home-140000863.html
     
    ORONTO, Sept. 10, 2024 /CNW/ - A new study has demonstrated that at-home palliative care by paramedics not only supports patient preferences and saves paramedic time, but also saves money. An estimated $2,773 is saved per 9-1-1 call when paramedics provide person-centred care in the homes of people living with cancer and other life-limiting conditions.
     
    These figures, along with other findings, were shared in a research article published in the Canadian Journal of Emergency Medicine in July 2024, which analyzed data from the Paramedics and Palliative Care: Bringing Vital Services to Canadians initiative. This initiative was led by the Canadian Partnership Against Cancer (CPAC) and Healthcare Excellence Canada (HEC), in collaboration with healthcare providers across Canada.
     
    Launched in 2011 in Nova Scotia, Prince Edward Island and Alberta, the program was later expanded to Newfoundland and Labrador, New Brunswick, Ontario, Manitoba, Saskatchewan and British Columbia. It has trained more than 7,500 paramedics to date.
     
    Some of the benefits of the Paramedics and Palliative Care initiative include:

    • 60 per cent of 9-1-1 calls resulted in people being treated at home instead of being transported to the emergency department (compared to 90 per cent of 9-1-1 calls typically resulting in emergency trips);
    • paramedics saved an average of 31 minutes per visit by treating palliative patients at home compared with transporting them to the emergency department;
    • a return of $4.60 for every one dollar invested in the program; and
    • over 92 per cent of surveyed patients and families were satisfied with the care they received by paramedics.
    The initiative took on added significance during the COVID-19 pandemic as healthcare systems tried to keep patients out of hospital whenever possible.
     
    "The Paramedics and Palliative Care initiative responds to patients who told us that they want to be at home at the end of their lives," says Jennifer Zelmer, President and CEO of HEC. "This study shows that this approach delivers better value for the health system while improving care for patients and their caregivers."
     
    "The positive impact of the Paramedics and Palliative Care initiative is a testament to the commitment and collaboration of 7,500 paramedics and 200 healthcare providers across the country," says Dr. Craig Earle, CEO of CPAC. "We are proud to see the results of the initiative. With the continued leadership of partners and paramedics services, we look forward to seeing this approach to palliative care applied within and beyond the cancer care system."
     
    "Our analysis of the initiative showed that enabling trained paramedics to provide palliative and end-of-life care at home helps palliative patients by reducing the time and stress of hospital visits," says Jean-Éric Tarride, the lead author of the study and Director of the Centre for Health Economics and Policy Analysis based at McMaster University's Faculty of Health Sciences. "By implementing this initiative more widely, emergency departments would be less congested, and paramedics would spend more of their time directly caring for patients rather than being tied up waiting to transfer patients into hospital care."


    Learn more:
    Tarride, J.E., Stennett, D., Coronado, A.C. et al. Economic evaluation of the "paramedics and palliative care: bringing vital services to Canadians" program compared to the status quo. Can J Emerg Med (2024). https://doi.org/10.1007/s43678-024-00738-9
    Paramedics and Palliative Care: Bringing Vital Services to Canadians
    Paramedics treating patients' palliative needs at home benefits everyone

  • 3 Sep 2024 5:17 AM | Matt Zavadsky (Administrator)

    Congratulations to Jonathan Washko, one of EMS’ major thought leaders and board member of the Academy of International Mobile Healthcare Integration on his interview for this report in Becker’s.
     
    Jonathan provides exceptional insight into the future of EMS delivery, and the need to continually transform EMS delivery to meet the goals of value-based care, and reduction of acute care services.
     
    The EMS profession has never been better poised to drastically transform, with innovative EMS leaders willing to embrace evidence-based research to challenge long-held myths about EMS delivery, numerous legislative initiatives in Congress, and recent state legislation that facilitates the ability for EMS systems to be more than simply a method of conveyance to an ED!

    Visit here to see current federal legislative proposals: https://naemt.org/advocacy/online-legislative-service#/bills
     
    Visit here to see recently passed state legislation: https://www.ncsl.org/health/emergency-medical-services-legislation-database

    ---------------------------- 

    Health systems brace for the 'silver tsunami'

    Laura Dyrda

    August 23rd, 2024

    https://www.beckershospitalreview.com/hospital-management-administration/health-systems-brace-for-the-silver-tsunami.html

    Around 10,000 Americans turn 65 years old every day, gaining access to Medicare benefits. The number of Medicare beneficiaries is expected to continue growing in the next five years, and health systems are making changes to keep up.

    In 2020, around 73 million Baby Boomers were eligible for Medicare benefits, and by 2030 all Baby Boomers will be Medicare-eligible, according to the Census Bureau. Advances in medicine and healthy lifestyle mean people are living longer and demanding more from their care.

    "In the next five years, the most significant disruptor to healthcare will be the capacity challenges associated with the 'silver tsunami' of baby boomers hitting the age of healthcare consumption," said Jonathan D. Washko, MBA, FACPE, NRP, AEMD, Assistant Vice President, CEMS Operations, Northwell Health; Assistant Professor, Department of Emergency Medicine, Pre-hospital and Disaster Medicine, Zucker School of Medicine at Hofstra, Northwell Health. "In this environment, coupled with lowering revenues, staffing shortages and higher expenses, healthcare is being forced from an abundance mindset to one of scarcity."

    Mr. Washko sees the shift causing leaders to reconsider care delivery models. He predicts movement away from traditional operations to care delivery models based on intelligent and intentional design for better outcomes, lower costs and faster results.

    "Solutions will require shifts to care in the home, new operational care models, and technology integration," said Mr. Washko. "These will allow the medicine being delivered to be effectively and efficiently optimized, vastly improving the productivity of existing and net new capacity."

    The increasing capacity issues are top of mind for large and small health systems. Shelly Schorer, CFO of the California division of CommonSpirit Health, said the increased aging population will likely strain Medicare, inpatient care and healthcare capacity in some regions. But the health system isn't sitting back and waiting to see what happens.

    "Anticipated regulatory challenges post-election will influence healthcare operations. The looming recession may alter how individuals access healthcare and treatment based on affordability," she said. "Despite these headwinds and challenges, at CommonSpirit we are prepared to pivot and meet the changing needs of our communities by accurately predicting and addressing their healthcare needs efficiently."

    In addition to the increased volume of Medicare patients, health systems are preparing for the upcoming coverage changes. CMS aims to transition all eligible Medicare fee-for-service and Medicaid beneficiaries to plans with a value-based component to reign in the total cost of care.

    "This represents the greatest market disruption on the near-horizon," said Ryan Nicholas, MD, chief quality officer at Mercy Medical Group in Folsom, Calif., part of CommonSpirit. "This has prompted Mercy Medical Group to move rapidly into value-based care with focus on total cost of care and network integrity."

    Dr. Nichols said Mercy Medical Group's Medicare Advantage population increased 24% in the last year and they're projecting additional 28% growth in the next 12 months. The swift shift to value-based care and Medicare Advantage plans has prompted the medical group to think differently about site of service and invest in additional resources.

    "Expanding ambulatory services and improving access for primary care services to reduce unnecessary ED utilization and shorten length of stay is our top priority," Dr. Nichols said.

    Alon Weizer, MD, chief medical officer and senior vice president of Mount Sinai Medical Center in New York City, has also made changes to innovate and implement value-based care policies. He said the entire team is embracing innovative solutions to meet current and future patient needs, especially as Medicare rolls out TEAMS in the next few years, building upon the Comprehensive Joint Replacement model.

    "This along with other risk and value based models will continue to drive integration of healthcare services and the value proposition through improving quality while reducing costs," said Dr. Weizer. "While we are investing heavily to be successful in these models through primary care expansion and technology that will help reduce the need for acute care services, we continue to focus our culture on providing safe and high quality care to our patients."


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