Brave New EMS World: A Squirrels Perspective -revisited

A Squirrels Perspective

of Legislation Affecting EMS and Good Decision Making

By Alan Perry 7/24/2013

Introduction

I have been trying to understand the pushes in EMS toward Mobile Integrated Healthcare Practice (MIHP), Community Paramedicine and the function of Accountable Care Organizations (ACO’s). It appears I have been looking at it from the wrong perspective, assuming that it has been driven internally by the healthcare community delivering on recommendations made by the National Highway Traffic Safety Administration (NHTSA), the Institutes of Medicine (IOM) and others which have spelled out clearly what steps need to be taken to integrate our healthcare system and move pre-hospital EMS into full partnership with other healthcare fields. While the power of these recommendations has moved many organizations and systems forward, they have failed to garner widespread adoption in the years since they were written. What is pushing the change now, at this late hour?

Methodology

I proceeded to work backward studying applicable portions of various programs, exploring the contents of pending legislation and healthcare law. I will admit that this process was not very methodical; I focused my attention on pieces that were overtly related to EMS and limited that material to what was most applicable to daily pre-hospital EMS operations, financing and coordination with other healthcare organizations. I compare my actions, and that of many EMS systems, to that of the squirrel finding itself in the middle of the road and not being able to decide which way to run, therefore my focus has jumped around quite a bit and I still see the vehicle of healthcare system reform coming at me! I hope I can illustrate for my own benefit, and others, what the options and potential consequences are before we simply get plowed over by the changes before we can react. My opinions here are by no means “expert” and I encourage everyone to read the actual documents before taking any action or embarking on a substantial project.

The Patient Protection and Affordable Care Act

Enter Obamacare; Section 5101(d)(2) of the Patient Protection and Affordable Care Act (Affordable Care act) Titles III & V provide the impetus for change in payment strategies, development of ACO’s, community healthcare teams and coordinated care. The mandates are very broad and do not specify the “how” or “who” just the desired outcome, leaving the whole process up to substantial interpretation, funding is achieved through costs savings to successful participants. The intended effects of the Affordable Care Act are sweeping change to business as usual in the healthcare arena; Emergency Medical Services (EMS) is no exception. The mandated changes will occur by adoption of new and more effective delivery methods by the existing providers within each region, or their replacement by new ones. This is not a suggestion; it is a flat out requirement. The federal government is using a carrot/stick approach, with financial rewards for performers and penalties for failure, such an approach will be game changing, spelling financial ruin for those who cannot adapt and creating much more competition, EMS systems will be no exception. This has created renewed interest in the ancient texts written by NHTSA and IOM, leaving me personally wondering if we may have waited too long. I can see control of EMS systems and organizations being slowly taken away and replaced with something we will have no hand in developing, unless we act quickly, deliberately and intelligently.