Loyal Customer Program

Loyal Customer Program

for

Your Emergency Medical Services & Fire Department

By Alan Perry

October 21, 2013

Introduction

Most EMS agencies & Fire Department's are aware of the growing momentum of changes affecting the delivery of pre-hospital EMS as a result of general healthcare reform and specifically the Patient Protection and Affordable Care Act. These departments would like to begin working on solutions that are easiest to achieve and can be accomplished without major changes to existing policy or major program development. They realize that the healthcare environment is becoming more dynamic and that their organization, and any new ideas, must be flexible and adaptable. EMS systems are frequently misused and abused by a small portion of the patient population; the premise of this program is that this unnecessary and unproductive behavior can be easily corrected without any major changes to the normal operational pattern by simply providing a little patient and public education among this target group. Ideally this program will include the voluntary cooperation of the loyal customer, their primary care physician and the EMS provider. It will incur no additional cost for the EMS agency, and may actually prove to save money by avoiding unnecessary and un-billable transports. It will have the added benefit of being an anchor point for validating efficacy through research allowing expansion of the program if needed to address hospital re-admission rates and other targets of the Patient Protection and Affordable Care act.

Program Development

·         Quantify the problem

·         Identify the stakeholders

·         Develop a policy, procedure & infrastructure

·         Conduct a pilot study

·         Analyze the data

·         Get stakeholder feedback

·         Monitor the results, seek continuous improvement

Quantifying the problem

We all have our suspicions about the number of patients that routinely misuse and abuse the 911 EMS system, we know their names, where they live, and what their primary complaints are. In order to prove that a change in our system is having the intended effect we must know exactly what the problems is, the number of transports, the number of patients, the primary complaints must all be documented and analyzed to identify a problem. Typically most EMS systems do not do anything about this type of problem until it becomes a major issue. Due to this and the changing shifts and personnel the problem may be greater or lesser than imagined. A quick and dirty way to accomplish this might be to conduct a retrospective analysis of EMS calls identifying specific addresses, patients and chief complaints to produce a good starting point. A better way would be to add a few targeted questions such as: Do you have a pcp? When were you in the hospital last for this problem? Do you have any means of transportation? These examples of questions could be used to flag your potential loyal customer for review.  

Identifying the stakeholders

You, your providers, the patient, the patients physician, your OMD, the hospital systems and your chief officer are all stakeholders in this immediate process. They should be heard before a plan is developed, again after it is finished, and ongoing as it is implemented and refined. For this to work, everyone needs to be happy with the process and the intended results. There may be other parties you will need to involve such as public and/or mental health and your state or regional EMS office. You must explain in basic terms what you hope to accomplish, a reduction in misuse and abuse of the 911 EMS system, and ask each what your agency can do to achieve that goal that can fit within the confines of a public and patient education program.

Developing policy, procedure and infrastructure

After quantifying the problem and collecting stakeholder input you can begin the process of creating an outline of your program’s policies, procedures and infrastructure needs. Your research will identify what the specific problems may be, your program should be targeted to achieve improvement in those specific areas and also seek to improve the experience for patients and providers.  A mechanism must be in place to fully record and document the presenting problem, what interventions were done, and ultimately whether or not the situation improved. Privacy policies and law will need to be examined to determine what data can be used to identify loyal customers and track their progress. Voluntary participation of the patient and the patient’s primary care physician will likely be needed to avoid any legal problems. The role of the provider will most likely be that of a health coach, monitor and recorder working in partnership with the patient’s physician and/or your OMD. A schedule or process must be created and supported for providers to perform routine or PRN health checks and follow-up. The same data used to identify your problem will be used to document its effectiveness.

Do a Pilot Study

Start with a small area, a single station or district with a clear problem that this program should be able to address. Train your personnel, identify and enroll your patients and physicians and kick it off. This is a good time to be hands-on, check with the providers and see how it went for them, with the patient and make sure it was a positive experience, and with the patients physician. They all must be satisfied with the way it is working or it must be modified. Document every contact with your usual PCR. Collect all the relevant NEMSIS data and any pertinent data relevant to your program objectives.  Once you have worked the bugs out of your program in the pilot (3-6 months minimum) you should have enough data to determine if it can be applied to the rest of your system or expanded to others.

Analyze the Data

Within 3-6 months you should have enough data to determine if your program is having the intended effect, and you may have identified several new target populations/sub-populations as well. If your program is producing the intend result you must be able to prove it with the data before expanding or continuing with it. If the results are mixed or show no/negative change try to identify why, this is a good time to go back to those stakeholders to discover where the program may have failed and get good suggestions about how to improve it. Make sure you are measuring the right metrics, any improvement in patient outcomes, healthcare experience and cost reduction are meaningful and positive results.

Stakeholder Feedback

Go back to your original stakeholders and any new ones you may have discovered, revisit the initial objectives of the program of reducing EMS system misuse and abuse by your loyal customers. Are there any concerns now? Are there any suggestions for improvement? Are there any unforeseen outcomes or consequences? Is everyone happy? Any concerns or negatives here must be addressed  before the program can grow, your stakeholders will remain your primary source of feedback about the performance of your program, they will be of great value in maintaining the program’s responsiveness and relevance as circumstances change.

Monitor the results, seek continuous improvement

Once your program is up and running you will still have to go through much of this process again as new information becomes available allowing you to tailor your approach to each new patient, refining and validating new approaches that produce better or more efficient results. If successful you will hopefully draw the attention of our healthcare partners who may seek to involve you with their patients as well or borrow ideas from your program. Keep in mind that it must be a dynamic program that can adapt to the needs of the patient, the providers and the requirements of local, state and federal law. Continuous Quality Improvement (CQI) will keep your system effective, efficient and popular with your stakeholders.

Summary

A Loyal Customer program is an easy to achieve first step for 911 EMS systems that are not sure where to go or what to do next in the face of healthcare reform and the Patient Protection and Affordable Care Act. Instead of waiting around for healthcare changes to be forced upon us, it seems prudent to start taking some positive action that will improve the quality of our service and the outcomes of the patients we serve. A by-product of positive action is public support, goodwill, and increased pride among your workforce for being proactive. 

Good hunting,
Alan