Another White Paper
By Alan Perry
August 18, 2013
August 18, 2013
In case you missed it, the two government bodies that are
most affected by proposed changes to the delivery of emergency medical services
(EMS) have recently weighed in with their joint assessment of the situation. On
July 15, 2013 the National Highway Traffic Safety Administration (NHTSA) and
offices of Health and Human Services (HHS) released a joint statement in the
form of a draft white paper entitled Innovation
Opportunities for Emergency Medical Services. The document does not contain
any new data, but expresses the desire of these two organizations to promote
their vision of health care reform as it pertains to EMS, and proffers a
generic model of cost savings that can be realized by making a few changes that
have already been identified in other publications by the Institutes of Medicine
(IOM) and NHTSA. While the paper certainly focuses on the cost savings and the
strategies required obtaining them, it leaves the process in the vague hands of
a number of “possibilities”. As we have seen from the activity following the
previous attempts at reforming healthcare, and EMS in particular, this falls
short and. The final conclusion being that Americans deserve a better system
that saves money improves care and creates less of a burden on critical
resources…. Duh.
As an industry, EMS recognized over a decade ago that our
delivery model is inefficient; this is confirmed in this white paper and
identifies by name the root source of the problem which we have known for
years, it’s the federal government. Medicare and Medicaid reimbursement
schedules are driving the inefficient allocation of EMS resources by only paying
for patients who get transported to a hospital, which is not always a
reasonable or cost effective choice. The paper goes on to address the specifics
of the potential cost savings in what it characterizes as a conservative
methodology, identifying the potential savings to be somewhere in the range of
half a billion dollars. Since we live in a democratic capitalistic society it
should come as no surprise that the biggest incentive for change will always be
a monetary one. From my perspective of relative ignorance, I must conclude that
the quickest and most effective way to change the system would be to change the
way it is paid for.
Unfortunately individual EMS systems lack the clout to
confront the Centers for Medicaid and Medicare Services (CMS) and challenge the
current fee for service schedule. This process is typically worked out between
CMS, physician and large healthcare organizations. Equally unfortunate is the
Patient Protection and Affordable Care Act (Obamacare) which does not
acknowledge the fee for service problem
directly, but instead offers incentives based on cost savings to encourage
larger healthcare systems to prove a different model works better. The
combination of these two circumstances favors large for-profit healthcare
organizations with the clout and money to have their preferences considered. I
fear it will leave many public safety organizations at a disadvantage in having
their concerns heard since few have the resources to effectively form and fund
an Accountable Care Organization (ACO) that can deliver the required savings to
get paid. We will be left to work out whatever deal we can with a much larger
organization if we are to survive at all. The Federal Government, through Obamacare
and CMS, has effectively shut out all small and moderate size public, private
and non-profit EMS providers out of the process and the discussion.
Our best hope at this point is the Field EMS Quality,
Innovation, and Cost Effectiveness Improvements Act of 2013. This bill is
currently in committee with 10 sponsors, it will move the national office for
EMS to Health and Human services, which more accurately reflects the realm in
which we operate, it acknowledges and incorporates the concepts and goals of
the EMS agenda for the future,
addresses the concerns of the IOM report EMS
at the crossroads, provides funding for study and implementation of new
delivery models, and directs CMS to include field EMS models in their testing.
This bill will provide the needed framework, funding and focus needed to move
EMS forward in a logical and responsible way without depending on Obamacare,
ACO’s or some other magic pill. This bill will achieve many of the goals of
Obamacare and healthcare reform in general as they pertain to EMS functions,
but it will also add the stability needed for 911 EMS systems to plan and
sustain operations while making these needed changes without selling them out.
The draft white paper produced by NHTSA & HHS does not articulate a strong
desire to maintain 911 EMS capabilities or identify how to accurately account
for its cost although other NHTSA publications, such as the EMS System Performance-based Funding and
Reimbursement Model by the National EMS Advisory Council do. Perhaps once
all realize that EMS is both public safety and public health we can realize
some progress.
Be Safe,
References;
EMS Agenda for the Future, NHTSA 1996
EMS Agenda for the Future- Implementation Guide, NHTSA 2010
EMS at the Crossroads, National Institutes of Medicine 2006
Innovation Opportunities in EMS- A Draft White Paper,
NHTSA/HHS 2013
H.R.809 - Field EMS Quality, Innovation, and Cost
Effectiveness Improvements Act of 2013, 113th U.S. Congress 2013
EMS System Performance-based Funding and Reimbursement Model,
NHTSA, National EMS Advisory Council 2012
