Workforce shortage is a burning challenge. Long term care providers everywhere, particularly in more remote, rural areas are especially pressed for resources to ensure patients discharged do not get readmitted. According to the National Rural Health Association, the patient-to-primary care physician ratio is about 40 physicians per 100,000 people. But how do you do more with fewer resources, especially when it comes to proactive population health management, readmission prevention and improving wellness of those you serve? The answer might just lie in one of the most under-utilized and recognized entities in the care continuum – partnering with your local EMS.
The healthcare model continues to undergo a paradigm shift by assuming a collaborative care delivery approach. And in this new world, providers – ranging from hospitals, primary care, nursing homes, homecare and now EMS – are being engaged and held accountable in ultimately improving patient outcomes and reducing the net financial burden of avoidable readmissions.
Enhancing outcomes, reducing readmissions
EMS providers, traditionally part of the public safety net, are metamorphosing into a health delivery service with recognized impact on patient outcomes. Take for instance, stroke. It is the fourth leading cause of death and the leading cause of disability in adults in the United States. Today, EMS is involved in 75 percent of strokes and is associated with decreased onset-to-treatment times and improved clinical outcomes.1 In situations of Out of Hospital Cardiac Arrests (OHCA), early engagement of EMS is known to increase chances of getting defibrillation and improving survival to discharge rates. In a recent example, University of Kansas Medical Center’s regional collaborative, that includes EMS, aims to reduce cardiac-related deaths in rural communities by 20 percent, which could cut healthcare costs by more than $13 million.
A fast emerging concept is Mobile Integrated Healthcare (MIH) – marking the facelift of the EMS. MIH is a community paramedicine system that is patient centered offering mobile resources in the out-of-hospital setting.2 Consider it more of a triage system where EMS providers respond to a 911 call, but that call is not an emergency or sometimes isn’t even health related. Instead of incurring the expensive cost to take that patient to an Emergency Department (ED) and provide services there, a dispatcher who could be a nurse is taking the call and providing immediate health services over the phone. This helps the healthcare provider avoid costs and inefficiencies which arise as part of the billing and reimbursement equation we have today.
Hospitals and Home Health agencies are also beginning to contract with ambulance providers with trained EMTs and paramedics. In these partnerships, EMS is leveraged to follow up with patients, once they are discharged, on their medications, setting up reminders and administering pain management. This can impact patient satisfaction and reduce the chances of rehospitalization.
Cost challenges persist… speed and efficiency is key
Revenue streams are volatile for ambulance providers, which is why it’s often been a fragmented part of the healthcare landscape. A bulk of the 911 calls EMS receives come from an aging population, one that is increasing. The number of Medicare enrollees increased 183 percent from 1966 to 2014.3 For this reason, some EMS providers are struggling with volume and profitability causing more consolidation of services in the market.4 The most recent Government Accountability Office report on ambulance providers estimated the costs for each ground transport varies, but can range from $224 to $2,204.5 Meanwhile, Medicare reimbursement rates are at least six percent below the cost per transport, sometimes hundreds of dollars less per transport.6
Fiscal responsibility is the ribbon that ties the challenges and the needs together. EMS providers are looking for affordable prices with the kind of speed and convenience a large healthcare supplier like Medline can deliver whether it be for gloves, gauze or oxygen equipment. EMS needs this flexibility as its role in healthcare starts to evolve.
Emergency Medical Services providers have shattered the confines of public safety delivery services. With better integration into the healthcare delivery model, their role in improving clinical and financial outcomes will only get more recognized and indispensable for the communities they serve.
1. Time to Treatment With Intravenous Tissue Plasminogen Activator and Outcome From Acute Ischemic Stroke, Jeffrey L. Saver, MD; Gregg C. Fonarow, MD; Eric E. Smith, MD, MPH; Mathew J. Reeves, PhD; Maria V. Grau-Sepulveda, MD, MPH; Wenqin Pan, PhD; DaiWai M. Olson, PhD; Adrian F. Hernandez, MD, MHS; Eric D. Peterson, MD, MPH; Lee H. Schwamm, MD, JAMA. 2013;309(23):2480-2488
2. What is MIH-CP?, https://www.naemt.org/MIH-CP/WhatisMIH-CP.aspx
3. CMS Statistics reference Booklet, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/CMS-Statistics-Reference-Booklet/Downloads/CMS_Stats_2014_final.pdf, U.S. Department of Health and Human Services, 2014.
4. Consolidation of Fire/Emergency and Law Enforcement Departments and the Creation of Public Safety Officers, https://www.iafc.org/docs/default-source/uploaded-documents/iafcposition-consolidationandpso.pdf?sfvrsn=0, January 23, 2009.
5. Ambulance Providers, http://www.gao.gov/assets/650/649018.pdf, U.S. Government Accountability Office, October 2012.
6. EMS System Performance-based Funding and Reimbursement Model, https://www.ems.gov/nemsac/FinanceCommitteeAdvisoryPerformance-BasedReimbursement-May2012.pdf, National EMS Council, May 31, 2012.