Healthcare Transformationand Fire Service EMS

Mark Stevens BA, EMTP

Primary Care

Specialty Care

Ambulatory Care

Emergency Dept

Urgent Care

Nursing Home

Home Health

Pharmacy

Hospitals - 2007Physicians - 2009

Reporting“Failure to submit data for FY2007 and beyond results in a

2%decrease in Medicare reimbursement.”…

(Additional impact after Oct 1, 2012.)

17 Clinical care measures in 5 categories: (AMI, Heart failure, Pneumonia, HC assoc infection, Surg improve)

8 Consumer assessments: (doc/nurse communication, staff responsiveness Pain mgmt, Cleanliness/quietness of environ.)

Physicians: 3 Financial incentive plans

- Quality reporting (199)- Electronic Prescribing- Electronic Health Records

2011

2012

2013

2014

2015

2016

2017

2018

2019

Quality Reporting

1.5% 1.5% 1.5% 1.5% -1.5%

- 2% - 2% - 2% - 2%

Electronic Prescribing

1% 1% 0.5% 0% 0% 0% 0% 0% 0%

E-Health Records

Spec amt

Spec amt

Spec amt

Spec amt

-1% -2% -3% -4% -5%

- Quality Measures- Accreditation/Certification- Electronic Records- Consumer Satisfaction- Efficiencies

EMS/Ambulance

HealthcareInformationExchange

Labs

Hospitals

Pharmacy

Physicians

GovtMedicaid/Pub H

Payers

Consumers

Clinics

EMS

The first call of the day was a 43 yo male that was

found laying in the front yard of a residence. I was

able to find the pt’s medical hx of seizure, and his

last ER visit to OUMC.

SMRTNET was used to confirm pt’s information she provided to me. Pt stated she had no

allergies, however SMRTNET found allergies in hx. Upon questioning pt remembered “yes” to

allergic to…

Health Information Exchange

EMSA, Oklahoma City

80% of HC $’s spent on 20% of people

Known causes and preventable.

Current direction will bankrupt State/Country

Oregon’s “Triple Aim” (HB3650)

-Improve lifelong health of all Oregonians.

-Increase quality, reliability and availability of care for all Oregonians.

-Lower or contain the cost of care so it is affordable for everyone.

Oregon Health Policy BoardHB3650

CCOWork grp

GlobalBudgetWork grp

MetricsOutcom

eQuality

CMSIntegratio

nWork grp

Health Homes

HospitalsHealth Homes

Food Mart

Specialty Clinics

Food Mart

Specialty ClinicsHealth Homes

Hospitals

Clinic

ClinicAccountable Care Organization

Health Plan Health PlanHealth Plan

http://www.emmisolutions.com/medicalhome/pcpcc/english.html

Public

Safety

Public

Health

Community

Health

ME S

The “New Normal”

Integration of EPCR

Hospital records

Bundling

No Money

AlternateDestination

Never Events

EMS Agenda for the Future

Alternate funding

http://www.youtube.com/watch?v=Z1SBgCL1qTg

Be at the table

Be on the table

Non-Traditional Health Workers

Team: Community Health WorkersPeer Wellness SpecialistsPersonal Health Navigators

Training: Core CompetenciesCross-cultural communication/liaisonGroup/family dynamics, Advocacy skills,Knowledge of resources, Needs assessment

*Opportunity

“Community Paramedic”

UK – Dispatch, NonTraditional & MD

Toronto – CREMS

U.S. – Minnesota, Eagle CO, MedStar, Wake Co, Nebraska… Tucson, TVF&R, King Co

Scope of Practice

Training Programs

Medical Liability (next legislative session)

CMS Innovation Challenge Grant

Local CCO activity/relationships

Non-Traditional Training opportunities

Nursing Associations

Protocols & Scope of Practice

Things to watch for

Things to watch (know your numbers)

Call breakdown:- Dry runs (# should drop)- No Pays (# should drop)- Freq caller (# should drop)- Number of transports to ED

Evaluate:- Effect on operations/staffing- Transport revenue- Alternate destinations- Innovative ways to get right resource/right pt- Alternate revenue streams

What should we be doing?

- Be aware of state/local changes- Support medical liability changes for EMS- Build relationships (CCOs, Medical Homes, hospital)- Market the value of EMS- Assess degree of involvement for your agency- Performance-based culture- Electronic charting (Image Trends)

Value of EMS

- We are healthcare providers.- Infrastructure for quick response to anywhere in our community.- EMS can assess/direct to alternate destination.- We can “fill the gaps” and support CCOs.- Clinics in fire stations?- Preventative health fairs?- Work under medical authority, QI.- Lessen hospital readmissions- Participate in care plans

What should we be doing?

- Think Innovation..right resource/pt/time- Accountability: Not just about response time-Work smarter (deployment, resource/demand)-Develop people for expanded roles-Become integrated with healthcare systems-Position external stakeholders to be advocates

Diversify Revenues/Efficiencies

Training ServicesCommunication ServicesOcc HealthBillingVehicle maintenanceConsolidate medical directionShare cost savings with payors

CMS Innovation Challenge Grant

- First grant for EMS eligibility- $1 – 30 million/grant- Three years to be self-sustaining

Portland metro area (4 counties)

-Dispatch triage (EMD & Nurse)-Alternate destination for 9-1-1 response-Post hospital discharge followup

Shifting emphasis of medical care from crisis intervention to prevention.

Don’t forget our mission…

Reduce lives lost

Reduce pain & suffering

http://health.oregon.gov

TestimonyRelationships/networkEHC GovernanceResourcesLinksLegislation

www.ofcaems.org

Your EMS Section

Serenity Prayer

God, grant me the serenity to accept the things I cannot change,

Courage to change the things I can,

And wisdom to know the difference.

Resources

www.health.oregon.gov

www.ofcaems.org

www.hitsp.org

http://communityparamedic.org

www.wecadems.com/cp.html

www.medstar911.org/community-health-program

www.wakegov.com/ems/staff/app.htm

http://www.emmisolutions.com/medicalhome/pcpcc/english.html