The days of “You call, we haul” are nearing an end for EMS. A burgeoning movement called mobile integrated healthcare, which includes such initiatives as telemedicine, prevention campaigns, community paramedicine, and nurse triage lines, promises to move the EMS industry out of the realm of public safety and into the realm of healthcare.
“EMS needs to rethink its basic mission of being about transportation and instead be about providing care in the most effective way for the patient,” says Eric Beck, DO, NREMT-P, medical director for the Chicago EMS System and the Chicago Fire Department and a leader in the mobile healthcare movement. “That could be community paramedicine. It could be by integrating nurse triage into dispatch, or using telemedicine to enable patients to be treated at home without having to transport.”
The goals of all reform efforts are summed up by what the Institute for Healthcare Improvement calls the “Triple Aim”: lowered costs, improved patient experience and improved outcomes. Passage of the Affordable Care Act accelerated the pace of reform by introducing both a carrot and a stick approach: large grant programs for healthcare providers that show they can achieve the Triple Aim, coupled with CMS (Centers for Medicare and Medicaid Services) fines for hospitals with excessive readmissions within a 30-day window.
Ed Racht, MD, medical director for American Medical Response, the nation’s largest private ambulance service, states that a fundamental change in measuring EMS performance is imperative.
“To make that cultural shift to accountable, performance-based care, we have to really, really focus on outcomes now,” says Racht. “That doesn’t mean, We get there in eight minutes, 59 seconds 90% of the time. We have to prove that we make a difference, such as improving pain and improving physiological conditions, which is something that is relatively new for EMS.”
The shift will add value to what EMTs, paramedics, and EMS systems have to offer a community, as well as improving their financial future as CMS and major insurers move away from fee-for-service and toward pay-for-performance reimbursement.