Keynote speaker Lisa Tofil, J.D., a recognized healthcare consultant. presented an enlightening, inspiring and visionary talk to the Pinnacle Conference audience, entitled, "Navigating the New Healthcare Environment: Practical Guidance for EMS Leaders."
Tofil spoke of "The shifting shades of sand" in health care and noted that the government has given us new requirements but no funding to go with it. The government made a false assumption the States would stand up and fund needed health care programs. But this has not occurred.
She noted that emergency care must move to patient-centered care and pointed out that:
There is a massive consolidation occurring in healthcare that federal regulators are watching closely for illegal actions and monopolies.
The sequester effects/impacts will continue and worsen. Be ready for it for years to come.
Change in health care is being driven by the deficit, entitlement programs (that are overtaking bridge construction and other infrastructure projects).
EMS agencies must budget for increase financial cuts and hardship as a result of the federal sequester.
The ACA healthcare coverage reality is that medicaid expansion by states is not occurring - with only about 50 percent of the states predicted to expand it - and the government is now holding back on the requirement for certain employers to provide medical coverage for employees because "employers are just not ready" to pay for employer-mandate healthcare benefits.
Health care "Exchanges" (available now on the Web) that operate like Expedia are allowing - and will continue to allow - people to SEE costs, rates and then purchase specific healthcare plan packages.
Blue Cross plans are now cutting major University Hospitals out of their healthcare plan in each state exchange so they can control services and healthcare delivery.
Tofil presented her view of what lies ahead for health care and healthcare payment. She said that she envisions a focus on "Global Payment" which will start with increased use of data and reporting, move to value-based purchasing, penalize hospitals for "preventable" re-admissions (accountability), provide incentives for quality and efficiency, "bend the cost care" (via prevention and population health), focus on critical conditions like trauma care (a high cost condition), focus on "Physician Payment structure" (Congress is trying to "fix" the Docs by passing bills that put "everything on the table" including ground/air care services), revamping of the ambulance fee schedule and get better cost data and look at quality more closely, and make sure ambulance services are made as accountable for care quality as hospitals are.
She said that Accountable Care Organizations (ACAs) will continue to grow with a goal of keeping people out of the hospital; "Bundling" initiatives will increase and bundling will pay for the complete care - with an emphasis on redesigning the delivery of care and making it "more efficient"; the market-driven innovations will increase with nurse navigators, urgent care in the office/industry setting, online "talk to the Doc" programs and "critical care in the home"; there will be larger implications of PPACA on EMS - with incentives on, not volume, but patient "happiness" and "experience" - holding everybody accountable and prevent the unnecessary movement of patients.
She predicted that EMS transports will eventually fall within "bundled payments" and hospitals will pay much more attention to what EMS is doing, look to EMS for more "value", and change the movement and volume of movement of patients.
She said EMS must look at bring mobile medical care TO the patient rather than taking the patient to the care.
Tofil concluded her inspirational talk to the Pinnacle audience by predicting that - in the future - medicare may be the best payer for ambulance services.
Her strongest message was that the federal government is finally taking a close look at total patient care - including "all that is done by EMS".
Jay Fitch consolidated Tofil's message to the EMS managers and said "the clinical strategies are going to drive the future of EMS."