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Changes Looming for EMS


Ed Racht, MD, told attendees at this year's Pinnacle conference in San Diego that health care and EMS are rapidly evolving. "The way we look a year from now is going to be dramatically different," Racht warned during his July 27 keynote address titled "The Looming Realities of Healthcare Reform for EMS."

Racht—who was named Chief Medical Officer for American Medical Response on July 26 and most recently served as the vice president of Medical Affairs and Chief Medical Officer for Piedmont Newnan Hospital in metro Atlanta—noted that health-care reform is really "payment reform that has huge health-care implications." EMS, he said, is only mentioned a total of four times in the 2,400-page behemoth bill, but there’s no doubt prehospital medicine will change along with everything else in health care.

"We're on the edge of another major change in EMS culture," Racht says. "Whether you buy into that or not, it's here." He believes there are many opportunities for EMS to define its role in the larger system, helping to cut costs while improving patient safety and outcomes through better-coordinated care. "The current system is based on the quantity of the care provided, with minimal focus on quality or coordination." Those days are coming to an end, Racht says.

Racht provided a timeline of the Patient Protection and Affordable Care Act implementation between now and 2018, noting that the bill's call for comparative effectiveness research shouldn't be taken lightly. "The things that make a difference in patient outcomes, we ought to be reporting," because sooner rather than later the government is going to "see how you do to decide if you deserve payment," Racht says, meaning Centers for Medicare & Medicaid Services (CMS) reimbursements will eventually be based on the quality of care provided, not the quantity.

New Opportunities for EMS
"What's coming next is going to be hard work," Racht says, but "our opportunities await."

One aim of the health-care reform legislation is to create Accountable Care Organizations (ACOs), he says. An ACO could be a hospital or group of physicians and ancillary health-care providers—labs, therapists, etc.—that coordinate medical care for a specific patient population. The health-care reform legislation says Health and Human Services will establish a program that supports ACOs for fee-for-service Medicare patients by Jan. 1, 2012. Under such a system, "hospitals will need to work with other health-care providers to avoid readmissions," because "soon they will not be compensated," according to Racht.

"Could there be a way that hospitals and EMS could collaborate? Yes," says Racht. "Can you imagine a post-hospital EMS role? Absolutely." The biggest challenge in realizing these opportunities is getting all the "adversaries" together, he says. "That's not been a natural process," but EMS agencies need to start asking questions and working with hospitals and others in the larger health-care system to develop potential solutions.

Other opportunities could include an EMS role in alleviating emergency department overcrowding through better triage, treat-and-release programs, transport to alternate destinations or even assisting in some way with managing patient flow in the emergency departments.

Payment reform is here; how that will play out isn't yet clear, but we have an "opportunity to play a totally different role in the EMS system." The key, Racht says, is ensuring someone else doesn't define that role.
Racht closed his speech, urging audience members to make the most out of the new legislation, with a quote by Sir Francis Bacon: "Wise men make more opportunities than they find."


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