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Video: Unscheduled Care & the Future of Reimbursements


In the 2020 Vision video interview entitled Unscheduled Care, James Augustine, MD, an EMS and hospital emergency care visionary, notes that we have to change our definition of what EMS does in this new era of healthcare. EMS is now known as the provider of unscheduled care. We must take care of people with unscheduled or unplanned health needs.

If you reflect on that statement by Augustine you will realize that what we in EMS really do is respond to the “needs” of others. Sometimes those are their critical needs, but usually that only accounts for less than 10% of our responses.

A majority of the time, we respond to what the public perceives as an emergent or urgent need. That can be a small laceration, a headache, or depression or loneliness during a holiday weekend when there are no relatives or loved ones around for the person.

They “need” attention or care and they call us—even if we aren’t the appropriate agency to meet their needs. We respond because that’s what we’ve always done. We assess their needs and determine if EMS is necessary. The problem is that we often “return to service” without ever really providing service or channeling the person’s need to the appropriate agency for “service.”

There are a couple of reasons I believe this has occurred in the past.
1. One is that it many of these services aren’t in the cadre of what we in EMS have traditionally provided or are services we don’t believe we need to provide;
2. The other is that our crews often don’t know who to refer these patients to and we in essence leave them stranded in their location, forced to navigate healthcare and public health agencies themselves.

The reality is that, if they truly knew who to call or where to go for assistance, they probably wouldn’t have called for us in the first place. So it behooves us to create a better system to either take care of their needs or direct them to the proper resources.

The Affordable Care Act puts heavy emphasis of the on follow-up and preventative care with the goal of keeping people from entering the health care system inappropriately—or returning too soon after discharge. That means there’s a new component being added to the realm of EMS, the provision of care that was previously “unscheduled.”

Experts believe that, in many regions, this will include EMS agency staff that will formally check on the health and welfare of patients recently released from a hospital to make sure they are following discharge orders, taking their prescribed medications, not digressing in their care or experiencing reoccurring or associated health issues.

If these “new” EMS customers haven’t filled their prescriptions because they are homebound, progressive EMS/community healthcare agencies will probably have a process through which they can pick up the patient’s prescriptions for them from a hospital or local pharmacy.

We will probably be performing assessment procedures and using tests and equipment we have never used before to help prevent these patients from entering or re-entering the EMS/hospital system.

During the 2020 Vision interview on Unscheduled Care, EMS educator, research specialist, paramedic and JEMS columnist, David Page, MS, NREMT-P, reflected on a statement made once by Ron Stewart, MD, an EMS care and system design expert. Stewart said:

“We can either put the ambulance at the top of the cliff or at the bottom of the cliff. We’ve been at the bottom of the cliff waiting for them to fall so that we can take care of them and we have all these skills that we learned to take care of them.

“But, yet if we were at the top of the cliff and we made sure that the guardrail was there and made sure that people knew what happens when you closer to the cliff, we’d have less people to take care of on the other side.” 

These words are powerful and worth passing on to others. We in EMS can control our own destiny and affect not just the health of our residents by becoming involved in preventative care and proactively policing the heath of discharged and homebound residents, but also the financial health of our budgets and EMS systems down the road.

Mobile healthcare services will save billions of dollars for the healthcare system, and it’s only right that EMS get reimbursed for performing these new services. Although this new level of reimbursement probably will not begin in the immediate future, I and many others predict that it will occur. When it does, those EMS delivery agencies that are at the front of the healthcare visionary pack will be poised to advance and receive reimbursement for performing these new services.

Will your service be at the front of the pack or following far behind?


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