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What Will Drive Healthcare Payment in the Future?

0403-aj-new-expectations-blog

There's no doubt that healthcare is getting more expensive. How expensive it will be, and who will reimburse EMS for unscheduled care, in 2020 is a quesiton on everyone's minds.

In the 2020 Vision video, “New Expectations,” EMS innovator and visionary, Matt Zavadsky from MedStar Mobile Healthcare in Fort Worth, Texas, points out that under the new healthcare reimbursement model, not only will patient outcomes drive payment, but hospitals (and ultimately EMS agencies as well) will be paid based on the patient’s satisfaction.

This raises several important issues for EMS, including the following items:

1.) EMS in the U.S. has not always focused on patient outcomes. Instead, emphasis has been placed on response times that don’t really affect outcomes and quality of care. We need to pay more attention to whether the care we rendered was optimal, timely and effective. Payors in the future will be looking at this and not how fast we go to the patient.

2.) Will the public be able to differentiate between hospital service and ambulance service when gauging and registering their satisfaction with the care provided to them?

The public is often confused about who delivered the care to them: Was it an ambulance based out of the receiving hospital or was it an ambulance from a public safety agency or volunteer system. Public relations, name identity and crew designation is lacking in many EMS organizations and, consequently, we get poor or limited credit for accomplishments.

Case 1: On Easter Sunday, college basketball guard Kevin Ware, No. 5 of the Louisville Cardinals men's basketball team, suffered one of the most horrific compound double fractures ever seen on live t.v. It happened in the first half of the game against the Duke Blue Devils during the Midwest Regional Final round of the 2013 National Collegiate Athletic Association (NCAA) Men's Basketball Tournament on March 31, at Lucas Oil Stadium in Indianapolis.

 

EMS personnel rush in wearing plain, non-descript uniforms and jackets, cared for the injured basketball player and wheeled him off the court under the watchful eye of millions of television viewers. But you could not tell where the EMS personnel were from. This isn't just is this a missed opportunity to give proper credit to the exceptional personnel involved. Down the road, it may even result in lost revenue when the patient is unable to credit the appropriate agency.

Case 2: I stopped at a fire scene the other day to shoot a few images. While there, I noticed a beautiful, clean, well equipped ambulance on standby. However, if that ambulance were parked in front of a residence with just the front of the vehicle visible, the affected family would never know where the ambulance was from that cared for their loved one. It’s a missed opportunity to educate the public there at the residence as well as every person who sees the ambulance headed toward them on the street. Label your ambulances on all four sides so they can see and read your “mobile billboard.”

In Australia, paramedics are the most respected profession in the country. One of the reasons is their high level of mandatory education. Another reason is the high level of exposure they get from great public relations. We can learn a lot from our international cousins. If your service does not have a designated Public Information Officer on each shift, you need to arrange for someone to assume that role.

Reassess your EMS service delivery model now to adapt it to gauge customer satisfaction as well as the quality and impact of care. Make sure the public knows who you are and remembers your name. It only takes 20 seconds to have an employee call the residence of a patient seen and/or transported 24 hours ago to determine the patient’s status and the level of satisfaction the patient (and their family) had with your crew. Hey, they might even tell you what the patient’s final diagnosis was so you can match that up with the crews assessment findings and care. In a time when hospitals still won’t open up their discharge diagnosis records to EMS agencies, this could be a novel way to learn more about “our” patients.

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