Following the events of Sept. 11, many EMS managers have had little time to devote to the next major challenge facing EMS: implementation of the Medicare fee schedule. However, it's obvious from this year's survey of EMS organizations in America's 200 most populous cities that they are preparing for the fee schedule's impact.
Some (18.5%) anticipate the fee schedule as a welcome change, increasing system funding. But for most (61.5%), who anticipate it will result in reduced revenues, the change looms ominously on the horizon. These managers know changes in staffing, deployment, billing and special services will be necessary. In order to address these changes, they'll need more information and new tools to make tough, sometimes politically unpopular decisions to minimize adverse effects on service levels.
The 2001 200-city survey presents findings from questions developed to assess the flexibility and readiness of EMS providers to respond to changing system requirements and funding. One hundred and sixty-seven cities replied to the 81-question survey, providing us with an in-depth look at their operational characteristics. To present complete alphabetized (see p. 68) and ranked listings (see p. 52), we extrapolated from previous surveys information for any missing cities.
Although insufficient to generalize the results to all U.S. EMS providers, reported findings can help you identify strategies to consider implementing in your service. As always, keep in mind that respondent interpretation of and access to operational data results in some data distortion.
Population values used in ranking cities were obtained from the U.S. Census Bureau's July 2000-updated figures. More than 71 million people—nearly a quarter of the U.S. population—reside in the surveyed cities, up four million from last year's reported 67 million.
Surveyed agencies respond to EMS requests received through 9-1-1. In some cities, multiple first responder and transportation providers share these responsibilities. Clinical procedures performed by field providers appear to have changed little, but how care is delivered continues to evolve.
Data is an essential component in building new system designs capable of adapting to changes in service demand and funding. This year's 200-city survey paid particular attention to activities employed by survey respondents to deploy, manage and finance EMS system resources. New questions asked for more in-depth descriptions of resource-deployment strategies, medical oversight and provider funding.