Healthcare is important to everyone; it affects you, your family and your community. For those of us active in EMS, the significance of healthcare goes a bit deeper. As providers, we see first-hand how healthcare delivery and policy have a life-changing effect on our patients.
Over the past year, I’ve consistently stressed the three common elements important to healthcare reform: cost, access and quality. It’s my belief that life has value and universal access to healthcare is critical. But if people are going to have access and receive care, then someone has to pay for it.
Cost matters because that “somebody” paying is ultimately you, me and the general population. We also have a right as healthcare consumers to expect quality, and we have a professional responsibility as EMS practitioners to deliver quality.
Although delivering access to quality healthcare at a reasonable cost is the ultimate goal of reform, for providers, the healthcare reform discussion will continue to circle back to the question of resources.
Staffing & Equipment
We’re all frustrated by abuses of 9-1-1 and the overall healthcare system. The reality is that when someone dials 9-1-1 in our country, it’s nice to know people and resources are available to answer the call.
This said, anybody with field experience in EMS also understands there will never be enough resources, no matter how wealthy their district, to meet every need without some sort of prioritization and sorting. Thus, the original intention of our nation’s 9-1-1 system has always been to not only put the right resources in the right place to respond in a timely manner, but also to redirect nonemergency patients to alternative resources (in more advanced systems).
Also, resources will continue to be important when talking about emerging technologies, information systems (e.g., electronic medical records), and workforce recruitment, retention and development.
The way to succeed under healthcare reform and manage with chronically limited resources is by working together and sharing information and opportunities.
Healthcare reform is ultimately about payment reform. Currently the healthcare reimbursement system in the U.S. is based on quantity, not quality. Under reform, one major concept is that payments will be “bundled” in many situations with EMS, hospitals, physicians and rehabilitation collectively paid for episodes of care.
A greater emphasis will also be placed on outcomes and quality instead of quantity. What’s to be included in the bundled payment and how all of these elements will come together are still to be determined. Regardless, reform will encourage healthcare providers to work together, which is exceedingly positive for the patient.
Hopefully, healthcare organizations will use this opportunity to take collaboration one step further. Physicians need to talk to each other about care plans. Information technology systems need to be able to communicate between facilities, organizations, counties and states. And all healthcare organizations need to work toward standardization of equipment, protocols and their delivery of care.
We in EMS also need to collaboratively engage in an advocacy campaign so decision-makers and our healthcare peers understand our patient-care needs and opportunities. EMS needs to secure a seat at the table and be engaged in the discussion and decision-making process as the nuts and bolts of healthcare reform are connected.
We in healthcare also need to come to an agreement that healthcare reform is a process, not a project with a defined end date or goal.
Process, Not Project
Healthcare is ever changing, and the opportunity for improvements and advances is immense. We’ll never arrive at the point of perfection. If you ever think that point has arrived, please recognize that in short order there will be more change in the winds.
The best thing we can do as healthcare providers is embrace and help guide the ongoing developments. We need to work together to develop a responsive, efficient and compassionate care system.
We have the ability to be part of the problem or the solution with regard to attitude, action and engagement. These things matter a lot. The late James O. Page, founder of JEMS and a true EMS visionary, set an example that we should all strive to follow.
He was a leader who embraced change and was a consummate advocate for improved and resilient EMS throughout his career.
Twelve issues ago, I committed to submit this monthly column on healthcare reform and policy for a one-year period. This article represents the final installment. Although it certainly wasn’t possible to cover every element of the moving target that is healthcare reform, I hope you were able to glean a few nuggets and understand the focus on cost, access and quality.
I hope I’ve helped you see that succeeding under healthcare reform—although it may appear daunting and will require some change—is possible if we all agree to keep our eyes on the primary goal: exceptional patient care. JEMS
This article originally appeared in May 2011 JEMS as “Cost. Access. Quality.”