As I sit back and attempt to watch our industry from afar, so that I can strategize to anticipate the next “big thing” in EMS, I find myself peering into tumultuous seas ahead. With the only consistency in healthcare, technology, society, finance and the economy being that of rapid fire and unpredictable change, the analogy often spoken of when I ask my peers how things are going and about their future is that they’re all drinking from fire hoses.
Although the thought of that concept initially brings me back to my childhood, when drinking from a garden hose was OK and a favorite summer pastime, clearly attempting to do this from a full-open fire hose would cause injury, aspiration and possibly drowning—all things not conducive to the fun times I found with my dad’s garden hose.
The one thing that does become clear when attempting to peer through all this chaos, is that massive disruption lies ahead for all of us on many fronts. Disruption is defined as something that’s simultaneously destructive and creative at the same time, a definite oxymoron.
‘Follow the Money’
One of my favorite passions is ideation, invention and theorization, taking inputs from the world around me—often seeing life in ones and zeros—and then playing a chess game in my mind, attempting to predict four or five moves ahead so that I can correct my course accordingly. As I play out the healthcare chess game in my head, I believe the one thing we can count on is that the enchanting volume we’ve all become so addicted to over the past decades is likely going to wane, and the commercial payer mix and rates that used to pay for unreimbursed and under-reimbursed services will go the way of MAST trousers and backboards.
Although some agencies might see this as a blessing, there are many communities where user fees pay for a majority of EMS and healthcare services, shrinking volume and shifting payer mixes translates to shrinking revenues. For communities where their EMS system is heavily or partially tax subsidized, drops in volume could translate similar to how fewer fires in the late 90s and early 2000s saw fire services scrambling for volume to justify their existence—which is what gave birth to the concept of the EMS-based fire agency.
My biggest concern here lies in the behavioral economics associated with the loss of volume and revenue. As I always tell people, “follow the money.” As revenues drop and pressures on improving or sustaining margins grow (remember: no margin no mission—this universal financial ethos holds true for all, and that includes government, for-profit and not-for-profit entities alike), the behaviors associated with these stresses will bring out the worst in people, industry and politics, as the shifting tides that once ebbed a descent business now begin to flow, and our boats are left high aground and unable to be leveraged for the owner’s desires.
Although some will adapt, most will try to fight the fight, blinded to the disruption around them, as they attempt to maintain yesteryear’s traditions, past practices and good times. The winners in this equation are the disrupters, change agents and investors that are taking advantage of healthcare’s and our own inability to adapt and acclimatize to our rapidly changing environment.
What’s to Come of Us
So where does this prediction come from? The massive cost of U.S.-based healthcare that represents just under 18% of our country’s GDP ($10,348 per person) and growth cannot be sustained. Employers and government (the groups that mostly foot our healthcare bills) have taken a stance, and in some cases, are taking matters into their own hands such as we see with the partnership between Amazon, Berkshire-Hathaway and JP Morgan Chase.
As I’ve stated in a previous edition of EMSOLOGY, necessity is the mother of invention and drives the acceptance of the previously unacceptable … necessity always equals money. In this case, the necessity for disruption is caused by the unsustainable costs of our healthcare system, and the acceptance of the previously unacceptable are the technological and structural changes that lie ahead—those that will disrupt our industry as we know it today: funded and fueled by venture capital, entrepreneurs and technocrats who can’t even spell EMS, but will completely transform our understanding of this business while making it profitable and likely more desirable to experience by providers and patients alike.
One can see this potential pathway of disruption from other industries: newspapers, magazines, malls, taxis, music and video industries whom have all been massively leveled overnight then rebuilt by virtual-platform business such as Uber, Amazon, Apple, Netflix, etc. The fundamental ingredients that enabled disruption in all of these industries: entrenched and protected past practices, business structures and leaders who couldn’t evolve with their changing environments—all of which occur in abundance in healthcare and EMS. Given this, the opportunity for disruption exists and the desire for change is in heavy demand, meaning that we’re ripe for significant transformation.
As I end this issue of EMSOLOGY, I glimpse into our future and see that the EMS and healthcare landscape looks massively different:
- The traditions, methods and practices of today are memorialized and honored by providers and forgotten by our patients of tomorrow;
- Technology reduces service demand and automates supply side service delivery;
- Patient behaviors are always aligned with the most effective, efficient and, therefore, the most appropriate preventive and reactive care pathway;
- Medicine is custom-delivered to the patient;
- Going out of the home to receive care is no longer needed; and
- The capacity bubble caused by artificial demand for services driven by fee-for-service economics collapses.
This is a future where EMS may not even be necessary except in the rarest of circumstances.