Advocates for EMS Looks Ahead

President Kurt Krumperman discusses AEMS new year’s agenda

Advocates for EMS was busy in 2010 drafting the EMS Field Bill, a legislative effort to move EMS closer to achieving NHTSA and the Institute of Medicine’s visions for developing an accountable, quality, evidence-based and cost-effective EMS system. In December, EMS Insider had an opportunity to sit down with AEMS President Kurt Krumperman to discuss this initiative and other goals for the new year.

 

Q: What’s the status of the EMS Field Bill?
A: We’re in round three with Legislative Counsel on the actual language of the bill. We’re working through our sponsors’ offices to communicate with the Legislative Counsel on getting the bill written. We have a Democratic sponsor on the Transportation and Infrastructure Committee and one on the Energy and Commerce Committee. We are also working on two Republicans, but they haven’t committed yet because they’re waiting for the final draft of the bill. We’re aiming for the same thing on the Republican side, to add to each committee.

 

Q: Are you concerned about how the shift to a Republican majority in the House could impact the EMS Field Bill?
A: Certainly, EMS is a bipartisan issue. We intend to have Republican and Democrat lead sponsors.

 

Q: Do you plan to introduce the bill during the lame-duck session?
A: Yes, that’s our plan. We’re very close to a final draft. It’s hard to say exactly what’s going to go on in the lame duck session, but we think it’s important to have the bill introduced this Congress, and then reintroduce it, as all bills have to be, in the new Congress.

 

Q: How do you envision the bill moving through Congress? Will it be introduced on its own?
A: We will introduce it on its own, but we don’t anticipate that it will move on its own. Given that it’s a relatively small item, our best bet for getting it passed is for it to be attached to other legislation next year. The Department of Transportation reauthorization occurs next year. It’s the highway funds that get reauthorized.

 

And then there’s the Pandemic All-Hazards Preparedness legislation that’s getting reauthorized next year. Those are two big pieces of legislation that have to move, so we’re thinking that it’s best that we have this legislation in the hopper before these bills started to move. They probably give us the best opportunity to be added as they pass.

 

Q: What is the total funding attached to the bill?
A: That hasn’t been determined yet. We’re working on the amount and funding mechanisms with the sponsors. We could get the bill authorized but not get the appropriation. The trauma program, for example, has been authorized for years but hasn’t been funded. We would like to identify an automatic funding mechanism for the components of our bill, such as every time there’s a traffic citation, a penny would be added to fund the bill. A lot of states use vehicle license fees to fund EMS programs. We just have to find the appropriate mechanism to do that. We’re still exploring our options.

 

The other route is for it to go into the appropriation process, and that’s a huge negotiation between thousands of players who all have a piece of the action. First, you have to get your first appropriation, which some folks never get. Then, assuming you get appropriated, you have to fight to continue every year, because it’s all considered “discretionary funding.” So, we would prefer an automatic funding mechanism.

 

Q: Getting consensus on the bill from the various EMS stakeholders must have been very difficult. Can you discuss some of the concerns regarding reimbursement for treat-and-release in particular?
A: One concern was that you could have a reduction in transport volume that doesn’t get compensated for through the fees that you would generate from treat and release, that somehow the ambulance services would lose on that arrangement–that they wouldn’t necessarily do less work but they’d get less revenue. So that’s one concern.

 

There’s also a concern about a scenario where the first responder service responds to calls and provides treat and release services that, somehow doesn’t involve an ambulance response.

 

I think the larger concern was that since Medicare pays us under the average cost–6% below the average cost of an ambulance transport–that this issue needs to be addressed before anything else is done related to reimbursements from Medicare.

 

In the current draft language, we’ve called for some pilot projects to investigate of the alternative of transporting patients to destinations other than EDs. This model can then be evaluated, and recommendations can be made.

 

Q: Is AEMS addressing the potential for EMS to be included in bundled reimbursements under health-care reform?
A: We haven’t discussed that in any great detail. We’re aware of it, and we’re concerned about how that would happen. There could be a great opportunity. For instance, that could be where this whole treat-and-release issue gets to be addressed as well. But, it’s all in the details. It’s very important for EMS to engage with the Department of Health and Human Services and with health-care reform, to be proactive in addressing the administration and CMS related to these ideas that they’re testing out.

 

Q: Do you think hospitals or accountable care organizations could eventually play a significant role in determining who transports patients and how much they’re paid?
A: There are two sides to this–the emergency side and the non-emergency side. I’m not so sure that the emergency calls would be captured in the domain of ACOs. But again, that’s where some of the opportunities may lie, for instance, in the regionalization pilot projects that are in the health-care reform bill. Those are the types of things that need to be looked at in terms of what works for EMS and works for the emergency care system and some of these innovative payment models.

 

Q: Do you know what the status is on the regionalization pilot projects?
A: They haven’t been appropriated yet. A request for proposals was released by HHS to do some preparatory work, but then the contract was never awarded. There was going to be a pre-pilot study to try to set up the criteria for evaluation of this pilot–pulling the data from around the country on some best practices in regionalization, some measures that could be used, things of that nature, so that they could write the requirements for these four pilots. But after they released the RFP, they decided not to even award it.

 

Q: Do you know the story with that?
A: It’s not entirely clear what their rationale was [for pulling back], but it’s still in the Act, and so it has to get appropriated one way or another. It’s conceivable that there’s money, for instance, within the CMS Innovation Center that could be used for the regionalization projects.

 

Q: What are your thoughts on the vast expansion of Medicaid under health-care reform and its effect on ambulance service providers?
A: It cuts both ways because they’re getting something where they might not be getting anything. My own opinion is that it’s a net positive for EMS. But from another perspective, if Medicaid becomes a bigger program, pays so poorly and is subject to state budget cuts, which it is, then it becomes a larger source of revenue that’s at risk. It’s a double-edged sword, without a doubt, and so for people to be raising concerns about it, it’s very legitimate. In the short term, it may help a bit.

 

The interesting thing, which is unknown, is what’s going to happen with the people going on these exchanges; what will their insurances pay for EMS?

 

Q: Beyond the EMS Field Bill, what do you see as AEMS’ highest priorities for 2011?
A: This is our priority and all the possible implications of health-care reform, particularly the pilot projects.

 
For more information on AEMS, visit www.advocatesforems.org or join the AEMS group on JEMS Connect at http://connect.jems.com.
 
Editor’s Note: On Dec. 17, Representatives Tim Walz (D-Minn.) and Sue Myrick (R-N.C.) introduced H.R. 6528, the Field EMS Quality, Innovation and Cost-Effectiveness Improvement Act.

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