Step 1: Gather data
If you are not already using electronic data-collection systems and/or collecting and digesting data, this needs to be your first priority. ACOs are built on quality and value, so the first step to convincing an ACO that your EMS agency adds quality and value for their beneficiaries is going to be data–lots of data. You will have to demonstrate not only that the ACO should include you in their equation–but that they need you as a partner.
“Need” is an extremely difficult standard to prove (if you are from a “certificate of need” state, you already understand this). It all comes down to the data. Specifically, you will have to demonstrate to an ACO why the services your agency provides are not only valuable to the ACO, but also why the ACO should choose to let your agency provide those services rather than looking elsewhere in the healthcare spectrum for the same thing or creating a homegrown solution of their own.
Step 2: Develop a short executive summary presentation
Perhaps you only respond to 9-1-1 calls, or maybe you provide other services such as a Community Paramedicine program. Regardless of what you do provide, it is important to start educating the people and organizations which rely on your services every day– whether they realize it or not.
Put together a short (i.e., no more than six PowerPoint slides), 15-minute presentation of the services your agency can and does provide within your community, using the data you compiled in Step 1.
Step 3: Get out from behind your desk
Recently, a young lawyer asked how best to communicate with a client. She stated she had sent countless emails, but had received no response. The answer: Pick up the phone and call the client.
In this day and age of technology, it is all too easy to rely on email as a primary means of communication. But in situations where you are blindly reaching out to people who you do not know (or do not know well), it is important to pick up the phone, introduce yourself, and make an appointment for a face-to-face meeting.
As we have discussed previously, it will most likely be up to the EMS agencies themselves to initiate ACO contracting discussions. Although the emergency department physicians and staff have, in recent years, come to understand what EMS is and does, the people who you need to speak with in terms of ACO contracting are the administrators, compliance officers, managers and other “C-suite” executives who have little or no understanding of EMS–and have very limited knowledge of what quality and value EMS agencies can bring to the ACO equation.
When you meet with people to discuss the role EMS can play in a successful ACO scenario, use the Executive Summary Presentation you developed in Step 2 as a starting point for the discussion. You don’t need an LCD projector or a big, fancy meeting space. A simple hard copy of the presentation which you talk through over a cup of coffee will suffice, and be sure to have a copy for your audience to have a take-away that they can refer back to after the meeting is over.
Step 4: Think outside the box
ACOs and their contracted partners will be penalized for recurrent readmissions of ACO beneficiaries. As most EMS agencies can attest, many of the calls received from post-acute care facilities are either low-acuity incidents that could be handled by other means or are for high-acuity patients who waited too long for EMS to be activated.
Healthcare reform will only add to the slippery slope of “when to call EMS.” On the one hand, an ACO will be penalized for readmissions within 30 days and because of that, a post-acute care facility may be hesitant to call for EMS. On the other hand, providing value and quality care for beneficiaries seems to dictate “erring on the side of caution,” lest the post-acute care facility be blamed for not providing proper care in a timely manner.
EMS agencies are uniquely situated to address this slippery-slope situation. Most agencies have training officers or educators on staff who can go out into the community and offer training programs to pre- and post-acute care providers about when it is appropriate to call EMS, what services, skills and training EMS provides on arrival, what local EMS agencies can provide in their particular geographic area, and how EMS can be viewed as a partner when it comes to providing value and quality to ACO beneficiaries under the care of these providers.
Even if your agency does not have the bandwidth to undertake a program such as community paramedicine at this time, it might be able to start a quarterly education program developed in conjunction with your EMS medical director and the medical director and physicians on staff at pre- and post-acute facilities. Offered as a CME-type format for area pre- and post-acute providers who are affiliated with an ACO, it can go a long way to ensuring proper and appropriate care for the ACO’s beneficiaries and will help situate the EMS agency as a partner with the ACO.
By approaching area health care providers in this way, EMS agencies can leverage the goodwill they have generated with those providers when it comes time to contract with the ACO.
Step 5: Ask the right questions
For providers who contract with ACOs, there are a lot of questions that need to be asked and answered. Specifically, there are several major areas that need to be considered, including:
“¢ The legal structure and governance of the ACO;
“¢ How the ACO is financed;
“¢ Whether any financial contribution will be required from the EMS agency in exchange for its participation;
“¢ What health information technology and electronic health records systems the ACO have in place and how compatible it is with the EMS agency’s systems; and
“¢ How will quality of care be tracked and measured by the ACO?
In a future article, we will delve farther into these questions, and provide a more comprehensive checklist to take to meetings with ACO representatives.
As with any process, ACO contracting will take time and patience. But the key is to lay the groundwork and make the contacts and connections now, and get in front of the right decision-makers early on.
This article scratches only the surface. Be sure to consult with an attorney to review your organization’s specific needs and obtain appropriate advice on these and related issues.
This column is not intended as legal advice or legal counsel in the confines of an attorney-client relationship. Consult an attorney for specific legal advice concerning your situation.