Imagine if fire departments’ primary operations funding came from being reimbursed for each fire they put out. Let’s say for every fire an agency responds to, there are three types of reimbursement: basic fire suppression (BFS), advanced fire suppression (AFS) and AFS2 for large fires for which three or more hoses, monitors or deck guns were used.
A Bad System
BFS would include some small fires, such as a weed, trash or car fire, whereas AFS may include garage fires or a small house fire. An AFS2 qualification would be reserved for larger fires for which multiple hose lines were deployed.
In this type of system, fire departments wouldn’t be able to provide the service they do now because they’d be dependent upon fires to survive. They wouldn’t be able to host prevention or other types of outreach programs for the community because they wouldn’t be reimbursed for them. Does this scenario sound familiar?
It should, because it’s basically the same model EMS follows. We’re essentially reimbursed for everyone we take to a hospital, assuming it was medically necessary.
What would happen if the police department in your community were to operate under this model? Without tax revenue, the police department would get its funding from every person they arrested or ticketed. You’d probably see a lot more arrests, many for no fundamental reason, and a ton of moving violation tickets.
Reform Needed
With the health-care reform bill signed by President Barack Obama this past March, the EMS community had an opportunity to make some changes. Instead, we sat on our hands while lobbyists, democrats, republicans and special-interest groups battled it out.
If the whole idea was “reform,” we missed the mark; even though, for many people, EMS is their introduction into the U.S. health-care system. Of the 2,500 pages of legislation, it appears that the impact to EMS is only an extension of the 2% urban, 3% rural and super rural bonuses for ground ambulance service providers.1
The main problem is the bill doesn’t change the current model. We’ve been following the same basic model for more than 40 years: Ambulance responds to the scene; patient is treated by first responders; patient is placed on stretcher and loaded into an ambulance and taken to a hospital; the service collects reimbursement.
EMS is a major player in the health-care industry. I’d estimate that providers care for 100,000 patients a day in the U.S.
Under the new health-care legislation, we had an opportunity to untie ourselves from the model of treating and transporting to an emergency room. We also had an opportunity to create a different model of delivering EMS, including injury and illness prevention programs.
How much would prescreening patients be worth to Medicare, Medicaid and private insurance companies? Providers could check blood pressure, glucose and cholesterol to identify those in crisis that didn’t know it.
What would have happened had the health-care legislation funded “treat and release” programs? We’d be reimbursed for taking someone to the hospital and not taking them to the hospital. We probably could have saved the federal government and private insurance companies millions by not transporting someone to an emergency room that didn’t need it–not to mention additional costs incurred for unnecessary treatments and diagnostic testing.
As an industry, we could have also requested the health-care legislation include pilot programs that reimburse EMS for evaluating someone on the scene, determining they didn’t need an emergency room and transporting them to less resource-intensive forms of care, such as clinics or urgent care centers.
The 1996 EMS Agenda for the Future said, among other things, “EMS of the future will be community-based health management that is fully integrated with the overall health care system.” If this is true, we certainly missed our opportunity.
Landmark legislation of this type doesn’t come along very often. The last time this type of major legislation was passed was in 1965 with the passage of Medicare. Before that, it was Social Security in 1937.
Whether you agree with the health-care reform legislation, it was passed by both houses of Congress, and it was signed into law. We providers sat at the train station, watched the train leave the station and never attempted to get on board. JEMS
Reference
1. Page, Wolfberg & Wirth. www.pwwemslaw.com/content.aspx?id=459
