A.J.’s Pinnacle Moments: Day One

On Tuesday, JEMS Editor-in-Chief A.J. Heightman attended the Pinnacle EMS Leadership & Management Conference in Boca Raton, Florida.

The Power Seminar sessions were presented by AIMHI. AIMHI is a group of organizations that are members of the International Mobile Healthcare Integration; systems with similar functions and who share ideas and programs across borders. Here are some key takeaways from the sessions:

Session: The Attributes of High Value EMS

Presented by: Jon Washko, Asst. VP, Northwell Health Center for EMS

Key Takeaways:

High Value Organizations Provide Value Beyond Their Mission

The Value Equation

Value = Quality+Service/Cost

Attributes of Value

  1. Quality
  2. Effective
  3. Safe
  4. Patient-centered
  5. Efficient
  6. Equitable
  7. Timely

The EMS Value Proposition

  • Sole Provider: The pool of dollars in EMS does not increase but, rather, decreases in light of the diseconomies of scale.  As more agencies (competitors) grow, the pool of available dollars decreases. Thus, the value of a sole provider or, better yet, a “high value” provider.
  • External Accountability: Agencies should have external accountability, somebody who can dive deep into your finances and operations.  Transparency must exist in a high-performance EMS system.
  • Financially Responsible: Agencies must be financially responsible.  Labor is your most expensive budget area; excessive units and overtime cost money.
  • Efficient & Effective: System status management; peak-load staffing; speed loading units; being lean; having satisfied patients and employees; good recruitment and retention.
  • Evidence-based Quality
  • Value Beyond Your Mission


Session: The “Intelligence Cycle”

Presented by: Rob Lawrence, Richmond Ambulance Authority

Key Takeaways:

Improved quality, safety & experience of care (patient satisfaction):

  • The “F-word” = Finance — Be fiscally and financially aware; don’t hemorrhage money via accidents; don’t waste shifts or crew.
  • Total Quality Management: Improve the next cycle of care; have effective call-takers; have effective/correct responses; have the right people in place, at the right time.
  • Measure as much as you can. Measure as many metrics as you can. Turn ” EMS intelligence” (metrics) into efficiency. Areas such as: treatment (is it correct and effective?); supply and demand; parts-repairs; collection rates.


Session: Financial Analysis and New Economic Models

Presented by: Doug Hooten & Matt Zavadsky, MedStar

Key Takeaways:

It’s all about Partner Motivation

  • Paradigm Shift: We used to rely on volume, but focus has shifted more toward outcomes and patient satisfaction.
  • We must be a provider of healthcare, not just a supplier of transportation. We’re healthcare providers and we must make payers realize that. We need to focus on shared savings by helping to reduce unfunded patients for hospitals; helping hospitals reduce the length of stay; work in tandem/cooperatively with hospice agencies; partner with home health agencies; Post-Acute Care Agencies need EMS to feed them patients; enrollment fees; some payers are looking at capitation (per member/per month). 
  • Total cost calculations and data, data, data.


Session: Balancing Medical Oversight & Operations

Presented by: Dean Dow, CEO, and Brad Lee, Medical Director, REMSA

Key Takeaways:

Both spoke passionately about the evolution of medical direction and the need, in today’s EMS economy, to integrate medical direction with the business side:

  • REMSA believes they should be integrated and the medical director should have a seat at the table.
  • Things don’t exist this way in many, perhaps  most, EMS agencies. Case in point: There was only one medical director in the room at this seminar.
  • Key factors: Do things make fiscal sense – Clinical oversight (Is ultrasound necessary?); Your protocols
  • Take your medical director with you to service contract negotiations.  They can speak well to quality and patient outcomes for your organization. They can also help sooth political tensions in your service area.


Session: Show Me The Money

Presented by: Brenda Staffan — REMSA

Key Takeaways:

The Question: Can Community Paramedicine work? The answer: Yes. REMSA was able to turn their three year ($9 Million) CMS grant into total program savings of $9.66 million.

Results of the Independent (RTI International) Evaluation:

Cross Comparison Results:

  • REMSA’s independent evaluation included 24 programs in the Community Resource Planning, Prevention and Monitoring group
  • Five awardees showed significant reductions in spendinf
  • Thirteen awardees had significant improvements in one or more utilization outcomes
  • Highlighted REMSA’s path to implementation effectiveness

Community Paramedicine – 30-Day:

  • Statistically significant reduction in Medicare spending ($2,394 per member, per quarter)
  • Significant reduction in inpatient admissions (543 fewer stays per 1,000 participants, per quarter)

Nurse Health Line:

  • Reduction in medicare spending ($12 per member, per quarter), not statistically significant
  • Significant increase in ED visits (64 more ED visits per 1,000 participants per quarter)
  • Limitations: The results may not fully represent the overall population served by the innovation due to sample size.  It’s highly likely that high medical utilization triggers participation.

Alternative Destinations: 

  • Had 1,212 transports to alternative destinations that weren’t repatriated to the ED
  • Limitations: Didn’t present Medicare regression results because researchers were unable to identify a comparison group that was well-balanced compared to the treatment group.

The Bottom Line:

  • REMSA and other grantees showed that a sustainability plan is possible for Mobile Integrated Healthcare (savings over expenditures).
  • REMSA was able to reduce transports to the ED.


Session: KAPE Crusader: Keeping the Agency in the Public Eye

Presented by: Matt Zavadsky, MedStar, and Rob Lawrence, Richmond Ambulance Authority

Key Takeaways:

Things the public is hearing and concerned about:

  • New articles are asking: Is ALS better than BLS?
  • There’s fraud and abuse in our industry.
  • City Councils are rejecting SAFER Grants because they will own staff/expenses for EMS after the grant runs out.
  • The price of an ambulance ride isn’t worth it. 

Building Community Trust:

  • Be proactive with the media and the community.  Utilize employees as ambassadors.
  • Develop a community Advisory Board and programming.
  • Host special events: free CPR classes, Home for the Holidays, golf tournaments
  • Develop E-newsletters
  • Train your team members
  • Attend/hold public town meetings
  • Offer public ride-alongs
  • Utilize social media (Facebook, Instagram, Twitter) to communicate your message. 
  • Establish a relationship with the media: Be available, know what they want, understand that they have a job to do, point them to someone who can help them, be honest, write guest columns for local media.


Session: Politics: All Those in Favor

Presented by: Chip Decker, CEO, Richmond Ambulance Authority

Key Takeaways:

  • You have to persuade others that your position is the best position.
  • You have many bosses (City Council, oversight committees, boards of directors).  Don’t get “voted off the island.”
  • Local politics are important. Meet new politicians and educate them. Show that you can be a trusted community partner. Stay in the room after the meeting; go in uniform; show that you are the subject matter expert; speak during the public comment session of meetings.
  • Be a member or participant in all EMS associations and groups
  • Participate in events like “EMS on the Hill” and AAA “Stars of Life.” These are ways to get into your politician’s office and influence them.


Session: Building and Maintaining Stakeholder Relationships

Presented by: Jonathan Washko, Asst. VP, Northwell Health Center for EMS

Key Takeaways:

  • A stakeholder is a person or group who has an interest or investment in what you do.
  • You must understand who your stakeholders are and how you can engage them.
  • The patient should be at the center of everything you do.

Triage your stakeholders with a power/interest grid.

Map your stakeholders with the patient always at the center.


Session: Beyond Paramedicine: From Emergency Responder to Mobile Integrated Health

Presented by: Brad Lee, MD, Medical Director, REMSA

Key Takeaways:

  • CPs should volunteer to do it
  • Select not just your best and brightest
  • Have patience, empathy and compassion
  • Possess the ability to work autonomously
  • Have confidence to see a patient by themselves and not have the patient seen immediately thereafter
  • Have good interviewing skills
  • Possess the ability to communicate well
  • Know the different types of insurance to help patients to navigate through the system
  • Have a CP ride-along and Preceptor program
  • Your CP system should have 100% chart review (via programs like First Watch/First Pass)


Session: Putting the “World” into “World Class” EMS

Presented by: Kevin Smith, Niagara (Canada) EMS

Key Takeaways:

Globally, we’re entering into major healthcare changes and we must learn about several key areas from one another:

  • Funding strategies
  • Ways we deliver the service
  • Ways to be adaptable
  • Understand patient populations
  • Be responsive to change
  • You need intelligence and (data) “intelligence”
  • Ontario has developed/presented Patients First: Action Plan for Health Care

We must address:


Closing Remarks

  • We must accelerate the education of our EMS personnel.
  • Some systems can’t hire enough paramedics and others have realized they don’t need an all-ALS system, so they’re going back to some BLS units.
  • Sepsis detection should be a prehospital parameter. By combining temperature and SIRS criteria with EtCO2 readings, we can identify these volatile patients early and reduce morbidity and mortality of patients. This also leads to reduced admissions, reduced death and increase in reimbursement (or fewer reimbursement penalties) for hospitals.

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