Sports Analogy Applied to Health-Care Reform

It may be strange to hear someone from the south talk about hockey, but I live in a southern city that not too many years ago brought home the coveted Stanley Cup. With this win, the team proved a recently relocated team could produce a winning outcome in a different environment.

Many parallels can be drawn between health-care reform and a sport like hockey. In hockey, the focus is always to get the puck into the net with the highest frequency possible and the fewest penalties and injuries. The rules are tweaked when it makes sense to do so, but the goal is the same.

In health care, the goal is–always has been, and will remain–to help the patient maintain, improve or regain their health. For EMS and trauma response, we can take this one step further and define the goal as preserving the patient’s life.

When someone calls 9-1-1, the response will remain the same regardless of health-care reform. But plenty of rule changes will directly and indirectly affect EMS. This will occur although EMS was, for all intents and purposes, absent from the initial legislation.

Power Plays
The most direct impact of health-care reform will be who pays the bills and how much they pay. Expanded eligibility and an aging population will make Medicaid and Medicare the primary payers for the majority of health-care organizations across the U.S.

Additionally, private payers will be quickly aligning with Medicaid and Medicare reimbursement rates under the premise that cost-shifting is a relic. Cost shifting, where reimbursements from privately insured patients that are primarily underwritten by businesses, helps offset costs of care for the under- and uninsured, which will still be necessary for the remaining 23 million Americans left uncovered.

Changes in how treatments and services are evaluated regarding timeliness, appropriateness and quality will be significant. With data mining and outcomes reporting, the best laid plans to mask outcomes will be a thing of the past.

The good news is there are plenty of ways to proactively analyze and perfect your performance through data mining and technologies, such as simulation training. These advances are revolutionizing how the next generation of nurses, doctors and EMS providers are trained.

This tremendous amount of feedback and sophisticated analysis can be likened to the training star athletes receive. EMS providers and teams have to train and improve until they have perfected plays (for EMS providers, their approach to calls), honing individual performance, teamwork and quality to produce exceptional outcomes.

It’s also clear ambulance use beyond traditional 9-1-1 response will be scrutinized. Cost, time and effort of inter-facility transports will potentially be figured into the bigger picture of the payer’s experience. More specifically, payments to all health-care organizations and providers will likely be bundled for episodes of care.

The idea is for this lump payment to be split between the different players. It isn’t clear where bundling will start: Will it apply street-side to rehabilitation, or will it begin with hospital admission, reimbursing transport separately? These details are yet to be determined.

Direct Assists
Hospitals will begin to see even more procedures and care traditionally provided on an inpatient basis move to outpatient. And, truly inpatient needs and specialty care for cardiac concerns (e.g., stroke) will become more centralized like trauma. These changes will affect EMS because transport patterns will likely change.

You’ll also see major changes in the way re-admissions are reimbursed. The government is taking the position that if someone is re-admitted with certain diagnoses within 30 days of discharge, the re-admitting hospital won’t receive payment regardless of whether the patient received the initial care at that facility. This is a clear directive to avoid unnecessary costs and another rule change that will be felt throughout the system.

At WakeMed, we have a program that sends staff to patients’ homes, because even today it’s cheaper to keep them well than to have a costly readmission. I expect EMS systems will be called on to help with programs like these, employing highly skilled practitioners to perform these services.

Win the Game
So what’s becoming clear is that many health-care reform elements address current issues for EMS: education and workforce development; liability; information technology; specialty transport and such innovations as advanced practice paramedics. These elements are potential losses or victories in the health-care reform arena. And, just like in sports, anything performed without practice, coaching, training and strategy will produce less-than-desirable outcomes.

Winning under health-care reform will be possible if we stay focused on access, cost and quality. And it’s critical we continue to play for the love of the “game”–not simply to bring home a cup. JEMS

This article originally appeared in November 2010 JEMS as “Moving the Puck: Health-care reform sports analogy”

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