Redefining EMS

“Emergency Medical Services.” Really?

 

Spend a week or two in our worthy profession taking some 9-1-1 calls, or responding to patient’s medical needs, and you will quickly realize that few of the requests for our services are really emergencies. Now, before everyone reading this quickly turns the page, let me offer some insight about the value of the services most “EMS” systems provide.

 

“˜Emergency’ calls
In the past 12 months, MedStar in Fort Worth (Texas) has responded to 100,161 “9-1-1″ calls. One might ask, is a call to 9-1-1 automatically considered an emergency? Yes, we think we can agree that an emergency is in the eye of the beholder and we often receive calls for rollover motor vehicle collisions (MVCs) with ejection. However, we also receive calls for hiccups, foot blisters and the dreaded “sick person” with no identifiable chief complaint.

 

In fact, an analysis of our call volume over the past 10 years reveals that as a percentage of overall call volume, the increases in 9-1-1 calls are for interfacility calls (11.3% increase) and “sick person” calls (10.4% increase). Some call types have actually decreased as a percentage of overall call volume. The two call types with the most significant decrease as a percent of overall call volume are breathing problems (10.5% decrease) and MVCs (10.4% decrease).

 

One of our industry’s most important stakeholders, the Centers for Medicare and Medicaid Services (CMS), has defined an “emergency response” in their “Medicare Coverage of Ambulance Services” beneficiary manual (www.medicare.gov/Pubs/pdf/11021.pdf) as follows:

 

“You can get emergency ambulance transportation after you’ve had a sudden medical emergency, when your health is in serious danger, and when every second counts to prevent your health from getting worse” (emphasis added).

 

Let’s drill down a little bit into the 9-1-1 calls MedStar responded to this past year. Nearly 35,000 (34.9%) of the calls received a non-lights-and-siren response in accordance with our medical director-approved Advanced Medical Priority Dispatch System response determinant. One could argue that these calls could be reviewed by CMS and determined to not meet the definition provided to their beneficiaries.
That could be problematic in the near future.

 

The value proposition
As Bill O’Reilly is famous for saying, “Caution! You are entering the “˜No Spin Zone.'”

 

Who reading this column can raise their hand and say for certain that “EMS” has done a good job demonstrating that we bring value? Yes, our patients can say that, in many cases, we alleviate pain (assuming we can still purchase analgesics!) and make them more comfortable.

 

However, to the payer–the folks who help keep the employees paid and fuel in our ambulances–that argument is more difficult to make. Does the fact that the patient with abdominal pain, or extremity fracture, or neck pain went to the hospital by ambulance mean that their length of stay in the hospital was less, or in any way improves the cost of caring for that patient? Not to say that there may be a benefit to the payer; it’s just that, to date, we have not done a thorough job of mining that data and providing it to the payers. We should put that on our “to do” list!

 

The future
Interest in programs designed to navigate patients through the healthcare system, regardless of how they access it, is growing exponentially. By providing services beyond simply using the most expensive mode of transport (ambulance) to take the patient to the most expensive treatment center (emergency department), payer and providers alike are quickly recognizing the clinical, economic and patient experience value that “EMS” can offer.

 

Examples include using 9-1-1 nurse triage systems to find the right setting for low-acuity 9-1-1 calls, providing transitional home visits for patients at risk for admission or readmission to the hospital, and other “prevention” type services.

 

Employers are now recognizing the value “EMS” agencies can bring in changing how we respond to on-the-job employee injury or illnesses and navigate them to a setting that is, perhaps, more appropriate than an emergency department.

 

So, back my question: What’s in a name?

 

For 26 years, MedStar Emergency Medical Services has provided ambulance service to Fort Worth and 14 surrounding cities. Over the past few years, we have seen a major shift in the customer’s perception of the value we bring.

 

Because we provide programs such as community health, 9-1-1 nurse triage, congestive heart failure readmission prevention, observational admission avoidance, hospice revocation avoidance and, now, occupational medicine, the community has come to value us as more than just an EMS agency. In fact, they realize that the greatest value we bring is navigating patients through the healthcare system when they need “unscheduled medical services.”

 

Recognizing that the way we are delivering service is different, and recognizing the stakeholder’s perception of the true value we bring to the patient, payer and community, MedStar made the decision this year to change our name to MedStar Mobile Healthcare.

 

This was done deliberatively and with the full input of our governing board and our employees. They are participating first-hand in the evolution of our agency from one that simply reacts to calls and sends the cavalry, to an agency that thoughtfully, carefully and deliberately manages patient movement through the healthcare system, regardless of how they access it.

 

Along with the name change, we changed our mission and vision statements to more fully reflect where we are headed and how we see ourselves.

  • Our Vision: “To be a world-class mobile healthcare provider.”
  • Our Mission: “To provide world-class mobile healthcare with the highest quality customer service and clinical excellence in a fiscally responsible manner.”

A name is more than what you call yourself. It represents a sense of purpose and a demonstration of how you view what you provide.
Is it time to revisit your organization’s name?

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