Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 13
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
services. Unfortunately, some early efforts have ignored the extraordinarily unique
circumstances of emergency medical services. Because EMS Systems already guarantee
universal access to 9-1-1 emergency medical service regardless of the patients’ insurance status
or ability to pay, Medicaid rates could be zero and there would be no change in the utilization of
or the need for services.
Review Models for Treatment without Transportation Services Provided by EMS. The
Committee also reviewed recent literature reviews regarding the successful pilot projects
associated with treatment and no transport by EMS.
Treatment with Referral and No Transport / Transport to Alternative Destination. Research is
showing that some EMS Systems can develop the capacity to safely transport to alternative
destinations and implement non-transport policies with additional investments in training,
oversight and a comprehensive quality improvement program. Based upon an extensive review
of the literature, the authors of the NAEMSP Resource Document describe the complexity of
determining medical necessity. Some of the data indicate that EMS Systems with exceptional
educational resources, strong medical oversight, and comprehensive quality management
programs may be able to implement paramedic-initiated non-transport (or alternative transport)
policies, particularly in narrowly defined circumstances, however, it is unreasonable to expect all
EMS Systems to implement such policies until this level of expertise and accountability become
the standard in EMS. In addition to achieving overall health care savings because fewer patients
will be transported to emergency departments, new payments will need to be developed to fund
the upfront investments necessary to implement these expanded services.
Attempted Resuscitation and No Transport / Treatment with Refusal of Transport. There are
existing services that currently are not reimbursed, yet costs are incurred for medically
appropriate care which is delivered to the patient. There are two examples where EMS services
currently achieve health care savings because fewer patients are transported to emergency
departments, however, new payments need to be developed to fund the costs of existing EMS
services. In the first example, an EMS crew responds to a patient in full cardiac arrest.
According to local EMS protocols, the crew performs an ALS assessment, performs resuscitation
efforts and ultimately determines the patient is clinically dead. According to local protocols, the
patient is not transported to the emergency department. While CMS allows a BLS transport
charge, this typically does not cover the cost of the service and many insurers will not provide
reimbursement for any of these services. In the second example, an EMS crew responds to an
asthmatic attack or an unconscious patient experiencing a diabetic attack. The EMS crew
responds to the emergency medical request, provides an ALS assessment and delivers treatments.
The patient’s medical condition is dramatically improved as a direct result of on scene EMS
treatments. This occurs following dextrose administration to an unconscious diabetic patient and
administration of respiratory treatments to asthmatic patients. A now conscious patient refuses
transport to the emergency department and many insurers will not provide reimbursement for
these services.
Review Models for Population Health Management Provided by EMS. There is a linkage
between the essential goals of the Accountable Care Act and the traditional public health model.
One of the essential goals of the ACA is to improve the health of a defined population. The
March 29,2012
Draft Advisory
13
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business