Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 14
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
collaboration that is necessary for population health management will emerge as a critical issue
with future shared savings programs. As the focus shifts from treating sickness to maintaining or
improving health, the considerable assets of the EMS system could be leveraged, for example:
1. Community Paramedicine. Under the existing scope of practice model, the paramedic’s
role is expanded in a community-based model to intervene in a variety of ways including
preventative care, follow-up care, basic treatments and other non-acute interventions.
Early pilot programs have demonstrated improved preventive care, readmission
reduction, reduction in emergency department visits and downstream health care cost
savings.
2. Advanced Practice Paramedics. Under a new expanded scope of practice model,
paramedic-initiated programs are implemented for treatment with referral and no
transport and transport to alternative destinations. These expanded models require
investments in additional education and training, strong medical oversight, and
comprehensive quality management program (NAEMSP, 2011). Early pilot programs
have demonstrated reductions in readmissions, improved patient outcomes and general
downstream health care cost savings. These programs require additional funding of the
upfront financial investment in additional training, oversight and quality improvement.
3. Continuum of Care Coordination by Medical Communications (9-1-1) Centers. The call-
talking and triage capacity of medical communications/9-1-1 centers is utilized to achieve
better coordination and more efficient access to the most appropriate type and level of
care.
According to the NAEMSP Resource Document, third-party payers may be able to realize some
cost savings by providing appropriate reimbursement for non-transport-related services provide
by EMS Systems that possess adequate resources and choose to adopt the additional necessary
program elements.
E:
Conclusions
Conclusion 1. A comprehensive evaluation of total EMS System cost must include each of the
individual system functions and activities.
Conclusion 2. EMS has had and continues to have a funding crisis. The Committee believes
this crisis may result in large part from the misperception of the role of EMS agencies in the
broader health care system, by both government oversight agencies and the general public. One
can argue the funding crisis is a direct result of these misperceptions. The Finance Committee
proposes the following pathway to enhance current and develop new funding models for the next
generation of EMS.
Pathway to move EMS response to a more sustainable readiness-based funding and
reimbursement model
1. Develop and adopt a comprehesive list of EMS functions and activities
2. Standardize language used to define EMS functions, specifically as it relates to EMS finance
a. Define terms that clearly articulate EMS response and EMS Systems
b. Define readiness and all inclusive terms
March 29,2012
Draft Advisory
14
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