Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 7
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
The 2006 Files Triage Guideline is a prime example. This study compared the 2006 Guidelines
to the 1999 version that evaluated the triage decisions made by EMS personnel and the cost
implications for transporting to trauma centers versus non-trauma centers. With approximately
5.4 million trauma patients being transported in 2007, the updated triage guidelines saved an
estimated $568,000,000 in national health care costs. EMS integrated into the healthcare system
has shown substantial savings in this one segment of EMS patients. With 18.1 million
ambulance transports to hospital ED’s, the trauma system is a minority of ambulance calls and
great potential exists for additional savings. The nation’s trauma systems also rely on inter-
facility ambulance services to re-triage trauma patients between emergency departments on an
urgent basis. Studies show effective trauma systems (with the goal for the right care, at the right
place, at the right time) lower the risk of death by 25% (Mackenzie, 2006).
Weaver, Moore, Patterson, Yealy. “Medical Necessity in Emergency Medical Services
Transports.” American Journal of Medical Quality. December 2011.
EMS transports for medically unnecessary complaints increased steadily over a 10-year period,
encompassing 17% of all EMS transports nationally in 2007. However, lack of insurance was
not the major factor, and use by those with this condition dropped over the time interval. This
nationally representative sample suggests that there is an opportunity for alternative patient
delivery strategies for selected patients seeking EMS services.
National EMS Advisory Council. “EMS Makes a Difference: Improved Clinical Outcomes
and Downstream Healthcare Savings.” National Highway Traffic Safety Administration.
Washington, DC, 2009.
The EMS Makes a Difference paper indicates “systems of care” improve patient outcomes and
decrease overall downstream health care costs and EMS plays a major role. EMS produces
downstream savings in healthcare costs because of actions taken in the field. The NEMSAC
white paper identified several categories of EMS work that benefit patients and health care
systems, including: EMS functioning with systems of care (cardiac, stroke, and trauma), use of
12-lead ECG, CPAP, termination of codes in the field, and treat, refer and release to name just a
few. The paper also highlights how an integrated EMS System within health care can improve
patient outcomes, decrease cost, and improve patient satisfaction.
Institute of Medicine. “Future of Emergency Care: Emergency Medical Services at the
Crossroads.” National Academy Press. Washington, DC: 2007.
In 2007, the Institutes of Medicine (IOM) of the National Academies of Sciences released its
landmark publication titled, “Future of Emergency Care in the U.S.” The publication
encompassed three reports addressing hospital-based emergency care, emergency care for
children and pre-hospital care. One of those reports, “EMS at the Crossroads,” evaluates the
development of EMS over the last 40 years resulting in the “fragmented system that exists
today.” The prestigious committee’s findings and recommendations rest on three broad goals for
the nation’s “systems” of emergency care:
• improved coordination
• expanded regionalization
• increased transparency and accountability
March 29,2012
Draft Advisory
7
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