DRIVING QUALITY IMPROVEMENT
PROTECTING QUALITY ASSURANCE COMMUNICATIONS
Finally, the fifth principle is that quality assurance activities and related communications, for both standard EMS activities and pilot programs, should be protected from liability proceedings. This needs to include communications between EMS agencies and between EMS and other health care entities like hospitals or ambulatory care practices. entities can obtain a high degree of protection by participating in a patient safety organization (PSO). These organizations were enabled by the Federal Patient Safety & Quality Act of 2005. A health care provider can only obtain the confidentiality and privilege protections of the Patient Safety Act by working with a PSO listed with the Agency for Health care Research and Quality. 39 innovation is the requirement of transportation, often to an ED, for an EMS claim to be paid. This financial barrier, discussed in greater detail in the financial section, may in fact require a legal or regulatory solution. At the federal level, CMS currently does not authorize payment due to language in Title 18 of the Social Services Act that describes an ambulance service benefit “where the use of other methods of transportation is contraindicated by the individual’s condition.” This has been narrowly interpreted and codified in federal regulation 410.40. Although Medicaid is administered by the states and has a great degree of flexibility, especially through the 1115 waiver process, states are not able to circumvent this narrow interpretation. However, states that recognize that new and future EMS models may consist of both medical transportation and health While it would be preferred for this to be included within explicit legislation, alternatively, EMS FLEXIBLE REIMBURSEMENT MODELS One of the most fundamental barriers to
The Emergency Medical Error Reduction Group (EMERG) is a patient safety organization (PSO) that demonstrates that coordination can drive quality
improvement across agencies. Many EMS agencies are small or under-resourced, and they find robust quality improvement processes difficult to maintain. EMERG seeks to fill that gap by providing personalized and coordinated quality improvement counseling to its members. By specializing in quality improvement and serving multiple agencies at once, EMERG is able to provide a higher quality service at a lower cost than most agencies would be able to provide on their own. EMERG also condenses safety and incident data from across states and regions to identify trends in patient and provider safety and keep state EMS directors informed. Part of this data gathering system includes a free reporting site for any providers who wish to report a safety incident. The EMERG model also shows that innovation does not always have to come from EMS agencies themselves, but can be driven by enterprising individuals who find and build new services that help agencies provide value to their local communities.
care delivery services should seek to support a more favorable and flexible reimbursement model.
Besides changing federal law, there may be other actions state and local actors can take to unleash innovation. First, in their power to regulate insurers, states should consider methods of promoting reimbursement for innovative models of EMS care. As one example, health plans might be required to
39 “Federally Listed PSOs,” Agency for Health care Research and Quality , accessed June 27, 2017, https://www.pso.ahrq.gov/listed.
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CHAPTER 2
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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