Promoting Innovation in EMS

cover EMS assessment and treatment regardless of whether the patient is transported. Regulators could require reimbursement for specific services such as paramedic home visits for specific types of patients. The state could also use its convening power and bring health plans and EMS agencies together on a periodic basis to either exchange data or explore new service offerings. Second, payment and reimbursement could be addressed in new or revised legislation as this will address revenue streams and sustainability. One potential avenue is to alter the definition of EMS providers to dissociate their services from the “ambulance” or the “transportation benefit”, which may make them eligible for reimbursement from Medicaid. Third, it is important to consider increasing the authority (and possibly budgets) of State EMS offices to enable them to play a more active role in the encouragement, vetting, authorization and direct funding of pilot programs. Perhaps their authority could grow to formally inform insurance regulation as it pertains to EMS. While states have an obligation to protect the public, they also have a responsibility to assure that public funds are expended wisely. Empowering these public officers would allow for both more rapid testing of innovations and an enhanced ability to protect both public health and public funds. INNOVATING WHILE COMPLYING WITH EMTALA In some states, it is fairly common to see EMS agencies that are owned and/or operated by hospital systems. For these agencies, the ambulance is considered part of the hospital, and EMTALA provisions attach when the personnel of such an ambulance make patient contact. Facilitating innovations that involve concepts

including treat and refer/release or alternative destinations may place the hospital at risk of breaching EMTALA unless the patient is deemed to have received a medical screening examination and appropriate stabilizing treatment. Allowing EMS personnel on these units to be appropriately trained and deemed “qualified medical personnel” capable of performing a standard medical screening exam, possibly in conjunction with direct medical oversight, will be needed to allow these agencies to successfully innovate with these concepts while maintaining compliance with EMTALA. 40 Another approach that may reduce liability for hospital-based EMS agencies and providers is to ensure that they are following regional (community-wide) protocols. If regional or state protocols direct EMS to transport a patient to a location other than an emergency department based on clinical criteria, the agency would be shielded from EMTALA violations. Of course, no evidence-based criteria have yet been established for safe triage of patients to alternative destinations, so medical oversight contact may be advisable. This can help from a protocol perspective, but might also serve to meet EMTALA if a physician can remotely evaluate the patient and determine that a there is not an emergency medical condition. PORTABILITY OF EMS PERSONNEL During large-scale emergency situations, there is often a need to move emergency personnel resources from one state to another (or one jurisdiction to another) quickly. As a consequence of our lack of standardization of education, licensure, and protocols across jurisdictions, it is not easy for EMS providers to migrate across jurisdictional borders. In some states, there seem to be excessive bureaucratic hurdles to rapidly

40 “Pub 100-07 State Operations Provider Certification,” Center for Medicare & Medicaid Services, 2010,




Made with FlippingBook - Online magazine maker