Promoting Innovation in EMS

In many cases, payments for services within the EMS scope of practice are being paid to other provider groups through billing codes and mechanisms already in existence, but EMS is considered ineligible for that reimbursement. This is at least partly because many outside of our industry are unaware of the capabilities of EMS providers or the nuances of our credentialing policies or legal status. When setting policies that are intended to be broad, they often will use phrases such as “any licensed practitioner,” which either intentionally, or perhaps unintentionally, excludes EMS from alternative payment models. 47 Similarly, EMS may be ineligible for certain types of reimbursement because of its status as a supplier, not a provider. EMS as an industry has done a poor job representing itself to the rest of health care and even to other stakeholders in public health or public safety. As discussed in other chapters, despite the development of the National EMS Scope of Practice model, there is a lack of standardization of provider types and scopes of practice across states. And despite the development of the National EMS Educational Standards, there is a lack of standardization of educational standards. 48 Together, these make it difficult for entities with a broader geographical span, like payers, to engage with EMS on reimbursing for services other than transportation. DIFFICULTY DEMONSTRATING VALUE AND OUTCOMES While the issue of payment reform is paramount, there are several important obstacles to achieving reform. One of those is the difficulty for most EMS agencies to demonstrate the financial value and health care outcomes of providing treatment independent of the transportation function. 49 Doing so would require several key components

including access to the necessary data, and the measurement and analytical skills to turn that data into information. Due to the frequent inability to obtain data from hospitals, as discussed at length in the data chapter, it often is difficult if not impossible to connect an individual EMS agency’s practices to the patient-level outcomes or to the patient’s clinical or administrative information related to utilization before and after an EMS encounter. However, within the EMS agency lies all the necessary information to analyze cost. And yet, most agencies lack a sophisticated understanding of their internal costs, miss opportunities to achieve greater efficiency, and have difficulty understanding the impact of new models of care on their cost structure. Whereas the current mainstays of EMS quality measurement are response times and protocol compliance metrics, the basis of bundled payment and pay for performance initiatives rests on proven outcomes while improving patient satisfaction and reducing cost. Even the EMS Compass project is “prioritizing measures that can be calculated with data already collected by EMS agencies” over those that require outcome data from hospitals, due to the practical realities of our industry. 50 Until EMS can accurately report outcome data in a compatible way with health plans and hospitals, it will be very difficult to negotiate payment contracts for innovative models of EMS. LACK OF BUSINESS ACUMEN Often, EMS managers and leaders rise to their positions through seniority. They may or may not have had previous training in management, finance, or leadership, or understand the complexities of the health care business. As a

47 “Medicaid Reimbursement for Community-Based Prevention.” Last modified October 31, 2013. 48 “National Emergency Medical Services Educational Standards.” National Highway Traffic Safety Administration . Last modified January 2009. 49 Munk, Marc-David. “Value generation and health reform in emergency medical services.” Prehospital and Disaster Medicine 27, no. 2 (2012): 111-114. 50 “What EMS Compass Is And Is Not.” EMS Compass . Accessed June 28, 2017.




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