quality improvement programs or reporting them externally should begin doing so. Meanwhile, national associations have been and should continue to work with CMS and other payers to design payment models that reward compliance with these clinical bundles to improve patient care and patient outcomes, independent of transportation. BUNDLED PAYMENTS External to EMS, many hospitals and physicians groups are beginning to participate in bundled payment programs in which a large lump sum is paid to a healthcare entity in order to manage a patient through an entire episode of care, sometimes as long as 90 days. 54 Payers would not EMS & HOSPICE MedStar Mobile Health care in Texas has partnered with VITAS, a national hospice agency with a presence in Fort Worth, TX, to help prevent unnecessary emergency department trips. Patients with high risk for revoking their hospice care plans are referred to MedStar. If one of those patients calls 9-1-1, MedStar is able to identify the patient by his or her address and send a hospice-trained mobile health paramedic to the scene. On scene the paramedic assesses the patient to determine if the issue is in line with their disease, gives medication from a ‘comfort pack’ if needed and contacts the patient’s hospice nurse. The mobile health paramedic waits on scene until the hospice nurse arrives. This program completely prevents patients from unnecessarily going to the hospital and possibly revoking their hospice plans. It has resulted in a 54% reduction in hospice revocation. http://www.medstar911.org/mobile-health care-programs
the part of national advocates for, and potential collaborators with, EMS working at the federal level. However, a number of steps can be taken at a variety of levels to begin to unravel this inhibiting finance structure. PAY FOR PERFORMANCE With 90% of CMS payments planned to be tied to value by 2018, the time when pay for performance arrives in EMS is close at hand. 52 EMS agencies should be envisioning the structural and process changes necessary to succeed in that environment today. Reflecting on whether an agency would receive high ratings from your patients might inspire retraining of providers, or brainstorming new ideas to improve the patient experience. Reflecting on the quality of clinical care might inspire new investments in quality assurance staff or tools. While this transition may be daunting, if managed appropriately, it could improve the financial sustainability of both emergency response services and alternative models of care. By preparing for a future in which pay for performance is the norm, EMS agencies will organically be transforming their agencies into ones that are more likely to be able to innovate. Perhaps the movement towards value-based purchasing will create the environment needed for small fragmented EMS agencies in the same market or in nearby jurisdictions to collaborate in order to meet data reporting and quality assurance requirements. Prehospital clinical bundles of care have been developed for acute conditions such as myocardial infarction, stroke, trauma, asthma, and hypoglycemia. 53 Compliance with these clinical bundles, or clinical processes of care, have been proven to improve patient outcomes and speed appropriate medical care. EMS agencies not already incorporating these bundles into internal
52 Burwell, Sylvia M. “Setting value-based payment goals—HHS efforts to improve US health care.” New England Journal of Medicine 372, no. 10 (2015): 897-899. 53 El Sayed, Mazen J. “Measuring quality in emergency medical services: a review of clinical performance indicators.” Emergency medicine internationa l 2012 (2011). 54 “Bundled Payment for Care Improvement Initiative (BPCI)”. Centers for Medicare and Medicaid Services . Last modified August 13, 2015. https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-18.html
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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