at obtaining funding for EMS care outside of traditional payment mechanisms through the Medicaid waiver process. 56 Using templates or provisions from other states may facilitate more rapid inclusion of EMS innovations in Medicaid waiver applications from the state to the Center for Medicare and Medicaid Services. (A sample of the Texas application is provided in the appendices). Minnesota has engaged quality improvement organizations (QIOs), groups of health quality experts, clinicians, and consumers working under the care of CMS to improve the care delivered to Medicare beneficiaries, 57 in the development and evaluation of their community paramedicine and mobile integrated health care programs. Other QIOs should recognize the critical role EMS plays in the emergency care system and wishes to play in other areas such as population health, and include EMS representation on those committees. TRANSFORMING TO EMS 3.0 At the national level, EMS associations should help EMS make the transition to a new era of health care. In the emerging concept of Health care 3.0, the patient becomes the center of health care commercial models and information becomes more available and optimized for both the patient’s and the provider’s ease of use. 58 EMS as an industry needs to come together and advocate in a unified way to be given the tools to transition EMS to its own 3.0. 59
articulate the need to decouple reimbursement from transportation across all public and private payers in order to achieve the very goals our partners in health care and public policy are seeking. CMS set a precedent for this change decades ago when they agreed to pay for response and treatment of cardiac arrest victims, regardless of ambulance transport. 60 This was most likely done to reduce the perverse incentive of the ambulance provider to transport patients who were clearly non-survivable simply to get paid for the response. EMS leaders should also continue to educate and engage payers about what EMS offers and can bring to the unmet needs of their patients. Since multiple groups of providers may possess overlapping competencies, payers could choose to reimburse for those competencies and skills independent of the licensure of the provider. Meanwhile, folks within EMS should become more familiar with quality initiatives in the health care sphere. An example is the National Committee for Quality Assurance (NCQA), one of the leading organizations in the development of health care quality measurement. NCQA is the steward of the Health care Effectiveness Data and Information Set (HEDIS) measures, one of the most widely used sets of measures in the United States. The EMS Compass Project, as well as the MIH-CP measures project, are seeking to follow the example of NCQA in their measurement development efforts. By improving our measurement of evidence-based
EMS leaders should continue to passionately
56 “Designing and Implementing Medicaid Section 1115 Delivery System Reform Incentive Payment Programs.” National Governor’s Association. Accessed June 28, 2017. http://www.nga.org/files/live/sites/NGA/files/pdf/2015/DesigningandImplementing MedicaidSection1115DeliverySystem.pdf. 57 “Quality Improvement Organizations.” Centers for Medicare & Medicaid Services. Last modified November 30, 2016. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityImprovementOrgs/index.html?redirect=/qualityimprovementorgs/ 58 “Health care 3.0: Health care for the new normal.” Deloitte. Accessed July 31, 2016. Available at: http://www2.deloitte.com/content/dam/Deloitte/sg/Documents/risk/risk-sea-health care-3.0-health care-for-the-new-normal.pdf. 59 “Realizing the Value of EMS in Our Nation’s Health Care Transformation.” EMS 3.0 Initiative. Accessed June 28, 2017. https://www.nasemso.org/Projects/MobileIntegratedHealth/documents/EMS-3.0-Initiative-Paper-Final-for-Association-Endorsement-and-Leadership-Participation-19Ap.pdf. 60 “Medicare Learning Network: Medicare Ambulance Services.” Centers for Medicare & Medicaid Services. Last modified May, 2011. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Medicare_Ambulance_Services_ICN903194.pdf.
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CHAPTER 3
MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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