need to be ready to both articulate and find data to support their proposals. Would a certificate of need be required for certain activities? Collaborators often need to learn about the level of training and education an EMT or paramedic would receive to safely perform new duties. Another concern is to what degree and by what mechanisms a novel EMS initiative be coordinated with the primary care team. Finally, the threat of lost revenue motivates some potential partners to oppose integrating EMS into community health care initiatives. The fear that innovative EMS programs might steer some low acuity patients away from the emergency department, for example, has generated opposition from some hospital and emergency care groups. Objections are rarely described as being motivated by volume and are typically described as concerns over patient safety and overall quality. 96 STRATEGIES TO IMPROVE INTERDISCIPLINARY COLLABORATION JOINING THE CONVERSATION The role EMS plays today and the value EMS could provide in the future in chronic care and as part of the health care safety net is not broadly recognized. Important reform and innovation initiatives, whether they are in the health care, public health, or public safety space should be inclusive of EMS. Local, state and national EMS leaders should actively participate in conversations about collaboration across health care sectors with the aim to improve patient-centered outcomes and the health status of the population. Representatives of EMS need to be politically savvy in order to ensure the prehospital perspective has a seat at the table.
By being present when problems and potential solutions are being discussed, it is far more probable that EMS, with its unique skills and access, might contribute to new innovative solutions. Home health agencies, hospital at home groups, home-based primary care groups, hospice agencies, public health, and other providers of home and community services are likely to benefit from collaboration with EMS. Together, they can better identify and understand the needs of patient populations traditionally served by each segment, avoid unnecessary duplication of services and contribute to improved health outcomes at the community level. Rather than being on the sidelines as other stakeholders engage in discussions about public safety, community health, and preventing emergency visits, EMS needs to take the initiative to drive those conversations, and build the right sets of relationships to ensure its voice is heard. Engaging primary and acute care providers as well as payers can also improve patient outcomes, risk management, population health services, and information exchange. Enabling and facilitating cross-provider dialogue can ensure clarity of role, expand opportunities and improve support for patients and family caregivers. PARTNERING FOR INNOVATION EMS has a unique role in a health care reform environment that has started to focus on value and out-of-hospital care. Agencies with the desire and capability to improve out-of-hospital care should take advantage of their position to partner with community health care stakeholders and fill the gaps of the current system.
EMS provider agencies that have expanded their care delivery options beyond the traditional 9-1-1
96 Sugarman, Thomas J. “Opinion: Paramedicine Diversion Programs Post Patient-Saftey Risks.” ACEP Now, 6/15/2015. Accessed 11/4/2017 http://www.acepnow.com/article/opinion-paramedicine-diversion-programs-pose-patient-safety-risks/ .
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MOUNT SINAI HEALTH SYSTEM | UNIVERSITY OF CALIFORNIA, SAN DIEGO
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