By Randall Hanifen
Contributor, EDM Digest
I recently attended a regional healthcare summit. One of the panels consisted of a hospital group administrator, a doctors’ group president, a medical insurance consultant and a medical insurance representative. They all spoke about the changes in healthcare insurance, the payment philosophy related to insurance and employee participation in healthcare.
We are at the crossroads of increasing healthcare costs. That will soon begin to affect the emergency medical services profession.
Traditional EMS Model
In the past 20 plus years, the traditional EMS model involved citizens calling 911 when they had a medical emergency. The EMS system, which is often fire department-based in many areas of the country, responded with at least an ambulance and possibly a fire truck and a paramedic supervisor.
The patient was cared for based on his or her symptoms and a certain protocol that often involved many procedures to be performed either on the scene or en route to the hospital. The patient was transported to the nearest emergency room and medical care was transferred to the hospital. If additional medical advice or permission were needed for the patient while in transit, the paramedic would call the receiving hospital and a doctor would tell the paramedic what steps to follow.
During the past few years of increased litigation, some medical organizations have begun to require a doctor’s permission to take a refusal. The goal of the EMS system was to wait for an emergency, then provide transportation services while emergency medical procedures were administered to a patient.
Much of the medical assistance focus has been on increasing the number of procedures conducted prior to an ambulance’s arrival at the hospital. This change is due to better paramedic instruction and billing revenue, which provides more revenue for the EMS organization. As I once heard at a conference, “An ambulance is the most expensive form of transportation per mile on the planet, excluding the space shuttle.”
The Shift to Wellness and Preventative Care According to a Paramedic Model
One of the latest shifts in EMS models is the inclusion of wellness and preventative care checks. But many ambulance services do not have sufficient funds to check on patients discharged from a hospital.
In addition, hospitals can be fined if a patient returns with the same ailment within a certain timeframe. In theory, these checks are a good idea because they reduce the number of emergency calls.
However, some healthcare professionals point out that preventative checkups pay only a fraction of the cost of an emergency call, while many returning patients provide a good portion of the billing revenue. The jury is still out on the effectiveness and feasibility of EMS systems taking on expanded healthcare procedures.
While adding healthcare procedures might work for EMS systems with smaller call volumes, many of the busier systems would need to hire additional personnel or pay overtime for them to perform the preventative tasks. That would increase operating costs. Although it could be argued that it is the “right thing to do,” funding from local government and local taxes continues to decrease, making it difficult to provide preventative healthcare service.
Pay for Value Rather than Pay for Service
The entire EMS system is built on the pay-for-service model with a pricing structure based on the procedures performed after paramedics assess a patient’s condition. Out of legal concerns, assessments might call for more care or procedures than needed and delay the patient’s arrival at the hospital.
There could be negative consequences for the patient’s health or financial situation. The pay-for-value model begs the question, “Did the intervention improve the patient’s short- and long-term outcome?” That is counterintuitive to the “stay-and-play” mentality currently taught to paramedics.
Paramedics Should Adopt a Global Healthcare Approach
Healthcare costs have skyrocketed due to the duplication of efforts, the extra technology available to give second opinions, and the worry about being sued for malpractice. As a result, healthcare tends toward overtreatment, especially by those who are not medical doctors such as paramedics.
The only way to lower healthcare costs is through collaboration. That would require the patient to partake in preventative measures. Also, the insurance companies and doctors would need to discuss how a patient would receive necessary treatment quickly without a duplication of effort.
This new approach will require a cultural shift that includes increased trust among the involved parties and an understanding of the purpose and limitations of the various healthcare providers. Ideally, care provided by a paramedic should not have to be repeated in the hospital.
Transporting a patient to a doctor or hospital facility should take priority over completing a certain number of procedures. Healthcare costs can only be lowered only if we streamline operations and work in a collaborative manner.
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