Matt Zavadsky is a featured speaker at EMS World Expo 2013 in Las Vegas, NV, September 8–12, and will lead the 1-day Mobile Integrated Healthcare Summit scheduled for September 11. Click here for more information.
The healthcare environment we currently find ourselves in is creating the perfect conditions for cultivating new relationships with healthcare partners such as payers, hospitals, physicians, skilled nursing facilities and even home care agencies. This is primarily due to the alignment of financial incentives being created in the healthcare market.
The recent Supreme Court of the United States (SCOTUS) decision on the Affordable Care Act doesn't really affect changes seen in our healthcare world. Things like accountable care organizations (ACOs), bundled payments, and reimbursements based on quality and patient satisfaction, have already been implemented and are being driven by market forces and not politics.
Visionary EMS leaders have wished for this environment for years. But before we begin our journey down this new road, there are a few statements we must ban from our vocabulary:
- "We've always done it that way …"
- "There's no money to be made in that …"
- "It's what our community expects …"
- "We're an ambulance service …"
- "We don't have the money …"
- "There are regulatory 'issues' …"
So how can we position ourselves as a valuable partner in the rapidly changing healthcare system? Over the next few Public Affairs columns, we will look at the 'then' and 'now' expectations of our healthcare partners; the challenge it creates for the partner; and our opportunity to add valuable services for these partners. For this column, let’s look at hospitals, skilled nursing facilities and hospice agencies.
Then = "Come when we call you and it better be easy to request your service."
Now = "Do we really need you?"
Transportation Challenge—Waning are the days of being able to bill fee-for-service for the individual services provided to patients. Hospitals and other providers are more often being paid a global or "bundled" payment for an entire episode of care. Consequently, more and more hospitals who are "on the hook" for the cost of caring for patients are looking for the safest and most cost effective way to move patients throughout their system.
Transportation Opportunity—Call centers that determine the most appropriate and cost effective level of transportation will be crucial. Some healthcare systems may have already created these for themselves. If they have, find a way to offer them an outsourced opportunity to replace their center. If they have not created one, offer to do it for them. Create an infrastructure that can screen the patient's medical need and match the need with the right resource. This may mean creating arrangements with other types of providers such as wheel chair van and medical livery services, or even consider providing these services yourself. If you can do this effectively, you can not only demonstrate ease of facilitation for the customer, but also significant cost savings.
Readmission Challenge—Hospitals are now being penalized for patients who re-admit to the hospital or even re-admit to the emergency department within 30 days after discharge. The penalty in most cases is no reimbursement for the care delivered upon readmission.
Readmission Opportunity—There are several value-added services you can provide to help hospitals with this challenge. The first is data. In many cases, you may be the only agency who actually knows how often patients are being readmitted. You can generate reports on patients transferred more than once in 30 days, then mine it further to weed out logical repetitive patients such as radiation or dialysis. The patients remaining may be of interest to the hospitals for target intervention to prevent readmissions.