Ed's Note: Registration is now open for EMS World's series of expert-led mobile integrated healthcare seminars that will provide solutions to the challenging new issues facing every segment of the EMS community. Summits are scheduled for February 19, March 7 and March 25. Register now at MIHSummit.com.
In Reno, with the help of a $9.8 million federal Innovation Grant, the Regional Emergency Medical Services Authority (REMSA) is partnering with local health and social service agencies to take intoxicated patients directly to detox and psych patients to a mental health facility. They’re also finalizing plans to make house calls to recently discharged hospital patients with chronic illnesses to prevent readmissions. And they’re working to establish a seven-digit nurse triage line as an alternative to 9-1-1.
In Fort Worth, MedStar Mobile Healthcare, formerly known as MedStar Emergency Medical Services, has arrangements with local hospitals, doctors’ groups and hospice organizations to be paid to provide services to congestive heart failure and hospice patients at home, also with the goal of improving care while avoiding costly trips to the emergency department.
These efforts are part of a burgeoning movement that some of EMS’s most influential leaders are calling mobile integrated healthcare practice. From telemedicine to prevention campaigns, from community paramedicine to nurse triage lines, mobile healthcare moves EMS industry definitively out of the realm of public safety and positions it firmly within the realm of healthcare.
“EMS needs to rethink its basic mission of being about transportation and instead be about providing care in the most effective way for the patient,” says Eric Beck, DO, NREMT-P, medical director for the Chicago EMS System and the Chicago Fire Department, and a leader in the mobile healthcare movement. “That could be community paramedicine. It could be by integrating nurse triage into dispatch, or using telemedicine to enable patients to be treated at home without having to transport.”
To its advocates, mobile healthcare is more than a tweaking of what EMS does, such as adding a new medication or procedure. Rather, it’s a redefining of what EMS is, emphasizing measuring patient outcomes over processes like response times, and enabling paramedics and EMTs to take on a broader role in the healthcare system by filling gaps in services based on community need. While no one questions that EMS will continue to answer 9-1-1 calls, or that emergency medical response will remain a key part of the mission, true emergencies represent a small percentage of call volume and EMS’s identity needs to be expanded to reflect that, mobile healthcare supporters say.
Not only does the shift add value to what EMTs, paramedics and EMS systems have to offer a community, but there’s a compelling financial reason to do so. With the Centers for Medicare & Medicaid Services (CMS) and major insurers moving away from fee-for-service toward a pay-for-performance reimbursement, EMS has to find a way—and soon—to make sure it’s not overly reliant on billing for transporting patients to the hospital, the most expensive place to receive care.
“For the last 27 years, we have been MedStar Emergency Medical Services. In January, we transitioned to MedStar Mobile Healthcare,” says Matt Zavadsky, MedStar’s public affairs director. “The fastest growing component of what we deliver does not involve ambulance transport to provide emergency medical services. More and more, what we are providing is mobile healthcare. The world is changing, and we have to change with it.”
Healthcare Reform Driving Changes
Just how substantially is the world of healthcare changing? Over the past two decades, as healthcare costs soared and it became evident that the pace of the increase was unsustainable, a healthcare reform effort took root. New models of care emerged, including patient-centered medical homes and accountable care organizations, which seek to put an end to incentivizing physicians for providing more services, and instead dole out rewards and penalties based on outcomes—that is, how patients fared, and whether the care they received was cost-effective.