As 2018 drew to a close, some key legislation important to the EMS industry became law:
On December 20 President Donald Trump signed the Agricultural Improvement Act of 2018, which included language from the SIREN (Supporting and Improving Rural EMS Needs) Act reauthorizing the Rural EMS Training and Equipment Assistance Program at $20 million a year through fiscal 2023.
On December 31 Trump signed the SOAR (Stop, Observe, Ask, and Respond) to Health and Wellness Act, providing healthcare providers, including EMS, training to identify and treat victims of human trafficking.
Both of those efforts, as well as multiple other bills running the recent Congressional gauntlet, bore the fingerprints of, among others, the National Association of Emergency Medical Technicians. And as the EMS advocacy organization conducts its biennial transition of leadership—its presidency passing from Dennis Rowe to Matt Zavadsky—that tangible success underscores the importance of a vital, engaged organization representing vital, engaged members.
“These things occur,” says Zavadsky, “because NAEMT members and other associations work together to advocate for our patients and our profession.”
During this time of great evolution in out-of-hospital care, that’s more important than ever.
Into the Future
Sitting out the high-level healthcare debates is a luxury our industry no longer enjoys. NAEMT members have recognized that, choosing consecutive presidents conversant with the mechanisms of power and payment: Rowe is director of government and industry relations for Priority Ambulance, headquartered in Tennessee and one of the largest national ambulance companies; Zavadsky is chief strategic integration officer for Texas’ MedStar Mobile Healthcare and an expert on integrated care and emerging models of reimbursement.
With a complex current landscape and so many irons in the fire—from their bread-and-butter educational courses to major conceptual projects like EMS 3.0 and a political action committee to amplify concerns in Washington—a lot goes into changing administrations. Under Rowe the NAEMT paid substantial attention to issues surrounding succession and sustainment, getting the right people in place and strengthening structures to carry its efforts forward.
“After Dr. McSwain’s death [Norman McSwain, MD, who founded NAEMT’s Prehospital Trauma Life Support program, passed in 2015], we unfortunately realized we had not fully prepared for any type of succession in many of our educational programs,” says Rowe. “So working with Matt and the officers and board, identifying those individuals and crafting a solid group that could continue leading those programs was paramount in the two years I was in office. Those are the core fundamentals NAEMT’s built a solid reputation on.
“In the meantime, with Matt coming in and the previous work he’s done—his leadership of the transformation programs—we can further establish ourselves as a forward-thinking organization not just in medical education, but with a name and stake in the changes being undertaken.”
“Dennis has done an amazing job with succession planning, which is something many EMS professionals don’t do very well,” says Zavadsky. “He’s become sort of a model for everyone who will follow him in developing the leaders of NAEMT as they assume their roles. Now I have this high bar to measure up to with Bruce Evans, our president-elect for the next two years, to do exactly what Dennis did with me, and make sure it’s a team approach to all of our strategic initiatives and alliances.”
Across more than 30 committees and various chairs and liaisons, there’s a lot to keep in order. The goal is to enable the involvement and input of a broad range of voices and perspectives—unlike many EMS organizations, the NAEMT’s membership is heterogeneous: roughly a third are from public-sector services, including fire; a third are private-sector; and a third are hospital-based, volunteer, and other—and make sure those with the interest and ability to lead have opportunities.
Care Without Conveyance
Besides continued attention to those core educational courses (a new one’s coming on community health paramedicine, among others), Zavadsky faces the imposing challenges of evolving reimbursement models and a looming transition to value-based care. For those issues it’s an especially key moment: Commercial insurers and other healthcare players are rapidly wising up to the idea that the best care doesn’t always end in transport to an ED. Big payers like Anthem Blue Cross Blue Shield, UnitedHealthcare, and Humana are all testing ways to reimburse care without conveyance.
Anticipating the growth of such efforts, NAEMT has begun enhancing its relationships with groups like AHIP (America’s Health Insurance Plans) and others to grease the way for coming changes.
“Our association alignment with AHIP is the first of its kind,” says Zavadsky. “We’ll become affiliate members of AHIP and have a liaison to the payer community for their national association, present at their conferences, and provide content for their publications. That is very important because that’s our bread and butter. And it’s just one of many examples.”
Here’s another: NAEMT is working with the Rand Corp., the respected research and policy think tank that’s consulted for the Centers for Medicare & Medicaid Services, to help shape ambulance cost data collection recommendations Rand is providing to CMS. And CMS reached out separately for information on things like protocols, policies, QA processes, and examples of alternative payment models that will help inform future reimbursement reform.
Zavadsky’s agency, MedStar, has a new arrangement where a top commercial payer pays it a capitated per-member per-month fee for all members in its service area. MedStar’s mandate is to navigate those members to appropriate care—be that an ED, urgent care, or referral to a primary-care doc or nurse triage line—but it doesn’t bill them for service.
“Our incentive,” says Zavadsky, “is to 1) prevent the 9-1-1 call, because we get paid the same regardless, and 2) if we get a 9-1-1 call, now we don’t have the incentive to transport to an ED because we don’t get paid any differently if we treat the patient and refer them to their own doctor. So it allows us to make patient-centric decisions.”
NAEMT’s role here is to assist such organizations in proving the value of such approaches—with clinical, management, and financial aspects that are still new to many in EMS. Adds Zavadsky: “There’s a big educational curve we can help with as we move into the next term.”
Meanwhile, some of the NAEMT’s existing educational content—namely its PEPL (Principles of Ethics and Personal Leadership) and safety courses—is helping shape up-and-comers through Priority’s new Leadership Foundation. Its goal is to deliver industry-specific leadership and management training for rising EMS leaders.
“It’s a nonprofit arm we’ve established to promote leadership development through a yearlong course, because our leaders see the same needs the association sees,” says Rowe. “That is, we have to start developing people and to get them to step up and fulfill their passion. That’s the key ingredient if we’re going to move forward as a profession.”
Even without leadership training, though, the NAEMT—as the umbrella organization bridging many EMS systems’ inherent differences—welcomes the involvement of anyone who wants to elevate the posture of EMS and put their stamp on its future.
“What we need people to do is join the group and become advocates,” says Zavadsky. “That’s our message for the EMT, the paramedic, the new supervisor, whoever: Be an advocate. Be an advocate for your patient through education and by being the best clinician you can be. Be an advocate for your profession, part of which is is lobbying and educating regulators and elected officials to change outdated, archaic, or bad public policy to make life better.”
Adds Rowe: “If people are interested in growing and developing into leadership positions and potentially on the board as officers, contact us. We’ll get with the committee and Matt and find or create opportunities that match their desire and energies. Because that’s what we desperately need, is the people with the ideas, thoughts, and energy to move forward.”