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Leadership/Management

Breaking Down EMS Innovation Barriers

Regular readers of EMS World are well-versed in the Promoting Innovation in EMS (PIE) project, a government-funded, multi-stakeholder, four-year project whose aim is to help agencies overcome common barriers to EMS innovation at the local and state levels, and to foster innovative models of EMS care delivery.

A summary of EMS World’s 2018 column series, along with links to individual columns, can be found here.

Kevin Munjal, MD, MPH, assistant professor of emergency medicine at Icahn School of Medicine at Mount Sinai in New York City, and Matt Zavadsky, MS-HSA, NREMT, chief strategic integration officer at MedStar Mobile Healthcare in Fort Worth, Texas, presented “Breaking Down Barriers to Innovation” Friday afternoon Feb. 22 at the EMS Today Conference & Exposition in National Harbor, MD. Their talk provided background on the PIE project and how they hope to see it used to guide EMS care in the future.

In 2014, a steering committee of key stakeholders and partner groups—including national associations, state EMS offices, educators and local agencies and health facilities—met in a series of meetings to define 250 actionable recommendations that services can implement to overcome barriers to effective EMS delivery.

The document is now live and downloadable at www.emsinnovations.org. “I like to think there’s something in it for everyone,” Munjal said.

Each chapter of the document describes a specific challenge, presents case studies and describes solutions.

Top recommendations fall along seven primary themes:

  • Finance. National EMS associations should continue to advocate for decoupling reimbursement from transportation across all public and private payers.
  • Law and regulation. National associations should advocate for reform of reimbursement policies at the national level.
  • Medical direction and oversight. Local medical directors should champion quality improvement efforts and align system EMS protocols with evidence-based consensus guidelines and best practices. “It may sound obvious, but it’s not necessarily happening right now,” Munjal said.
  • Regionalization. EMS associations should highlight the evidence that supports regionalization of care.
  • Interdisciplinary collaboration. Local authorities and agencies should engage in discussions with other stakeholders such as public health, public safety and local community healthcare resources to arrive at a common understanding of how community health needs can be met.
  • Data and telecommunications. Associations should steward the development, harmonization and dissemination of EMS performance measures (such as the EMS COMPASS measures).
  • Education. National EMS associations should promote efforts to integrate EMS and hospital records. Knowing how a patient did after an EMS encounter is tremendously insightful to adjusting care protocols, said Zavadsky. EMS authorities should advocate for the routine sharing of information with EMS.

The steering committee is now working to publicize the availability of the document, through efforts such as the PIE article series in EMS World, discussions with the Reimbursement 3.0 Task Force, EMS 3.0 Transformation Summit, an upcoming NAEMT webinar on coding for response and treatment without transport, and ongoing, direct involvement with CMS on the rollout of the proposed ET3 model.

“We want to make sure that it is actually used,” Zavadsky said of the work that went into developing PIE.

Munjal ended the talk by discussing the difference between the PIE project and the EMS Agenda 2050 initiative, stressing that PIE is aimed more at the 5–10 year window of actionable implementation. And while there was an underlying degree of skepticism regarding funding of these initiatives during the development of the PIE document, ET3—while there are still many details yet to emerge—has changed the conversation and made many of these formerly lofty recommendations more tangible.

“The impossible has already happened,” Zavadsky said.

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