News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,893 news reports have been chronicled, with 40% highlighting the EMS staffing crisis, and 39% highlighting the funding crisis. Combined reports of staffing and/or funding account for 79.2% of the media reports! 234 reports cite EMS system closures/takeovers, or agencies departing communities, and 94% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals 3-31-25.xlsx

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  • 24 Apr 2025 7:36 AM | Matt Zavadsky (Administrator)

    An excellent news report in the trade publication for health insurers and others that may generate additional interest from payers to help financially sustain valuable EMS-based MIH programs!

    ---------------------- 

    Why insurers may want in on mobile integrated healthcare

    Diane Eastabrook

    April 24, 2025

    https://www.modernhealthcare.com/providers/mobile-integrated-healthcare-medicaid-costs

    Health systems have been shouldering the cost of mobile integrated healthcare programs for at-risk patients, but some insurers may be ready to start picking up the tab as providers prove they can save money.

    UMass Memorial HealthGeisinger, Prisma Health and others that operate these at-home care programs say the service saves millions of dollars by preventing emergency room visits and rehospitalizations of chronically ill patients. Government and private insurers have been covering little to none of the cost, but that could be changing as systems get information to prove the programs are effective.

    Related: Hospital-at-home, emergency medical systems vie for paramedics

    Mobile integrated healthcare is a 30-year-old model designed to provide on-demand and preventive care to patients who may not have a physician or reliable access to healthcare — especially those with chronic conditions such as diabetes and chronic obstructive pulmonary disease. It brings coordinated care where people live, including to those who are homeless. Patients receive examinations, medication and sometimes diagnostic services, mostly from paramedics.

    The concept has taken off over the last decade, especially during the COVID-19 pandemic as providers tried to stem the tidal wave of patients flooding hospital emergency rooms, said Victoria Reinhartz, executive director of the National Association of Mobile Integrated Healthcare Providers.

    Systems that looked at program results have found mobile integrated healthcare keeps high-risk patients out of the hospital and lowers overall costs.

    For example, nearly 1,100 Florida Medicare Advantage members who received care for three months from a mobile integrated healthcare service operated by Nashville, Tennessee-based Envision Healthcare experienced a 21% decrease in emergency department visits and a 40% decrease in hospital utilization, according to a 2017 study.

    Worcester, Massachusetts-based UMass Memorial Health released a study earlier this year that found 76% of patients who received care through its mobile integrated healthcare program from 2022 through 2024 avoided going to the emergency room within 30 days of an in-home visit.

    Researchers from Worcester Polytechnic Institute this month estimated the program saved up to $1.8 million dollars in avoidable emergency service costs for the 550 unique patients who received approximately 1,000 home visits through the program during that time.

    Savings generated by the program could be even greater, said Dr. Laurel O’Connor, director of Mobile Integrated Health at UMass Memorial Health.

    “It does not take into account other costs that are associated with those acute encounters that end up in the ER, like hospitalization, because many of the patients that end up in the ER are hospitalized and that is extremely expensive,” O’Connor said. "They could also get COVID in the waiting room. So, there are a lot of potential downstream costs that patients will not suffer from if they are at home.”

    While mobile integrated healthcare programs may help control the cost of delivering care to at-risk patients, most providers are not fully reimbursed for the service because Medicare, Medicaid and private insurance don’t typically cover care provided by paramedics that does not involve an ambulance trip to the hospital.

    UMass Memorial Health supports its mobile integrated healthcare program mostly through grants, O’Connor said. She said Medicare and Medicaid cover telehealth visits that physicians provide and the health system’s hospital-at-home program — which is reimbursed by Medicare and Medicaid — pays for paramedics’ salaries.

    Greenville, South Carolina-based Prisma Health also uses grant funding to support its mobile integrated healthcare program, which is expected to provide in-home care to more than 7,000 patients this year, said Aaron Dix, Prisma Health vice president of mobile health.

    Dix could not estimate how much the six-year-old program has saved the health system. He estimates the cost savings are significant because many of the patients who receive care have severe chronic conditions that can escalate and lead to hospitalizations without the program's preventive care.

    “You just have to take a small leap of faith that financially there is cost avoidance. It’s the uninsured and the underinsured population groups that the hospital systems are footing the bill for to control their health,” he said.

    Some health systems pay third-party vendors out of pocket to provide mobile integrated healthcare to patients because it's less expensive than incurring penalties from Medicare when those patients bounce back to the hospital.

    Hyannis, Massachusetts-based Estella Health provides the service to hospitals in New Hampshire and Massachusetts, including Beth Israel Deaconess-Plymouth in Massachusetts and Cape Cod Hospital in Hyannis, Massachusetts, said Estella Health Chief Operating Officer Brendan Hayden.

    “They see the value because the visit decreases the overall cost of care for that patient, so it is money well spent to them,” he said.

    Some health insurers are also beginning to see the value of paying for the home-based service, according to Hayden. He said he has received inquiries from a few insurers interested in piloting mobile integrated healthcare reimbursement.

    “Insurance companies are at risk for every life they have covered and they are looking for strategies that will better manage patients in a more proactive way instead of reactive, which is very expensive,” Hayden said.

    Blue Cross Blue Shield of New Mexico is one step ahead. The insurer piloted a mobile integrated healthcare program for some patients in Albuquerque in 2017 that resulted in a 61% reduction in emergency room visits, a spokesperson said in an email. She said the insurer has since expanded coverage to members living in three other New Mexico communities who are enrolled in Turquoise Care, a Medicaid managed care plan.

    Some states are also considering Medicaid coverage of the service.

    A bill before the Illinois General Assembly would require insurers to pay for all services provided under mobile integrated healthcare. Legislation introduced earlier this year in the Oregon House of Representatives would set up a registry for mobile integrated healthcare providers to participate in a state medical assistance program and establish billing codes for reimbursement under the state's Medicaid program.

    Congress is considering Medicare coverage, as well. Legislation introduced in both the House and Senate would allow Medicare to reimburse for care emergency service providers offer in the home without requiring patients to be transported to the hospital.

    O'Connor hopes the positive results from UMass Memorial Health can help move those coverage conversations forward and encourage insurers to begin reimbursing for mobile integrated health, as well as encourage other health systems to launch or expand similar programs.

    “This is one program in one hospital in one state. We really wanted to say in this analysis that we saved a substantial amount of money in a very small, conservative way. Imagine if you took into account all of the things that we are preventing and scaled it up. It could be really impactful," O'Connor said.

  • 21 Apr 2025 11:54 AM | Matt Zavadsky (Administrator)

    Another example of the EMS staffing crisis effecting all provider types, including fire departments.

    Public officials and EMS leaders should carefully evaluate evidence-based options for managing EMS system delivery such as staggered deployment based on response volume, tiered deployment(BLS and ALS ambulances), Emergency Medical Dispatch (EMD) to prioritize responses based on acuity level and alternate responses such as 1st response units only for low-acuity calls.


    Tip of the hat to Rodney Dyche, one of the contributors to EMSIntel.org, for sharing this article

    ------------------ 

    City confirms ambulance shortage during fatal Landis Drive incident

    By Tessa Noble,

    Staff writer

    April 17, 2025

    https://www.beaumontenterprise.com/news/article/ambulance-shortage-confirmed-landis-dr-fatality-20279723.php

    City officials have confirmed that no ambulances were available when a pedestrian was hit fatally hit by a car on April 9. However, had a unit been available, they don't believe the outcome would have changed.

    Trey Guillory was hit by a car in the 8600 block of Landis Drive but was not taken to a hospital until about 45 minutes after the call came in. He was later pronounced dead at the hospital.

    Since the incident, community members have expressed concern about the availability of ambulances in the city.

    Ward II Council member Mike Getz recently took to social media to share more information about the issue, prompting an in-depth conversation in the comments.

    “All of the city EMS units were tied up on other calls and not immediately available to transport this man, but a senior paramedic arrived on the scene within minutes and immediately began lifesaving efforts,” Getz said.

    Records also confirm this. The Enterprise requested records showing when EMS department had reached "level zero" any time from April 3 to April 10." Level zero is the formal name for a lack of available ambulances. In response, the Enterprise received a list of 9-1-1 calls, including the call in question.

    RELATED: City EMS response time questioned after pedestrian death on Landis Dr.

    According to International Association of Firefighters Local 399 President Jeff Nesom, it took 30 minutes for an ambulance to arrive due to the “level zero” status. Getz stated in a Facebook post that even though units were tied up, the patient couldn’t have been moved faster.

    “When a person sustains the type of injuries as in this case, you don't just scoop them up, load them in an ambulance and rush them off to the hospital. You immediately begin life-saving efforts at the scene and try to stabilize their condition,” Getz said. “That is what happened in this case. In fact, when the EMS unit did arrive, the paramedic was still working to stabilize the citizen, and it was a few minutes before the paramedic declared he was stable for transport.”

    City spokesperson Tracy Kennick said Guillory was taken to the hospital within 45 minutes of the first 9-1-1 call.

    Even with the additional information, Joey Hilliard, who is running against Getz for the Ward II seat, said on social media that the city failed its citizens.

    “There is no excuse for the failures of current city management,” Hilliard stated. “Enough is enough.

    Citizens and families like the man lost last night deserve better. Taxpayers are tired of 'level zero' service from bad politicians at City Hall and the Beaumont Fire Department fire chief.”

    Nesom said the ambulance was due to a lack of staffing. The department is around 30 firefighters short and only running eight ambulances despite being licensed for nine. This number was increased in 2023 from five ambulances.

    Some people in the comments of posts by Getz and the union expressed a belief that the department needs more than eight ambulances running at one time. Ward I Candidate Cory Crenshaw said they need more than two ambulances assigned to the West End of Beaumont. One citizen, Deborah Markham Rice, commented on Getz’s post that the city needs two more additional units.

    RELATED: New software for Beaumont dispatch aims to streamline emergency response

    When asked by Getz how many ambulances were needed, the union responded by saying, “Enough to be able to respond when citizens need our help.”

    Robie Morris commented on the Union’s post, saying the city needs 17 ambulances.

    “To be on par with the rest of the nation regarding the amount of times those med units spend only running calls (not to include daily unit inventory, supply inventory, monthly expirations which take hours, charting as many as three cardiac arrest reports that take 1-2 hours each, etc.) the city needs seventeen.”

    The department also has a policy that allows them to transport a patient in a fire truck when no ambulances are available but a patient needs immediate transport. However, Nesom said this isn’t safe.

    “You can't transport a patient that is that critical in the back of a fire truck; there's no way to secure a patient back there,” Nesom said. “There's no way to provide continuous care to a patient in the back of a fire truck, and his policy that he has on that is absurd.”

    One citizen commented on Getz's post, agreeing that patients should be stabilized before transport.

    “The level zero status explains the delay in response,” said Courtney Thompson. “It seems the patient was getting treatment until then by appropriate staff, so an immediate response by an EMS box doesn't mean you immediately transport to the ER. The patient has to be stabilized first. You can add more trucks, but who is going to staff it if they can't even staff what they have now?”

    She also stated that another part of the issue must address the abuse of the 9-1-1 system for non-emergency calls.

    “The entitlement of the public is atrocious,” Thompson said. “EMS isn't a taxi service, but they are treated as such. … There are some cities that are addressing the frequent flyer abuse, and I think Beaumont should consider the same.”

    The city is working to implement two programs to target this issue, including the Good Sam software and partnering with RightSite Telehealth.

  • 8 Apr 2025 9:59 PM | Matt Zavadsky (Administrator)

    The Academy of International Mobile Healthcare Integration (AIMHI) Excellence in EMS Integration Awards celebrates and promotes high-performance, high-value EMS, its partners, and leaders.

    Nominations for the 2025 Awards are open now through May 7, 2025.

    Winners will be recognized at the AIMHI Board Meeting on June 21st, 2025, during the American Ambulance Association Conference & Trade Show June 22 – 24, 2025. They will also receive recognition on the AIMHI website and social media platforms.

    Please see below for criteria for each specific award category.


    Excellence in EMS Integration Award

    External Award | Integration with EMS Agencies | Organizational Recipient

    This award recognizes a non-EMS organization that has developed and implemented a partnership with EMS organizations that have demonstrated enhancement of patient experience of care, improved patient outcomes, or reduced the cost of healthcare.

    Award Philosophy

    Awards should be based on measurable data that sets a benchmark for others to follow. These awards could be geared to best practices that support AIMHI’s mission of transforming EMS care. Award winners should demonstrate clear approaches to transformation, well deployed processes that demonstrated cycles of learning and benchmark results in the top decile of EMS agencies.

    Eligibility

    Integrated Healthcare Networks

    • Payers
    • Hospital Systems
    • Home Health Agencies
    • Hospice Agencies
    • Other EMS agency partners

    Entry Criteria

    • Nominator demographics and contact information.
    • Nominee demographics and contact information
    • Description of program
    • Date of implementation

    Judging Criteria

    • Number of patients/members enrolled
    • Utilization change
    • Patient experience scores
    • Other criteria/outcomes
    • Demonstrates a clear approach to change, with system-based deployment (of process, procedure, etc.) and benchmark results.

    Winning agencies should be learning organizations that are willing to share best practices.

    Nomination Link: https://forms.office.com/r/6g9zpqTkHs


    Excellence in Public Information or Education

    EMS Internal or External Award | Communications/PR/Public Affairs | Organizational Recipient

    This award recognizes an EMS or non-EMS organization that has developed and implemented an effective public information or education campaign designed to encourage patients, members, or the public to develop or maintain healthy lifestyles, or to more effectively utilize healthcare resources.

    Benchmark results demonstrating a significant change in how the public integrates with EMS practices. Agencies that have a clear approach to motivating the public to partner with EMS and local hospitals in obtaining outcome-based results.

    Award Philosophy

    Awards should be based on measurable data that sets a benchmark for others to follow. These awards could be geared to best practices that support AIMHI’s mission of transforming EMS care. Award winners should demonstrate clear approaches to transformation, well deployed processes that demonstrated cycles of learning and benchmark results in the top decile of EMS agencies.

    Eligibility

    •  EMS Agencies
    • Integrated Healthcare Networks
    • Payers
    •  Hospital Systems
    • Home Health Agencies
    • Hospice Agencies
    • Other EMS agency partners

    Entry Criteria

    • Nominator demographics and contact information
    • Nominee demographics and contact information
    • Description of program
    • Date of implementation

      Judging Criteria

      • Estimated program reach (number of impressions)
      • Cost of the campaign
      • Any data on changes in behavior as a result of the campaign
      • Demonstrates a clear approach to change, with system-based deployment (of process, procedure, etc.) and benchmark results. Winning agencies should be learning organizations that are willing to share best practices.

        Nomination Link: https://forms.office.com/r/jHMvdKZki6


        Excellence in Value Demonstration or Research

        EMS Internal or External Award | Reporting/Data Analytics | Organizational Recipient

        This award recognizes an EMS or non-EMS organization that created and implemented an analysis of data and/or research project to demonstrate the value impact of the services provided by the organization. Examples could include:

        • Distributed analytics relating to the cost and outcomes from innovative EMS delivery.
        • Study published in a peer reviewed journal that demonstrates improved patient outcomes, patient safety, or reduced cost of care as the result of a change to a protocol or process
        • Benchmark improvement in efficiency that demonstrates a reduction in cost, and/or increase in patient safety with outcome-based metrics that exceed 90% of the national average for favorable results.

          Award Philosophy

          Awards should be based on measurable data that sets a benchmark for others to follow. These awards could be geared to best practices that support AIMHI’s mission of transforming EMS care. Award winners should demonstrate clear approaches to transformation, well deployed processes that demonstrated cycles of learning and benchmark results in the top decile of EMS agencies.

          Eligibility

          EMS Agencies

          Entry Criteria

          • Nominator demographics and contact information
          • Nominee demographics and contact information
          • Description of data distributed and method of distribution
          • Submission of published studies that meet award submission criteria

            Judging Criteria

            • Value demonstration of data distributed
            • Publication Impact Factor (IF) or Journal Impact Factor (JIF) of the journal publishing the research
            • Demonstrates a clear approach to change, with system-based deployment (of process, procedure, etc.) and benchmark results. Winning agencies should be learning organizations that are willing to share best practices.

              Nomination Link: https://forms.office.com/r/AR6jUsKs5R


              Leadership in Integrated Healthcare Award

              EMS Internal or External Award | Individual Recipient

              This award recognizes an individual who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

              Award Philosophy

              Awards should be based on measurable data that sets a benchmark for others to follow. These awards could be geared to best practices that support AIMHI’s mission of transforming EMS care. Award winners should demonstrate clear approaches to transformation, well deployed processes that demonstrated cycles of learning and benchmark results in the top decile of EMS agencies.

              Eligibility

              • EMS agency leaders
              • Healthcare system leaders
              • Leaders from payer organizations
              • Leaders from EMS or Healthcare Associations

                Entry Criteria

                • Nominator demographics and contact information
                • Nominee demographics and contact information
                • Description of the initiatives/activities of the nominee
                • Description of the impact the nominee’s initiatives has on EMS integration

                  Judging Criteria

                  • Effort of the initiatives undertaken by the nominee
                  • Outcomes of the initiatives of the nominee
                  • Demonstrates a clear approach to change, with system-based deployment (of process, procedure, etc.) and benchmark results. Winning agencies should be learning organizations that are willing to share best practices.

                    Nomination Link: https://forms.office.com/r/xrEHGtKN7W


                    Advocacy in Integrated Healthcare Award

                    EMS External Award | Individual Recipient

                    This award recognizes a legislator or regulator who has made significant impact on the integration of EMS, or the advancement of the integration of EMS into the healthcare system.

                    Eligibility

                    • Legislators and regulators from all levels of government

                    Entry Criteria

                    • Nominator demographics and contact information
                    • Nominee demographics and contact information
                    • Description of the initiatives/activities of the nominee
                    • Description of the impact the nominee’s initiatives has on EMS integration

                      Judging Criteria

                      • Effort of the initiatives undertaken by the nominee
                      • Outcomes of the initiatives of the nominee

                        Nomination Link: https://forms.office.com/r/yS9UXQgQnQ


                      • 8 Apr 2025 6:12 AM | Matt Zavadsky (Administrator)

                        While this Rand study highlights the crisis in America's emergency departments, many of the findings are equally true for EMS systems across the country.

                        EMS leaders should work with national and state associations to advocate for scientific, evidence-based system redesign to help assure EMS system sustainability.

                        Click the link below to view a recent AIMHI webinar on "Emergency Medical Services Delivery – Expectation vs. Reality".


                        https://aimhi.mobi/ondemand/13420011  

                        ------------------------- 

                        Emergency departments risk closing over pay, overcrowding: Rand
                        Hayley DeSilva
                        April 06, 2025
                         
                        https://www.modernhealthcare.com/providers/emergency-departments-closing-pay-rand
                         
                        Emergency departments are in danger of closing without legislative intervention, according to a new report.
                         
                        Increased violence towards providers, declining reimbursement from payers and higher volumes of complex patients are endangering the future of emergency departments, nonprofit research organization Rand wrote in a report on Sunday. Rand said policymakers must pass legislation to help hospitals navigate the challenges that have surmounted for emergency departments over the years.
                         
                        "If we want [to maintain] this 24/7 service that we have right now, in the form that we have where everyone comes, and it doesn't matter if you can pay or not.. then we really have to proactively do something as a country," said Dr. Mahshid Abir, lead author of the report and senior policy researcher for Rand. "The current level of dependence on the [emergency departments], the value they offer [along] with the challenges they've faced, is not going to be sustainable." 
                         
                        For the report, Rand used a combination of peer-reviewed research, interviews with emergency physicians, survey responses from emergency care leaders and two case studies of shuttered emergency departments. 
                         
                        Here are five challenges facing emergency departments, according to Rand. 
                         
                        1. Overcrowded emergency departments
                        Not only has the number of visits to the emergency room reverted back to pre-COVID-19 levels, but Rand researchers say a higher level of acuity and complexity among patients is overcrowding emergency departments. Researchers say a larger number of older adults, patients with mental illness, survivors of violence, veterans, unhoused individuals and undocumented immigrants are receiving care in the emergency department. 
                         
                        As a result, emergency departments are providing more critical types of care. They've also been forced to board patients in hallways and waiting areas due to limited inpatient capacity in hospitals. 
                         
                        Higher levels of complex patients can also put a significant strain on a department and hospital's finances. Rand researchers say policymakers should focus on offering financial incentives for hospitals to address emergency department boarding. They also recommend hospitals create flexible expansion areas for patient care and leverage efficient inpatient discharge strategies.
                         
                        2. Increased violence towards clinicians
                        The result of emergency department overcrowding has led to frustrated patients. Several emergency department workers interviewed by Rand said they're facing more violence from patients. 
                         
                        Physical and verbal abuse from patients has become more common and there are little standards in place to protect workers, said Rand researchers. One nurse interviewed for the report said emergency departments have become a high-risk environment. 
                         
                        Researchers recommend state and federal legislators enforce anti-violence policies by instituting laws that will increase the legal consequences for violence against healthcare workers.
                         
                        3. Burned out workers
                        Overcrowding and violence from patients has led to more doctors and nurses feeling burned out, said Rand researchers. Female clinicians are also facing increased levels of gender or sexual harassment, which is another reason for the rising attrition levels within the emergency department workforce. 
                         
                        Pay is another contributing factor to burnout. The report highlights that physician pay per visit is down and has not kept up with inflation over the years. 
                         
                        "I mean, if you're not paying people well to do this really difficult work, people who graduate from medical schools, maybe the better students, with the higher grades, they may not want to go into emergency medicine, and maybe then ERs are staffed with people who just are scrambling to just find some kind of residency," Abir said. 
                         
                        4. Lack of funding for uncompensated care 
                        Emergency department are seeing a higher number of patients who are either uninsured or cannot pay for care. The Emergency Medical Treatment and Active Labor Act of 1986 compels emergency departments to treat these patients.
                         
                        This mandate causes funding gaps and threatens the sustainability of emergency departments, said Rand researchers. Commercial, Medicare and Medicaid insurance payments are inadequate to cover the costs of providing care to those populations.
                         
                        Rand recommends that lawmakers mandate that a certain percentage of commercially-insured visits are allocated to cover EMTALA-related care. They also recommend legislators allocate state and federal stipends for EMTALA-related care. Industry groups and healthcare organizations should institute uninsured and underinsured patient compensation benchmarks so that emergency departments are compensated based with the level of care they provide, Rand reports. 
                         
                        5. Lower reimbursement rates from payers
                        Additionally, Rand researchers reviewed data from revenue cycle management companies and found that insurance administrators regularly underpay or deny payment for significant portions of what they're obligated to pay. The report found that 20% of all emergency physician expected payments go unpaid across all payer types, totaling roughly $5.9 billion per year of unpaid physician services.
                         
                        Rand said its interview and focus group participants have seen a reduction in payments and insufficient reimbursement from public insurance programs. Also, emergency department facility fees, which cover overhead expenses, have gone up significantly in the last few years, researchers said. This has all led to budgetary challenges and in some cases, the closure of emergency departments. 
                         
                        Researchers said policymakers should require a minimum emergency physician professional fee as a percentage of facility fees and mandatory commercial coverage for all emergency department visits at the level of services provided. 

                      • 3 Apr 2025 1:51 PM | Matt Zavadsky (Administrator)


                        Emergency Medical Services (EMS) play a critical role in public health and safety, yet their structure, funding, and effectiveness vary significantly across different countries. This webinar offers a comparative analysis of EMS delivery in the United States, Canada, and the United Kingdom, examining key differences in system design, response times, accessibility, and patient outcomes.
                         
                        Join industry experts from the U.S., Canada and the U.K as we explore:
                        Economic models and involvement of government oversight
                        Response times and clinical metrics across the three countries
                        Differences in 911, 999, and 112 emergency call systems
                        Retention and Recruitment
                        Formal recognitions of paramedicine as a profession
                        Challenges and best practices in EMS coordination and innovation (MIH/CP)
                         
                        Whether you're a healthcare professional, policymaker, or simply interested in how emergency care systems function globally, this discussion will provide valuable insights into the strengths and challenges of each approach.
                         
                        Date: Tuesday, April 22, 2025
                        Time: 12n ET
                        Location: Zoom Webinar

                        Register now to gain a deeper understanding of how EMS systems operate and what lessons can be learned to improve emergency care worldwide!

                        Register in advance for this webinar:

                        https://us02web.zoom.us/webinar/register/WN__eTbdXdxSPC3Ryq1h7l05g

                        After registering, you will receive a confirmation email containing information about joining the webinar.


                      • 2 Apr 2025 7:30 PM | Matt Zavadsky (Administrator)

                        AIMHI President Rob Lawrence presented Congressman Jason Smith (R-MO), Chairman of the House Ways and Means Committee, AIMHI's 2025 Legislator of the Year Award.

                        Rep. Smith, his staff and his committee have been exceptional advocates for EMS, introducing the Emergency Medical Services Reimbursement for On-Scene and Support Act (Medicare Reimbursement for Treatment in Place) and the Improving Access to Emergency Medical Services Act (Community Paramedicine funding bill).

                        His committee also hosted a field hearing on EMS and EMS reimbursement at an EMS facility where committee members heard 3 hours of testimony about EMS and the EMS reimbursement model.  Congressman Smith and his staff are ardent EMS advocates.

                        One of his key staff members, Ari Kirsh, accepted the award on behalf of Representative Smith. Ari has been the driving force behind much of the committee's EMS legislation work, and he attended, in full, the recent webinar on the results from the Ground Ambulance Data Collection System (GADCS) report.

                        Click here to see Ari's acceptance video message: https://youtube.com/shorts/GNPYN84Rbnw

                        Click here to watch the EMS segments of the March 2024 Ways and Means Committee field hearing: Ways and Means Committee Meeting EMS Focus 3 18 24



                      • 1 Apr 2025 6:04 AM | Matt Zavadsky (Administrator)

                        It’s unfortunate that there is so much focus on response times, when more evidence-based patient outcome data could be evaluated, such as those contemplated in the Joint Position Statement from 16 EMS, fire, public policy and patient safety organizations on EMS Performance Measures Beyond Response Times (https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2375739).
                         
                        Measures for clinical care, patient and provider safety, patient and provider experience and financial outcomes would provide a more balanced evaluation of provider performance.
                         
                        Still, response times goals and measurements, when evaluated as an operational process measure, should be evidence-based, and tracked and reported from a patient-centric perspective, starting when the call is received by the dispatch center, and ending at patient contact.
                         
                        Individual time durations such as call processing, activation, drive, and patient access can then be trended over time to identify opportunities for enhancement.

                        -------------------------------- 

                        Contract dispute with Sonoma County Fire District delays release of key ambulance performance data

                        County and fire district officials are locked in a dispute over how to calculate response times, a key component in evaluating how local ambulance service is performing.

                        March 29, 2025

                        https://www.pressdemocrat.com/article/news/sonoma-county-fire-discrict-ambulance-contract-dispute/

                        Three things to know:

                        • Sonoma County's contract with the Sonoma County Fire District for ambulance services is under dispute, affecting the timely release of performance data.
                        • The fire district is arguing the contract does not cover requirements for low-priority calls and wants them thrown out of 2024 performance data.
                        • The county argues that low priority calls make up 40% of all ambulance calls and removing them from the equation would erode public trust.

                        It’s been a year since Sonoma County Fire District took over the exclusive contract to provide ambulance service in the county’s central core. Those exclusive rights — worth $30 million annually for at least five years — come with response time standards and data reporting requirements.

                        That data is only now trickling out, and on the surface it shows the providers met response time thresholds during the last three months of 2024, which fire district officials say outperforms the previous provider’s “anemic” service.

                        But that may not tell the complete story.

                        Behind the scenes, officials and the district are locked in a dispute over the fundamental criteria used to calculate response times, a key component of the district’s performance evaluation.

                        That means the average Sonoma County resident may have no way of knowing for sure whether response times are better or worse than they were a year ago.

                        The disagreement, which started last May, has for months hamstrung the county’s ability to monitor and enforce the contract, which calls for periodic compliance reviews.

                        Compliance data is a critical information source both for the county officials, who are tasked with ensuring the district is meeting requirements, and district officials who need to make sure the system is operating efficiently. At the center are patients ― the public ― who are reliant on ambulances to reach them quickly.

                        “An EMS system is essentially bringing the hospital to a patient's door and making a lot of the interventions that would exist at a hospital available to you right there on the scene,” said Gabriel Kaplan, assistant director for the county’s health services department, which oversees the contract.

                        The dispute over compliance requirements is laid out in a series of letters exchanged between officials and attorneys and obtained by The Press Democrat through a public records request.

                        Feb 25 Letter from District Attorney to Solito.pdf

                        One of the key disagreements is whether the contract holds the district accountable for low priority calls, which amount to 40% of calls for ambulance services. Such calls, referred to as “Code 2,” are still considered urgent but do not require lights and sirens.

                        The county says it has always enforced standards for Code 2 calls, the terms of which are spelled out in the contract. Jennifer Solito, interim health services director, made that clear in the correspondence.

                        March 3 Letter from Solito to Fire District Attorney.pdf

                        “The County cannot and will not bend on this requirement because a lack of a response time requirement would erode public trust in both DHS and SCFD,” Solito wrote to Sonoma County Fire District Chief Mark Heine in a March 3 letter.

                        But the district says the contract is ambiguous and has accused the county of being “unreasonable” and risking “breach of contract.” In multiple letters, an attorney representing the district said the county’s stance “is unfairly prejudicial to SCFD by moving the proverbial goalposts.”

                        A representative of the county’s previous exclusive ambulance contractor pushed back on any attempt to loosen response time requirements.

                        Jason Sorrick, a spokesman for American Medical Response, locally known as Sonoma Life Support, said Code 2 calls may not require lights and sirens but still need urgent medical attention and require some type of performance measurement.

                        He questioned the fire district’s high marks.

                        “We believe that the system is likely 30% understaffed, and it is our opinion that the demands of the system were underestimated in the bid,” he said.

                        Disputed chart

                        When the Board of Supervisors approved the district’s contract in June 2023 after months of contentious debate, both county and fire district officials heralded their partnership as a significant step toward bringing ambulance services under public domain. The benefits would include transparency, accountability and enhanced emergency response.

                        Landing the contract was a major coup for the relatively new fire district, which was created in 2019 through a series of local fire agency consolidations. Its firefighting territory at the time included Windsor, Rincon Valley, Bennett Valley, Bodega Bay, Guerneville and Forestville.

                        The five-year deal provides exclusive rights covering the county’s most populated areas. On a single day in March 2025, for example, the county’s 911 dispatch system received more than 300 ambulance calls.

                        To help cover the significantly larger territory under the county contract, the fire district brought in a subcontractor, Vallejo-based Medic Ambulance.

                        This map shows Sonoma County Fire District’s newly expanded ambulance service area, covering most of Sonoma County. Service in the area shaded in pink begins Jan. 16, 2024. (Dennis Bolt/ For The Press Democrat)

                        The district’s contract took effect mid-January last year and offered a three-month grace period before penalties for failure to meet compliance standards kicked in.

                        In a single compliance period, the district must meet response times at least 90% of the time. The number of minutes an ambulance has to reach a patient varies depending on the severity of the call and whether the location is in a rural, semirural or urban area.

                        The contract outlines a sliding scale of penalties if the district is out of compliance in any of the six zones that make up the coverage territory.

                        A few months into the new contract, a dispute erupted between the district and county as officials began to review the district’s performance during the first three months of operation, according to a Feb. 25 letter an attorney representing the district sent to Solito.

                        “At that meeting, and in subsequent discussions, it became clear that the parties were interpreting the … response time standards tables differently,” the attorney, Andrew Schouten of Wright, L’Estrange and Ergastolo, wrote, referring to a May meeting.

                        The county and district disagreed on four points regarding how to calculate response times: when the clock starts during a call; how to measure calls that do not come through the 911 system; how to calculate response times for a call where the severity is downgraded over the course of the call; and ― the biggest point of contention ― whether the district should be held to Code 2 response time standards for its 2024 performance.

                        The Code 2 disagreement boils down to a single chart in the 134-page contract.

                        That chart outlines the response time thresholds broken down by the severity of the emergency and by the six coverage zones that make up the district’s territory. Its title includes a set of parentheses that includes only “Code 3.”

                        The district says there is no “Code 2” table in the contract.

                        The county counters that response times for Code 2 calls are clearly listed in the body of the chart.

                        The county has acknowledged in correspondence with the fire district that “(Code 3)” is an error, but maintain the contents of the table cover requirements for all calls, including Code 2.

                        “Our position is … that all calls have a response time requirement, including Code 2 calls,” Solito told The Press Democrat.

                        But the district has argued that the Code 3 label means the chart only applies to the higher acuity calls, even though the lowest acuity calls, called Alpha and Bravo, are listed in the chart with response times.

                        In letters to the county, Schouten, the attorney for the fire district, said that “ambiguity” could create an unsafe situation for responding ambulance crews, patients and the general public if calls that are considered Code 2, are tied to response times in the same Code 3 chart.

                        But in the Feb. 25 letter, Schouten also noted the district added the “Code 3” parenthetical to the first draft of the contract, which was negotiated over a six-month period.

                        “Given its silence during negotiations and acceptance of SCFD’s proposed language, SCFD reasonably believed County interpreted the response time standards charts to apply to Code 3 responses only,” Schouten wrote.

                        An oral agreement

                        Heine acknowledged there should be time standards for low priority calls and called it “good public policy,” but stressed that such requirements should be spelled out clearly in the contract.

                        “Where I have to draw the line is when you decide you don’t like what’s in the contract, or that it’s missing something, and you want to impose it upon us without successfully negotiating,” Heine said. “That’s a problem.”

                        Last summer, the district attempted to negotiate with the county on Code 2 response times, going back and forth over a few months.

                        Following a mid-August meeting, Heine believed the two parties had reached a resolution. He said former county health services director Tina Rivera, who was overseeing the contract, had agreed to extend the amount of time they are allowed to respond to low priority calls by seven minutes.

                         

                        Not long after that meeting, Rivera left her post with the health services department. She had announced her resignation and impending departure a month earlier.

                        The district believed Rivera’s agreement amounted to a binding revision of the contract.

                        But in an interview last week, county officials relayed a different version of that discussion.

                        County lawyers said changing the table would potentially be a substantive change to the contract, Kaplan said. Such a change would risk the county having to start the competitive contracting process over again at the direction of the state’s Emergency Medical Services Authority.

                        Sorrick, AMR’s spokesperson, agreed.

                        “This could be in violation of the State EMS Act and the State EMS Authority’s approval of the RFP,” he said.

                        The county has only recently dragged itself out of a painful yearslong bidding process that began after the county’s contract with its previous provider, American Medical Response, expired in 2019.

                        The county repeatedly extended AMR’s contract as it struggled to launch a new competitive process and attributed the delay to complications from the wildfires and pandemic.

                        The bidding delays sparked lawsuits and eventually drew the attention of the state authority throwing the core operating area’s exclusivity into question.

                        “We're providing a franchise monopoly on a provider to operate in the exclusive operating area and in order to do that, you need state blessing, because otherwise it’s an antitrust violation,” Kaplan said. “And counties don't have the legal authority to be exempt from antitrust violations, but states do.”

                        The county was under a lot of pressure from the state agency to execute the competitive bid for the exclusive contract, Kaplan said.

                        Questioning the data

                        Under the new contract, which went into effect mid-January 2024, the fire district and county officials must review monthly compliance data and produce a public report. By mid-December, nearly a year into the contract, data still had not been publicly released.

                        On Dec. 17, 2024, The Press Democrat submitted a public records request for data covering the first year of the district’s performance. The county did not provide any records related to that request until March 4 and so far has only provided data covering last October, November and December.

                        The report shows the district scored 98% overall, exceeding compliance requirements. Though locked in a debate about how to measure response times, both county and district officials said the district has been successful.

                        But for some in the local emergency response industry, the delay has raised questions about whether the behind-the-scenes dispute will weaken the standards applied to the district.

                        A former emergency medical services agency official with detailed knowledge of county ambulance contracts said the district’s high score is unusual. The official, who requested anonymity in order to speak freely, said scores in the low to mid-90s are more common in the industry.

                        Traditionally, the official said, the clock starts ticking on ambulance response times when ambulances are dispatched and ends when the crew arrives at the scene of the emergency. Beginning the clock after the dispatcher has finished interviewing the caller to determine a priority level, can leave anywhere from 30 seconds to minutes off the clock, the official said.

                        “If they’re getting two or three extra minutes, you would expect them to be on time more,” the official said.

                        Data for the bulk of 2024 remains pending as county and district officials debate how to evaluate the compliance data. Those officials were due to present a proposed contract amendment to the Board of

                        Supervisors on March 25, but that discussion was delayed because the related documents could not be completed in time to comply with the state’s open meeting law requirements.

                      • 27 Mar 2025 5:23 PM | Matt Zavadsky (Administrator)

                        Further news that may indicate significant changes to the GEMT programs in the very near future. Ambulance GEMT programs, including the Managed Care and IGT programs, are part of these referenced State-Directed Medicaid Supplemental Payment Programs.

                        States and agencies that currently participate in GEMT programs of any kind may want to closely monitor developments that may dramatically change how these programs are structured.

                        ------------------- 

                        Conservatives push to cut extra Medicaid payments to hospitals
                         By Maya Goldman
                        3/26/25
                         
                        https://www.axios.com/2025/03/26/congress-medicaid-payments-hospitals-states
                         
                        A think tank with close ties to the Trump administration is making the case for wonky changes to state Medicaid payments that could solve a big problem for Republican lawmakers: They could cut federal spending in the name of simply cracking down on waste and abuse within the program.
                         
                        The big picture: State-directed Medicaid payments have grown rapidly, and there's been bipartisan support for reining them in.

                        • But slashing or getting rid of the payments would be a big financial hit for providers, and especially hospitals, who vehemently disagree that the payments are wasteful.

                         Driving the news: Paragon Health Institute released a report Wednesday characterizing state-directed payments as "legalized Medicaid money laundering."

                        • States can tax providers or use other means to increase their state share of Medicaid funding, which allows the state to draw down additional federal Medicaid dollars. States can then use that extra money to increase payments to providers.
                        • "Not only do these programs sidestep the truly needy on Medicaid and favor special interests instead, but all this is financed by growing the federal debt, leading to inflation and higher interest rates," the report says.

                         Zoom in: State-directed payment arrangements approved as of last August are projected to cost more than $110 billion per year, a nearly 60% increase over cost projections from early 2023.

                        • A small portion of these arrangements are driving most of the increase, according to independent Medicaid advisers to Congress.

                         What they're saying: "All of this is fits within waste and abuse in the program," Paragon President Brian Blase, who co-authored the report, told Axios. "Congress, looking at $2 trillion budget deficits, needs to make significant reform to the federal-state partnership" in Medicaid.

                        • The report advocates for Congress to cap the amount of federal Medicaid funding states can receive, though it acknowledges that such a change is unlikely.
                        • The report also recommends other policy changes, like prohibiting states from using provider and insurer taxes to finance Medicaid payments, ending or capping state-directed payments and stopping policy consultants from being paid with Medicaid funds.

                         Between the lines: The Government Accountability Office and independent Medicaid advisers have both said in recent years that state-directed payment arrangements need more oversight. Democratic lawmakers have also advocated changes to provider taxes.

                        • The Biden administration last year finalized a rule to increase transparency into state-directed payments. The Paragon report says the rule helped, but that it should still be repealed over fiscal concerns.

                         The other side: Hospitals say patients' access to care could suffer without the supplemental payments.

                        • "Let's be clear: provider taxes and state directed payments provide the means to offset the crippling underpayment by Medicaid for critical care that meets the medical needs of so many kids, mothers, disabled, and seniors," Chip Kahn, president and CEO of the Federation of American Hospitals, said in a statement to Axios.
                        • Taking federal money out of the Medicaid system may ultimately force hospitals to cut back services or staff, affecting beneficiaries' access to care, said Megan Cundari, senior director of federal relations for the American Hospital Association.

                         What we're watching: Blase said his team is having discussions with congressional offices.

                        • Still, lawmakers tend to be very protective over their districts' hospitals, which could make changes an uphill battle.
                        • "Everybody knows this is a scam, but it benefits hospitals," Blase said of his team's conversations on Capitol Hill.

                         Excerpts from the Paragon Report:
                        These financing schemes have been around since the mid-1980s. They started with provider taxes or donation programs, primarily through hospitals and nursing homes. States collect funds from providers, then return those funds in the form of additional Medicaid spending. These expenditures garner federal matching funds, which are subsequently paid to providers through state directed payments (SDPs) and supplemental payments, with states often keeping a portion of this additional money for other purposes. SDPs are payments that states direct insurers to make to providers.”
                         
                        When Congress made those schemes somewhat more difficult in the early 1990s, states turned to intergovernmental transfers (IGTs) to finance the state share of Medicaid. Through an IGT, a local government or government-owned provider transfers money to the state that the state then uses to make much higher Medicaid payments on providers, which are often the very same providers that make the IGT. IGTs raise significant conflict of interest concerns and result in government-owned providers receiving favorable treatment over private providers.”
                         
                        States have expanded their use of provider taxes and IGTs in recent years. The newest money laundering tactic are taxes on insurance companies that participate in Medicaid managed care.”
                         
                        The providers, with schemes often developed by consultants, lobby the states to engage in this legalized money laundering apparatus. Historically, states made additional supplemental payments to providers, and they are still a significant component of Medicaid, particularly through the IGT mechanism. As states have largely transitioned Medicaid from fee-for-service to managed care, states are requiring insurers to make extra payments to providers through SDPs.”
                         
                        States’ reduced financial share means that states are now setting very high Medicaid payment rates for certain providers. In some states, these rates are approaching average commercial rates—rates that are more than 2.5 times above Medicare rates.”
                         
                        SDPs exceeded $110 billion in 2024—more than double the amount from just two years earlier. These are on top of supplemental payments that exceeded $57 billion in 2023. Both provider taxes and SDPs soared in 2024, as provider taxes fuel the legalized money laundering that permits states to substantially increase SDPs.”
                         
                         “What We Recommend
                        Considering a new Congress and the Trump administration’s intent on cutting waste, fraud, and abuse throughout government, there is a real opportunity for federal policymakers to address and limit Medicaid money laundering. Addressing this issue has been bipartisan in the past. Presidents Bush, Obama, and Trump all pushed to rein in Medicaid financing gimmicks.”
                         
                        The Paragon Report highlights a 2016 report by George Mason University, that states:
                        “The specified 19 classes of providers [eligible for SDPs] are those that provide inpatient hospital services, outpatient hospital services, nursing facility services, services of intermediate care facilities for the mentally retarded, physicians’ services, home health care services, outpatient prescription drugs, services of Medicaid managed care organizations, ambulatory surgical centers, dental services, podiatric services, chiropractic services, optometric/optician services, psychological services, therapist services, nursing services, laboratory and x-ray services, emergency ambulance services, and other health care items or services for which the state has enacted a licensing or certification fee.
                         



                      • 19 Mar 2025 12:03 PM | Matt Zavadsky (Administrator)
                        DispatchHealth offers in-home urgent care and is a key partner in some EMS-Based MIH programs, including Treatment in Place initiatives.
                         
                        Medically Home has agreements with several EMS agencies across the country to provide Hospital at Home support using Mobile Healthcare Paramedics, specifically allowed under the currently extended CMS waiver referenced in the news report.

                        ------------------

                        DispatchHealth and Medically Home merge, creating one of nation's largest hospital-at-home providers
                        By Emma Beavins 
                        Mar 18, 2025
                         
                        https://www.fiercehealthcare.com/hospitals/dispatchhealth-and-medically-home-merge-creating-one-nations-largest-hospital-home
                         
                        DispatchHealth and Medically Home, two leaders in the hospital at home industry, are merging, the companies announced Tuesday.
                         
                        The companies leverage telehealth, virtual call centers and devices in patients' homes to provide high-complexity care, including for oncology patients and organ transplant patients. Dispatch Health and Medically Home tout that their merger creates the nation’s most comprehensive high-acuity care platform delivering care to patients at home.
                         
                        Medically Home’s technology powers a large swath of hospital at home programs across the country and gives them frameworks to provide hospital at home care with additional support from Medically Home’s technology and staff. Its range of services includes a Medical Command Center that oversees patients’ care 24/7, technology to use at the bedside and a team of clinicians. The company was founded in 2016.
                         
                        Dispatch Health, founded in 2013, provides full-service hospital at home care to patients across the country. DispatchHealth clinicians attend patients at the bedside and coordinate work and requirements for hospitals. The company also provides in-home urgent care services to patients and post-facility recovery at home.
                         
                        Once the merger closes, expected midyear, the combined entity will continue under the name DispatchHealth. It will care for patients in 50 major metropolitan areas with 40 health systems and connections to most major health plans and value-based care entities. The terms of the deal were not disclosed.
                         
                        Together, the companies will save up to 62,000 inpatient hospital stays per year and reduce the cost per patient by up to 30% per month by providing acute hospital-level care in patients’ homes.
                         
                        "Healthcare demands innovative solutions that align clinical excellence with financial sustainability," Jennifer Webster, CEO for DispatchHealth, said in a statement. "We've proven the home can be an extension of the hospital while improving the quality of care. This merger brings together two complementary pioneers in hospital-level care at home, accelerating our ability to expand access, lower costs, drive value, and improve capacity for health systems across the country."
                         
                        This comes as the federal government recently extended the waiver for hospitals to get Medicare dollars by participating in its Acute Hospital Care At Home program. Starting during the pandemic, the Centers for Medicare & Medicaid Services (CMS) began offering incentives for hospitals to shift qualifying patients out of facilities and to care for them at home due to hospital overcrowding.
                         
                        The program has been repeatedly extended since the end of the COVID-19 public health emergency, albeit for short periods of time. Most recently, Congress extended the CMS’ hospital at home program through Sept. 30, 2025, though there is bipartisan support for a five-year extension.
                         
                        "Hospital-at-home has consistently demonstrated better outcomes, and we believe every patient—regardless of where they live—deserves access to that level of care. This merger allows us to break down barriers, reaching more families in underserved communities with high-quality, advanced medical care in their homes," Pippa Shulman, chief medical officer and chief strategy officer of Medically Home, said in a statement.

                      • 12 Mar 2025 8:16 AM | Matt Zavadsky (Administrator)

                        March 12, 2025

                        The Honorable Brett Guthrie

                        Chair

                        Committee on Energy and Commerce

                        United States House of Representatives

                        2161 Rayburn House Office Building

                        Washington, DC 20515

                        The Honorable Buddy Carter

                        Chair

                        Energy and Commerce Subcommittee on Health

                        United States House of Representatives

                        2432 Rayburn House Office Building

                        Washington, DC 20515

                        The Honorable Frank Pallone, Jr.

                        Ranking Member

                        Committee on Energy and Commerce

                        United States House of Representatives

                        2107 Rayburn House Office Building

                        Washington, DC 20515

                        The Honorable Dianna DeGette

                        Ranking Member

                        Energy and Commerce Subcommittee on Health

                        United States House of Representatives

                        2111 Rayburn House Office Building

                        Washington, DC 20515

                        Re: Medicaid Reimbursement for Ground Ambulance Services

                        Dear Chair Guthrie, Ranking Member Pallone, Chair Carter, and Ranking Member DeGette,

                        On behalf of our members, and the more than 16 million citizens served by our members, the Academy of International Mobile Healthcare Integration asks for your continued support for Medicaid supplemental payment programs that provide critical support to Emergency Medical Service (EMS) systems and providers.

                        Ambulance service providers face financial pressures and risk closure at an alarming rate in every state. A new tracking system we help support has documented over 2,700 local and national news reports about EMS, with 79% of the reports highlighting the economic and staffing crisis in EMS. In rural communities in particular, EMS providers are often the only healthcare providers delivering care for hundreds of miles. Medicaid supplemental payment programs offer transparent and sustainable ways to support first responders, allowing them to continue providing life-saving services, train paramedics, and ensure our rural communities are not left without care.

                        The most at-risk ambulance service providers—those serving rural communities—face unique challenges including large coverage areas, increased travel distances, and higher costs per transport. Adequate support for staffing, training, and equipment is already a major challenge. Medicaid and Medicaid supplemental payment programs help improve rural access to care by helping to fund the dedicated resources serving those communities.

                        We are deeply concerned by recent reports of proposals that may severely reduce critical Medicaid reimbursement by reducing federal matching funds, altering provider assessments and mandating the use of artificial caps on supplemental payments, any of which would likely have a significant impact on EMS delivery, especially in rural communities or communities with large proportions of Medicaid beneficiaries. 

                        EMS and ambulance service providers, rural hospitals, and safety-net health clinics would be at risk of closure without continued funding that Medicaid supplemental payment funds provide. The previously mentioned news tracking system has already identified 219 news reports of ambulance service closures since January 2021.

                        We, and other ambulance associations, are eager to collaborate with Congress and the Administration on solutions that sustain Medicaid financing to help ensure ambulance service providers can continue to meet the needs of their communities.

                        We appreciate the opportunity to engage in further discussion and provide data on how these programs directly affect each of our states.

                        Sincerely,

                        Robert Lawrence, President

                        Academy of International Mobile Healthcare Integration

                        Member Agencies:

                        • ·         Alberta Health EMS; Alberta, Ontario, CA
                        • ·         Emergency Medical Services Authority; Tulsa and Oklahoma City, OK
                        • ·         Mecklenburg EMS Agency; Charlotte, NC
                        • ·         Medic Ambulance; Vallejo, CA
                        • ·         Medic Ambulance of Scott County; Davenport, IA
                        • ·         Metropolitan Area EMS Authority; Fort Worth, TX
                        • ·         Metropolitan EMS, Little Rock; AR
                        • ·         Northwell Health Center for EMS; Syosset, NY
                        • ·         Novant Health; Wilmington, NC
                        • ·         Pinellas County Ambulance Authority; Largo, FL
                        • ·         Pro EMS; Cambridge, MA
                        • ·         REMSA Health; Reno, NV
                        • ·         Richmond Ambulance Authority; Richmond, VA
                        • ·         Three Rivers Ambulance Authority; Fort Wayne, IN


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