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. Since January 2021, 2,127 news reports have been chronicled, with 46% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 80% of the media reports! 105 reports cite EMS system closures/agencies departing communities, and 92% 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 Protected.xlsx

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  • 3 Sep 2024 5:17 AM | Matt Zavadsky (Administrator)

    Congratulations to Jonathan Washko, one of EMS’ major thought leaders and board member of the Academy of International Mobile Healthcare Integration on his interview for this report in Becker’s.
     
    Jonathan provides exceptional insight into the future of EMS delivery, and the need to continually transform EMS delivery to meet the goals of value-based care, and reduction of acute care services.
     
    The EMS profession has never been better poised to drastically transform, with innovative EMS leaders willing to embrace evidence-based research to challenge long-held myths about EMS delivery, numerous legislative initiatives in Congress, and recent state legislation that facilitates the ability for EMS systems to be more than simply a method of conveyance to an ED!

    Visit here to see current federal legislative proposals: https://naemt.org/advocacy/online-legislative-service#/bills
     
    Visit here to see recently passed state legislation: https://www.ncsl.org/health/emergency-medical-services-legislation-database

    ---------------------------- 

    Health systems brace for the 'silver tsunami'

    Laura Dyrda

    August 23rd, 2024

    https://www.beckershospitalreview.com/hospital-management-administration/health-systems-brace-for-the-silver-tsunami.html

    Around 10,000 Americans turn 65 years old every day, gaining access to Medicare benefits. The number of Medicare beneficiaries is expected to continue growing in the next five years, and health systems are making changes to keep up.

    In 2020, around 73 million Baby Boomers were eligible for Medicare benefits, and by 2030 all Baby Boomers will be Medicare-eligible, according to the Census Bureau. Advances in medicine and healthy lifestyle mean people are living longer and demanding more from their care.

    "In the next five years, the most significant disruptor to healthcare will be the capacity challenges associated with the 'silver tsunami' of baby boomers hitting the age of healthcare consumption," said Jonathan D. Washko, MBA, FACPE, NRP, AEMD, Assistant Vice President, CEMS Operations, Northwell Health; Assistant Professor, Department of Emergency Medicine, Pre-hospital and Disaster Medicine, Zucker School of Medicine at Hofstra, Northwell Health. "In this environment, coupled with lowering revenues, staffing shortages and higher expenses, healthcare is being forced from an abundance mindset to one of scarcity."

    Mr. Washko sees the shift causing leaders to reconsider care delivery models. He predicts movement away from traditional operations to care delivery models based on intelligent and intentional design for better outcomes, lower costs and faster results.

    "Solutions will require shifts to care in the home, new operational care models, and technology integration," said Mr. Washko. "These will allow the medicine being delivered to be effectively and efficiently optimized, vastly improving the productivity of existing and net new capacity."

    The increasing capacity issues are top of mind for large and small health systems. Shelly Schorer, CFO of the California division of CommonSpirit Health, said the increased aging population will likely strain Medicare, inpatient care and healthcare capacity in some regions. But the health system isn't sitting back and waiting to see what happens.

    "Anticipated regulatory challenges post-election will influence healthcare operations. The looming recession may alter how individuals access healthcare and treatment based on affordability," she said. "Despite these headwinds and challenges, at CommonSpirit we are prepared to pivot and meet the changing needs of our communities by accurately predicting and addressing their healthcare needs efficiently."

    In addition to the increased volume of Medicare patients, health systems are preparing for the upcoming coverage changes. CMS aims to transition all eligible Medicare fee-for-service and Medicaid beneficiaries to plans with a value-based component to reign in the total cost of care.

    "This represents the greatest market disruption on the near-horizon," said Ryan Nicholas, MD, chief quality officer at Mercy Medical Group in Folsom, Calif., part of CommonSpirit. "This has prompted Mercy Medical Group to move rapidly into value-based care with focus on total cost of care and network integrity."

    Dr. Nichols said Mercy Medical Group's Medicare Advantage population increased 24% in the last year and they're projecting additional 28% growth in the next 12 months. The swift shift to value-based care and Medicare Advantage plans has prompted the medical group to think differently about site of service and invest in additional resources.

    "Expanding ambulatory services and improving access for primary care services to reduce unnecessary ED utilization and shorten length of stay is our top priority," Dr. Nichols said.

    Alon Weizer, MD, chief medical officer and senior vice president of Mount Sinai Medical Center in New York City, has also made changes to innovate and implement value-based care policies. He said the entire team is embracing innovative solutions to meet current and future patient needs, especially as Medicare rolls out TEAMS in the next few years, building upon the Comprehensive Joint Replacement model.

    "This along with other risk and value based models will continue to drive integration of healthcare services and the value proposition through improving quality while reducing costs," said Dr. Weizer. "While we are investing heavily to be successful in these models through primary care expansion and technology that will help reduce the need for acute care services, we continue to focus our culture on providing safe and high quality care to our patients."


  • 29 Aug 2024 5:27 AM | Matt Zavadsky (Administrator)

    Although this article highlights the EMS crisis in rural Wyoming, this same issue is happening in virtually all part of the country.

    --------------------------- 

    Should the state provide life support to Wyoming’s ailing ambulance services?

    Most people expect an ambulance to arrive quickly when they call for help. But Wyoming’s EMS system isn’t funded like an essential service, and a critical failure can cost lives.

    by Madelyn Beck

    August 26, 2024

    https://wyofile.com/should-the-state-provide-life-support-to-wyomings-ailing-ambulance-services/

    Bondurant sits about halfway between Pinedale and Jackson along scenic Highway 191 in western Wyoming. The area is buffeted by the Gros Ventre Wilderness, Hoback River, and both the Wind River and Wyoming ranges. From the road along the valley floor, you can see abrupt pine-tree-freckled hills and the snowy peaks of nearby mountains to the northwest.

    The tranquil location is a draw to folks like Sam Sumrall and his wife, who retired there after moving from Mississippi. But it comes with risks.

    “We lived in the country [in Mississippi], but we were literally five minutes from the hospital, five minutes from Walmart,” he said. “When we moved out here, we did so with the awareness of the fact that we weren’t going to have that luxury.”

    Bondurant is part of Sublette County, the only county in Wyoming without a hospital. About 40 miles southeast on Highway 191, a new hospital under construction in Pinedale — the county’s largest community — is expected to open next year. However, the EMS crews based there are already covering 5,000 square miles with just a few ambulances.

    In the winter of 2022-23, Sumrall was one of only three volunteer firefighters who lived in the town of around 100, all of whom only had basic first aid training and couldn’t transport patients. If someone needs to be transferred to a hospital, the closest emergency medical services are more than 30 minutes away. Life flights have to be used at times — but those can be expensive and take time to call in, too.

    Response times are important because they can directly translate to the survivability of a medical event. That’s especially true for severe trauma, stroke and heart attack.

    The scenery and limited taxes attract retirees to the area. But they should know about the limitations of EMS there, Sumrall told WyoFile in an interview last year.

    “It’s not for everybody, it’s just not,” he said. “But, you know, we do everything we can to educate people.”

    Since then, the volunteer group in Bondurant has grown to 10 people, according to Sublette County Unified Fire Chief Shad Cooper, thanks to support from those who were planning a luxury resort. However, that project is now planning to move elsewhere, putting future EMS sustainability at risk once again.

    Bondurant’s isolation from emergency services isn’t unique. In fact, all Wyoming counties — and rural areas across the country — are considered EMS deserts.

    Providing emergency medical care has become increasingly challenging in a state with small communities scattered across wide open spaces. Across Wyoming, EMS agencies are grappling with funding struggles brought on by rising costs, declining volunteerism and insufficient levels of reimbursement.

    Those challenges raise simple but profound questions. When we call 911, should we expect someone to arrive? Who should that be, and how long should it take?

    And what are we willing to pay to save a life?

    In this three-part series, WyoFile explores the importance of EMS, why it’s so hard to maintain in Wyoming and where there’s hope for the future.



    Expectations vs. reality

    Andy Gienapp directed Wyoming’s Office of EMS for 11 years, and after leaving in 2021, is now deputy executive director of the National Association of State EMS Officials. He’s long known rural EMS was facing a money problem.

    “I was trying to ring this alarm bell 10 years ago,” he said during a conversation last year.

    Part of the problem is people take EMS for granted, Gienapp said. During presentations when he was working in Wyoming, he’d give local groups a scenario where the governor signed an order so counties were no longer required to provide certain expected services like snow removal and education. Locals were “aghast.” The order wasn’t real, he’d tell them, but the outrage was. 

    “And yet, we’re OK with not paying for what we all consider to be an essential service, and not paying for an ambulance?” he asked.

    Gienapp noted that people still expect someone skilled to arrive in a timely manner if they call 911. That was backed up by the Wyoming Department of Health’s listening sessions in 2022, which found many people living in and around towns expected the best emergency medical care.

    What people don’t often understand is the money that allows EMS to respond to medical emergencies is far from guaranteed.

    The maps shows ambulance responses in under 9 minutes only near town centers, responses under 30 minutes only a short way out of towns and much of the state not getting responses in less than half an hour.


    This map shows 2022 EMS response times as agencies reported them to the Wyoming Ambulance Trip Reporting System. The large colored areas are the state’s “trauma regions.” The green spots represent EMS reportedly arriving in less than nine minutes, while the blue shows arrival times in under 30 minutes. Non-shaded areas “represent response times longer than 30 minutes or not at all.” (Wyoming Department of Health)

    EMS funding comes from a complicated patchwork of counties, towns, hospitals, property taxes, grants, insurance reimbursements and direct patient payments. EMS also operates under a variety of organizational structures ranging from private companies and hospitals to local governments.

    That is to say, there’s not much funding uniformity among EMS agencies.

    And an ambulance ride isn’t cheap. Those paying big bills for the service may wonder why EMS needs public money at all. But the problem is one Wyoming sees all too often: not enough people.

    If no calls come in, or if a patient doesn’t need a ride to the hospital, EMS agencies don’t make money. If EMTs or paramedics are being paid by the hour, and the vehicles still need maintenance and expensive equipment, the math doesn’t work.

    When the Legislature’s Labor Health and Social Services Interim Committee met in April 2023, health department officials noted that about 30% to 35% of 911 responses go fully unreimbursed because patients aren’t transported. Others are only partially reimbursed.

    Meanwhile, to keep a Wyoming ambulance with basic life support running, it costs an average of $527,000 a year in staffing and equipment, the health department estimates. That translates to 650 reimbursed trips per year to just break even, which is hard to achieve for many Wyoming communities.

    Advanced life support — utilizing more complicated procedures and medications to help those who need a higher level of care — costs even more.

    “For advanced life support, 1,400 to 2,000 transports per year would be required to break even solely on a fee-for-service basis,” said Wyoming Department of Health Director Stefan Johansson, referencing the average.

    Some point to the reimbursement-funding model as the original sin that made rural EMS so difficult to sustain. The concept for emergency medical services in the U.S. only started in the 1950s and became a robust, formalized system in the ‘70s and ‘80s.

    To change it now would take every level of government, according to Dia Gainor, executive director of the National Association of State EMS Officials.

    “That would require a very strong dose of federalism,” Gainor said. “And I’m using the textbook governmental term there, which means something collaborative at the federal and state and local level, because each one of those levels of government has a different capacity and different role to make change.”

    Expectations have only increased since the ‘80s for vehicles that transport patients as well as training for the EMS employees. More time and training — and finding training opportunities that fit into a busy schedule — also translate into fewer people willing to volunteer their time.

    Staffing

    Nationally, EMS volunteerism is starting to slump, even though volunteers long made up more than 70% of the staff. A similar trend is true for Wyoming. Some blame complacency of residents, while others note the skyrocketing costs of housing, groceries and gas. Why not find a paying job to support your family instead?

    Sumrall in Bondurant is in his early 70s, and said last fall that he wasn’t sure he could leave the volunteer fire department just yet.

    “Personally, I want to make sure that the battalion is in good shape with a replacement for me before I leave, because the manpower shortage would just be magnified, especially during the winter months,” he said.

    During an AARP webinar, Jen Davis — Gov. Mark Gordon’s health and human services policy advisor — noted that younger people are moving out of the state while older people are moving in.

    “Some recent data that we saw in the last couple of months, Wyoming has one of the largest out migration[s] of our population, particularly in the younger generation,” she said in January. “Wyoming is up on in-migration. However, it is with older adults who are retiring and coming to Wyoming.”

    She added that through the Wyoming Innovation Partnership, the governor’s office established a program to fund education and training for EMTs and paramedics. But, she added, “the program may run out of money quicker than we anticipated because of the need and the response so far.”

    It can also be hard to entice career EMTs or paramedics into rural areas without enough pay, for which there’s no uniform amount. And once people get into the position of EMT, they tend to want to move up to paramedic, firefighter, nurse or doctor.

    In Cody, EMTs received a pay increase a few years ago. Evan James Bartel, who’s worked there for three years, told WyoFile last summer he appreciated it. Things were tight.

    “They did a tremendous bump last year, prior to which … I drove past every fast food restaurant in this town and saw they were advertising more starting [pay] than I was making here,” he said.

    Bartel has since worked his way up to become a paramedic, a position that pays better and can perform more kinds of medical services. But the job is not about the money, he said. He loves helping the community and the diversity of challenges that come with the job.

    Likewise, Braydon Bond was working to become a paramedic last August as one stepping stone on his way to medical school. EMS is great training for doctors, he said, but there’s not much financial incentive to work in it — it’s more about passion and training.

    “I see EMS as the very fundamentals of emergency/patient care,” he said.

    Staffing, funding for operations and inadequate wages are Wyoming EMS agencies’ greatest perceived challenges, according to the health department’s 2022 report.


    The Wyoming Office of EMS conducted a survey of Wyoming EMS agency directors before conducting state-wide listening sessions. Here are some of the results from the report published in Oct. 2022. (Wyoming Department of Health)

    At the same time, a major issue for reimbursement comes from those who either can’t afford to pay for their ambulance ride or who belong to government federal insurance programs. Reimbursement rates under the Centers for Medicaid and Medicare Services have barely budged compared to increasing costs, according to a 2022 report from national nonprofit FAIR Health Consumer.

    About 40% – 50% of Wyoming EMS responses are for Medicare recipients, according to the state health department. That program is reserved for those over 65 and people with specific disabilities and conditions. It rarely reimburses for the full cost of a service, sticking extra charges with patients or, when patients can’t pay, the EMS agency.

    Medicaid reimbursements are even lower than Medicare rates. States have some say in Medicaid — states like Idaho and Indiana recently increased rates for EMS — but it can be a hard sell for lawmakers who oppose new taxes.

    Michael Petty is a volunteer firefighter with Sublette County Unified Fire living near Big Piney. His day job is working as a field safety specialist in oil and gas.

    With decreasing funding from fossil fuels in Wyoming, Petty said, people won’t be able to count on the EMS services they’ve come to expect without paying for them in a new way.

    “People still want to have really good care and be cared for where they live,” he said. “The money has to come from somewhere.”

    Wyoming is one of 10 states that haven’t expanded Medicaid to cover more uninsured people here, leaving thousands who may not be able to pay ambulance and medical bills. The Wyoming Hospital Association has said that’s harming hospitals, many of which operate local EMS services.

    Medicaid expansion could help, advocates say, but that would cost the state $22 million every two years, according to Department of Health estimates. The Legislature has discussed expanding Medicaid numerous times, but a fear that the federal government will someday leave states with the full cost has won out.

    Essential service?

    There have also been efforts to make EMS an “essential service” in Wyoming so every county or community must have access to it. More than a dozen states have done something similar, including nearby Colorado and Nebraska.

    However, those efforts have failed so far here, mainly due to one key point: Many lawmakers don’t want to pass an unfunded mandate. The vast majority of counties — 21 out of 23 — maxed out the 12 levies allowed by the state last year. If communities are expected to fund EMS and can’t pass more levies, or if locals vote against a hospital or EMS district, where does money for the service come from? Funding for the schools? The roads?

    For Luke Sypherd, president of the Wyoming EMS Association, if anything should be mandatory, it should be the crew of people responding to medical emergencies.

    “There are other things that are certainly not essential to life or limb that are put ahead of emergency medical services,” he said.

    County fairgrounds might be culturally important, but why should they get priority over a medic who can save someone’s life, he wonders.

    To help sustain his own EMS agency within Cody Regional Health, Sypherd said he’s partially leaned on grants, amounting to about $3 million the last few years.

    “Taxpayers here have paid taxes, and we’re trying to bring some of that back into our community,” he said.

    But he hasn’t seen state lawmakers make the same effort to preserve emergency services.

    “There’s this idea that’s circulated that we can’t afford it, and that’s completely false,” he said. “We choose not to afford it. At least the legislators of the state of Wyoming have chosen that they’re not going to afford stable EMS systems.”

    At the statewide level, Sen. Fred Baldwin (R-Kemmerer) pushed for an essential service designation, noting that parts of the state — like the southwest — are struggling and now reaching crisis levels, he said. Baldwin is a physician assistant and volunteer fire chief in Kemmerer, but has worked with EMS in various capacities for decades.

    “We’re losing services,” he said. “There are small places, small communities, where if one EMT is sick, and the other one is on vacation, and you dial 911, they don’t have an ambulance. There’s nobody there.”

    Others are operating equipment that’s on its last legs, he said. Still, he acknowledged, funding is difficult when EMS is a money-losing business in much of Wyoming.

    “Nobody wants to talk about raising taxes,” he said. “You know, you want things, but you don’t want to have to pay for them. It’s difficult. It’s a conundrum, and I don’t know the answer. I wish I did. I’ve been trying to find one for several years.”

    However, Baldwin didn’t seek reelection.

    Other lawmakers remain skeptical.

    “Given that only 13 states have said that EMS is essential, I don’t see the need for Wyoming to do that,” said Jeanette Ward (R-Casper), voting against an essential service designation last April. “And I think that generally, in general, when people call for an ambulance, one shows up.”

    Another solution: Community EMS

    Johansson and the governor’s office has asked the Centers for Medicare and Medicaid Services — generally referred to as CMS — to rethink how the federal government reimburses EMS calls in rural areas, he said. While rates are hard to change on the federal level, he suggested Medicare could reimburse for “community” EMS.

    “Meaning that there’s more of a community-based approach that doesn’t require a trip to the hospital to kind of satisfy payment conditions,” he said.

    That is, he wants EMS agencies to be reimbursed for helping someone in their home instead of only getting money for a transport, something he’s mentioned Wyoming Medicaid has started to do.

    It’s an idea that Sypherd with the EMS association has said so far hasn’t generated enough money on the ground, especially as major payers like Medicare won’t reimburse for it.

    “Right now, you are not going to get enough money to support yourself out of community EMS,” he said.

    When Johansson has asked CMS to start implementing this kind of community paramedicine reimbursement, he says agency officials will often just say they understand Wyoming’s challenges and “we’ll communicate that up the chain.” Then, nothing happens.

    CMS did run a pilot program for something similar called ET3, or the Emergency Triage, Treat, and Transport model. That program reimbursed EMS for transporting patients to facilities like urgent cares or to primary care providers instead of hospital emergency rooms. It also reimbursed agencies for treating patients at home or via telehealth.

    However, that experiment ended two years early on Dec. 31, citing “lower-than-expected” participation and administrative costs exceeding potential long-term savings. Of the program’s 152 participants, none were in Wyoming.

    In the meantime, Johansson remains frustrated with CMS’ lack of follow-through, and said his office and the governor’s office will continue to push for new reimbursement models.

    “It is frustrating that one of the — if not the — largest payers of this type of service has kind of been somewhat intractable on those policy changes,” he said.

    But some individual EMS agencies, he added, are requesting enhanced CMS reimbursement rates, arguing they should be considered the sole critical access medical provider in a rural area that may also include a nearby fire department.

    Some involved in EMS suggest U.S. Sen. John Barrasso (R-Wyo.) could help spur CMS into action because of his medical background as an orthopedist. The senator didn’t return emails and calls for comment.

    In the second part of this series “A Critical Call” on EMS in Wyoming, WyoFile looks at whether local agencies’ creative workarounds are enough to fill funding gaps.


  • 27 Aug 2024 5:07 AM | Matt Zavadsky (Administrator)

    The Academy of International Mobile Healthcare Integration (AIMHI) is partnering with PWW Advisory Group (PWW|AG) for management services of the Academy.
     
    Under this partnership, PWW|AG will support AIMHI’s administrative functions, educational programming (including AIMHI’s insightful industry webinars), AIMHI’s High Performance/High Value EMS Benchmarking Reports, and a vital new project: creating a guide for communities to implement and evaluate high performance/high value EMS systems.
     
    “We are excited about what this new partnership brings for enhanced industry leadership and advancement of high performance, high value and patient-centered EMS system design” explains Chip Decker, CEO of the Richmond (VA) Ambulance Authority, and president of AIMHI. “The challenges that communities face with sustainability of their EMS systems makes education to elected and appointed officials about the value of high-performance EMS system design even more important.”
     
    Under this arrangement, PWW|AG EMS/Mobile Healthcare Consultant Matt Zavadsky will serve as AIMHI’s Executive Director.
     
    Steve Wirth, Co-President of PWW|AG said “This will be a valuable partnership for the EMS industry.  The leadership, resources and relationships developed by PWW|AG’s team members will be highly synergistic with the outstanding and innovative work of AIMHI. We are honored by the trust AIMHI is placing in PWW|AG.”
     
    The new partnership will launch September 1, 2024.
     


  • 19 Aug 2024 6:46 AM | Matt Zavadsky (Administrator)

    Kudos to the San Antonio City Manager for proposing increases to the ambulance fees charged by the fire department.
     
    It’s generally good public policy to reduce tax burden for ambulance service by charging a market rate for those services. Under-billing (referred to recently by a Texas Medicaid official as a ‘nominal fee’) essentially uses tax dollars to subsidize commercial insurers.
     
    Medicare and Medicaid reimburse ambulance agencies at a fixed fee schedule, and patients are not balance billed. Self-pay patients generally don’t pay. Commercial insurers typically reimburse 80% of what they determine to be the usual and customary rate, or 80% of billed charges.
     
    Charging an appropriate market rate helps assure the commercial insurers are reimbursing at a reasonable rate.
     
    Also, many states are proposing GEMT programs that are not cost-based, but instead based on the difference between what Medicaid reimburses and the average commercial reimbursement.
     
    Departments that do ‘nominal’ billing (billing far below the market rate) are penalizing taxpayers (by not maximizing insurance reimbursement), and each other (by lowering the average commercial reimbursement calculation).
     
    It’s reasonable public policy to charge fees that maximize commercial reimbursement and implement charity care policies for patients without health insurance.


    San Antonians could soon pay more for ambulance transport. Here's why.
    The proposed rate increase for ambulance rides in San Antonio would go from $1,000 to $1,500 in two years.
    Author: Meredith Haas
    August 16, 2024
     
    https://www.kens5.com/article/news/politics/san-antonio-proposes-rate-increase-ems-transports-kens5/273-27125857-608f-402d-b620-6ee28cc123cd
     
    SAN ANTONIO — The City of San Antonio is considering upping the price of ambulance rides by hundreds of dollars.
     
    There hasn’t been an increase in this medical cost since 2019, but one City Council member is speaking out against the proposal. In a Thursday meeting, City Manager Erik Walsh recommended raising the current EMS transport fee from $1,000 to $1,500 in the next two years, as part of a budget proposal presentation.
     
    Walsh said their plan is to raise the cost by $250 in Fiscal Year 2025 and another $250 the year after. The expectation is to generate $2.6 million in FY 2025, which begins Oct. 1 and runs through Sept. 30 of next year.
     
    They expect 69% of the costs to be covered by insurance and 25% by Medicaid. But not everyone thinks this is a good way to bring in revenue for the city.
     
    "We need to keep it at a thousand dollars… we call it a charity fund, but it really is an equity fund," District 3 Councilwoman Phyllis Viagran said.
     
    Uninsured residents have the chance to waive their bill through a charity fund created by council members three years ago, but Viagran wants to do more.
     
    She said the constituents in her district are already running low on hospital beds.
     
    "So if there are no more beds… they’re transferred a second time.”
     
    That can be costly. And if the cost of transport goes up, Viagran said, that just adds to the burden.
     
    The Center for Health Equity in South Texas will try to advance community members' health and create better outcomes.
     
    “That’s why I'm supportive of the center of health equity taking a look at that [rate increase]."
     
    Viagran said she is hopeful to look at different ways to find the $2.6 million.


  • 12 Aug 2024 6:42 AM | Matt Zavadsky (Administrator)

    The Urgent Care/ED hybrid model could be an effective Transport to Alternate Destination (TAD) option from communities in which this option is available.  It will be interesting to evaluate which level of service is provided most often.
    ---------------------------- 

    Hospitals, private equity partner to offer urgent care-ER combo
    Phil Galewitz, KFF Health News
    August 09, 2024
     
    https://www.modernhealthcare.com/providers/hospital-private-equity-urgent-care-emergency-room-combination-uf-health-jacksonville
     
    Facing an ultracompetitive market in one of the nation’s fastest-growing cities, UF Health is trying a new way to attract patients: a combination emergency room and urgent care center.
     
    In the past year and a half, UF Health and a private equity-backed company, Intuitive Health, have opened three centers that offer both types of care 24/7 so patients don’t have to decide which facility they need.
     
    Instead, doctors there decide whether it’s urgent or emergency care —the health system bills accordingly — and inform the patient of their decision at the time of the service.
     
    “Most of the time you do not realize where you should go — to an urgent care or an ER — and that triage decision you make can have dramatic economic repercussions,” said Steven Wylie, associate vice president for planning and business development at UF Health Jacksonville. About 70% of patients at its facilities are billed at urgent care rates, Wylie said.
     
    Emergency care is almost always more expensive than urgent care. For patients who might otherwise show up at the ER with an urgent care-level problem — a small cut that requires stitches or an infection treatable with antibiotics — the savings could be hundreds or thousands of dollars.
     
    While no research has been conducted on this new hybrid model, consumer advocates worry hospitals are more likely to route patients to costlier ER-level care whenever possible.
     
    “It’s good to have a place like this that can treat you no matter what,” said Penny Wilding, 91, who said she has no regular physician and was being evaluated for a likely urinary tract infection.
     
    UF Health is one of about a dozen health systems in 10 states partnering with Intuitive Health to set up and run hybrid ER-urgent care facilities. More are in the works; VHC Health, a large hospital in Arlington, Virginia, plans to start building one this year.
     
    Intuitive Health was established in 2008 by three emergency physicians. For several years the company ran independent combination ER-urgent care centers in Texas.
     
    Then Altamont Capital Partners, a multibillion-dollar private equity firm based in Palo Alto, California, bought a majority stake in Intuitive in 2014.
     
    Soon after, the company began partnering with hospitals to open facilities in states including Arizona, Indiana, Kentucky, and Delaware. Under their agreements, the hospitals handle medical staff and billing while Intuitive manages administrative functions — including initial efforts to collect payment, including checking insurance and taking copays — and nonclinical staff, said Thom Herrmann, CEO of Intuitive Health.
     
    Herrmann said hospitals have become more interested in the concept as Medicare and other insurers pay for value instead of just a fee for each service. That means hospitals have an incentive to find ways to treat patients for less.
     
    And Intuitive has a strong incentive to partner with hospitals, said Christine Monahan, an assistant research professor at the Center on Health Insurance Reforms at Georgetown University: Facilities licensed as freestanding emergency rooms — as Intuitive’s are — must be affiliated with hospitals to be covered by Medicare.
     
    At the combo facilities, emergency room specialists make medical decisions that determine whether patients are billed for higher-priced ER care or lower-priced urgent care after patients undergo a medical screening. The health system compares the care needed against criteria for urgent- or emergency-level care and bills.
     
    Inside its combo facilities, UF posts a sign listing some of the urgent care services it offers, including treatment for ear infections, sprains, and minor wounds. When its doctors determine ER-level care is necessary, UF requires patients to sign a form acknowledging they will be billed for an ER visit.
     
    Patients who opt out of ER care at that time are charged a triage fee. UF would not disclose the amount of the fee, saying it varies.
     
    UF officials say patients pay only for the level of care they need. Its centers accept most insurance plans, including Medicare, which covers people older than 65 and those with disabilities, and Medicaid, the program for low-income people.
     
    But there are important caveats, said Fisher, the patient advocate.
     
    Patients who pay cash for urgent care at UF’s hybrid centers are charged an “all-inclusive” $250 fee, whether they need an X-ray or a rapid strep test, to name two such services, or both.
     
    But if they use insurance, patients may have higher cost sharing if their health plan is charged more than it would pay for stand-alone urgent care, she said.
     
    Also, federal surprise billing protections that shield patients in an ER don’t extend to urgent care centers, Fisher said.
     
    Herrmann said Intuitive’s facilities charge commercial insurers for urgent care the same as if they provided only urgent care. But Medicare may pay more.
     
    While urgent care has long been intended for minor injuries and illnesses and ERs are supposed to be for life- or health-threatening conditions, the two models have melded in recent years. Urgent care clinics have increased the scope of injuries and conditions they can treat, while hospitals have taken to advertising ER wait times on highway billboards to attract patients.
     
    Intuitive is credited with pioneering hybrid ER-urgent care, though its facilities are not the only ones with both “emergency” and “urgent care” on their signs. Such branding can sometimes confuse patients.
     
    While Intuitive’s hybrid facilities offer some price transparency, providers have the upper hand on cost, said Vivian Ho, a health economist at Rice University in Texas. “Patients are at the mercy of what the hospital tells them,” she said.
     
    But Daniel Marthey, an assistant professor of health policy and management at Texas A&M University, said the facilities can help patients find a lower-cost option for care by avoiding steep ER bills when they need only urgent-level care. “This is a potentially good thing for patients,” he said.
     
    Marthey said hospitals may be investing in hybrid facilities to make up for lost revenue after federal surprise medical billing protections took effect in 2022 and restricted what hospitals could charge patients treated by out-of-network providers, particularly in emergencies.
     
    “Basically, they are just competing for market share,” Marthey said.
     
    UF Health has placed its new facilities in suburban areas near freestanding ERs owned by competitors HCA Healthcare and Ascension rather than near its downtown hospital in Jacksonville. It is also building a fourth facility, near The Villages, a large retirement community more than 100 miles south.
    “This has been more of an offensive move to expand our market reach and go into suburban markets,” Wylie said.
     
    Though the three centers are not state-approved to care for trauma patients, doctors there said they can handle almost any emergency, including heart attacks and strokes. Patients needing hospitalization are taken by ambulance to the UF hospital about 20 minutes away. If they need to follow up with a specialist, they’re referred to a UF physician.
     
    “If you fall and sprain your leg and need an X-ray and crutches, you can come here and get charged urgent care,” said Justin Nippert, medical director of two of UF’s combo centers. “But if you break your ankle and need it put back in place it can get treated here, too. It’s a one-stop shop.”

  • 12 Aug 2024 6:40 AM | Matt Zavadsky (Administrator)

    This report on the in-home ‘emergency care’ model cites the average ED cost of $2,700 identified by UnitedHealth Group. This may be a good reference point for EMS agencies who are evaluating the economic savings to payers and patients for avoided ED visits. The report also highlights the ongoing challenges with payment models catching up to clinically innovation and patient centric care delivery.

    ------------------ 

    In-home emergency care cuts costs, but needs more payer buy-in
    Diane Eastabrook
    June 27, 2024
     
    https://www.modernhealthcare.com/providers/emergency-room-care-at-home-growth-challenges
     
    At-home emergency care is gaining momentum — and could cost millions less — but reimbursement challenges create an access barrier for some patients.
     
    Deploying healthcare in patients' homes gained traction during the COVID-19 pandemic as a way to ease overcrowding at hospitals and prevent the virus from spreading. Emergency department care at home lets patients bypass the waiting room through referrals from hospitals or primary care providers if they determine patients do not have life-threatening illnesses or injuries. While many private insurers reimburse for such care, traditional fee-for-service Medicare and Medicaid do not pay for it as a stand-alone service.
     
    Emergency department-at-home programs deploy paramedics or nurses to check vital signs, draw blood and take x-rays with portable imaging devices. Physicians supervise the visits via telehealth, then refer patients to primary care providers for further treatment or to hospital emergency departments if more complex care is needed.
     
    Healthcare technology company Medically Home and primary care provider Atrius Health, a division of UnitedHealth Group's Optum Health, offer emergency department-care-at-home through a partnership in the Boston area. A study they published last week in the New England Journal of Medicine found more than 83% of 3,668 patients who received emergency care at home over two years did not require a trip to the hospital, saving Atrius approximately $4.5 million.
     
    Medically Home launched its service in 2020 and has served approximately 7,000 patients through contracts with three provider groups, including Atrius. The primary care provider has value-based care contracts with most of its patients and takes on the full risk for their care.
     
    Hospital emergency departments are the default care option for many Americans and are expected to account for about 150 million visits this year, according to the Emergency Department Benchmarking Alliance, a nonprofit that represents more than 2,000 emergency departments. They are also the most expensive places to get healthcare. The average emergency department visit costs about $2,700 versus $185 at an urgent care facility, according to UnitedHealth Group’s website.
     
    Companies including Medically Home and Denver-based DispatchHealth see emergency department-at-home as a huge opportunity to save millions of dollars in unnecessary hospital visits.
     
    “Health systems sometimes get overrun and they want to make sure that patients get the right type of care," said Dr. Phil Mitchell, DispatchHealth's chief medical officer. “In some circumstances, they are actually actively looking to decant what comes into their emergency department.”
     
    DispatchHealth launched its emergency department-at-home program in 2015 and has partnerships with 150 health plans, value-based care providers and health systems. The company has provided care to 1.2 million patients in 50 locations across 23 states, according to Mitchell. It wants to bring the service to another seven locations by the end of this year.
     
    Falls Church, Virginia-based Inova Health Systems contracted with DispatchHealth two years ago to treat some patients in their homes. The service helps the hospital free up beds for sicker patients and helps emergency medical assistance teams turnaround ambulances more quickly, said Toni Arabell, Inova Health System’s chief clinical officer of enterprise operations.
     
    New providers are also jumping into at-home emergency care, including Minnesota-based Lifespark, which operates senior living facilities and provides primary care and home health services to about 20,000 older adults in the Minneapolis area. On Tuesday, the company launched an urgent response service that will provide in-home emergency department care to patients enrolled in certain Medicare Advantage plans who live in its communities or receive primary care services from Lifespark.
     
    CEO Joel Theisen said urgent response aims to close care gaps for about 3,000 chronically ill older adults who frequently use hospital emergency departments and can cost Lifespark thousands of dollars per visit.
     
    “The igniter for setting off the bomb of costs is the acute hospital event,” Theisen said. “If you can keep them out of the emergency room, everyone wins big.”
     
    Still, a large cohort of patients covered by traditional fee-for-service Medicare and Medicaid don’t have access to home-based emergency department care because those government programs don't fully cover for the service.
     
    A spokesperson for DispatchHealth said the company is reimbursed for urgent medical services by Medicare and Medicaid, but the programs may not fully cover the cost of care. The company is optimistic traditional Medicare and Medicaid will eventually pay for the entire service, the spokesperson said.
     
    Medically Home plans to continue expanding the emergency department-care-at-home program despite reimbursement gaps, according to Dr. Greg Snyder, the company’s vice president of clinical strategy and quality improvement. But he said getting buy-in from all payers would be helpful.
     
    “We need to be delivering the service innovations that are going to support the home-based care ecosystem and [emergency department]-at-home is one of those things,” Snyder said.

  • 9 Aug 2024 7:09 AM | Matt Zavadsky (Administrator)

    Insider analysis: ‘What truly matters in EMS systems’

    A coalition of EMS organizations advocates for new performance indicators that prioritize effectiveness, safety, satisfaction, equity and efficiency over traditional response times

    August 08, 2024

    The Overrun Podcast & Blog

    What happened: On July 31st, a significant shift in evaluating EMS performance metrics was heralded by the publication of a joint statement from 16 prominent EMS organizations. This initiative involves key players like the American Ambulance Association, the American College of Emergency Physicians and the International Association of EMS Chiefs.

    This diverse coalition seeks to redefine the key performance indicators (KPIs) for EMS systems, emphasizing metrics that are effective, safe, satisfying, equitable and efficient.

    16 EMS groups publish joint statement on EMS performance metrics

    Highlights

    Watch as Ed Bauter, MBA, MHL, NRP, FP-C, CCP-C; and Daniel Schwester, MICP, highlight the significance of this development, including:

    • A move away from response times. Historically, response times have dominated as the primary measure of EMS system quality. However, growing evidence suggests that response times alone do not correlate with improved patient outcomes. The joint statement challenges the long-held belief that faster response times equate to better patient care.
    • Reduced red lights and sirens. The statement draws attention to the inherent risks associated with the use of red lights and sirens, which have been shown to increase the likelihood of collisions by up to 60%. These incidents not only endanger patients and providers but also civilians. The focus now is on using lights and sirens only when they provide a direct, demonstrable benefit to patient outcomes.
    • A nuanced approach to performance metrics. This shift represents a fundamental change in EMS practice, advocating for performance indicators that reflect the quality of care provided, rather than the speed of response. The coalition’s unified stance marks a critical step towards a more comprehensive and patient-centered approach to EMS evaluation.

    As EMS systems nationwide begin to adopt these new metrics, the focus will likely shift towards improving the overall quality and safety of patient care.

    This evolution in performance measurement promises to enhance the effectiveness and reliability of EMS services, ultimately benefiting patients, providers, and communities alike.


  • 31 Jul 2024 11:03 AM | Matt Zavadsky (Administrator)

    EMS is the subject of many current legislative proposals, all of these very favorable for EMS agencies, and the communities they serve. 

    If you would like to support any of these initiatives with a letter to your members of congress, visit: https://naemt.org/advocacy/online-legislative-service#/ 

    Current EMS Economic Legislation

    Treatment In Place (EMS ROCS Act): S.3236 and H.R.6257

    Improving Access to Emergency Medical Services Act: H.R. 8977

    Community Paramedicine Act of 2024: H.R. 8042

    SIREN Reauthorization: S.265 and H.R. 4646

    Medicare Extenders: S.1673 and H.R. 1666

    EMS Counts: S.1115 and H.R. 2574

    VA Emergency Transportation Access Act: S.2757

    ------------------- 

    Medicare patients could get emergency treatment at home under new bill

    The proposal could give 67.2 million Medicare enrollees more flexible treatment choices

    By Jessica Hall

    July 31, 2024

    https://www.marketwatch.com/story/medicare-patients-could-get-emergency-treatment-at-home-under-new-bill-aa394ca3

    A new proposal in Congress would allow older Medicare recipients to receive emergency medical services at home rather than having to be transported to a hospital for care, which could help them avert potential health and financial consequences resulting from a hospital visit.

    The proposal, called the Improving Access to Emergency Medical Services for Seniors Act, would allow people to receive care at home for minor but urgent medical incidents instead of being sent to a hospital, where they risk long waits, hospital-acquired infections and higher costs.

    Under the proposal, a pilot project would be created to demonstrate the financial and medical impact to Medicare of reimbursing paramedics and emergency medical technicians for treating patients in place.

    The bill was introduced by a bipartisan group of representatives, including New York Democrat Pat Ryan, Ohio Republican Mike Carey, Texas Democrat Lloyd Doggett, West Virginia Republican Carol Miller and Michigan Democrat Debbie Dingell.

    "Not every patient is best served by an emergency room visit," Carey said in a joint statement from the lawmakers. "In fact, for many seniors, a trip to the hospital can mean long wait times, increased costs and potentially life-threatening complications."

    The proposal would end a requirement that Medicare patients be transported to emergency healthcare facilities in order for providers to receive reimbursement, thus allowing emergency responders to receive compensation for in-home care they provide. Patients would still be taken to a hospital's emergency department if needed, but under the proposal, they could, when possible, be treated at home.

    People 60 and older account for nearly 20% of all emergency-room visits, according to the Centers for Disease Control and Prevention.

    Patients who received care through treatment-in-place programs had experiences similar to or better than those treated in a hospital, according to a study published in JAMA in 2021. They faced similar mortality risk, a 26% lower hospital readmission risk and a lower risk for admission into a long-term care facility compared with their counterparts treated in hospitals, the study found.

    Medicare is federal health insurance that covers people age 65 and older, as well as some people under 65 who have certain disabilities or medical conditions. As of March 2024, more than 67.2 million people were covered by Medicare or Medicare Advantage programs, according to the Centers for Medicare and Medicaid.

    "Treating patients immediately at home and preventing an emergency room trip is sometimes both the best way to help the patient and the taxpayer," Doggett said in the statement.

    In rural areas, some older people live hours from an emergency room and would benefit from being treated at home by emergency personnel, Miller said.

    "Allowing EMTs to be reimbursed for this care and preventing unnecessary hospital visits would be an immense cost-saver for Medicare, free up emergency room space for those who really need critical care, and improve quality of life for our seniors," Dingell said in the statement.

    The bill has received support from the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians.

  • 30 Jul 2024 4:29 PM | Matt Zavadsky (Administrator)

    COMMUNITY RELEASE: Top EMS Groups Publish Joint Statement on EMS Performance Metrics – Beyond Response Times

    Sixteen national and international EMS, patient safety and public policy associations have partnered on the release of a Joint Statement on EMS Performance Metrics – Beyond Response Times.

    The joint statement encourages EMS systems and community leaders to implement an approach to EMS system performance that prioritizes patient-centered care and uses a broad, balanced set of clinical, safety, experiential, equity, operational, and financial measures to evaluate the effectiveness of EMS systems.

    The endorsing associations include:

    • Academy of International Mobile Healthcare Integration

    • American Ambulance Association
    • American College of Emergency Physicians
    • American College of Surgeons – Committee on Trauma
    • American Paramedic Association
    • Center for Patient Safety
    • International Academies of Emergency Dispatch
    • International Association of EMS Chiefs
    • International City/County Management Association
    • National Association of EMS Physicians
    • National Association of Emergency Medical Technicians
    • National Association of State EMS Officials
    • National EMS Management Association
    • National EMS Quality Alliance
    • National Volunteer Fire Council
    • Paramedic Chiefs of Canada

    These associations recommend that local communities and governments modernize the assessment of the performance of their EMS systems/agencies by evaluating a broad array of domains with key performance indicators (KPIs) that can be measured and trended over time, and whenever possible, benchmarked with comparable EMS systems, or other national data, and published to local community stakeholders on a regular basis.

    “Historically, response time performance has been the primary measure used to assess the quality of an EMS system. However, response times have not generally been associated with improved patient outcomes in the growing body of EMS evidence and research, and the reliance on response time performance prevents communities from evaluating other EMS system quality measures that have greater significance for patient care and outcomes”, states Dr. Doug Kupas, the primary author of the Joint Statement.

    Matt Zavadsky, one of the contributing authors of the statement adds “This Joint Statement is the second major collaboration for most of these national and international associations, representing a significant coalescence of these associations, including public policy makers, to help assure that evidence-based clinical, operational, experiential and financial measures are used to more appropriately evaluate system performance.” 

    The prior Joint Position Statement from these groups encouraged EMS agencies to reduce lights and siren responses to improve community and patient safety.

    The Joint Statement includes the domains that should be used when evaluating an EMS system/agency including:

    • EffectiveIs the health care provided clinically appropriate and high quality?

    • Safe: Are services being provided in a way that is clinically and operationally safe for patients, responders, and the community?
    • Satisfying: How do patients and EMS clinicians feel about the service being provided?
    • Equitable:  Is the system providing care that is equitable based on patient demographics and service area geography?
    • Efficient:  Is this service being provided in a way that maximizes the use of economic and operational resources?

    The participating associations emphasize that it is essential for government and community leaders and decision-makers to consider all elements of the EMS system from the moment a 9-1-1 call is made to the conclusion of care by the EMS system/agency. 

    By considering these additional performance measures, local communities can gain a more comprehensive understanding of the effectiveness of their EMS system/agency, identify areas for improvement in patient care, system efficiency, and overall emergency response capabilities.

    The Joint Statement on EMS Performance Metrics – Beyond Response Times can be found here: https://doi.org/10.1080/10903127.2024.2375739

    A PDF of the document can be downloaded here:

    Kupas - Zavadsky - with Logos - Joint Statement on EMS Performance Measures Beyond Response Times - FINAL Approved by Named Associations CLEAN 4-30-24.pdf

    A resource guide for effective evaluation of EMS systems can be downloaded here:

    References-Resources on EMS Performance Measures _ Beyond Response Times FINAL 2-15-24.pdf


     


  • 30 Jul 2024 9:13 AM | Matt Zavadsky (Administrator)

    Interesting insight from a former elected official in Manitoba, Canada

    Although the context is Canadian, the issue is very similar in many U.S. communities.

    Thankfully, elected and appointed officials, and brave EMS agency leaders, are appropriately driving EMS delivery changes, using evidence-based research to 'right-size' response plans for low-acuity calls, deploying ALS, BLS, CIT and community paramedic units to low-acuity calls, and preserving valuable medical first response resources for high-acuity calls by assuring they are NOT on low-acuity calls.

    -------------- 

    Firefighters need to focus on core jobs

    By: Rochelle Squires

    Jul. 30, 2024

    https://www.winnipegfreepress.com/opinion/analysis/2024/07/30/firefighters-need-to-focus-on-core-jobs

    It takes an average of six minutes for a house to become engulfed in flames. Not every house, of course. Depending on the building materials and contents inside, it may burn slower or faster, with newer builds typically experiencing structural failure quicker than a house made of traditional lumber. In those instances, especially, if firefighters aren’t on the scene immediately, it takes almost no time for it to collapse and burn to the ground.

    Thankfully, there’s a fire department nearby. Not just in my south St. Vital neighbourhood where I am three minutes away from a station, but in every community throughout the city.

    I’ve had to call 911 exactly two times in my life, both for a loved one’s emergent medical crisis that was thankfully rectified, one with a hospital visit and one without. Of course, as anyone who has ever called 911 knows, it’s not usually the paramedics in an ambulance that arrive first, but a fire engine and four firefighters with at least one dually trained as a paramedic.

    Yet having a fire hall close by does not always guarantee a fast response for a fire or medical emergency.

    Consider this: the Winnipeg Fire Paramedic Services is one of the busiest departments in North America on a per capita basis, surpassing cities like Detroit, Chicago and Los Angeles, yet resources have not kept pace.

    In the Canadian context, the WFPS nearly quadruples fire calls in places like Toronto and Calgary. Further, Winnipeg’s firefighters battle more fires of significance than any other jurisdiction, meaning Winnipeg has a greater frequency of big fires that take more than an hour to fight and require multiple apparatus on scene.

    This alone should be a substantial part of any firefighter’s job. Yet ask anyone working in the department today and they’ll undoubtedly tell you that a significant part of the job nowadays is also doing things they weren’t trained to do and don’t always have the capacity for, causing incredible strain on the service and its members.

    Put bluntly, today’s firefighters spend countless hours attending non-emergent calls where there is no fire or safety hazard present.

    Almost a daily occurrence now, firefighters provide well-being checks for people who are not experiencing medical emergencies and respond to mental health crises. It’s also not uncommon for them to get sent to scenes because someone is acting aggressively or belligerent, are expected to intervene in incidents of vandalism and other criminal activity, and even get involved in domestic violence situations.

    Undoubtedly, in most of the above-mentioned cases, intervention is necessary. But surely there’s got to be a better response to non-emergent situations than sending fire apparatus and a team of firefighters. Not only is it creating workload issues, fatigue and burnout, it’s putting us in danger.

    That’s because non-emergent calls routinely tie up emergency resources to the point of creating vulnerabilities or gaps in service. It is a growing concern that in any given week, there are moments when resources are unavailable, and if a catastrophe or a major blaze erupts, there’ll be a delay in the arrival of life-saving resources.

    In other words, if my house caught on fire and there was six minutes on the clock before it became fully engulfed, even though I’m only three minutes from a fire hall, resources may not arrive in time.

    So what needs to be done?

    The province has stepped up in a few ways, including a $20 million boost to ambulance funding by my former government, and the current government deserves kudos for providing new funding for 40 more firefighters.

    Yet additional cash isn’t the sole answer when the system needs a reboot.

    For starters, empowering dispatch resources to find alternate responses for non-emergent situations is worth looking at. Yes, it’s complex. People calling 911 deserve to be treated first with an assumption there is an emergency. But when it is clear that there is no emergency, what then? Alternatives to sending a battalion of fire resources should be considered, including an expansion of the community paramedic program where personnel are trained to handle some of the aforementioned calls.

    Firefighters also spend countless hours sitting with stable patients waiting to go to hospital. Expanding transportation options would also go a long way in ensuring life-saving resources are available when most needed, and firefighters should have the ability to disengage and be made available for prioritized emergencies.

    As stated before, it’s a complex problem needing a comprehensive solution. But nothing is more complex than waiting on help in a time of emergency.

    Rochelle Squires is a recovering politician after 7 1/2 years in the Manitoba legislature. She is a political and social commentator whose column appears Tuesdays. rochelle@rochellesquires.ca



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