“EMS is available in every community, EMS is fully mobile, EMS can address patient needs 24/7, and EMS is expected, respected and welcomed.”

With these words Matt Zavadsky, chief strategic integration officer for Texas’ MedStar Mobile Healthcare, kicked off the 2017 EMS 3.0 Transformation Summit on April 24 in Arlington, VA. Zavadsky continued his long-standing advocacy and leadership with words of inspiration for those looking to move EMS toward an outcomes-based healthcare economy.

Various major national players in mobile integrated healthcare and community paramedicine took the stage at this event, offering best-practice advice and motivating the eager EMS audience to continue to strive for what the National Association of EMTs (NAEMT) calls “EMS 3.0.”

NAEMT defines EMS 3.0 as a way to “contribute to our nation’s healthcare transformation by filling gaps in the care continuum with 24/7 medical resources that improve the patient care experience, improve population health and reduce healthcare costs” (the Institute for Healthcare Improvement’s Triple Aim).

Aligning the Incentives
A major reform thrust discussed this year is changing EMS’s billing status from “supplier” to “provider” so home visits and other MIH services can be compensated. Many summit attendees participated in the EMS On The Hill event the following day, walking miles and miles of the U.S. Capitol building to visit lawmakers and press for the cause. Currently most insurance rules only allow billing for transporting patients.

“This is a misaligned incentive,” said Zavadsky. “Right now EMS is a ‘transportation’ benefit, not a medical benefit.”

MIH data geeks, policy wonks and transformational leaders like Zavadsky gave updates on the progress of many of the country’s earliest MIH adopters: MedStar, San Diego Fire-Rescue’s (SDFR) Resource Access Program and Reno’s Regional Emergency Medical Authority (REMSA).

Bradford Lee, MD, REMSA’s medical director, presented impressive results from his agency’s 2012 $9.9 million CMS Innovation grant. REMSA mined its data and found that 953 unique individuals were costing the system $65 million in EMS services. Upon receiving the grant REMSA instituted a number of MIH components, such as a nurse health line, alternative-destination transport and community paramedic (CP) home visits for patients discharged from the hospital. So far, REMSA has reduced its readmission rate for CHF patients to 12% versus the 25% national rate.

REMSA CPs enroll discharged patients as they leave the hospital. “Our community paramedics provide follow-up for 30 days, medical care plan adherence, medication reconciliation, point-of-care lab tests and personal health literacy,” Lee said.

While it’s impressive how these new initiatives have driven down costs, Lee stressed that what’s more important is that REMSA had no adverse events and very high patient satisfaction.

In California state officials issued waivers to various EMS agencies in June 2015 to test various CP concepts. The agencies have instituted MIH programs in discharge follow-up, frequent-user reduction, tuberculosis therapy, home hospice and alternative-destination transports. These results are also promising, showing no adverse outcomes, improved patient safety and large decreases in avoidable ED visits.

“Our data collection and results reporting on these programs is helping move the programs faster through the state,” said Cynthia Wides, who works at University of California, San Francisco (UCSF) as a Healthforce Center researcher alongside Janet Coffman, PhD, the principal investigator tracking California’s programs.

Satisfied Customers
With many speakers displaying high marks from patient satisfaction metrics, it is clear the move to EMS 3.0 is working. CMS is already basing some of its reimbursements on patient surveys, and Zavadsky stressed that EMS must work on adopting pay-for-performance and value-based purchasing reimbursements linked to clinical outcomes.

Theories that paramedics aren’t highly trained enough or that the only safe destination for patients is the hospital were also debunked. Mark Conrad Fivaz, MD, who chairs the Council of Standards for Emergency Nurse Triage at the International Academy of Emergency Dispatch (IAED), detailed the elements of nurse triage at the dispatch level. Fivaz presented statistics that show striking increases in 9-1-1 call demand in most major U.S. cities. He said nurse triage can be a solution for this “supply and demand mismatch.”

“You need clinical governance of these systems, with clinically sound medical protocols,” said Fivaz. “There should be a trained RN housed in a PSAP with medical oversight.”

These nurses provide an appropriate, safe resource to many 9-1-1 callers. MedStar surveyed patients who used its 9-1-1 nurse triage and found a 90% satisfaction rate. MedStar also recently announced a partnership with Lyft, the ride-hailing service. Zavadsky explained that MedStar’s nurse triage line uses Lyft when appropriate, and that his company is pleased with Lyft’s driver screening process, liability provisions and the ability for the dispatcher to follow the progress of the Lyft car once a patient is picked up.

Another common theme was the importance of gathering good data, analyzing it to determine gaps, and then using it to evaluate a program’s success. Paramedic Anne Jensen, Resource Access Program manager at SDFR, showed the success of her city’s data collection and analysis efforts but stressed that they always strive for more.

“Integrated healthcare needs data management methods to meet patient needs,” she said. “But we are not yet all the way there.”

SDFR’s Street Sense program is an alerting system and has a robust, bidirectional health information exchange with various community partners. Jensen has made sure the software program collects and disseminates data fast enough so providers are informed in a timely manner, not after the chance to intervene has passed.

Stacy Elmer, Kaiser Permanente’s director of medical device integration and special programs, recounted similar efforts at appropriate data analysis within her company. Kaiser was deliberate in its process to address patient needs. Elmer detailed the process of trying to gather the hospital leaders, formulate a working group, pull the necessary data and then decide on what program to launch.

“You have to be able to ask, ‘What is the problem?’ first,” Elmer advised the audience. “To do so, make sure you look at the right data and consider which patient groups have the best chance of success in an MIH program.”

Utilize Your Opportunities
Clearly many of the summit speakers have the staying power to not give up in the quest to transform EMS. Zavadsky noted that reforms take a long time but are worth it. He ended the summit with an inspirational call to action for the audience to continue lobbying, especially at the state level, where reforms can happen more quickly.

“Some of us in this room have been lobbying Congress since when we still had hair, and very little has happened,” he said. “Utilize all the opportunities you have to advocate how EMS 3.0 supports the healthcare transformation.”

Original article can be accessed here.