News & Updates

Below is a report on Medicare’s Acute Hospital Care at Home Program. This program was implemented during the public health emergency and has been extended by Congress.

Of interest to EMS, is the inclusion of visits by ‘mobile integrated health paramedics’ in the eligible provider list, and some EMS agencies are partnering with AHCAH providers, with reimbursement to the EMS agency.

https://www.cms.gov/files/document/covid-acute-hospital-care-home-program-approved-list-hospitals.pdf

From the CMS announcement in 2020:

The Acute Hospital Care at Home program is an expansion of the CMS Hospital Without Walls initiative launched in March 2020 as a part of a comprehensive effort to increase hospital capacity, maximize resources, and combat COVID-19 to keep Americans safe.

This program creates additional flexibility that allows for certain health care services to be provided outside of a traditional hospital setting and within a patient’s home. There are several requirements that a hospital must meet in order to participate in the program.

These include:

• Having appropriate screening protocols in place before care at home begins to assess both medical and non-medical factors
• Having a physician or advanced practice provider evaluate each patient daily either in-person or remotely
• Having a registered nurse evaluate each patient once daily either in-person or remotely
• Having two in-person visits daily by either registered nurses or mobile integrated health paramedics based on the patient’s nursing plan and hospital policies
• Having the capability of immediate, on-demand remote audio connection with an Acute Hospital Care at Home team member who can immediately connect either an RN or MD to the patient
• Having the ability to respond to a decompensating patient within 30 minutes
• Tracking several patient safety metrics with weekly or monthly reporting, depending on the hospital’s prior experience level
• Establishing a local safety committee to review patient safety data

The report below illustrates the clinical and financial outcomes of the initiative. It seems the Acute Hospital Care at Home (AHCAH) program is resulting in some positive outcomes, which could result in this model becoming permanent. It may help provide additional economic stability for EMS based MIH programs.

Lessons from CMS’ Acute Hospital Care at Home Initiative

Danielle N. Adams, RN, BSN, MSN, Ashby J. Wolfe, MD, MPP, MPH, Jessica M. Warren, RN, BSN, MA, and Dora L. Hughes, MD, MPH,

December 2024

https://www.cms.gov/blog/lessons-cms-acute-hospital-care-home-initiative

The COVID-19 public health emergency (PHE) challenged hospital bed capacity severely limiting access to critical medical services in patients’ time of need. In response, the Centers for Medicare & Medicaid Services (CMS) collaborated with outside experts to develop what ultimately became the Acute Hospital Care at Home (AHCAH) initiative, which is set to expire on December 31, 2024, unless Congress takes action to extend it. After three years of implementation experience, early lessons on quality, cost, and care experiences have begun to inform the future of CMS’ program and related efforts in the field.

CMS launched the “Hospital Without Walls” initiative in March 2020, using authorities under section 1135 of the Social Security Act permits the Secretary of Health and Human Services to waive or modify certain facility standards during PHEs, such as the COVID-19 PHE.[1]

Building upon this initiative, CMS began the AHCAH initiative in November 2020, which allowed acute care hospitals that are paid under the inpatient prospective payment system to expand their delivery of inpatient care into patients’ homes.

The waivers supporting AHCAH include waivers of certain Medicare Hospital Conditions of Participation (CoPs), which are established in federal regulations.[2] These waived CoPs require nursing services to be provided on premises 24 hours a day, seven days a week, and the immediate on-premises availability of a registered nurse for the care of any patient. In addition, the Secretary waived the hospital “physical environment” and “Life Safety Code” requirements, including requirements for fire safety protection standards in a facility meeting healthcare occupancy standards. However, hospitals providing care in patients’ homes were and are still required to meet most health and safety requirements, even in the patient’s home, as well as requirements under various quality reporting programs, which collectively maintain guardrails for patient safety and quality that have long been the standard for inpatient care.   

To participate in the AHCAH initiative, hospitals are required to submit a waiver request through a dedicated CMS portal. Following review, CMS meets with each requesting hospital to assess whether it can provide high-quality and safe care in home settings, compliant with the Medicare Hospital CoPs. Once approved, hospitals can begin admitting eligible patients to their homes for inpatient care. As of October 2024, 366 hospitals have participated in the AHCAH initiative, serving over 31,000 patients in home settings.

The AHCAH initiative would have ended with the termination of the COVID-19 PHE. However, in December 2022, Congress passed the Consolidated Appropriations Act (CAA), 2023, which extended the AHCAH initiative through December 31, 2024.[3] The CAA, 2023, also required CMS to conduct a study to evaluate several aspects of the AHCAH initiative.  The Report on the Study of the AHCAH Initiative was published on September 30, 2024, and describes early lessons on quality, patient experience, and cost of care.[4]

The study used the best available quantitative and qualitative data to compare AHCAH patients and brick-and-mortar hospital inpatients served by 332 participating hospitals across 38 states from November 2020 through July 2024. Data analysis focused on patient inclusion criteria and demographics, clinical conditions treated, quality of care, cost and utilization of services, and experience of care.

Patient Demographics

Patient inclusion criteria were developed by each hospital, based on the hospital’s experience and resource capabilities to provide inpatient-level care in the home environment and informed by nationally recognized criteria.[5] Specific patient selection criteria included clinical and psychosocial factors, home environment, and willingness to participate.

In an analysis of demographic characteristics, statistically significant differences were found between AHCAH patients and brick-and-mortar inpatients receiving services from the same hospital. AHCAH patients were more likely to be white and live in an urban location, while less likely to be Medicaid beneficiaries.

Quality of Care Comparison

Using the Medicare Severity Diagnosis Related Group (MS-DRG) and Major Diagnostic Category (MDC) classification systems, the study found that the most common illnesses treated through the AHCAH initiative were respiratory (36%), circulatory (16%), renal (16%), and infectious diseases (12%).

Three different quality metrics were calculated for quality-of-care comparisons: 30-day mortality rates; 30-day readmission rates; and hospital-acquired condition rates. CMS analysis found that AHCAH beneficiaries generally had a lower 30-day mortality rate than their brick-and-mortar inpatient counterparts.

Regarding the 30-day readmissions metric, findings from the CMS study demonstrated differences between the AHCAH and inpatient comparison groups for half of the conditions. Readmission rates were significantly higher in the AHCAH group for two MS-DRGs (177-Respiratory infections and inflammation with mucociliary clearance (MCC) and 871-Septicemia or severe sepsis without mechanical ventilation > 96 hours with MCC) but significantly lower for three other MS-DRGs (194- Simple pneumonia and pleurisy with complication or comorbidity (CC), 195-Simple pneumonia and pleurisy without CC/MCC, and  191-Chronic obstructive pulmonary disease with CC). See Table 1.

Regarding cost, CMS evaluated the impacts on Medicare program spending rather than costs to individual hospitals participating in AHCAH. The episodes of care from inpatient admission to discharge showed that AHCAH episodes had on average, less than one day longer length of stay but AHCAH beneficiaries accounted for significantly lower Medicare spending in the 30 days after discharge. Specifically, Medicare spending was approximately 20% less for most of the top 25 MS-DRGs in the AHCAH group, as shown in Table 2. However, the differences in clinical complexity across the two groups make it difficult to conclude definitively that the AHCAH initiative resulted in lower Medicare spending overall.

Patient Experience

Qualitative data on the patient experience under AHCAH was collected through listening sessions, site visits, and anecdotal feedback through informal interviews with caregivers. Findings suggest that patients and caregivers who provided feedback had positive experiences with the care provided through the AHCAH initiative, which is broadly consistent with patient experience outcomes with Hospital at Home programs.

This is one example of the experience of a patient who received inpatient care in the home under the AHCAH initiative in 2022:

“I have chronic lymphocytic leukemia and had recently started treatment. They advised me to drink between 4-5 liters of water every day to avoid tumor lysis syndrome, which I did. After a couple of days, I started to feel sick and went to the emergency department. I was found to have severe hyponatremia and admitted to the hospital. With water deprivation, my sodium level began to return to normal; however, I started to have renal insufficiency, which was attributed to the reduced water intake. My doctor felt that I needed to stay hospitalized until my lab stabilized. It was at that point that I was asked if I was interested in a new federal program that would allow me get hospital level care in my home. I agreed to try it out and was transported home by ambulance. They installed a Wi-Fi phone system with a direct line to nursing and primary care staff. An iPad with wireless connectivity was set up to record my vital signs, fluid balance, and facilitate teleconference calls.  A 24-hour telephone line was established for support as well. In addition, a nurse came twice a day to assess my condition and collect blood samples. In my opinion, I received the same level of care at home as I did in the hospital, and it was much more comfortable. I was much happier to be at home. It is always better to be at home than in a hospital if you have the choice.”

Feedback from clinicians who participated in AHCAH reflected mostly positive experiences.

Limitations

The AHCAH study provided preliminary, time-limited comparisons, and did not evaluate the long-term efficacy or financial viability of this care delivery and payment model. Additional limitations of this study included the inability to conduct a rigorously controlled study comparing AHCAH and brick-and-mortar hospital patients; difficulty analyzing Medicaid data; and lack of standardized inclusion criteria for each hospital or detailed cost information. Future studies are needed to make definitive conclusions about the impact of the AHCAH initiative. 

Conclusion

The mission of the CMS Center for Clinical Standards and Quality (CCSQ) is to improve lives, health outcomes, and care experiences by advancing quality, safety, and equity. Early lessons from the AHCAH initiative suggest that providers can deliver safe, quality inpatient care in home settings for appropriately selected patients, aligned with and helping to advance CCSQ’s core mission.

With the AHCAH initiative set to expire on December 31, 2024, important questions remain, and CMS is exploring opportunities to answer these questions should the program be extended. One such opportunity pertains to the inclusion of additional measures of cost, including costs to individual hospitals, as well as additional measures of quality and utilization. A second opportunity relates to the homogeneity of the current AHCAH patient participants, CMS is considering ways to work with hospitals to diversify patient populations receiving care through AHCAH, particularly lower-income and rural populations.

Lastly, CMS has begun to engage in greater outreach and educational efforts for the AHCAH community and the hospital community at large. These efforts include sharing technical assistance on the use of technology and its integration in home settings, resource and funding needs for hospital participants, training requirements for the range of clinicians providing care, and optimizing support for patients and caregivers.

The CMS AHCAH initiative was created in a time of crisis. CMS will continue to study and share findings regarding AHCAH outcomes and costs, which will be needed for program sustainability in the long term if this initiative is extended.

 

[1] 42 U.S. Code § 1320b–5 - Authority to waive requirements during national emergencies. Accessed June 25, 2024. https://www.law.cornell.edu/uscode/text/42/1320b-5.

[2] 42 CFR 482.23(b) and (b)(1) of the SSA

[3] Section 4140 of the Consolidated Appropriations Act, 2023 (CAA, 2023) (Public Law 117-328)

[4] Report on the Study of the Acute Hospital Care at Home Initiative. September 30, 2024. https://qualitynet.cms.gov/acute-hospital-care-at-home/reports

[5] Clarke DV , Newsam J , Olson DP , Adams D , Wolfe AJ , Fleisher LA . Acute hospital care at home: the CMS waiver experience. NEJM Catalyst. Published online December 7, 2021.

https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0338

Medic, Charlotte Fire agree to 6-month contract extension for EMS care: What to know

By Luke Tucker

Jan. 7, 2025

https://www.wbtv.com/2025/01/07/medic-charlotte-fire-agree-6-month-contract-extension-ems-care-what-know/

CHARLOTTE, N.C. (WBTV) - The Charlotte Fire Department and Medic reached a six-month contract extension while the two sides work to reach a longer-term agreement on EMS protocol, officials said.

The extension is not a new contract, but rather a memorandum of understanding that prolongs the current contract for another six months. The contract was previously set to expire on Thursday, Jan. 9.

With the contract extension, both sides can work out a new agreement that addresses one of the central issues between the groups: Medic’s protocol.

Medic, which is Mecklenburg County’s paramedic agency, implemented a new protocol within the past few years that gave it 30 minutes to respond to non life-threatening EMS calls. In many cases, fire trucks would be the first to arrive at those calls.

Charlotte Fire claims that Medic ambulances would sometimes not show up for well over its half-hour limit. The fire department claimed that the slow response left firefighters waiting and doing more work -- and not being properly reimbursed for it.

A growing city population and number of calls added to the work for Charlotte Fire, officials said.

Charlotte Councilwoman Dr. Victoria Watlington said that last year, conversations regarding a new contract “fell flat.” However, as city leaders began working toward a new agreement more recently, she said dialogue has been “much more smooth and much more quick.”

Watlington said she hopes that the seemingly-improved communication can lead to a longer-term contract. Charlotte Fire said Tuesday that both sides are collaborating and will meet monthly to “monitor progress, evaluate operations, and address emerging needs as they arise.”

“What we’re hearing from our fire department is that there is an opportunity to reset the agreement and reset the pay scale to make sure that what we are providing in terms of resourcing is sufficiently covered through the budget,” Watlington said.

Earlier in the week, Medic said in a statement that as it works toward a new, more permanent deal, “any proposed changes to the contract need to be carefully studied by Medic’s Medical Director and Medical Control Board to ensure that the EMS System’s standard of care is not adversely impacted.”

Charlotte Fire said the existing contract, which has now been temporarily extended, gave it the “authority and medical oversight” to respond to emergency medical calls. Had the contract expired, the department said it would have no longer been “legally authorized to respond to such calls.”

Following Tuesday’s six-month extension between the two agencies, Medic said it “will provide the time necessary to redefine the role that CFD plays as a First Responder in the EMS System.”

This is one approach…

The referenced HB 1365 was enacted in April 2023 – wonder how many communities have acted to fund EMS under the law?

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North Dakota lawmakers consider bill to prevent abrupt ambulance service closures

By: Michael Achterling 

January 8, 2025 

https://northdakotamonitor.com/2025/01/08/north-dakota-lawmakers-consider-bill-to-prevent-abrupt-ambulance-service-closures/

A bill addressing distressed ambulance services aims to give North Dakota communities a safety net before EMS companies abruptly close.

Senate Bill 2033 would require ambulance services that are failing to meet state or federal regulations or are at risk of closing within 60 days to comply with a new program administered through the Department of Health and Human Services.

A survey sent to North Dakota ambulance service providers showed about 30 may close in the next five years, Adam Parker, chair of the advocacy committee for the North Dakota EMS Association, told the Senate Human Services Committee Wednesday. 

“When an ambulance fails, that jeopardizes the community, as well as stresses the neighbors,” Parker said. 

The program would lay out procedures for HHS to create an improvement plan with the struggling ambulance services and inform local medical directors and local subdivisions of the issues. It also creates a coordinator position under HHS to manage the program, expected to cost about $210,000 during the 2025-27 biennium and $218,000 in the 2027-29 budget.

The program would require both HHS and the ambulance provider to sign off on an improvement plan that would be presented to local residents before going into effect.

Rep. Robin Weisz, R-Hurdsfield, testified in favor of the bill.

“It’s a tool to make sure we don’t all of a sudden reach a crisis situation,” Weisz said. 

He added he would advocate for additional funding for rural ambulance services, though the bill does not include that funding.

“For someone in a rural area, when I do something stupid, which I do occasionally … I want somebody to show up,” Weisz said. “I don’t want to sit there and wait for 30 minutes hoping somebody comes while I’m bleeding out, or whatever. And I want somebody who knows what they are doing.”

Committee members voted 5-1 to give the bill a “do pass” recommendation.

“There hasn’t been a process to require some communication and I think that’s sometimes just critical,” said Sen. Judy Lee, R-West Fargo, chair of the Senate Human Services Committee.

During the 2023 legislative session, House Bill 1365 created districts for rural ambulance services with an oversight board that would be in charge of crafting an EMS plan for its area and raising local taxes to cover the costs of the service. But, Parker said that bill didn’t address potential closures.

Parker said the goal of the new bill is to force a dialog between the provider and the state and to come up with a plan to leave reliable emergency services in place. If ambulance service providers fail to respond or participate in the new HHS program, the state could revoke its EMS license.

The sole member of the committee to vote against the bill, Sen. David Clemens, R-West Fargo, said he didn’t think the state should be involved in another program at HHS when the issue could be best resolved at the local level.

“If people are becoming concerned about their ambulance service then I think it’s their responsibility to go to their county, county commissioners, and say, ‘Look, we’ve got to have this fixed,’ and I think they are capable of fixing it,” Clemens said.

The bill will now move to the Senate Appropriations Committee to be considered as a part of the larger HHS budget.

Enhancing Fire Response: How Medical Dispatchers Elevate Care and Service for the Community

January 2, 2025

By Shannon Popovich, JD, CMCP

https://www.jems.com/exclusives/medical-dispatchers-elevate-care-and-service/

As the exclusive ground emergency medical services provider for Washoe County, Nevada, REMSA Health has provided emergency medical services for the community for more than 38 years. As the community has expanded and evolved, REMSA Health has enhanced its services to provide the best care for patients when they need it most––and our philosophy is that care starts with the call.

REMSA Health’s Regional Emergency Communications Center answered nearly 94,000 emergency calls in 2023. As trained EMTs or paramedics, our center’s 24 full-time medical dispatchers are truly the “first” first responders and are highly skilled in providing critical and life-saving care over the phone while collecting information for the clinical care providers who will arrive on the scene.

In 2021, our dispatch team’s role expanded and we began dispatching fire and medical resources for Truckee Meadows Fire Protection District (TMFPD) through a public-private partnership. REMSA Health dispatches approximately 1,800 fire-related emergency calls for TMFPD annually.

Doubling the Dispatcher’s Skillset – Pursuing Accreditation for Emergency Fire Dispatch

In 2024, the Communications Center team earned the designation of Emergency Fire Dispatch (EFD) Accredited Center of Excellence (ACE) from the International Academies of Emergency Dispatch (IAED) further expanding REMSA Health dispatchers’ advanced skillset.

Pursuing accreditation for EFD bolstered our dispatch team’s skillset and strengthened our partnership with TMFPD. During the accreditation process, we worked through approximately 300 fire response configurations. Our dispatchers identified areas for improvement and created a training plan to address knowledge gaps.

The accreditation process also involved REMSA Health’s clinical quality department. Our quality assurance coordinators, who already hold specialized emergency medical dispatch (EMD) and EMD Quality Assurance Coordinator certifications, also took EFD Quality Assurance Coordinator courses to perfect their EFD call-response skills. Our quality assurance coordinators were required to earn their EFD quality certification.

Serving a geographically-challenging area

Washoe County is a beautiful place to live and recreate where residents enjoy views of the Sierra Nevada mountains, trees and foliage that change with the seasons and several accessible outdoor activities. While the landscape is breathtaking, it is incredibly varied and it can be challenging.

The county spans several elevations, experiences varying weather patterns and includes densely populated areas dotted by expanses of public lands with open terrain and rugged landscapes, creating obstacles for first responders when fighting fires. Our dispatchers have to be at the top of their game to dispatch fire calls that can come from any corner of our diverse county.

Additionally, our region of northern Nevada is susceptible to wildland fires that occur in remote areas, as well as in proximity to residential developments. To ensure readiness, our team collaborates with the TMFPD’s wildland division to prepare for fire season.

All team members complete an annual two-part training that educates them on what to expect during a wildfire, who to call, what resources are available to dispatch to the scene and how to understand weather predictions.

The wildfire training provided a critical base of knowledge for our dispatchers ahead of 2024’s wildfire season. Our dispatchers proved ready for wildland season with the recent Davis Fire that burned nearly 6,000 acres across southern portions of Washoe County and neighboring areas.

As our TMFPD partners and other co-response agencies worked to contain the fire, our Communications Center continued to answer and triage calls across the county. While working at our highest proficiency to serve the firefighters during a growing wildland fire, we also continue to provide exceptional care to new incoming medical and fire calls.

As fires grow, so do our call volumes. Additional staffing in the communications center is needed during these large incidents to support the influx of calls, as well as continue to support the day-to-day 911 calls and run communications for the fire’s incident command.

Our dispatchers intake calls about the wildfire and communicate pertinent updates from the community to the responders on scene to ensure they are responding to all the hot spots and protecting residential structures.

Continuous Training and Improvement for Fire Dispatch

REMSA Health’s dispatchers are required to understand fire dispatching terminology, firefighting tactics and fire response configurations. This extensive and specialized training ensures they have a comprehensive understanding of what’s happening on the scene, how to anticipate the needs of the responders and are equipped to efficiently support firefighters.

Additionally, new dispatchers are required to be EMD- and EFD-certified and undergo a 16-week immersion-style training program to further enhance their medical, fire, and ambulance dispatch knowledge.

Our dispatchers are also required to complete fire ride-alongs so they can visualize what the firefighters do at the station, enroute to a call, while onscene, and after the call is complete. This gives them the chance to fully understand what happens in the field and to build relationships with the responders.

We give our dispatchers several opportunities to “hear it, learn it, do it,” utilizing simulations in a collaborative educational environment so trainees can make mistakes and correct them before they begin answering live 9-1-1 calls.

REMSA Health works with fire department leaders to conduct After Action Reviews for complex fire calls. The reviews outline successes and points of improvement, providing essential feedback for continuous improvement and maintaining high quality dispatch standards.

Becoming dually accredited to effectively dispatch for medical and fire emergencies was a years-long process for our Communications Center team. But the endeavor is worthwhile as we continue to streamline our community’s resources and work to ensure the closest most appropriate and available resource is sent to the scene.

Accreditation also ensures we continue to surpass the standard of medical and fire dispatching due to the 3rd party review of our performance.

The fire dispatch training, accreditation and commitment to continuous improvement has advanced our team’s dedication to excellence and has built a respectful, productive relationship with our co-responder agencies that benefits the citizens we serve.

About the Author

Shannon Popovich is the director of REMSA Health’s Regional Emergency Communications Center.

 

Interesting to have this ‘quantified’, although not terribly groundbreaking…

Somewhat surprised that only 7-8% of the respondents indicated they were likely to LEAVE EMS in 12 months? Thought it would have been higher than that…

Notable finding that EMTs and paramedics with associate or bachelor’s degrees indicated higher propensity of leaving the profession.

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Factors Associated With Emergency Medical Clinicians Leaving EMS

Christopher B. Gage, Christine B. Cooke, Jonathan R. Powell, Jacob C. Kamholz, Jordan D. Kurth, Shea van den Bergh & Ashish R. Panchal

Received 05 Oct 2024, Accepted 18 Nov 2024, Published online: 13 Dec 2024

PREHOSPITAL EMERGENCY CARE https://doi.org/10.1080/10903127.2024.2436047

https://www.tandfonline.com/doi/full/10.1080/10903127.2024.2436047#d1e255

Abstract -

Objectives:

Many United States (U.S.) communities face challenges with Emergency Medical Services (EMS) workforce turnover. The demands created by the pandemic have worsened the stressors EMS clinicians face, possibly changing the drivers of workforce turnover. Our study aims to understand the factors associated with Emergency Medical Technicians (EMTs) and paramedics’ likelihood of leaving EMS.

Methods:

We conducted a cross-sectional analysis of nationally registered civilian EMTs and paramedics ages 18–85 from October 2021 to April 2022. After recertifying their National EMS certification, respondents were invited to complete a survey regarding their primary role, additional jobs, and the likelihood of leaving EMS in the next 12 months. If likely to leave, reasons for leaving were collected and evaluated for the top reasons. Multivariable logistic regression modeling (OR, 95% CI) was used to describe the odds of being likely to leave in 12 months, adjusted for age, agency type, education level, primary role, and job satisfaction.

Results:

A total of 29,671 (response rate-25.9%) EMTs and paramedics were included in the analysis, with 7.1% and 7.9%, respectively, reporting they were likely to leave EMS in 12 months. The EMTs likely to leave were younger (median age 32 vs. 37) and had fewer years with main EMS job (median 3 vs. 4) than paramedics. A lower proportion of EMTs were male (68.8% vs. 78.6%) and non-Hispanic White (79.8% vs. 87.6%). The EMTs were less likely full-time (65.6% vs. 87.5%) and held fewer EMS jobs (23.4% vs. 32.3%). The EMTs and paramedics reported stress as the most significant reason for leaving (27.9% and 38.8%, respectively), followed by COVID-19 (12.9% and19.3%) and education (18.3% and 6.4%). Those dissatisfied had significantly higher odds of leaving (11.91 and 13.46, respectively). The EMTs and paramedics in hospitals (OR = 2.32, OR = 2.37), private (OR = 2.72, OR = 2.38), and government non-fire (OR = 2.22, OR = 1.98) agencies were likelier to leave than fire agencies.

Conclusion:

Although increased stress and pandemic-related factors are most common reasons reported for being likely to leave EMS, job dissatisfaction was the most impactful factor. A better understanding of factors that drive job satisfaction needs evaluation to develop strategies to enhance retention.

Other interesting findings:

Associates With Leaving EMS in 12 Months

Age was a significant predictor of leaving for EMTs (OR = 0.96, 95% CI [0.95–0.96]) and paramedics (0.97, 0.97–0.98) (Table 3). Education level was also significant, with EMTs holding an associate degree (1.45, 1.11–1.90) and a bachelor’s degree or higher (2.13, 1.70–2.66) showing higher odds ratio of leaving. Paramedics with bachelor’s degrees or higher exhibited a higher odds ratio of leaving (1.58, 1.20–2.06).

Job satisfaction was the most significant predictor of leaving for EMTs and paramedics. Those unsatisfied with their EMS job had dramatically higher odds ratios of leaving (EMT 11.49, 9.61–11.74; paramedic 13.48, 11.64–15.61) than those satisfied.

Likely as a result of the recent Boston Globe report on failing EMS systems, Winthrop is moving forward with evidence-based EMS system redesign changes such as emergency medical dispatch (EMD) response prioritization and certifying first response firefighters as EMTs.

Community and EMS leaders should critically evaluate their EMS delivery models, using national evidence-based, scientific studies and local data to challenge traditional myths about EMS delivery that may no longer be true.

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Winthrop to revamp emergency response procedures in wake of patient deaths

By Jason Laughlin Globe Staff

December 31, 2024

https://www.bostonglobe.com/2024/12/31/metro/winthrop-toddler-ambulance-emergency-massachusetts-als-bls/

Winthrop is revamping its emergency response services following at least three deaths, including a toddler’s, that have been linked to ambulance shortages and overworked emergency crews.

The town is making the changes after a Boston Globe story earlier this month detailed statewide problems with emergency response that have left patients without critically needed care.

Winthrop Fire Chief Scott Wiley and town manager Anthony Marino declined to comment, citing the possibility of civil litigation. But earlier in December they released a statement describing changes in how the community prepares for and responds to emergency calls.

Those include paramedic training for some firefighters and a reevaluation of how ambulance services prioritize calls for help.

“No one should experience delayed paramedic service in Winthrop or anywhere else due to the unavailability of ambulances or emergency medicine,” the town officials said in their joint statement released Dec. 6.

Almost a year ago, Yuna Feeley, a Winthrop 2-year-old, went into cardiac arrest at home. The fire department responded to a 9-1-1 call from the child’s mother, but Action Ambulance, the private company that provides service to Winthrop, didn’t have a vehicle available to transport Yuna to the hospital. A backup company didn’t have the staff needed to get an ambulance on the road. Wiley, the fire chief, drove the child to Mass. General in Boston himself, but she died at the hospital.

The girl might have been saved had an ambulance stocked with the medications and equipment designed to provide advanced life support been available, experts have said.

The Globe’s reporting identified two other Winthrop patients over the past three years who died while being cared for by paramedics from Action Ambulance.

In another incident in Western Massachusetts, a state investigation determined an Action Ambulance paramedic misdiagnosed a patient and administered medications that caused the person to go into cardiac arrest.

The deaths underscore critical shortcomings plaguing emergency response services statewide. There’s little to no regional coordination to ensure coverage when a community’s primary ambulance

providers are occupied with other calls, and no central authority evaluating whether a region has the number of ambulances it needs. In addition, staffing shortages can keep needed vehicles out of circulation or lead to a lack of experienced personnel responding to serious emergencies.

Winthrop, which says it has 31 firefighters and officers, requires all firefighters to be certified as Emergency Medical Technicians. Several are now training as paramedics, who undergo additional education and can provide more advanced life saving care, according to the town’s statement. It also is consulting with a software vendor that can track the locations of fire and EMS vehicles and provide information about their status and availability.

“We believe that technology can assist communities in being as efficient and responsive as possible in the delivery of all services, emergency and non-emergency,” the town manager and fire chief said in their statement.

Winthrop officials are also discussing with Action Ambulance how to update the way the company prioritizes its calls for service and are working to introduce paramedic supervisor “chase vehicles,” which would support ambulance crews or determine the level of care a patient needs before an ambulance arrives.

“These are challenges we are working to overcome every day, and we look forward to working with our community partners and local and state governments on meaningful solutions for all residents,” Mike Woronka, Action Ambulance’s chief executive, said in a statement Friday.

While having fire personnel trained as EMTs and paramedics may help, it wouldn’t eliminate the need for ambulances and the lifesaving tools they carry, said Matt Zavadsky, a national EMS consultant with the Pennsylvania-based PWW Advisory Group.

Along with ensuring there are enough emergency vehicles in a region, what is most needed is a sophisticated system to ensure the best trained personnel are available for the most serious emergencies.

EMTs are trained to respond to most calls, but paramedics are invaluable when a patient needs an immediate medical response.

They are in short supply, Zavadsky said.

“Paramedics are very expensive and for the majority of calls they’re not necessary,” he said.

Patients requiring advanced life support account for just 30 percent of all ambulance calls, Zavadsky said, and calls that require an immediate, potentially life-saving response are even less common.

When one of those calls comes in, it can be critically important that a paramedic is among the responders.

“A person who called 9-1-1 because they twisted their ankle is different than a 65-year-old male with a history of cardiac problems complaining of chest pains,” he said.

The first call can be handled by EMTs. The second, though, needs a fast response and the patient would likely benefit from the presence of a paramedic. Software is available, Zavadsky said, to help

emergency responders prioritize those two calls, and ensure an ambulance with a paramedic isn’t tied up with a broken bone while somewhere else a patient is having a heart attack.

“Doing the two things combined, adding basic life support ambulances and triaging calls, will in essence dramatically improve this process,” Zavadsky said.

In this special crossover episode of Inside EMS and EMS One Stop, host Rob Lawrence is joined by Matt Zavadsky of PWW Advisory Group and Rodney Dyche of PatientCare EMS for an in-depth look at the biggest EMS stories of 2024.

From critical staffing shortages to groundbreaking changes in system design, the trio tackles how the EMS landscape has evolved and what lies ahead for 2025.

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This lively discussion explores how data from the EMS Media Log has illuminated topics like tiered response models, legislative battles for better funding, and solutions to ambulance thefts and ambulance patient offload time (APOT) delays. Packed with insightful quotes, actionable strategies, and the latest data, this episode is a must-listen for EMS professionals striving to shape a better future for their communities.

A key tool driving this discussion is the EMS Media Log, maintained collaboratively by the American Ambulance Association (AAA) and the Academy of International Mobile Healthcare Integration (AIMHI). This log aggregates EMS-related news stories from local, regional and national outlets across the U.S.

https://www.ems1.com/ems-advocacy/ambulance-thefts-bed-delays-response-times-tackling-tough-ems-issues  

Over the weekend, Congress passed, and the President signed a Continuing Resolution (CR), to fund the federal government through March 2025. The CR included several healthcare provisions of interest to EMS.

These provisions only carry through March, 2025, so please stay engaged with your national associations as they work diligently to make continue these important provisions beyond March 2025!

Full text of the CR is available here.

EMS Interest Items Included in the CR:

Provider Payment Policies:

• Extends ambulance add-on payments through March 31, 2025
• Extends increased payments for low-volume hospitals through March 31, 2025

 
Telehealth Flexibilities:

• Extends Medicare telehealth geographic and originating site flexibilities through March 31, 2025
• Continues expanded practitioner eligibility for telehealth services through March 31, 2025

Extends audio-only telehealth services through March 31, 2025

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Congress votes to keep government open, abandons health package
Michael McAuliff
December 20, 2024
 
https://www.modernhealthcare.com/politics-policy/spending-bill-house-healthcare-package
 
Congress overcame two failures in the House and advanced a last-minute measure to keep government funded into next year on Saturday, but abandoned a set of ambitious health policies promised just days ago.
 
The bill that debuted on the eve of a federal shutdown after a week of turmoil will have limited effects on the healthcare system. The health provisions mostly consist of short-term delays of Medicare and Medicaid payment cuts set to kick in Jan. 1 and brief extensions of several programs. President Joe Biden endorsed the measure.
 
Telehealth and hospital-at-home providers will remain eligible for Medicare reimbursement until March 31 under the bill. Those authorities would have extended for two years and five years, respectively, under the bipartisan deal House Speaker Mike Johnson (R-La.) announced Tuesday but scrapped after President-elect Donald Trump came out against it.
 
The new measure will postpone scheduled cuts to Medicaid disproportionate share payments for safety-net hospitals and extend special Medicare reimbursements for low-volume hospitals and Medicare-dependent hospitals until April 1. It sustains funding for community health centers and pandemic preparedness programs until March 31.

The EMSIntel.org log is beginning to show a growing number of news reports like this.

Financial issues in many communities across the country requiring tough decisions regarding EMS delivery.

Thankfully, some communities are using evidence-based research published in peer-review journals and local data to reimagine EMS delivery based on science.

Tip of the hat to Bill Schneiderman for sharing this news report.

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Costly EMS tax might hit Fort Lauderdale
By Susannah Bryan South Florida Sun Sentinel
December 19, 2024
 
https://www.sun-sentinel.com/2024/12/18/costly-ems-tax-might-be-coming-down-the-pike-in-fort-lauderdale/
 
Fort Lauderdale might start charging a new tax that would bring in tens of millions to help cover the cost of ocean rescue and emergency medical services.
 
The tax would come to $456.78 for a home with a taxable value of $590,000, according to current estimates. The higher the value of the home or commercial property, the higher the tax.
 
Commissioners got details about the possible new tax from an outside consultant on Tuesday.
 
If Fort Lauderdale moves forward with the plan, the tax would show up on property tax bills as soon as 2026.
 
The tax would apply not only to single-family homes, but to all properties currently taxed in Fort Lauderdale, said Peter Napoli, a senior manager with Stantec Consulting.
 
Napoli had a dire warning for the commission, saying the city can expect a growing shortfall over the coming years if drastic measures are not taken.
 
The city will face a deficit of $4.7 million in 2026; a deficit of $35.4 million in 2027; $39.4 million in 2028; $52.9 million in 2029; and $45.3 million in 2030, Napoli said. Emergency reserves would be depleted by 2029, he added.
 
Commissioner Ben Sorensen said he was alarmed by the news.
 
“We’re going to be in trouble if we don’t increase revenue or significantly reduce spending,” he said.
 
Mayor Dean Trantalis said an Emergency Medical Services tax would help close the gap, but he sees no reason to move forward with a new tax at this time.
 
“I’ve seen these (projections) for years and they’re always jaw dropping,” he said. “And at the end of the day, we seem to find a way to close the gap.”
 
Fort Lauderdale Fire Rescue has a $127.4 million budget.
 
Here’s how the budget breaks down:

• The cost of fire/first responders is $68.5 million.
• Costs related to Emergency Medical Services come to $52.9 million.
• And Ocean Rescue costs an additional $5.9 million.

 
Fort Lauderdale homeowners already pay a yearly fire fee of $328.
 
Unlike the fire fee, the EMS tax would be tied to the value of their property.

Collecting an EMS tax rate of $68 per $100,000 in assessed value would bring in nearly $75 million over the next 10 years, Napoli said. Increasing the EMS tax to $86 per $100,000 in assessed value by 2033 would bring in close to $95 million.
 
“You can adopt the EMS tax rate at full cost recovery in the first year,” Napoli said. “Or you can phase it in, ramp it up over a four-year period or five-year period.”
 
Here’s the cost breakdown if the EMS tax were phased in:

• 25% cost recovery in Year 1: $101.64 for a home with a taxable value of $590,000
• 50% cost recovery in Year 2: $208.57
• 75% cost recovery in Year 3: $322.67
• 100% cost recovery in Year 4: $454.83.

 
After hearing the presentation, Trantalis said he and the commission needed time to vet the idea with the community.
 
“According to your chart, this is not going to creep up on us until 2027,” he told the consultant. “We don’t really have to do anything now. I see a projected deficit of only $4.7 million in 2026. It’s something we can consider down the road. I think it might be important to reach out to the community and see what the appetite is for this.”
 
Acting City Manager Susan Grant suggested the commission move forward with a new ordinance to get the framework in place, even if they decide to wait on collecting the new tax.
 
“That way we’d be prepared based on what budget numbers look like,” Grant said. “Set up the framework and we wouldn’t have to decide until June or July.”
 
Vice Mayor Steve Glassman and Commission John Herbst both agreed.
 
“I think to set up the structure is not a bad idea,” Glassman said.
 
The mayor’s response: “I don’t want to scare anybody either.”
 
Herbst chimed in.
 
“I concur that establishing a structure right now doesn’t necessarily obligate us to fund anything,” he said. “And it puts the infrastructure in place so if we do decide we want to move forward we’re not hamstrung by timing considerations.”
 
Herbst suggested the commission continue the discussion at their annual goal-setting session in January.
 
“I do think we should come to some consensus in January before we get too much further down the road,” Herbst said.
 
Grant said she’d direct staff to begin working on an ordinance so the commission can be poised to move forward with the new tax if that’s the route they decide to take.

This is CMS’ first report on the GADCS data that was reported by selected ground ambulance organizations In Year 1 and Year 2.

The full report, as well as the codebook that accompanies the report which describes the structure and contents of the Medicare Ground Ambulance Data Collection System (GADCS) Year 1 and Year 2 analytic file used to conduct the analyses described throughout the report, can be found here.

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Notable Highlights of a Preliminary Review of the Report

• Among 4,529 selected organizations actively billing Medicare in 2023, 95 percent (n = 4,321) started the GADCS process, and, of those, 3,694 selected organizations, or 85 percent, completed reporting as of July 15, 2024.

• Over half—56 percent—of transports were at the basic life support (BLS) level.
• Advanced life support, level 1 (ALS1) services accounted for an additional 42 percent of transports.
• Advanced life support, level 2 (ALS2) and Specialty Care Transport (SCT) services combined accounted for 3 percent of total transports.
• The Unadjusted Mean Cost Per Transport across all NPIs was $2,673.
• The Unadjusted Mean Revenue Per Transport across all NPIs was $1,147.