News & Updates

Bloomberg Source Articles | Comments Courtesy of Matt Zavadsky

This is a gap that local EMS agencies, especially those who are currently conducting MIH programs, or approved ET3 Participants, could logically fill with some out of the box thinking.

 

New CMS Waivers for telehealth could help make telehealth a logical partner for services like this.

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Ambulnz Agrees to Go Public Via Motion Acquisition SPAC

Company, to be renamed DocGo, offers at-home medical services

Firm transports patients, set to have $1.1 billion valuation

By Gillian Tan

March 8, 2021

 

https://www.bloomberg.com/news/articles/2021-03-09/ambulnz-said-to-agree-to-go-public-via-motion-acquisition-spac

 

Ambulnz Inc., a provider of mobile medical services and patient transportation, has agreed to go public through a merger with Motion Acquisition Corp.

 

The special purpose acquisition company is raising $125 million in new equity from investors including Light Street Capital and Moore Strategic Ventures to support the transaction, which is set to value the combined entity at about $1.1 billion, according to a statement Tuesday, following an earlier Bloomberg report.

 

Ambulnz, to be renamed DocGo Inc., is led by Chief Executive Officer Stan Vashovsky. The New York-based company, which operates in 23 U.S. states and the U.K., offers non-critical medical services to patients at home including vaccinations, blood work and testing, according to the statement.

 

“We’re excited to invest further in our TeleHealth Plus business, which has grown tremendously in the past year,” Vashovsky said in an interview, referencing the company’s last-mile telemedicine services which bridge the gap between a video or voice call and a visit to a physician’s office.

 

The SPAC transaction arms the company with cash to further expand its national footprint and with public currency to pursue acquisitions in related fields such as personal emergency response systems, Vashovsky said.

 

The firm can provide data including real-time vehicle locations, and was the largest private ambulance operator responding to the pandemic in New York State, its website shows. The company also operates Covid-19 mobile testing and vaccination units through an arm known as Rapid Reliable Testing, which has handled about 1.2 million tests and administered about 25,000 vaccines.

 

The company, which has partnerships with dialysis specialist Fresenius Medical Care, New Jersey hospital network Jefferson Health and Colorado’s UCHealth, also provides on-site medical services at events. It posted revenue of about $94 million in 2020, nearly double the year-earlier amount. That figure is expected to surpass $155 million this year.

 

Motion Acquisition, led by CEO Michael Burdiek, raised $115 million in an October initial public offering and said at the time it would focus on searching for target businesses in connected vehicle industries globally.

 

While there are other companies focused on telehealth, such as Teladoc Health Inc. and American Well Corp,. none dispatch licensed care professionals to patients at home, Burdiek said.

 

Like most CEOs striking deals during the pandemic, Vashovsky and Burdiek have yet to meet -- the entire transaction was negotiated via Zoom.

This official introduction into the House version of the pending COVID relief Bill, with the same language as in the Senate version, greatly enhances the chances of the language being included in the final Bill!

The volunteer leaders and Government Affairs experts of NAEMT, IAFC, IAFF, AAA, and others have been diligently working together on this initiative. 

An outstanding example of what can be accomplished when the stakeholder associations are aligned on a mission! 

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FOR IMMEDIATE RELEASE

March 5, 2021

 

Reps. Axne, Larson, Westerman Unveil Fair Reimbursement Legislation for First Responders

 

Bipartisan bill would revise reimbursement rates for treatment provided at the location of a medical emergency

 

WASHINGTON, D.C. – Today, Rep. Cindy Axne (IA-03), Rep. John Larson (CT-01) and Rep. Bruce Westerman (AR-04) announced they are introducing bipartisan legislation to provide fair reimbursements for firefighters, emergency medical services (EMS), and other medical first responders.

 

Currently, Medicare reimbursements are not provided to firefighters and medical first responders for supplies and services they provide if they treat someone on location, known as treatment in place. Reimbursements for these services are approved only when a patient is transferred to a hospital.

 

The Treatment in Place Act directs the Centers for Medicare and Medicaid Services (CMS) to reimburse ambulance providers for care delivered to beneficiaries when the patient is treated in place, providing vital funding to ground ambulance organizations. This will also eliminate the need to bring non-emergency patients into hospitals during COVID-19 for care, reducing COVID-19 exposure and demand on emergency professionals.

 

“Our fire departments and EMS first responders have been on the front lines, responding to the COVID-19 public health emergency. Our first responders are highly trained professionals, able to respond to a lot of the medical situations they face right there on location. By offering reimbursements for medical supplies and their treatment, we can avoid having to send people to the hospital unnecessarily during this pandemic,” said Rep. Axne. “Just as our firefighters and EMTs are here for us, we need to ensure federal health agencies are here for them. CMS reimbursements should still be available for those who are helping our citizens – especially with looming budget shortfalls at our state and municipal levels.”

 

“Our first responders have been on the forefront of this pandemic and are out on the frontlines daily caring for our communities. This legislation will ensure our first responders can be reimbursed by Medicare for the treatments they provide in place,” said Rep. Larson. “This is essential as many of municipalities have been forced to bear the financial brunt of this pandemic, while trying to keep people safe. I’m proud to join Reps. Axne and Westerman in introducing this legislation today.”

 

“Our ambulance, EMS, and firefighter first responders have served our country with perseverance and dedication during the COVID-19 pandemic, adapting quickly as hospitals were stretched to their limits,” said Rep. Westerman. “These first responders have been vital to our nationwide effort to fight the Coronavirus by treating individuals where they are and mitigating the spread of the virus. I am proud to co-lead the Treatment in Place Act to ensure that first responders are compensated fairly for their hard work and service on the front lines.”

 

Because of high demand for hospital beds during COVID-19, many ambulance providers have been directed to care for patients in settings other than emergency rooms—whether at patients’ homes or in health care facilities.

 

The bipartisan bill is endorsed by the International Association of Fire Chiefs (IAFC), International Association of Fire Fighters (IAFF), National Association of EMTs, National Volunteer Fire Council, American Ambulance Association, and Congressional Fire Services Institute (CFSI).

Fierce Healthcare source | Comments courtesy of Matt Zavadsky

Many of us have discussed the opportunity for the potential ‘permanency’ of some of the more valuable CMS waivers, and telehealth has been prominent in those discussions.

This may be a good sign for the telehealth waivers.

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House health leader calls for permanent Medicare telehealth expansions

by Heather Landi 

Mar 2, 2021

https://www.fiercehealthcare.com/tech/house-health-leader-calls-for-permanent-medicare-telehealth-expansions-but-concerns-about

House health subcommittee chair Rep. Anna Eshoo said Tuesday it's time to make telehealth flexibilities enacted during the COVID-19 pandemic permanent to help close gaps in care.

 

The Centers for Medicare & Medicaid Services (CMS) waived many telehealth payment policies during the public health emergency, which helped open up access to virtual care. It drove 10.6 million Medicare beneficiaries to use telehealth visits by the end of July, Eshoo said during a Committee on Energy and Commerce health subcommittee hearing.

 

"The wide adoption of telehealth has been a bright spot during a very dark time in our country," she said. "For the first time, we’ve had substantiative data on the quality and the use of telehealth at scale."

 

CMS has taken steps to add services to the telehealth list, but a permanent expansion of coverage across the country will require an act of Congress. Only certain areas will continue to get telehealth services after the public health emergency ends.

 

Many providers would like to see Congress take action to lift legislative barriers, such as removing limitations on originating sites of care, enabling payment parity for virtual visits, and allowing more providers to offer telehealth visits, witnesses said during the hearing.

 

"Based on experience and what we have learned to-date, these policy changes should be made permanent. They have dramatically improved access to patient-centered care without increasing overall healthcare utilization," said Megan Mahoney, M.D., chief of staff at Stanford Health Care and a witness at the hearing.

 

She also called for CMS to continue adding services to the list of telehealth services it reimburses and for policy leaders to reevaluate medical licensing restrictions.

 

But telemedicine’s ability to make care convenient and more accessible may also be its Achilles’ heel, according to Ateev Mehrotra, M.D., an associate professor of healthcare policy at Harvard Medical School.

 

"The concern is that in some circumstances telemedicine is too convenient and translates into more care and increased healthcare spending," he said. "Policymakers face a difficult challenge in designing an optimal payment and regulatory policy for telemedicine."

 

One strategy is to move away from fee-for-service to alternative payment models such as full or partial capitation and bundled payments, he said. He also recommended that telemedicine visits be paid for at a lower rate than for in-person visits as virtual care will have lower costs. 

 

Consistency across insurers also is important, he said. "If Medicare covers telemedicine for opioid-use disorder but private insurers or Medicaid do not, then substance use providers will be less likely to embrace telemedicine," he said.

 

Without proper oversight by policymakers and purchasers, greater use of telehealth could lead to increased fragmentation, duplicative and unnecessary spending, higher rates of fraud and ultimately higher overall costs and worse outcomes for patients, said Elizabeth Mitchell, president and CEO of the Purchaser Business Group on Health.

 

Mitchell's organization does not support making permanent any payment parity requirements for Medicare and urges policymakers to focus on a telehealth value-based payment system, she said.

 

Rep. Frank Pallone Jr., chairman of the Committee on Energy and Commerce, said he continues to have concerns about telehealth driving overutilization of healthcare services and ways to combat fraud and abuse.

 

"While the convenience of telehealth can help provide critical services to hard-to-reach populations, it can also lead to overutilization or low-value care. It’s important to consider how future policies can encourage the use of high-value care, while, at the same time, discouraging potential low-value care and overutilization in Medicare fee-for-service," he said.

 

The Department of Health and Human Services' Office of Inspector General said last week it's conducting "significant oversight work" assessing telehealth services during the public health emergency, including fraud, abuse and misuse. 

 

Mahoney said the perception that telehealth may be overused and lead to increased healthcare costs has not become reality.

 

"Telehealth is a tool in our toolkit and it is largely substitutive and not additive to in-person care," she said. About 30% to 40% of Stanford clinics' visits are conducted via telehealth.

 

"We believe this will be our new normal going forward," Mahoney said.

From JAMA on February 24, 2021

Economic Analysis of Mobile Integrated Health Care Delivered by Emergency Medical Services Paramedic Teams

Question  Is mobile integrated health care (MIH) delivered by emergency medical services more efficient than regular ambulance responses in addressing the needs of urgent care in the community?

Findings  This economic evaluation compared 1740 calls serviced by MIH in 2018 to 2019 with propensity score–matched ambulance calls for the same period and 2 years prior and found that MIH was associated with a decrease in the proportion of patients transported to the emergency department and saved health care costs compared with regular ambulance responses.

Meaning  These findings suggest that MIH is a promising and viable solution to meeting urgent health care needs while improving the efficiency in using emergency care resources.

Continue Reading►

CDC Source | Comments Courtesy of Matt Zavadsky

Dates and Deadlines:

• February 9: Registration opens: www.cdc.gov/covidvaccineforum
• February 16: Last day to register
• February 22: Building Trust and Vaccine Confidence
• February 23: Data to Drive Vaccine Implementation
• February 24: Optimize and Maximize Equitable Access

AP Source Article | Comments Courtesy of Matt Zavadsky

OUTSTANDING report by AP’s Stefanie Dazio!  Message is spot on, depiction fully accurate, and images are excellent!

EMS providers face this real enemy every day – and just like the rest of the healthcare system, are stretched beyond belief across America.

These heroes have earned, and deserve our thanks, our respect, and our support!!

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In Ambulances, an Unseen, Unwelcome Passenger: COVID-19

By STEFANIE DAZIO

January 25, 2021 

LOS ANGELES (AP) — It’s crowded in the back of the ambulance.

Two emergency medical technicians, the patient, the gurney — and an unseen and unwelcome passenger lurking in the air.

For EMTs Thomas Hoang and Joshua Hammond, the coronavirus is constantly close. COVID-19 has become their biggest fear during 24-hour shifts in California’s Orange County, riding with them from 911 call to 911 call, from patient to patient.

They and other EMTs, paramedics and 911 dispatchers in Southern California have been thrust into the front lines of the national epicenter of the pandemic. They are scrambling to help those in need as hospitals burst with a surge of patients after the holidays, ambulances are stuck waiting outside hospitals for hours until beds become available, oxygen tanks are in alarmingly short supply and the vaccine rollout has been slow.

EMTs and paramedics have always dealt with life and death — they make split-second decisions about patient care, which hospital to race to, the best and fastest way to save someone — and now they’re just a breath away from becoming the patient themselves.

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ICMA Source Article | Comments Courtesy of Matt Zavadsky

Hopefully, education like this will help cities and counties consider the impact on EMS as they consider public safety changes...

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Hidden Costs: How Police Reform Could Change the Shape of Other Public Safety Agencies

Emergency medical services start a new year with uncertain futures.

By Matt Zavadsky, senior associate, CPSM | Jan 14, 2021

The year 2020 presented a number of new challenges to the emergency medical services (EMS) world, pushing paramedic and fire services to overhaul many longstanding practices. With every day delivering new findings on COVID-19 and how it might impact communities, chiefs, union officials, city managers, and other leaders have had to adapt in unprecedented ways. But this summer’s protests and calls to “defund the police” have presented new and completely different challenges. 

As jurisdictions consider the effects of reforming police department budgets and the allocation of funds, they often look to redistribution of responsibilities and limiting police presence in certain areas. In these cases, EMS departments (frequent partners of the police) might be caught in the crosshairs of budgetary changes and be forced to completely shift the way they operate. As public agencies start a new year with uncertain futures, there are some major implications of budget changes that should be addressed to ensure EMS agencies continue to operate at an optimal level.

How Could EMS Change?

It’s important for agencies to address how “defunding the police” could have a ripple effect on their emergency medical services. EMS workers are often called into dangerous situations, but do not carry their own protective equipment or weapons. Instead, they rely on police co-response for their own safety, particularly when responding to calls involving possible drug use, behavioral issues, or suicidal patients. And, it’s not always apparent if a situation will be dangerous until police arrive to assess scene safety.

Should police departments reduce or eliminate their involvement in non-emergency calls, as some groups are suggesting, EMS workers would be expected to head into potentially unknown situations without police protection.

This could lead to expensive adjustments for the agency.

For one, unions would likely demand higher compensation and/or increased insurance benefits to make up for the increased dangers of the job. And if a worker is injured while providing emergency medical services, the agency could be liable.

Another possibility is that EMS teams would demand personal protective equipment like ballistic vests, or even weapons of their own. They might also demand the ability to restrain unpredictable and violent patients (currently the responsibility of police). These requests would require specialized training, the hiring of new staff, or other changes that are not only expensive but nullify efforts to remove weapons from the scene of “non-emergency” calls. Another possibility, and perhaps the most problematic, would be for EMS departments to deem situations too unsafe for responders and begin to decline calls entirely, citing the need to protect their personnel. In cities that receive a high volume of drug overdoses or behavioral health calls, this could be particularly detrimental.

While it’s unclear exactly how these situations would unravel in specific agencies, it’s important to consider the possibilities to best prepare for any outcome.

How Can Cities Prepare?

Before any meaningful action can be taken to prepare a city for changes in public safety operations, it’s essential to first understand the needs of their community.

Determining these needs would ideally be a collaboration between a combination of city management; police, fire, and EMS leadership; city council; community leaders; and an outside analytics group that can provide unbiased data. 

The goal of this process should be to flag major call categories in the area (i.e., overdoses, suicidal patients, mental health issues, etc.), as well as what destination options the city has for patients. Oftentimes, there are only two options for such calls—either the hospital or jail, but some areas might have sobering centers/detox facilities, behavioral health centers, homeless shelters, or transitional housing.

Once data is collected and input is received, city leadership can then work on a solution with solid information to guide their decisions. If, for example, your city receives a high percentage of nonviolent behavioral health calls, it might be worth exploring how to reduce the nights these patients spend in jail and instead support them with a transitional mental health facility. If the number of jail intakes is reduced, that jail budget could be reduced and used to fund a mental health facility—just as a for instance. Solutions will take time, collaboration, and creativity, but they are possible.

Maximize Your Agency’s Reimbursement Now

As a final reminder, whenever the subject of budget reform comes up, it is wise to take a hard look at the numbers and become intimately familiar with the costs and revenues associated with local EMS. When these numbers are transparent, it’s easier to maximize revenue sources now to better weather a potential budgetary storm.

When it comes to EMS, a data analytics partner (like CPSM) can deliver raw, unbiased data to illustrate specific points, such as the payer mix of patients that the department sees, deployment models (down to how many minutes certain pieces of equipment are deployed), and the kinds of calls to which the department is responding. This kind of data is invaluable to all cities, but particularly those that are in financial crisis. Not only can these numbers help maximize the revenues being brought in by EMS now, but they could potentially offer support for maintaining police services in conjunction with EMS by illustrating the department’s need.

While every agency is different, and there is no one-size-fits-all solution to the prospect of police reform, it’s imperative for all public safety leadership to ask questions, prepare for a variety of outcomes, and maximize their revenue ASAP. The sooner those steps are taken, the sooner answers—and hopefully solutions—will be ready for action. 

CNN Source Article | Comments Courtesy of Matt Zavadsky

Further national recognition of the amazing job EMS providers, provider agencies, and the entire healthcare system is doing around the country! 

We are very thankful for our heroes managing this crisis!

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Los Angeles ambulance ride-along shows the pandemic's grueling toll on EMTs

By Josh Campbell, Jack Hannah and Eric Levenson, CNN

Mon January 11, 2021

https://www.cnn.com/2021/01/11/us/los-angeles-ambulance-emt-coronavirus/index.html

(CNN)  EMT Sadi Pope takes pride in her job, but the recent Covid-19 surge in Los Angeles County has made for some grueling 10-hour shifts.

The mother of three and former stay-at-home mom has been running an ambulance for the last six months, but the call volume has grown so much in this latest wave of the coronavirus pandemic that "we're running and running" all day now, she said.

"A few months ago, there would be times where we'd sit for a couple hours just waiting for a call in our area, but now ... we're lucky if we sit for a half an hour," she said.

To understand how Los Angeles' crushing Covid-19 surge has impacted first-responders, CNN spent a day with EMTs and at the emergency communication hub for Care Ambulance, the largest emergency ambulance service in Southern California. Over nearly eight hours, the group of hard-working yet harried workers tried to handle a large volume of calls and brought sick patients to hospitals so full that the patients were left waiting for hours for an available bed.

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#EMS association leaders say THANK YOU to #paramedics, #EMTs, #dispatchers, and other #MobileHealthcare professionals. Thank you for serving on the very front lines of our nation’s #COVID19 response!

ABC Source | Comments Courtesy of Matt Zavadsky

Many systems may be considering similar protocols as healthcare system capacity becomes more strained...

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American Ambulance will only transport Fresno County 911 callers who have life-threatening or emergency conditions

Instead of transferring patients to a local hospital, paramedics will evaluate them first.

By Gilbert Magallon

Monday, December 21, 2020

 

https://abc30.com/american-ambulance-fresno-county-911-emergency-call/8962755/

 

FRESNO, Calif. (KFSN) -- The way American Ambulance responds to your 911 calls in Fresno County is changing.

 

As of Monday, only patients with life-threatening and emergency conditions will be transferred to the hospital.

 

"If you feel like you need to call 911, if your family member is sick and you need to call 911, call 911," said Edgar Escobedo, American Ambulance operations manager. "We are going to be there, we are going to assess that patient and if necessary we are going to transfer that patient."

 

The new Assess and Refer Policy was implemented Monday to relieve overwhelmed emergency rooms.

 

Escobedo said instead of transferring patients to a local hospital, paramedics will evaluate them first.

 

Their condition will then determine if they go to the hospital or if they're referred to an urgent care facility, their primary care doctor, or telemedicine.

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