News & Updates

CMS Source | Comments Courtesy of Matt Zavadsky

CMS is delaying the data collection and reporting period for ground ambulance organizations selected to participate in year 1 for two years and for one year for ground ambulance organizations selected to participate in year 2.

With this modification, the data collection period for year 1 and year 2 selected ground ambulance organizations will begin between January 1, 2022 and December 31, 2022.

Does cause a bit of a challenge, since the data from this process is going to be used to evaluate the Medicare reimbursement rates, so further delays may cause a time compression issue on the back end of this timeframe.

CMS has issued a revised blanket waiver yesterday: https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf to delay the Medicare Ground Ambulance Data Collection System. 

Please see page 31 of the above linked document 

Source Slide Deck | Comments Courtesy of Matt Zavadsky

Nice to see EMS in the Phase 1a sequence recommended by the (Advisory Committee on Immunization Practices) ACIP yesterday afternoon! 

May help with talking points for state officials who do not seem to think EMS providers should be in Phase 1?!

You can download the full slide deck here è https://www.cdc.gov/vaccines/acip/meetings/slides-2020-12.html

Modern Healthcare Source | Comments courtesy of Matt Zavadsky

Perhaps a little bit of a mixed-bag for some telehealth services, but overall, seems that the extension of the telehealth services for emergency department visits, and the hint that those provisions may become permanent, may help the role of telemedicine in EMS and patient navigation.

The final rule also contains coverage for telehealth services provided in a patient’s home.

The use of video telemedicine for physicians to supervise other healthcare providers – could also be beneficial for an EMS integration strategy.

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CMS signs off on physician fee schedule changes

MICHAEL BRADY

December 01, 2020

https://www.modernhealthcare.com/physician-compensation/cms-signs-physician-fee-schedule-changes

 

CMS on Tuesday signed off on Medicare's 2021 physician fee schedule, giving providers just a month to prepare for the changes.

 

The final rule permanently allows Medicare providers to use telehealth to carry out home visits for so-called evaluation and management services and some visits for people with cognitive impairments. It also temporarily continues telehealth services for emergency department visits and other services with an eye toward making them permanent, according to a CMS fact sheet.

 

"Telehealth has long been a priority for the Trump Administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be," CMS Administrator Seema Verma said in a statement.

 

According to CMS, more than 24.5 million of Medicare's 63 million beneficiaries and enrollees received a Medicare telemedicine service during the public health emergency. The agency expanded the telehealth services rural enrollees can receive at healthcare facilities. During a call with reporters, Verma reiterated that Congress needs to change federal law to permanently allow non-rural beneficiaries to receive telehealth benefits or for Medicare beneficiaries to receive telehealth services at home. She noted the agency will study the safety, quality and cost of remote patient monitoring and virtual physician supervision.

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NBC News source article | Comments courtesy of Matt Zavadsky

At the same this this came out, it was reported that a bipartisan group of Senators are proposing a $900B aid package, wonder if more aid, or Treatment in Place language could be added to the package!?

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Ambulance companies at 'a breaking point' after receiving little Covid aid

In a letter obtained exclusively by NBC News, the American Ambulance Association told the Department of Health and Human Services that “the 911 emergency medical system throughout the United States is at a breaking point.”

Dec. 1, 2020

By Phil McCausland

https://www.nbcnews.com/news/us-news/ambulance-companies-breaking-point-after-receiving-little-covid-aid-n1249586

 

Stefan Hofer's ambulance company, West Traill EMS, in Mayville, North Dakota, has received only one or two calls that weren’t related to Covid-19 over the past two months. But he said the case count has ballooned by 20 to 30 percent because of the pandemic. At the same time, the company's expenses have mounted, its revenue has cratered and its workforce is being decimated by the virus.

 

The company — which is private and supported by volunteers, a few employees and four trucks — covers more than 1,500 miles of North Dakota prairie and serves about 10,000 people on the far east side of the state.

 

Private EMS services, both in urban and rural centers across the country, collectively received $350 million in Covid-19 relief funds in April, but those companies said that money ran out within weeks. Months later, the need remains great as they face another coronavirus surge.

 

Hofer said he doesn’t know how long his company can keep up its current pace — much less how it will manage the increase in cases they expect from the Thanksgiving holiday — if ambulance services like his don’t receive additional federal aid. He said he may lose employees soon. That could mean answering fewer calls, too.

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Modern Healthcare source article | Comments courtesy of Matt Zavadsky

This is an area for a logical police/EMS/Community Health Paramedic partnerships...

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Sending specialists to handle mental health crises, not police officers

November 28, 2020

STEVEN ROSS JOHNSON

 

https://www.modernhealthcare.com/safety-quality/sending-specialists-handle-mental-health-crises-not-police-officers

 

The recent killing of Walter Wallace Jr. by Philadelphia police underscores long-standing concerns about asking police officers to deal with people experiencing a mental health crisis.

 

The 27-year-old was reportedly wielding a knife when he was shot and killed by officers Oct. 27. Family members claimed they called for an ambulance to get Wallace help, but instead the police came, according to news reports.

Wallace’s death came shortly after Philadelphia unveiled a program in early October designed to handle such situations. Behavioral healthcare specialists will work alongside police dispatchers to determine the appropriate response to calls about a person having a mental health emergency.

 

The program apparently wasn’t fully implemented in time to address Wallace’s situation. A pilot phase began in late September, according to representatives from the Philadelphia Department of Behavioral Health and Intellectual Disability Services. The agency is partnering with the Police Department to embed a behavioral health navigator in the police 911 radio room for the program’s second phase, which will dispatch co-response teams when needed; it isn’t expected to begin until early 2021.

 

A spokeswoman for the city agency was unable to comment because of an ongoing investigation into the matter. But it’s clear the circumstances of Wallace’s death speak to a broader problem many communities face: the criminal justice system is the de facto primary responder for handling mental health.

 

“When you rely on law enforcement to respond to a situation, they’re looking at the situation through a safety lens and interpreting behaviors as potential threats, and then they respond accordingly,” said Angela Kimball, national director for advocacy and public policy at the National Alliance on Mental Illness.

 

To address the issue, a growing number of police departments have formed crisis intervention teams, which are sent instead of regular patrol officers to potentially volatile situations. The number of police departments that have added crisis intervention team programs has soared over the past decade from 400 in 2008 to more than 2,700 by 2019. 

 

Kimball hopes to see more investment in crisis intervention alternatives as public sentiment on law enforcement’s role in responding to mental health emergencies evolves. “It defies logic why this has not happened” before, Kimball said. “It is far easier to maintain the status quo and complain about it than to change your systems.”

 

As the COVID-19 pandemic exacerbates anxiety and depression, 911 calls for those experiencing a mental health or a substance use disorder crisis are only expected to rise.

 

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CMS Newsroom Source | Comments Courtesy of Matt Zavadsky

This is an interesting waiver that directly references Mobile Integrated Healthcare Paramedics as an eligible part of the care team.

EMS agencies providing MIH services should consult with their local hospitals to see if this is a program the hospital may be applying for.

Tip of the hat to Chris Crowley from West Health for assuring we were aware of this in the waiver.

Additional webinars will be forthcoming...

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CMS Announces Comprehensive Strategy to Enhance Hospital Capacity Amid COVID-19 Surge

Nov 25, 2020 

 

https://www.cms.gov/newsroom/press-releases/cms-announces-comprehensive-strategy-enhance-hospital-capacity-amid-covid-19-surge

 

Today, the Centers for Medicare & Medicaid Services (CMS) outlined unprecedented comprehensive steps to increase the capacity of the American health care system to provide care to patients outside a traditional hospital setting amid a rising number of coronavirus disease 2019 (COVID-19) hospitalizations across the country. These flexibilities include allowances for safe hospital care for eligible patients in their homes and updated staffing flexibility designed to allow ambulatory surgical centers (ASCs) to provide greater inpatient care when needed. Building on CMS’s previous actions to expand the availability of telehealth across the nation, these actions are aimed at allowing health care services to be provided outside a hospital setting while maintaining capacity to continue critical non-COVID-19 care, allowing hospitals to focus on the increased need for care stemming from public health emergency (PHE).

 

“We’re at a new level of crisis response with COVID-19 and CMS is leveraging the latest innovations and technology to help health care systems that are facing significant challenges to increase their capacity to make sure patients get the care they need,” said CMS Administrator Seema Verma. “With new areas across the country experiencing significant challenges to the capacity of their health care systems, our job is to make sure that CMS regulations are not standing in the way of patient care for COVID-19 and beyond.”

 

Acute Hospital Care at Home

In March 2020, CMS announced the Hospitals Without Walls program, which provides broad regulatory flexibility that allowed hospitals to provide services in locations beyond their existing walls. Today, CMS is expanding on this effort by executing an innovative Acute Hospital Care At Home program, providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes. This program was developed to support models of at-home hospital care throughout the country that have seen prior success in several leading hospital institutions and networks, and reported in academic journals, including a major study funded by a Healthcare Innovation Award from the Center for Medicare and Medicaid Innovation (CMMI).

 

The development of this program was informed by extensive consultation with both academic and private sector industry leaders to ensure appropriate safeguards are in place to protect patients, and at no point will patient safety be compromised. CMS believes that treatment for more than 60 different acute conditions, such as asthma, congestive heart failure, pneumonia and chronic obstructive pulmonary disease (COPD) care, can be treated appropriately and safely in home settings with proper monitoring and treatment protocols.

 

Participating hospitals will be required to have appropriate screening protocols before care at home begins to assess both medical and non-medical factors, including working utilities, assessment of physical barriers and screenings for domestic violence concerns. Beneficiaries will only be admitted from emergency departments and inpatient hospital beds, and an in-person physician evaluation is required prior to starting care at home. A registered nurse will evaluate each patient once daily either in person or remotely, and two in-person visits will occur daily by either registered nurses or mobile integrated health paramedics, based on the patient’s nursing plan and hospital policies.

 

CMS anticipates patients may value the ability to spend time with family and caregivers at home without the visitation restrictions that exist in traditional hospital settings. Additionally, patients and their families not diagnosed with COVID-19 may prefer to receive care in their homes if local hospitals are seeing a larger number of patients with COVID-19. It is the patient’s choice to receive these services in the home or the traditional hospital setting and patients who do not wish to receive them in the home will not be required to.

 

The program clearly differentiates the delivery of acute hospital care at home from more traditional home health services. While home health care provides important skilled nursing and other skilled care services, Acute Hospital Care at Home is for beneficiaries who require acute inpatient admission to a hospital and who require at least daily rounding by a physician and a medical team monitoring their care needs on an ongoing basis.

 

To support these efforts, CMS has launched an online portal https://qualitynet.cms.gov/acute-hospital-care-at-home to streamline the waiver request process and allow hospitals and healthcare systems to submit the necessary information to ensure they meet the program’s criteria to participate. CMS will also closely monitor the program to safeguard beneficiaries by requiring hospitals to report quality and safety data to CMS on a frequency that is based on their prior experience with the Hospital At Home model.

 

Six health systems with extensive experience providing acute hospital care at home are being approved today for the new waivers and include Brigham and Women’s Hospital (Massachusetts); Huntsman Cancer Institute (Utah); Massachusetts General Hospital (Massachusetts); Mount Sinai Health System (New York City); Presbyterian Healthcare Services (New Mexico); and UnityPoint Health (Iowa). This immediately expands the at-home care options for Medicare beneficiaries in the regions served by these organizations. CMS has been in discussions with other health care systems and expects new applications to be submitted.

 

To view the Acute Hospital Care At Home initiative and application, please visit: CMS’: https://qualitynet.cms.gov/acute-hospital-care-at-home  

 

To view comments from health systems participating in the Acute Hospital Care at Home, please visit: https://www.cms.gov/files/document/what-are-they-saying-hospital-capacity.pdf

 

Link to FAQs:
https://www.cms.gov/files/document/covid-hospital-without-walls-faqs-ascs.pdf 
https://www.cms.gov/files/document/covid-acute-hospital-care-home-faqs.pdf

 

JEMS Source Article | Comments Courtesy of Matt Zavadsky

• Very concerning data from this study from JEMS. 

  Something we can use to remind our field providers about the importance of compliance with infection control process, and advocate for additional mental health resources for our personnel.

  Most notable quotes:

• We know that the pandemic fatality rate for the U.S. population as of October 17 (217,918 deaths) is 66.4 per 100,000 persons. Using the formula from above we see that the relative risk for FDNY EMS is about 36% higher than the national rate.
• The data that are available indicate that EMS clinicians are at higher overall risk of death, pandemic-related mortality and suicide than other emergency services and health professions.
• This shows that in FDNY during the first eight months of 2020, the risk of occupational fatality for EMS clinicians was 14 times higher than the risk for firefighters.  
• The DOL reports that the civilian occupation with the highest fatality rate in the U.S. in 2018 was “Logging” with a rate of 97.6.¹⁶ The FDNY EMS clinicians have a rate of occupational fatality that is 2.5 times higher.
• The EMS suicide risk in the U.S., as measured by the percent of all fatalities, is about twice as high as the national average²⁰ and twice as high as the risk for firefighters.

 

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Occupational Fatalities Among EMS Clinicians and Firefighters in the New York City Fire Department; January to August 2020

By Brian J Maguire, Dr.PH, MSA, EMT-P, Barbara J. O’Neill, PhD, RN, Daniel R. Gerard, MS, RN, NREMT-P, Paul Maniscalco, PhD(c), MPA, MS, EMT/P, LP, Scot Phelps, JD, MPH and Kathleen A. Handal, MD

11.19.20

https://www.jems.com/2020/11/19/occupational-fatalities-among-ems-clinicians-and-firefighters/

On October 6, 2020, the Fire Department of the City of New York (FDNY) conducted a memorial service for department members who had recently died. It was a somber ceremony for the many fallen personnel. The ceremony was very inclusive and noted the passing of emergency responders, FDNY civilians and mechanics as well as a paramedic who had come to NYC on a FEMA deployment to assist during the pandemic.¹ The information on the notice also provided an opportunity for a preliminary agency-level epidemiology analyses to develop a better understanding of the risks faced by FDNY personnel in 2020.

 

New York City is both the most populous and most densely populated major city in the U.S.; over eight million people live in 302 square miles.² FDNY covers this entire area and employs 11,230 firefighters and 4,408 emergency medical services (EMS) clinicians (including paramedics and emergency medical technicians).³ In 2018, there were 1.8 million “ambulance runs” in NYC; FDNY firefighters responded to 619,378 calls.⁴ EMS crews in NYC typically respond to about 4,000 emergency calls a day; at times during the pandemic, demand swelled to over 7,000 calls a day.^5,6 Of almost 1.5 million people tested in NYC by August 20, 27% had antibodies to the coronavirus.⁷

 

Prior research has shown that EMS clinicians face high risks and have occupational fatality rates similar to police and fire and non-fatal injury rates higher than police and fire.^8-10 The purpose of this analyses was to both document current fatalities among FDNY personnel and to compare risks between two occupational groups in FDNY.

 

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Comments Courtesy of Matt Zavadsky

Many of you have been aware of CMS’ interactive “Compare” sites for several years.  There were separate sites for hospitals, nursing homes, physicians, etc. 

CMS has consolidated all the separate “Compare” sites to a single resource, with a much more comprehensive and user friendly interface. 

Just navigated it, and it’s really cool!

https://www.medicare.gov/care-compare/

Remember that the Advisory Board makes data available on value-based purchasing hospital outcomes (including multi-year trends of their Pay for Performance results), as well as dollar amounts of bonuses or penalties for the various CMS VBP measures for all hospitals that are part of the P4P program.

That information can be accessed here è https://maps.advisory.com/D/P4P

For our EMS brethren, these two resources can be used to help determine opportunities in your local community for enhanced EMS/Healthcare partnerships to improve patient outcomes, enhance patient experience, and reduce health system utilization.

High-Performance High-Value Financial Outcome Measures
Recorded November 12, 2020 | 14:00 ET | FREE

View Recording 
View/Downloads slides
Mentioned during webinar: NAEMT.org / Initiatives /3.0

Your largest payer just sent you an email asking to start an Alternate Payment Model (APM) with you in which they pay you for the response, as opposed to the transport.  They are offering to pay you 75% of the Usual, Customary and Reasonable (UCR) payment for a transport.  Do you take the deal or not?  Knowing your High-Performance/High-Value financial metrics like cost and revenue per response, per unit hour, and per transport are crucial.  Further, changing payer mixes, payer policies and evolving service lines add to financial complexities.  This webinar will focus on the development, tracking, and evaluation of the key financial performance metrics that will prepare you for the dynamic changes occurring in the EMS industry.

Presenters

Matt Zavadsky
Medstar Mobile Healthcare
Fort Worth, Texas

Jonathan Washko
Northwell Health CEMS
Syosset, NY

Bob Nadolski
Emory University / Emory Healthcare

Host

DHealthcare Source Article | Comments Courtesy of Matt Zavadsky

This has been a topic of discussion in some EMS and healthcare circles....

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Can Employers Force Their Employees to Receive the COVID-19 Vaccine?

Advice from a labor and employment lawyer about getting back to work safely.

BY WILL MADDOX 

NOVEMBER 4, 2020 9:00 AM

Can employers force their employees to get the COVID-19 vaccine? The WHO says it doesn’t expect widespread vaccinations until mid-2021, but employers are asking this and other questions about how it will impact their ability to get back to work or back into the office.

 

The short answer is yes. The federal Equal Opportunity Employment Commission (EEOC) is likely to make it legal for an employer to require the vaccine if its employees come back to work, according to Sarah Montgomery, a labor and employment attorney with Jackson Walker. “There are probably going to be situations where a lot of employers are going to want to have a mandatory vaccination program,” she says. “The EEOC is likely going to say that mandatory vaccination programs are permitted because COVID-19 is a pandemic.”

 

Healthcare providers have long required its employees to be vaccinated for different diseases, get the flu shot, and other requirements because they will be caring for compromised patients. During the pandemic, the EEOC has been more lenient about what all employers can do regarding taking temperatures, contact tracing, and health screenings because of the direct threat of COVID-19. Most likely, the office will continue that trend and give employers the power to mandate a vaccine. Because an unvaccinated employee might pose a high risk to their co-workers, clients, or customers, an employer will have similar legal protection to require its employees to get a vaccine when it becomes available. “The EEOC may say that you need to have a justification to have a mandatory vaccine program,” Montgomery sats. “But if employers have individuals working closely together in a workplace, I think they’re going to be able to pretty easily justify why they would want a mandatory vaccine program.”

 

The reasoning behind the EEOC’s guidance was established during the Swine Flu pandemic when the commission decided that employers could do health screenings to prevent the disease’s spread without violating the Americans with Disabilities Act. “It’s certainly not the first time that these issues were on the radar,” Montgomery says.

 

Employers will most likely not be required to have a mandatory vaccination program, Montgomery says, but it will probably be permitted. Some employees will be excused from a potential requirement because of a medical condition. Employers will have to make accommodations for that employee by sequestering them away from everyone else or allowing them to work from home if possible, much like employers must accommodate those in a wheelchair or those who are pregnant.

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