News & Updates

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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KHN Source Article | Comments Courtesy of Matt Zavadsky

Hospital and EMS partnerships to reduce preventable readmissions continue to be very synergistic...

Here’s a link to the KHN chart of all hospitals, with their readmission and hospital acquired conditions penalties.

https://khn.org/news/hospital-penalties/?penalty=readmission

Here’s a link to an interactive map from the Advisory Board that also lists several current and historical value-based purchasing metrics.

https://maps.advisory.com/D/P4P

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Medicare Fines Half of Hospitals for Readmitting Too Many Patients

By Jordan Rau

NOVEMBER 2, 2020

 

https://khn.org/news/medicare-fines-half-of-hospitals-for-readmitting-too-many-patients/

 

Nearly half the nation’s hospitals, many of which are still wrestling with the financial fallout of the unexpected coronavirus, will get lower payments for all Medicare patients because of their history of readmitting patients, federal records show.

 

The penalties are the ninth annual round of the Hospital Readmissions Reduction Program created as part of the Affordable Care Act’s broader effort to improve quality and lower costs. The latest penalties are calculated using each hospital case history between July 2016 and June 2019, so the flood of coronavirus patients that have swamped hospitals this year were not included.

 

The Centers for Medicare & Medicaid Services announced in September it may suspend the penalty program in the future if the chaos surrounding the pandemic, including the spring’s moratorium on elective surgeries, makes it too difficult to assess hospital performance.

 

For this year, the penalties remain in effect. Retroactive to the federal fiscal year that began Oct. 1, Medicare will lower a year’s worth of payments to 2,545 hospitals, the data show. The average reduction is 0.69%, with 613 hospitals receiving a penalty of 1% or more.

 

Out of 5,267 hospitals in the country, Congress has exempted 2,176 from the threat of penalties, either because they are critical access hospitals — defined as the only inpatient facility in an area — or hospitals that specialize in psychiatric patients, children, veterans, rehabilitation or long-term care. Of the 3,080 hospitals CMS evaluated, 83% received a penalty.

 

The number and severity of penalties were comparable to those of recent years, although the number of hospitals receiving the maximum penalty of 3% dropped from 56 to 39. Because the penalties are applied to new admission payments, the total dollar amount each hospital will lose will not be known until after the fiscal year ends on July 30.

 

“It’s unfortunate that hospitals will face readmission penalties in fiscal year 2021,” said Akin Demehin, director of policy at the American Hospital Association. “Given the financial strain that hospitals are under, every dollar counts, and the impact of any penalty is significant.”

 

The penalties are based on readmissions of Medicare patients who initially came to the hospital with diagnoses of congestive heart failure, heart attack, pneumonia, chronic obstructive pulmonary disease, hip or knee replacement or coronary artery bypass graft surgery. Medicare counts as a readmission any of those patients who ended up back in any hospital within 30 days of discharge, except for planned returns like a second phase of surgery.

 

A hospital will be penalized if its readmission rate is higher than expected given the national trends in any one of those categories.

 

The industry has disapproved of the program since its inception, complaining the measures aren’t precise and it unfairly punishes hospitals that treat low-income patients, who often don’t have the resources to ensure their recoveries are successful.

 

Michael Millenson, a health quality consultant who focuses on patient safety, said the penalties are a useful but imperfect mechanism to push hospitals to improve their care. The designers of the penalty system envisioned it as a way to neutralize the economic benefit hospitals get from readmitted patients under Medicare’s fee-for-service payment model, as they are otherwise paid for two stays instead of just one.

 

“Every industry complains the penalties are too harsh,” he said. “if you’re going to tell me we don’t need any economic incentives to do the right thing because we’re always doing the right thing — that’s not true.”

Recently, Reno's REMSA launched a tiered response model. The news segment from Aging and Awesome featured below offers a clear explanation about how using a variety of healthcare provider levels for an out-of-hospital medical response is an effective and safe way to help patients access the healthcare they need – which can range from an urgent ambulance transport to the emergency room or access to a telehealth provider.

From: Matt Zavadsky, AIMHI Communications Chair

Participants in the CMMI ET3 Model should have received an email from CMS late yesterday advising that the Implementation Plan template has been uploaded to the portal.

Accessing the section where the Implementation Plan template can be viewed and downloaded is a little tricky, so here is a brief guide of how to access the document.

Also, several ET3 Model participants have been asking when the new Participation Agreement might be available.  Interestingly, while accessing this document this morning, I also noticed that the new Participant Agreement has been uploaded, with a due date of 12/15/20.

 Download Instructions

From EMS1 | By Chuck Gipson, Medic EMS

Thinking outside the box can lead to untapped potential from a previously overlooked resource. All of our agencies have a dispatch center of some sort that gets the right resources to the right place at the right time. Right? That call taker is the first person to make contact with the patient after the 911 system is activated. Many times as EMS providers, we forget the care that gets delivered to that patient before the first response vehicle ever arrives on scene.

Elapsed time is a big factor in the outcomes for stroke patients as a stroke occurs roughly every 40 seconds, 87% of which are thrombolytic in nature.

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Modern Healthcare source article | Comments courtesy of Matt Zavadsky

Many have expressed concern about the shifting payer mix, as well as the impact of the pandemic on state and local budgets. 

This will likely be the 2^nd wave of the economic storm for healthcare providers.

In states where EMS agencies enjoy “GEMT” payments, there is even concern about the ability of those programs to continue under the current economic climate.

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Medicaid payments under threat as COVID pummels state budgets

MICHAEL BRADY

September 19, 2020

https://www.modernhealthcare.com/medicaid/medicaid-payments-under-threat-covid-pummels-state-budgets

Like many hospitals struggling to cope with the financial fallout of the COVID-19 pandemic, University Medical Center of Southern Nevada has made tough decisions and reevaluated its business strategy to survive.

The Las Vegas hospital has gotten federal relief funding, but “it’s just not enough” to offset increasing care costs and declining revenue, UMC CEO Mason Van Houweling said. The hospital’s fortunes are deeply intertwined with the state’s tourism-heavy economy, which has been hammered for the past six months as casinos shuttered, and conferences were canceled.

UMC’s supply budget has more than tripled since the outbreak began, and it recently offered voluntary buyouts to staff members to rein in its growing labor costs. It also curtailed investments in new capital projects over the next five to 10 years, even though its finances were on solid footing before the pandemic hit the U.S. The hospital reported $691 million in operating revenue and a total profit margin of 4.3% in fiscal 2019, according to a Modern Healthcare analysis of CMS cost reports.

Now reductions to Nevada’s Medicaid program threaten to cut UMC’s finances even closer to the bone. Nevada lawmakers agreed to a 6% across-the-board rate reduction during a special session in July to help close a $1.2 billion budget shortfall, saving the state $53 million, and with the loss of federal matching will cost providers more than $100 million. It’s the largest cut to Medicaid provider rates any state has made since the pandemic began and a massive blow to Nevada’s largest public hospital.

“The new proposed rate puts us back to 2001 levels,” Van Houweling said.

With Medicaid enrollment snowballing and tax revenue falling off a cliff thanks to the pandemic, many states are sharply reducing their Medicaid spending to balance their budgets.

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From APA PsycNet | Comments Courtesy of Matt Zavadsky

Very interesting findings – Summary statements:

 

First responders have a unique position as first-line response to COVID-19 patients, which results in an increased likelihood for exposure to the virus. Because of this position, mental health problems, such as anxiety, depression, insomnia, and stress, have been revealed in this population.

 

During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

Solutions to this problem could include real-time and urgent information being conveyed to the public while being mindful of untoward exposure to the media (Garfin et al., 2020). The goal is to reduce hysteria and mitigate the transmission of misinformation.

 

Conclusion

Facing stigma is often invisible, in that the effects are not often recognized; despite the inability to see it, experiencing stigma can be dangerous to health while also diminishing the value of a person through discrimination and loss of status by being devalued, rejected, and excluded (Link et al., 2006). The compounding adverse mental health effects in an essential population used to fight the pandemic turns an already challenging situation dire.

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Stigma on First Responders During COVID-19

Tara Rava Zolnikov email the author, Frances Furio

Zolnikov, T. R., & Furio, F. (2020).

 

http://dx.doi.org/10.1037/sah0000270

 

Abstract

During the pandemic, first responders were at an increased risk of being stigmatized because of their direct exposure to COVID-19; stigmatization is an undesirable stereotype that can contribute to a myriad of adverse effects, including, but not limited to, anxiety, depression, devaluing, rejection, stress, health problems, exposure to risks, and limiting protective factors. The objectives of this research were to understand stigma on first responders during the COVID-19 pandemic as well as the consequences of stigma on first responder’s mental health. A qualitative phenomenological study used semistructured interviews to understand the experiences of first responders during the pandemic. This study included a convenience sampling of 31 first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) located worldwide. First responders reported feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal in immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated). By answering these research questions, this information highlighted additional challenges that may be faced by first responders aside from being a frontline worker during a pandemic, which is equally stressful. By understanding the role of stigma, public health practitioners during pandemics or emergency situations can seek to diminish it.

 

On March 11, 2020, the World Health Organization (2020) characterized the newly emerging respiratory illness, coronavirus 2019 (COVID-19), as a global pandemic. COVID-19 had rapidly spread across the world, creating a surge of cases in countries like Italy, Iran, South Korea, and the United States. Pandemics and disease outbreaks pose significant threats to human health as well as contribute to adverse mental health effects because of drastic life changes along with the inability to predict daily events (Pike, Tomaney, & Dawley, 2010). Anxiety, stress, and fear felt by people during the coronavirus pandemic was real and overwhelming, resulting in strong emotional reactions in adults and children (Centers for Disease Control and Prevention, 2019). The culmination of these reactions could be directed at first responders, who were at the forefront of treating people affected by the disease and sequentially considered the most exposed population (Adhanom Ghebreyesus, 2020; Ehrlich, McKenney, & Elkbuli, 2020).

 

During the pandemic, first responders were at an increased risk of being stigmatized (Adhanom Ghebreyesus, 2020; Ehrlich et al., 2020), which is an undesirable stereotype that reduces an accepted person to a tainted one (Goffman, 1963). Stigma has several components, including stereotyping, discrimination, labeling, status loss, and separation (Link & Phelan, 2001). Stigmatization can negatively impact individuals faced with it, especially if stigma has become internalized (Drapalski et al., 2013). Stigmatization is problematic and can contribute to a myriad of adverse effects, including, but not limited to, anxiety, devaluing, rejection, exposure to risks, and limiting protective factors (Link & Phelan, 2006). Stigma has been shown to increase stress among the individuals who experience it (Major & O’Brien, 2005) as well as depression (Benoit, McCarthy, & Jansson, 2015). Stigma can impact an individual’s self-esteem and their overall achievements (Major et al., 2005). Studies have shown that low self-worth and negative health outcomes are both potential outcomes of stigma (Benoit et al., 2015).

 

During the COVID-19 pandemic, health care workers and first responders described experiencing stigma in their communities. Amid this crisis, a qualitative phenomenological study was conducted to understand the experiences of first responders during the pandemic; this is the first study of its kind to review the effects of stigma on first responders in any pandemic. This study used a convenience sampling of first responders (e.g., physicians, nurses, paramedics, police officers, firefighters, etc.) who discussed their personal experiences during the pandemic.

 

Highlighted topics of discussion focused on treatment, stigma, feelings, and mental health. The expectation of this research was to upend aspects related to adverse mental health in a vital working population during the pandemic.

Method

 

A qualitative study was conducted to understand and explore the experiences of health care workers and first responders during the COVID-19 pandemic. This study used a descriptive phenomenological approach, which has been continuously described as a valuable research tool and strategy to understand the lived experiences of participants related to a phenomenon (Neubauer, Witkop, & Varpio, 2019; Marques & McCall, 2005; Husserl, 1980); the aim of this type of research is to identify the common themes, factors, or components related to a phenomenon to better understand the perspectives of those who have experienced it (Marques & McCall, 2005). A phenomenological study looks at both what was experienced and how it was experienced (Neubauer et al., 2019). This method was utilized for this study because first responder experiences offer a unique perspective during the pandemic, although they are not authorities on pandemic stigma, in general.

 

Health care workers and first responders were selected as the target population. This selection was due to the fact that these individuals have a unique position within this pandemic because they are likely the population most exposed to COVID-19 during this time. Inclusion criteria for this study was: above the age of 18 years, health care worker or first responder, and worked during the COVID-19 pandemic. Participants were recruited through convenience sampling, which used the Facebook platform; participants were then screened, selected, and interviewed via Zoom (per social distancing recommendations by the Centers for Disease Control and Prevention) in a private setting and format, during which questions reviewed challenges faced during the pandemic. After interviews, the data were then analyzed via hand coding, in which themes emerged and presented themselves through repetition. Themes were then made into a codebook, which were used to review all quotes related to the subject matter that directly correlated to answering the research questions. This thematic analysis followed the Moustakas (1994)–modified Van Kaam (1966) method.

 

All qualitative research must provide measures to ensure validity of the data in the research. In this case, the researchers established trustworthiness through credibility, multiple participant perspectives, peer debriefing and review, reflexive journaling, and field notes. Credibility was gained through triangulation of sources and member checking. Multiple participant perspectives were sought when female and males of various ages in different parts of the world working in different occupations were all included to participate in the interviews. Peer debriefing and review occurred before and after developing interview questions and analyzing themes in the data. Reflexive journaling and field notes occurred in a diary, which was used to report on questions related participant reactions and impressions of each interview. That said, limitations in all research exists. Limitations of this study included the possibility of nontransferable results to other first responders in the world, researcher personal bias (e.g., mental health researcher), and research participant bias.

 

The study protocol and ethics review were approved by California Southern University. All participants signed informed consent prior to the commencement of the interviews and audio recording. Codes were immediately assigned to every participant to ensure deidentified data collection.

 

Results

Participants’ answers concluded various challenges related to treatment, stigma, feelings, and mental health. Participants described factors that were associated with stigma, including feelings of isolation, lack of support and understanding by family or friends, decreased or forced removal of immediate social interaction (e.g., within family and friend circles), sentiments of being infected or dirty, increased feelings of sadness and anxiety, and reluctance to ask for help or get treatment (e.g., self-approval of being isolated).

 

Participants

A total of 31 health care workers and first responders were interviewed for this study. The mean age was 36.129 years, with a range between 23 and 57 years. In relation to gender, 18 participants identified as female, and 13 participants identified as male. Participants were located worldwide, including the United States (28), Kenya (one), Ireland (one), and Canada (one). Ethnicities included African/Kenyan, Arab/Palestinian, Caucasian, Caucasian/Russian, Caucasian/Iranian, and Caucasian/Irish. Of these, 18 of the participants were married, and 13 of the participants were single. Sixteen of the participants had children, with an average of 2.25 children per subject, a median of 2.5 children, and a range of one to four children.

 

The education levels of participants included high school (one), some college (four), associate degrees (six), bachelor degrees (13), graduate degrees (three), and medical school educations (four). All participants worked within roles as health care workers or first responders during the COVID-19 pandemic; there were physicians/doctors (three), nurses (14), a nurse tech, a behavioral therapist, an orthodontist, a dialysis technician, a technician in medical surgery, a data specialist, a paramedic, firefighters and paramedics (three), a firefighter and emergency medical technician, and police officers (three).

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