News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January, 2021, over 1,900 news reports have been chronicled, with 48% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 82% of the media reports! 99 reports cite EMS system closures/agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals as of 5-15-24.xlsx

  • 9 Jul 2020 10:07 AM | AIMHI Admin (Administrator)
    From JAMA Network Open | Comments Courtesy of Matt Zavadsky

    Tip of the hat to Dr. Marshal Isaacs from the UT Southwestern/BioTel system in Dallas for this excellent find!

    Might be interesting for other systems to conduct a similar analysis of the pre-hospital system, including dispatch and field encounters.

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    Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

    JAMA Netw Open. 2020;3(7):e2014549. doi:10.1001/jamanetworkopen.2020.14549

    July 8, 2020

    Betty Y. Yang, MD1; Leslie M. Barnard, MPH2; Jamie M. Emert, MPH2; et al

    https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767993

     

    Question  What is the clinical presentation to emergency medical services among persons with coronavirus disease 2019 (COVID-19)?

     

    Findings  This cohort study of 124 patients with COVID-19 revealed that most patients with COVID-19 presenting to emergency medical services were older and had multiple chronic health conditions. Initial concern, symptoms, and examination findings were heterogeneous and not consistently characterized as febrile respiratory illness.

     

    Meaning  The findings of this study suggest that the conventional description of febrile respiratory illness may not adequately identify COVID-19 in the prehospital emergency setting.

     

    Abstract

    Importance  The ability to identify patients with coronavirus disease 2019 (COVID-19) in the prehospital emergency setting could inform strategies for infection control and use of personal protective equipment. However, little is known about the presentation of patients with COVID-19 requiring emergency care, particularly those who used 911 emergency medical services (EMS).

     

    Objective  To describe patient characteristics and prehospital presentation of patients with COVID-19 cared for by EMS.

    Continue Reading►


  • 7 Jul 2020 9:48 PM | Matt Zavadsky (Administrator)

    This may also be the future for most EMS agencies…  Tough fiscal times ahead…

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    Hospitals will take $320B hit this year, AHA says

    MICHAEL BRADY

    June 30, 2020

    https://www.modernhealthcare.com/finance/hospitals-will-take-320b-hit-this-year-aha-says

    Hospitals and health systems will lose over $320 billion in 2020 due to the COVID-19 pandemic, according to an American Hospital Association report Tuesday.

    More than $200 billion in financial losses occurred from March to June. But the AHA expects hospitals to lose another $120 billion—about $20 billion per month—through year-end, mostly driven by lower patient volumes.

    The report probably underestimates 2020's total financial losses because "the analysis does not account for currently increasing case rates in certain states or potential subsequent surges of the pandemic occurring later this year," the AHA said in a statement.

    "Hospitals and health systems are in the midst of the greatest financial crisis in our history," AHA CEO Rick Pollack said.

    "While we appreciate the support to date from Congress and the (Trump) administration, this report clearly shows that we are not out of the woods. More action is needed urgently to support our nation's hospitals and health systems and front-line staff."

    According to the report, average inpatient volume is down about 20% compared with 2019, while average outpatient volume has slipped nearly 35% relative to last year.

    "Most hospitals and health systems do not expect volume to return to baseline levels in 2020," the AHA said in a news release.

    The AHA's report doesn't account for hospitals' direct COVID-19 treatment costs or other expenses like higher acquisition costs for drugs and non-PPE supplies and equipment.

    Nearly all providers rely on payments closely tied to fee-for-service models. When the COVID-19 pandemic struck the U.S. in March, patient volumes fell off a cliff, dragging down hospitals' revenue. The lack of fee-for-service revenue led many hospitals and group practices to lay off or furlough staff, slash office hours, cut pay, and delay or cancel investments, just as the crisis ramped up and the economy cratered.

    Congress passed a series of financial relief packages to make sure providers would be able to keep their doors open during the public health emergency. But many hospitals and group practices have had trouble getting hold of the money, and some of the funds are starting to dry up. If the federal government doesn't step up with more aid soon, hospitals and health systems will have to make more tough decisions.

    In the long term, providers may shift more of their business to value-based arrangements and take on added financial risk to stabilize their revenue streams and guard against future declines in patient volume, which have proven catastrophic. Providers that rely more heavily on capitation and other value-based arrangements report that their businesses have experienced less financial distress than those dependent on traditional fee-for-service payments.

    Experts say that while value-based payments aren't a cure-all solution, the pandemic has shown that volume-based payments aren't as safe as many providers thought.


  • 7 Jul 2020 9:46 PM | Matt Zavadsky (Administrator)

    This is important as the continuation of some of the innovations that have been implemented require a PHE being declared.

    The article mentions that the CMS waivers are actually authorized under the Presidential declaration of an emergency, activating the Stafford Act.  Some of us were concerned about the potential ‘expiration’ of either declaration.

    One of NAEMT’s Government Relations groups, Winning Strategies Washington, provides some commentary on that process that we’ve included in the section below the article.

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    HHS will renew public health emergency

    June 29, 2020 08:09 PM

    RACHEL COHRS

    https://www.modernhealthcare.com/government/hhs-will-renew-public-health-emergency

    HHS spokesperson Michael Caputo on Monday tweeted that HHS intends to extend the COVID-19 public health emergency that is set to expire on July 25.

    The extension would prolong the emergency designation by 90 days. Several payment policies and regulatory adjustments are attached to the public health emergency, so the extension is welcome news for healthcare providers.

    "[HHS] expects to renew the Public Health Emergency due to COVID-19 before it expires. We have already renewed this PHE once," Caputo said.

    Provider groups including the American Hospital Association have urged HHS to renew the distinction.

    Some notable policies attached to the public health emergency are the Medicare inpatient 20% add-on payment for COVID-19 patients, increased federal Medicaid matching rates, requirements that insurers cover COVID-19 testing without cost-sharing, and waivers of telehealth restrictions.

    Adjustments CMS made to the Medicare Shared Savings Program for accountable care organizations are also connected to the length of the public health emergency. The number of months the emergency lasts affects the amount of shared losses an ACO must pay back to CMS.

    Even if HHS maintains the public health emergency, some changes the Trump administration has made to help healthcare providers are also dependent on a separate Stafford Act national emergency declaration staying active. These changes include CMS Medicaid waivers that allow bypassing some prior authorization requirements, temporarily enrolling out-of-state providers, delivering care in alternative settings, and pausing fair hearing requests and appeal times.

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    From Winning Strategies:

    The National Emergency declared by the President does not have a set expiration. A national emergency issued pursuant to the NEA can be terminated by a subsequent presidential proclamation or by a joint resolution of Congress.

     

    Please see below a few more details in the situation. 

     

    Charla

     

    A top spokesman for HHS tweeted Monday night the department "expects to renew" the public health emergency for COVID-19 currently set to expire at the end of next month.

     

    HHS did not respond to requests for further comment Tuesday morning. No official statement from the department has addressed the issue, but the tweet from Michael Caputo uses the official account of the HHS assistant secretary for public affairs.

     

    Extending the emergency will allow providers to continue to use flexibilities and waivers meant to help them respond to the COVID-19 pandemic, including those that promote the use of telehealth and adjust requirements for CMS value-based payment models.

     

    There are two emergencies currently in effect:

    • The first one, a Public Health Emergency issued pursuant to Section 319 of the Public Health Services Act, is a Public Health Emergency initially issued by HHS Secretary Azar on January 31, 2020.   The PHS was extended by Secretary Azar on April 21, renewed effectively on April 26, 2020. This PHE is set to expire on July 25. 

     

    • The second one is the President's declaration under the National Emergencies Act pursuant to Section 501(b) of the Stafford Disaster Relief and Emergency Assistance Act, issued on March 13, 2020. But the National Emergency declared by the President does not have a set expiration. A national emergency issued pursuant to the NEA can be terminated by a subsequent presidential proclamation or by a joint resolution of Congress. https://www.lawfareblog.com/whats-trumps-national-emergency-announcement-covid-19

     

    The PHE declaration by the Secretary is not contingent on a Presidential NEA declaration.

     

    The question is what HHS related waivers are tied to which Emergency Declaration, Sec. Azar’s PHE or the President's NEA. 

    • The 1135 Medicaid waivers, both individual and blanket waivers, issued by HHS need BOTH the National Emergency and the Public Health Emergency declarations. 
    • The CARES Act had provisions about telehealth that are linked to the duration of the PHE.  So, some of the telehealth flexibilities are linked only to the PHE and others need both types of declaration to continue.
      • However, there is a special dispensation in the CARES statute that ties the telehealth-related waivers specifically to the public health emergency for Covid-19. (See (g)(1)(B) of SSA Section 1135).
      • Azar could probably keep extending the Covid-19 public health emergency declaration for 90-days at a time and keep the telehealth-related waivers in effect. The other 1135 waivers likely would expire if/when POTUS ends the national emergency declaration, but telehealth is a special case.
    • The NEA permits FEMA to provide assistance under Sections 502 and 503 of the Stafford Act, which describe the scope and amount of federal emergency assistance. The declaration also instructs the FEMA administrator to coordinate and direct other federal agencies in providing assistance under the Stafford Act.


  • 23 Jun 2020 9:14 AM | AIMHI Admin (Administrator)

    Fierce Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    The same analysis could be applied to the EMS delivery model. 

    Many have shared a similar concern about the payer mix of the future!

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    Moody's: Patient volume recovered a bit in May, but providers face long road to recovery

    by Robert King | Jun 22, 2020

     

    https://www.fiercehealthcare.com/hospitals/moody-s-patient-volume-recovering-may-but-providers-face-long-road-to-recovery

    Patient volumes at hospitals, doctors' and dentists' offices recovered slightly in May but lagged well behind pre-pandemic levels, according to a new analysis from Moody’s Investors Service.

    In all, the ratings agency estimated total surgeries at rated for-profit hospitals declined by 55% to 70% in April compared with the same period in 2019. States required hospitals to cancel or delay elective procedures, which are vital to hospitals' bottom lines.

    “Patients that had been under the care of physicians before the pandemic will return first in order to address known health needs,” officials from the ratings agency said in a statement. “Physicians and surgeons will be motivated to extend office or surgical hours in order to accommodate these patients.”

    Those declines narrowed to 20% to 40% in May when compared to 2019.

    Emergency room and urgent care volumes were still down 35% to 50% in May.

    “This could reflect the prevalence of working-from-home arrangements and people generally staying home, which is leading to a decrease in automobile and other accidents outside the home,” the analysis said. “Weak ER volumes also suggest that many people remain apprehensive to enter a hospital, particularly for lower acuity care.”

    The good news:  The analysis estimated it is unlikely there will be a return to the nationwide decline of volume experienced in late March and April because healthcare facilities are more prepared for COVID-19.

    For instance, hospitals have enough personal protective equipment for staff and have expanded testing, the analysis said.

    For-profit hospitals also have “unusually strong liquidity to help them weather the effects of the revenue loss associated with canceled or postponed procedures,” Moody’s added. “That is largely due to the CARES Act and other government financial relief programs that have caused hospital cash balances to swell.”

    However, the bill for one of those sources of relief is coming due soon.

    Hospitals and other providers will have to start repaying Medicare for advance payments starting this summer. The Centers for Medicare & Medicaid Services doled out more than $100 billion in advance payments to providers before suspending the program in late April.

    Hospital group Federation of American Hospitals asked Congress to change the repayment terms for such advance payments, including giving providers at least a year to start repaying the loans.

    Another risk for providers is the change in payer mix as people lose jobs and commercial coverage, shifting them onto Medicaid or the Affordable Care Act’s (ACA's) insurance exchanges.

    “This will lead to rising bad debt expense and a higher percentage of revenue generated from Medicaid or [ACA] insurance exchange products, which typically pay considerably lower rates than commercial insurance,” Moody’s said.


  • 19 Jun 2020 8:42 AM | AIMHI Admin (Administrator)

    Niagara EMS is recruiting for the position of Deputy Chief! This is an exciting opportunity to join the leadership team of a progressive organization that is advancing the modernization of EMS to a Mobile Integrated Health service model. If this sounds interesting to you, read more and consider submitting your application today! 
    https://bit.ly/3d9KU4z

  • 18 Jun 2020 10:21 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Way to go Michigan! Model for other states?

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    Michigan Legislature approves $220M for frontline pandemic healthcare workers

    6/17/20

     

    https://www.modernhealthcare.com/safety-quality/coronavirus-outbreak-live-updates-covid-19

     

    (AP) The Michigan Legislature on Wednesday unanimously approved spending $880 million in federal relief aid in response to the coronavirus pandemic, setting aside funding for frontline workers, municipalities and child care providers.

     

    Democratic Gov. Gretchen Whitmer, whose administration was involved in negotiations, will sign it.

     

    The legislation includes $220 million to give pay raises to certain health workers ($2 an hour) and first responders (up to $1,000), $200 million to reimburse local governments for virus-related spending and $125 million to reduce child care costs.


  • 18 Jun 2020 10:01 AM | AIMHI Admin (Administrator)

    Modern Healthcare source article | Comments courtesy of Matt Zavadsky

    Interesting potential developments – the telemedicine waivers have helped a lot of EMS agencies bring innovation to their communities… May be a good opportunity for EMS to weigh in on EMS-specific interventions when the white paper is open for comment.

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    Senate health chair lays out two COVID-19 telehealth changes he wants permanent

    RACHEL COHRS  

    June 17, 2020

     

     

    Senate health committee Chair Lamar Alexander (R-Tenn.) said on Wednesday that he wants to make permanent two telehealth changes brought about by the COVID-19 pandemic: nixing the so-called originating site rule and expanding the scope of reimbursable services.

     

    Alexander laid out his wish list at a hearing on the issue scheduled weeks before lawmakers are expected to begin negotiations on another COVID-19 relief package.

     

    Pre-coronavirus policy dictated that patients had to live in a rural area and access telehealth services at a doctor's office or clinic. But because of temporary changes in response to the COVID-19 pandemic, patients can receive care anywhere in the country, and can be seen remotely from their homes.

     

    Alexander also indicated support for Medicare and Medicaid's expansion to cover nearly twice as many telehealth services. The temporary changes also allowed Federally Qualified Health Centers and Rural Health Clinics to use telehealth services.

     

    Many of the telehealth changes made on a temporary basis extend throughout the COVID-19 public health emergency. The current designation is scheduled to end in July, but it could be renewed.

     

    But Alexander said he doesn't support extending waivers for requirements under the Health Insurance Portability and Accountability Act, and didn't highlight pay parity as an issue of interest.

    Continue Reading►


  • 18 Jun 2020 9:48 AM | AIMHI Admin (Administrator)

    HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

    Interesting ‘Fast Track’ study released yesterday in Health Affairs as communities consider mandating face masks. 

    Enforcement can be a little ‘thorny’.  The Center for Public Safety Management recently published an article for ICMA on that topic.

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    Community Use Of Face Masks And COVID-19: Evidence From A Natural Experiment Of State Mandates In The US

    Wei Lyu and George L. Wehby

    JUNE 16, 2020

     

    https://www.healthaffairs.org/doi/10.1377/

     

    CONCLUSION

    The study provides evidence that states in the US mandating use of face masks in public had a greater decline in daily COVID-19 growth rates after issuing these mandates compared to states that did not issue mandates. These effects are observed conditional on other existing social distancing measures and are independent of the CDC recommendation to wear facial covers issued on April 3. As countries worldwide and states begin to relax social distancing restrictions and considering the high likelihood of a second COVID-19 wave in the fall/winter,30 requiring use of face masks in public might help in reducing COVID-19 spread.

     

    ABSTRACT

    State policies mandating public or community use of face masks or covers in mitigating novel coronavirus disease (COVID-19) spread are hotly contested. This study provides evidence from a natural experiment on effects of state government mandates in the US for face mask use in public issued by 15 states plus DC between April 8 and May 15. The research design is an event study examining changes in the daily county-level COVID-19 growth rates between March 31, 2020 and May 22, 2020. Mandating face mask use in public is associated with a decline in the daily COVID-19 growth rate by 0.9, 1.1, 1.4, 1.7, and 2.0 percentage-points in 1–5, 6–10, 11–15, 16–20, and 21+ days after signing, respectively. Estimates suggest as many as 230,000–450,000 COVID-19 cases possibly averted By May 22, 2020 by these mandates. The findings suggest that requiring face mask use in public might help in mitigating COVID-19 spread. [Editor’s Note: This Fast Track Ahead Of Print article is the accepted version of the peer-reviewed manuscript. The final edited version will appear in an upcoming issue of Health Affairs.]

     Continue Reading►


  • 15 Jun 2020 10:13 AM | AIMHI Admin (Administrator)

    CNN Health / Kaiser Health News Source Article | Comments Courtesy of Matt Zavadsky

    Hats off to everyone helping to keep our communities safe on the front lines!

    An added challenge for local EMS agencies is that often, ‘sponsoring’ organizations use freelance EMS personnel without coordinating with the local EMS agency.  This may cause confusion on-scene.

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    No 'rule book' for EMTs responding to protests amid a pandemic

    By Carmen Heredia Rodriguez, Kaiser Health News

    Mon June 15, 2020

     

     

    (Kaiser Health News)  Emergency medical services across the country, already burdened by the high demands of Covid-19, have faced added pressure in the past week as they responded to protests ignited by the death of George Floyd in the custody of Minneapolis police.

    The need to protect themselves against the coronavirus adds another complication to emergency crews' efforts in these dangerous conditions. Their personal protective equipment (PPE) can be difficult to wear in a crowd, said emergency medical services officials. Plus, switching from that gear to equipment needed to shield medics from bullets, rocks or tear gas can be challenging.

    Brent Stevenson, assistant chief of the Denver Health Paramedic Division, said facing a protest and a pandemic at once is uncharted territory.

    "I don't think there was a rule book for me really to figure out what we're gonna do," he said.

    In addition, many crews must overcome the fatigue caused by months of fighting Covid-19. In Dallas, some senior-level EMS officers have worked every day for the past several weeks, said EMS deputy chief Tami Kayea.

    First responders are trained to handle emergencies in large events. And even though many protesters have assembled peacefully, the size and mobility of last week's protests surprised EMS officials in some cities.

    "Any large gathering of people is unpredictable in nature, because it's just people," said Sean Larkins, superintendent of emergency medical services in Detroit. "You just never know what could happen."

    An added consideration is how to distinguish themselves from the police and deflect any crowd hostility, several EMS officials said. In Oakland, California, the word "medic" is printed on the vests, said the private ambulance shift commander.

    Continue reading►

  • 12 Jun 2020 9:52 AM | AIMHI Admin (Administrator)

    Study by Northwell Health | Comments Courtesy of Matt Zavadsky

    Very nice pre-publication copy of a study from the team at Northwell about the impact of video vs. audio consultations for ED alternatives during Community Paramedic visits.

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    Video or Telephone? A Natural Experiment on the Added Value of Video Communication in Community Paramedic Responses

    Karen A. Abrashkin, MD*; Jonathan D. Washko, MBA; Timmy Li, PhD; Jonathan Berkowitz, MD; Asantewaa Poku, MPH; Jenny Zhang, BS; Kristofer L. Smith, MD, MPP; Karin V. Rhodes, MD, MS

     

    Study objective: The objective of this study was to determine the effect of video versus telephonic communication between community paramedics and online medical control physicians on odds of patient transport to a hospital emergency department (ED).

     

    Methods: This was a retrospective analysis of data from a telemedicine-capable community paramedicine program operating within an advanced illness management program that provides home-based primary care to approximately 2,000 housebound patients per year who have advanced medical illness, multiple chronic conditions, activities of daily living dependencies, and past year hospitalizations. Primary outcome was difference in odds of ED transport between community paramedicine responses with video communication versus those with telephonic communication. Secondary outcomes were physicians’ perception of whether video enhanced clinical evaluation and whether perceived enhancement affected ED transport.

     

    Results: Of 1,707 community paramedicine responses between 2015 and 2017, 899 (53%) successfully used video; 808 (47%) used telephonic communication. Overall, 290 patients (17%) were transported to a hospital ED. In the adjusted regression model, video availability was not associated with a significant difference in the odds of ED transport (odds ratio 0.80; 95% confidence interval 0.62 to 1.03). Online medical control physicians reported that video enhanced clinical evaluation 85% of the time, but this perception was not associated with odds of ED transport.

     

    ConclusionWe found support that video is considered an enhancement by physicians overseeing a community Paramedicine response, but is not associated with a statistically significant difference in transport to the ED compared with telephonic communication in this nonrandom sample. These results have implications for new models of out-of-hospital care that allow patients to be evaluated and treated in the home. [Ann Emerg Med. 2020;-:1-7.]

    Download Pre-Print Study►

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