News & Updates

The International Board of Specialty Certification (IBSC) is collecting data to better understand the scope of practice between community paramedics practicing in a various countries, their own expectations regarding their ability to provide optimal patient care, and their perception of their role compared to that of their traditional emergency response ambulance counterparts.

 

They are circulating a brief, 10 question survey and asking folks from around the world to contribute their input into the analysis.  It would be very valuable if you could invest a few minutes to answer this quick 10 question survey is posted on SurveyMonkey…  Also feel free to share this with others so we can help better understand this scope even better!!

https://www.surveymonkey.com/r/RMYPMZR

The survey results will be available on the IBSC website and the International Roundtable on Community Paramedicine (IRCP) website by 31 March 2020. 

Modern Healthcare source article

CMS rejects Wyoming plan to lower air ambulance costs

January 16, 2020

By RACHEL COHRS

The CMS earlier this month rejected a Wyoming Medicaid waiver proposal that aimed to lower air ambulance costs for all residents of the state.

Wyoming essentially proposed making air ambulances into a public utility by using a Medicaid waiver to make all residents eligible for Medicaid coverage of air ambulances, regardless of their income level. The Wyoming Department of Health submitted the waiver to the CMS on Oct. 28, 2019 and it was denied on Jan. 3.

"We do appreciate the timely decision from CMS on our waiver application related to air ambulance service. Working with our policymakers here at the state, we will look at the options of what we might do next," said Kim Deti, a spokesperson for the Wyoming Department of Health.

Federal law limits states' power to regulate air ambulance billing, and the CMS said Medicaid waivers should not be used to circumvent federal law.

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Florida Mobile Integrated Healthcare Community Paramedicine Program Guidebook PDF Download

From AIMHI Education Chair Matt Zavadsky. "Congratulations to Jane Bedford and the team at the Florida EMS Bureau for publishing an excellent guidebook for MIH-CP."

From the introduction:

The purpose of this Guidebook is to do just that – guide you through the research, analysis, planning, development, and successful

launch of your own customized Florida Mobile Integrated Healthcare – Community Paramedicine (MIH-CP) Program. This resource

is straight-forward and easy to read. In addition to guidance, it provides recommendations and lessons learned from MIH-CP

programs in Florida, advice from experts across the country, with expanded resources and templates.

This Guidebook is not designed to tell you what you must do,

but to provide suggestions and ideas on what to consider in

developing your own MIH-CP. As you read it, remember that

not all the information in the Guidebook will apply to you or

your organization. Use it to think through the elements of

your program and remember that a successful program must

be anchored in your community

Please see this notice for information about an urgent recall of certain iStat cartridges. 

ModernHealthcare source article | Matt Zavadsky

Interesting editorial from Dr. Harrison with perhaps some peals for all participants and leaders in today’s healthcare environment!

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Healthcare leaders still learning how to offer value-based care

Dr. Marc Harrison

January 11, 2020

 

https://www.modernhealthcare.com/opinion-editorial/healthcare-leaders-still-learning-how-offer-value-based-care 

A group of senior healthcare leaders and I recently discussed the transformation from volume-based care—in which providers are paid based on the number of services they provide and procedures they perform—to value-based care, which rewards us based on the health outcomes of our patients.

This transition represents a huge change in incentives for health systems—encouraging hospitals and physicians to provide high-value, evidenced-based care—determined by comparing clinical results with the cost of care.

Our discussion was held at the Intermountain Healthcare Leadership Institute and I’d like to share some key lessons learned from it, specifically for leaders embarking on the transformation toward value in healthcare.

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ModernHealthcare Source Article | Comments Courtesy of Matt Zavadsky

• This pending recommendation from MedPAC is notable for EMS agencies on several fronts…

• It’s the second time this month that MedPAC is recommending no rate increases for providers.  For ambulatory surgery centers it was based on lack of cost reporting, and in both ASCs and hospice providers, MedPAC is citing financial standing of the providers and the provider’s access to capital.  This finding may also be true for some EMS agencies.
• Many innovative EMS agencies have partnerships with hospice agencies to reduce ED use and revocations.  Note that MedPAC is interested in further analysis of the ‘revocation’ issue.  Also note the ALOS for hospice enrollments.

MedPAC thinks hospice payments are too high

December 06, 2019

MICHAEL BRADY

 

https://www.modernhealthcare.com/hospice/medpac-thinks-hospice-payments-are-too-high

 

The Medicare Payment Advisory Commission is expected to vote against a pay increase for hospice in January.

 

Medicare hospice payments are probably too high, MedPAC's staff said at a meeting on Friday. Their research found that access to care is trending upward, while quality seems to have improved slightly. Hospices also have steady access to capital and robust Medicare margins—12.6% overall—so there's little reason to worry that beneficiaries' access to care would be hurt by financial problems anytime soon.

 

"The hospice rates may be higher than needed to ensure appropriate access to care," said Karen Neuman, a principal policy analyst for MedPAC.

 

The commission will likely recommend to Congress that they shouldn't increase the conversion factor, or base payment amount, for hospices. Most MedPAC members also favor reducing the hospice aggregate cap by 20% and instituting a wage adjustment for 2021.

 

Their proposed recommendation was met with opposition from hospice providers.

 

"(The National Hospice and Palliative Care Organization) does not support today's MedPAC recommendation to modify the hospice aggregate cap," said Edo Banach, president and CEO of NHPCO. "NHPCO shares MedPAC's goals, but this approach appears overly broad and likely to lead to a decrease in hospice access for patients and families. In the short term, we urge MedPAC to use a targeted approach that will have a higher likelihood of rewarding high quality, punishing low quality, and increasing access."

 

Lowering the aggregate cap and wage adjustment would help level the playing field for hospice providers, generate cost savings and target the most profitable hospices with payment cuts.

 

These changes wouldn't affect most providers because the hospices with the highest margins are mainly free-standing and for-profit providers. Those providers are disproportionately costly because their average lengths of stay are much higher.

 

"Hospice margins increase with the length of stay," said Neuman.

 

Not-for-profit hospices have an average length of stay of 68 days, while for-profit hospices have an average length of stay of 110 days. Likewise, free-standing hospices have an average length of stay of 92 days compared to just 70 and 57 days for home health- and hospital-based hospices, respectively.

 

"For the same diagnosis, there tends to be a longer length of stay for the for-profits," said Dr. Jaewon Ryu, president and CEO of Geisinger. "They also tend to enroll folks who (are more likely) to have a longer length of stay."

 

For-profit hospices have different patient mixes than other hospices, but it's not clear whether that's driven by the types of referrals they receive—or solicit—or if they're choosing to admit patients that are more likely to stay longer, he said.

 

Some commission members also wanted to know more about high live-discharge rates among hospices that have exceeded the annual cap on hospice payments—hospices that go over the cap must repay Medicare for the overages.

 

Most live discharges result from patients opting out of hospice or because they're no longer terminally ill, according to MedPAC's research. But there are questions about what's driving patients to leave hospice care.

 

"Is the beneficiary choosing not to enroll? Is the beneficiary being encouraged to leave hospice?" said Neuman.

 

Some larger hospice organizations track how close they are to the aggregate cap and their average length of stay, said James Mathews, executive director of MedPAC. They even adjust their business practices to make sure they don't exceed the limits.

 

"They are able to change their referral sources . . . if they start to see they're having cap issues," said Mathews. "They might seek referrals from hospitals who are more likely to have shorter lengths of stay."

 

Several MedPAC members lamented that Medicare's hospice benefit hadn't changed much since it was created for cancer patients in the early 1980's, even though the needs of Medicare beneficiaries and medical practice have transformed.

 

It's time to rethink the design of the benefit in light of the "changing demography of end-stage disease, and an aging and increasingly disease-burdened society," said Dr. Jonathan Perlin, president of clinical services and chief medical officer of HCA Healthcare.

ModernHealthcare Source Article | Comments Courtesy of Matt Zavadsky

Interesting that there has been some movement on this issue – although it does appear there is still some discussions ongoing inside the beltway.

 

Some states already have this type of provision…

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Senate, House negotiators announce bipartisan surprise billing deal

December 08, 2019

 

https://www.modernhealthcare.com/politics-policy/senate-house-negotiators-announce-bipartisan-surprise-billing-deal

 

Three key lawmakers in the U.S. Senate and House of Representatives on Sunday announced a bipartisan deal on legislation to address surprise billing including an arbitration process, though one Democratic senator directly involved in the negotiations was not included in a press release announcing the deal.

 

Details remain sparse, but the lawmakers said they hope the legislation can be included in an end-of-the-year spending deal.

 

Senate health committee Chair Lamar Alexander (R-Tenn.), House Energy & Commerce Chair Frank Pallone (D-N.J.), and Energy & Commerce Ranking Republican Greg Walden (Ore.) announced the agreement.

 

Under the surprise billing provision, providers would be paid for out-of-network care based on a benchmark of the median in-network rate in the area. Providers could appeal some large claims to arbitration, but the threshold for arbitration and which factors an arbiter would be directed to weigh are still unclear. The legislation is similar to a bill that passed the House Energy & Commerce Committee in July. The bill outline was first reported by The New York Times.

 

Air ambulances are also included in the surprise billing provision. Moody's Investor Service warned in late November that the air ambulance industry's business model could be threatened if legislation similar to a provision in the Senate health committee's bill passed.

 

Sens. Bill Cassidy (R-La.), Maggie Hassan (D-N.H.) and Michael Bennet (D-Colo.), who advocated for a provider-friendly surprise billing fix, said they were glad a "simple arbitration safety valve" was included in the legislation, but indicated that discussions may be ongoing.

 

"As our discussions continue around the final details, we are encouraged that we're one step closer to giving patients these vital protections," Cassidy, Hassan and Bennet said in a statement.

 

Previously, hospitals have been mixed in their support of arbitration. The American Hospital Association testified before Congress in May that any legislation should have "baseball-style" arbitration and allow the request for arbitration with the provider or health insurer, not the patient.

 

Many important details of the legislation remain unclear, including the threshold for the arbitration process and whether payment benchmarks would be indexed to inflation.

 

The White House has signaled it would be open to supporting surprise billing legislation including an arbitration backstop.

 

However, Senate health committee Ranking Democrat Patty Murray (Wash.) was not included in a press release announcing the agreement. A spokesperson for Murray said she is still working with Democrats who have concerns about the legislation.

 

"She didn't want to sign onto a press release until those were worked through," the spokesperson said.

 

The Senate health committee's version of surprise billing legislation did not include an arbitration backstop, but the House Energy & Commerce bill did.

 

Pallone, Alexander and Walden said the surprise billing fix would save the government nearly $20 billion. The deal also includes five years of funding for community health centers, a bill that would increase the purchasing age for tobacco to 21, and measures to increase transparency and competition in the prescription drug market. The lawmakers did not specify whether reforms to hospital and insurer contracts were included in the deal.

 

It is unclear whether leadership is supportive of the deal.

 

Senate Majority Leader Mitch McConnell (R-Ky.) said he was glad to see progress on solutions to the teen vaping crisis, including his and Sen. Tim Kaine's (D-Va.) bill to raise the tobacco purchasing age, but did not take a position on the surprise billing provision.

 

"I look forward to reviewing the details on this and the other policies included in the package announced today," McConnell said in a statement.

 

A spokesperson for House Speaker Nancy Pelosi (D-Calif.) did not respond to an inquiry by press time.

An example of why accurate cost & revenue reporting is so important to the ambulance industry…  Many of the things highlighted in the MedPAC report could similarly be surmised by MedPAC about the ambulance industry…

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MedPAC says ambulatory surgical centers don't need a pay raise

MICHAEL BRADY 

December 05, 2019

https://www.modernhealthcare.com/medicare/medpac-says-ambulatory-surgical-centers-dont-need-pay-raise

The Medicare Payment Advisory Commission is expected to vote against a pay increase for ambulatory surgical centers next month because they don't provide cost data.

Medicare payments to ambulatory surgical centers are probably high enough, MedPAC's staff said at a meeting on Thursday. They found that beneficiaries have reliable access to care and that quality is improving. In addition, ambulatory surgical centers have plenty of access to capital and have experienced strong growth in Medicare revenue—it grew 7.4% from 2017 to 2018.

Those trends led several MedPAC members to conclude that there's no need to increase the conversion factor for ambulatory surgical centers. The conversion factor is a base payment amount that's used to calculate how much Medicare pays providers. It's currently scheduled to go up by 2.8% for 2021, but it doesn't appear necessary based on the findings.

"For the calendar year 2021, Congress should eliminate the update," said Dan Zabinski, a senior analyst for MedPAC.

Eliminating the increase would produce cost savings for Medicare without hurting access to care or the willingness of ambulatory surgical centers to deliver services to Medicare beneficiaries, according to MedPAC's staff.

But there's no way to know for sure how much money ambulatory surgical centers earn from Medicare services. That's because MedPAC's staff couldn't calculate profit margins for ambulatory surgical centers because they don't report cost data to the CMS.

"If you won't show us your cost reports, we won't show you an update," said David Grabowski, professor of health care policy at Harvard Medical School.

The commission can't recommend an update without access to the data they would need to make an informed decision, said Dr. Francis J. Crosson, MedPAC chairman and founder of the Permanente Federation.

Ambulatory surgical centers should be able to submit cost data because other small providers such as hospices already do it, according to Zabinski.

"We remain concerned that (ambulatory surgical centers) don't submit cost data, even though the commission has recommended doing so since 2009," said he said.

HHS Secretary Alex Azar has the authority to require ambulatory surgical centers to submit cost data to the CMS, but he hasn't exercised that power yet, Zabinksi said.

Some members of the commission were skeptical of the value of ambulatory surgical centers in the absence of data. Ambulatory surgical centers are often physician-owned. That could give them greater financial incentives to perform additional, unnecessary surgeries.

"I'm really struck that we do not know whether (ambulatory surgical centers) have been a good development or not," said Dana Safran, head of measurement for Haven. "Paying a lower price for something you don't need isn't a bargain.

AJC Source Article | Comments Courtesy of Matt Zavadsky

There is A LOT to unpack about this article. 

Yamil used to be a reporter in the MedStar service area, and she knows a fair amount about effective and quality EMS service delivery.  She, and the AJC, have been doing a series of articles about the Atlanta area EMS system.

Many of us in EMS have advocated for quality and performance measures that can be universally applied to EMS agencies and their providers.  Almost every study that has researched the impact of ambulance response times on patient outcome has demonstrated that any response time greater than 5 minutes has virtually no impact on patient outcomes (see references below).  And, only about 2% of EMS calls could benefit from a response time within 5 minutes (e.g. cardiac arrest).

Therefore, it is a logical presumption that response time is not a measure of clinical quality, but it may be a measure of patient experience (which should be measured separate from clinical quality).

This article seems to highlight the need for communities to develop, and hold EMS agencies accountable for, performance measures that truly matter, and represent a quality EMS system.

References:

Paramedic response time: does it affect patient survival?

https://www.ncbi.nlm.nih.gov/pubmed/15995089

Lack of association between prehospital response times and patient outcomes.

https://www.ncbi.nlm.nih.gov/pubmed/19731155

Emergency medical services advanced life support response times: lots of heat, little light.

https://www.ncbi.nlm.nih.gov/pubmed/11927458

Eight minutes or less: does the ambulance response time guideline impact trauma patient outcome?

https://www.ncbi.nlm.nih.gov/pubmed/12217471

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Proposal falls short of needed EMS reforms, critics say

State urged to require that life-threatening emergency calls be a priority

By Yamil Berard, The Atlanta Journal-Constitution

Nov 27, 2019

 

Some of Georgia’s most influential leaders in emergency medical services, as well as patient advocates, are pushing for more dramatic reforms to a state proposal affecting the hiring of ambulance providers.

 

The proposal, expected to take effect Dec. 9, is a first step to EMS reforms that are long overdue, said Bud Owens, chairman of an advisory committee of state EMS leaders that makes recommendations to the state.

 

But he and others also believe the revision is not enough to block potential abuse in the hiring of providers and to ensure the standard of care provided by emergency medical services. They say that the state needs to provide better oversight and develop standards to hold providers accountable.

 

The proposal is the state’s response to concerns by the groups that ambulance providers and their representatives have had undue influence on state regional EMS councils, leading to decisions that were not in the public interest.

 

Under its key provisions, the proposal will require the councils, which evaluate and hire EMS and ambulance providers, to conduct business in public, as stipulated by the Georgia Open Meetings laws. The revision also will require council members to disclose any potential conflicts of interest, and refrain from voting on contracts when those interests could compromise their decisions.

 

“I believe we all have to conduct our business appropriately to make sure we’re making decisions in the best interest of those we serve,” said Owens, who is also a county commissioner in Gordon County, in northwest Georgia. “If we can’t handle the business end of it, I don’t think we should be handling the patient care.”

 

Those changes won’t be enough, though, to ensure that those with life-threatening emergencies receive they care they need, other critics say.

 

Across the state, too often ambulances have been slow to arrive. Because of the delayed response or substandard care, some critically ill Georgians have died, said Elmer Stancil, an Atlanta-based attorney who represents the Georgia Ambulance Transparency Project, a group formed last year to push for reforms in EMS.

 

Those losses “illustrate the profound consequences and real human devastation when the state neglects its duty to ensure quality emergency medical care,’’ Stancil wrote in a Nov. 6 email to a lawmaker and state officials, which was obtained by the Atlanta Journal-Constitution under the Georgia Open Records Act.

 

“That’s really what’s at stake with this rule revision: the lives and welfare of real Georgians,” Stancil wrote.

 

In June, an AJC examination found that state has operated for years with vague standards and weak oversight. In most cases, the Georgia Department of Public Health, which oversees the state’s EMS system and ambulance providers, leaves it up to ambulance company officials to determine the quality of care provided by their medics and to investigate complaints.

 

It also leaves it to regional councils to recommend ambulance providers. But the department does not share with the councils, or the public, the reams of performance data it has on ambulance providers, based on detailed patient care reports and response time. As a result, many hiring decisions are the result of recommendations that have no substantive data to back them.

 

Even EMS leaders say they have tried for years to wrestle data from the state to no avail.

 

“I can’t review anybody if I don’t have the data as to what they’re doing,’’ said Courtney Terwilliger, EMS director in Emanuel County and a member of the state’s EMS advisory council. “The only people who have it is the state office of EMS, and they are notorious for not providing it.”

Continue Reading>

Pro Publica Source Article | Comments Courtesy of Matt Zavadsky

Very interesting article – tip of the hat to EMS legend and healthcare guru Donald Jones for making us aware of this article.

A little long, but an interesting read…

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This Doctors Group Is Owned by a Private Equity Firm and Repeatedly Sued the Poor Until We Called Them

After the Blackstone Group acquired one of the nation’s largest physician staffing firms in 2017, low-income patients faced far more aggressive debt collection lawsuits. They only stopped after ProPublica and MLK50 asked about it.

 

By Wendi C. Thomas, MLK50, with Maya Miller, Beena Raghavendran and Doris Burke, ProPublica

Nov. 27, 2019

https://www.propublica.org/article/this-doctors-group-is-owned-by-a-private-equity-firm-and-repeatedly-sued-the-poor-until-we-called-them

MEMPHIS, Tenn. — After nine visits to the emergency room at Baptist Memorial Hospital in 2016 and 2017, Jennifer Brooks began receiving bills from an entity she’d never heard of, Southeastern Emergency Physicians.

 

Unsure what the bills were for, Brooks, a stay-at-home mother, said she ignored them until they were sent to collections. She made payment arrangements, but when she was late, she said the collection agency demanded $500, which she didn’t have.

 

In December, Southeastern sued her for more than $8,500 in unpaid bills — a third of what her husband makes per year as a cook.

 

The case against Brooks is one of more than 4,800 lawsuits Southeastern has filed against patients in Shelby County General Sessions Court since 2017. In the first six months of this year, Southeastern filed more lawsuits than local hospitals Methodist Le Bonheur Healthcare, Baptist and Regional One combined.

 

Lawsuits against poor patients over unpaid medical debts have received widespread media attention over the past few years. In almost all cases, the plaintiff has been a hospital system, often a nonprofit.

 

What sets the practices of Southeastern, and its parent, TeamHealth, apart is that it is a physician staffing firm that contracts with the doctors who treat patients in four of Baptist’s emergency rooms around the region. Physicians historically have avoided suing patients en masse, instead choosing to send unpaid bills to collections or writing them off as bad debt.

 

TeamHealth is owned by the Blackstone Group, a private equity firm. In 2017, Blackstone acquired TeamHealth and its subsidiary Southeastern in a $6.1 billion deal. It was just one in a growing number of large private equity investments in health care in the last decade.

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