News & Updates

President Donald Trump signed an executive order Friday evening aimed at immediately lessening the economic burden of the ACA as Republican lawmakers work on a repeal and replacement plan.

Here are five things to know about the scope of the executive order.

1. The order offers broad guidance. It authorizes states and agencies to make changes “to the maximum extent permitted by the law,” which is somewhat limiting. Not much can be done until the heads of the federal departments that oversee the ACA are officially appointed, according to Timothy Jost, a professor at Lexington, Va.-based Washington and Lee University School of Law. Mr. Jost wrote in a Health Affairs blog, “In sum, nothing happens yet, nor is it likely to happen until the heads of HHS, Treasury, and probably Labor, as well as the CMS Administration and IRS Commissioner are in place; even then it will take a while for changes to be put into motion.”

2. The executive order could end the individual mandate. According to Mr. Jost’s blog, the main way the order can undo the individual mandate is by creating new types of hardship exemptions from the penalty. If this were to happen, it could kill the individual insurance markets, which rely on healthy enrollees to help fund coverage for those with pre-existing conditions. Kellyanne Conway, the counselor to the president, told ABC News Saturday President Trump may stop enforcing the mandate. “[H]e wants to get rid of that Obamacare penalty almost immediately, because that is something that is really strangling a lot of Americans to have to pay a penalty,” she said told George Stephanolopoulos on ABC’s “This Week.”

3. It could also expand Medicaid waivers under the ACA, giving states more flexibility in how they implement the law. In particular, the executive order signals “Section 1115 Medicaid waivers will be granted more liberally, but that was expected, and until they are changed, 1115 waiver regulations promulgated by the Obama administration will continue to apply,” according to Mr. Jost. Section 1115 Medicaid waivers allow states to implement their own budget-neutral expansions of Medicaid and CHIP coverage and determine who and what the programs cover.

4. It encourages the creation of interstate insurance markets. This is one of the main goals listed in the order to be executed to “the maximum extent permitted by law.” The sale of insurance across state lines is allowed under the ACA, according to Mr. Jost’s blog, so it is likely we will see this change. Ms. Conway confirmed this in her interview with ABC Saturday. “[H]e’s going to replace this with a plan that allows you to buy insurance across state lines, that is much more centered around the patient and [improves] access to healthcare,” she said.

5. The order could also undo some taxes under the ACA, according to Politico. These include the tax on health insurers and taxes on pharmaceutical companies. It encourages agencies to delay or waive taxes, fees and penalties created under the law. Many of the revenue-generating taxes of the ACA are already on the chopping block in Congress as it works on drafting a reconciliation bill aimed at axing budget-related parts of the ACA.

Original article can be accessed here.

CMS and Pennsylvania are joining forces on a new model designed to improve health and healthcare is rural areas of the state.

Here are eight things to know about the model.

1. The Pennsylvania Rural Health Model, announced Tuesday, is a new initiative by CMS, through the CMS Innovation Center, and Pennsylvania. CMS and the state’s health department will administer the model together.
2. The goal of the model is not only to improve health and healthcare in rural areas of Pennsylvania, but also to reduce the growth of hospital expenditures across payers — including Medicare — and improve the financial viability of the state’s rural hospitals, according to CMS.
3. The model is broken up into seven performance years, according to CMS. It is scheduled to begin Jan. 12, 2017, and end Dec. 31, 2023.
4. CMS said Pennsylvania rural hospitals participating in the model will receive all-payer global budgets — funded by all participating payers — to cover inpatient and outpatient services they provide. In exchange, these hospitals will use the money “to deliberately redesign the care they deliver to improve quality and meet the health needs of their local communities,” the agency added.
5. Pennsylvania, during each performance year, will prospectively set the all-payer global budget for each participating hospital, CMS said. The all-payer global budget will primarily be based on hospitals’ historical net revenue for inpatient and outpatient hospital-based services from all participating payers, according to CMS.
6. Participating hospitals will also detail a plan to improve care quality by preparing a Rural Hospital Transformation Plan that must be approved by Pennsylvania and CMS.
7. CMS said it will provide Pennsylvania with $25 million, which is a portion of the funding to begin implementing the model.
8. Any critical access hospital or acute care hospital in rural Pennsylvania may participate in the model.

Original article can be accessed here.

Health care is an “attractive” industry. Everybody wants it. It is vital to people, families, neighborhoods, cities, states, countries and their governments. It therefore attracts an abundance of bright, motivated, caring people and some of the world’s most sophisticated technology.

Health care also attracts money. U.S. health care, in particular, has a great deal of financial resources and has attracted a continued inflow of capital. For example, U.S. health care spending was $3 trillion in 2014 and is predicted to consume 20 percent of U.S. gross domestic product in the next few years. That’s a lot of attraction.

But health care has a “value” problem. Managed care started in the United States in the late 1970s with the goal of providing better care at lower cost. Despite 40 years of dedicated effort using all these attractive forces and resources, everyone agrees we have a big value problem to solve.

I propose value in health care is easy to measure: more access to better, safer care, at continually lower cost. No large health care organization in America can consistently do that. If that’s the measure, despite our attractiveness, value has eluded us. We still struggle with the following questions:

• Why, despite our great resources, does value remain so elusive?
• How, learning from other industries, can we attract value rather than chase it away?
• What does attracting health care value look like?

Relying on past success

Health care organizations, like those in every industry, suffer from what made them great. In the history of innovation, great capabilities can become disabilities when it is time to innovate and attract value. For example, take a look at the following lists of great, or formerly great, companies:

List 1	List 2
Digital Equipment	Intel
General Motors	Toyota
Blackberry	Apple

The companies on list 2 have profitability, customer satisfaction, staff engagement, innovation, growth and industry leadership; they attract value.

List 1 companies attracted layoffs, downsizings, bankruptcies, closures and failure.

Here is a difference: The list 1 companies were powerful leaders in their industries that failed to develop or attract simple innovations that list 2 companies, when they were smaller and weaker, used to create competitive advantage that changed their industry. They attracted value. When the list 1 companies discovered they were losing, they all failed to make a transition, even if it meant bankruptcy or extinction. They had great resources but failed to attract new value.

I studied this phenomenon working with Professor Clayton Christensen as a visiting scholar at Harvard Business School. 

Christensen developed the theory of disruptive innovation — “great capabilities become innovative disabilities” is one of its principles. Perhaps that is why we fail to attract value in health care — our past capabilities have become innovation- and value-repelling disabilities.

But what are those value-repelling disabilities? And how can we create new, more attractive capabilities? The work of Stephen Haeckel, former director of strategic studies at IBM’s Advanced Business Institute, has helped me develop some “attractive,” strategic answers and solutions to our chronic value problems.

Improvement versus innovation

Organizations became great in the 20th century by developing capabilities to make, improve and sell products and services. They built hierarchical organizational structures to gather and analyze data, make decisions, implement solutions, cut costs and increase productivity. They implemented changes through projects, often using consultants, Lean/Six Sigma process improvement, new technology and training.

People were an important cost to control or eliminate. Key to success was standardizing work processes and holding people accountable to do their work as designed. Once the companies produced standardized products and services, companies expertly marketed and sold them to customers and end users.

Make/standardize/sell organizations are terrific at improving. They don’t waste time trying to reinvent the wheel. They just keep making that wheel better and better and better. If it works, don’t fix it.

But problems start to occur when it’s time to reinvent the wheel. Make/standardize/sell organizations know how to improve what they know how to do but find it almost impossible to do what they don’t know how to do, i.e., innovate.In Christensen’s database of thousands of companies, he discovered it was almost impossible for an established, successful company to take the lead in developing an industry-transforming innovation.

A recent McKinsey & Co. survey of CEOs across the world showed that 87 percent of them believed that “innovation is essential to our company’s future,” while an astonishingly small 6 percent were satisfied with their company’s innovation success. Make/standardize/sell companies have a hard time attracting innovation in any industry, not just health care.

Attracting greatness in 21st-century health care

The great health care organizations of the 21st century will make new choices that attract innovation. So what attracts innovation? Decades of well-accepted research across the globe and in many realms has shown that innovation requires a different set of capabilities: sense/respond/adapt.

Every successful startup has to sense, respond and adapt to succeed. My work has focused on the small number of successful make/standardize/sell companies that were also able to sense, respond and adapt: Toyota, Intel and Apple, for example. 

Sense/respond/adapt requires different capabilities than make/standardize/sell does. Here are the characteristics of sense/respond/adapt success, whether in a new startup or an innovative venture inside a large, established organization:

• A market or customer-centric value proposition focused on an unmet need. In health care, it’s easy: more access to better, safer care at continually lower cost. Leaders then translate the value proposition into a meaningful purpose to align the people attracting innovation.
• A replicable, scalable, low-risk, high-reward system with these tenets: People with autonomy build mastery, simple rules match accountability to control, and self-managing teams rapidly prototype new value opportunities close to real-time work.
• Sustainable, inspiring results that are low-risk, high-reward and fast.

Consider the case of the Mayo Clinic Health System. Mayo tested a sense/respond/adapt approach to diabetic population health at five different clinic sites. Within one year, the physicians in those clinics had improved their diabetic scorecard results by 122 percent compared with the cumulative results of the rest of the Mayo system.

That was a significant pay-for-performance benefit for the system, while the physicians gained the value of all the flexible, responsive teams that sense/respond/adapt thinking developed to support them. Four years later, theAmerican Journal of Medical Quality (Jan. 11, 2013) documented that those sense/respond/adapt clinical teams continued to outperform the rest of their Mayo Clinic Health System peers.

Make/standardize/sell fails at innovation because it views the workplace as a machine with identifiable problems and implementable solutions. Innovation is seen as a technical “fix.” But innovation isn’t a mechanistic improvement because, by definition, it doesn’t exist. It’s new and yet to be discovered. Make/standardize/sell organizations are great at improving what they know how to do, but the data show that they find it almost impossible to do what they don’t know how to do. It is clear that value-driven health care is not a system fix, consulting engagement, new technology or implementation; it is something you attract value to and create.

The potential for innovation is everywhere. You have to attract its components and bring them together. Purpose; the ingenuity of people; simple rules focused on low-risk, high-reward discovery; and a safe place to work are the attractors. Once you start, it’s so attractive it’s difficult to get people to stop innovating to create new value.

Attraction creates the innovation, and the innovation closes the loop. Now, the parent organization has something new to make, standardize and sell. That’s the great advantage that the attractive 6 percent acquire. 

In the future of high-value health care, the choice is not either make/standardize/sell or sense/respond/adapt, it’s and.

That’s very attractive.

Original article can be accessed here.

In an effort to fulfill its mission to expand its provider footprint to serve about two-thirds of the U.S. population, Optum has agreed to acquire Surgical Care Affiliates for about $2.3 billion in a cash and stock deal.

Deerfield, Il..-based SCA owns or operates 190 ambulatory surgery centers and surgical hospitals, most as joint ventures with physicians and health systems. The company says SCA and its affiliates serve approximately 1 million patients per year in more than 30 states. In 2015, it had operating revenue of around $1.1 billion.

The deal signals that Optum is betting that any changes to the Affordable Care Act, which have lowered the level of the uninsured throughout the country and brought in patients to healthcare providers in droves, will continue to provide coverage to the up to 30 million people it has insured.

“Joining with OptumCare will enable us to better support and empower independent physicians, helping them provide high-quality care for their patients while making healthcare more affordable,” said Andrew Hayek, chairman and chief executive officer of SCA. “We already have a strong relationship with OptumCare, so we have seen firsthand that our cultures and strategies are aligned and complementary.”

Larry C. Renfro, vice chairman of UnitedHealth Group and Optum chief executive officer, said: “Combining SCA and OptumCare will enable us to continue the transition to high-quality, high-value ambulatory surgical care, partnering with the full range of health systems, medical groups and health plans.”

UnitedHealth has said Optum aims to provide primary care and ambulatory services in 75 markets, representing about two-thirds of the U.S. population. Over the past year, Optum has purchased physician practices around the country. It also acquired urgent-care provider, MedExpress.

The company told investors in late November that it had clinical practices in 26 markets.

Optum, which is the healthcare arm of the nation’s largest insurer, UnitedHealth Group, will pay $57 per share of SCA to be funded between 51% and 80% with UnitedHealth common stock. Optum will have an outstanding payout in cash. The deal is expected to close in the first half of 2017.

Hayek and the SCA leadership team are expected to remain a part of the merged company.

Original article can be accessed here.

The New York Times has identified three healthcare industry trends and reforms that should survive a repeal of the Affordable Care Act.

A repeal of the Affordable Care Act looms large as President Barack Obama’s time in office winds down, but even a rollback of the healthcare law is unlikely to curb all of the momentum to innovate care delivery and the patient experience.

The ACA ensured that millions of previously uninsured Americans received healthcare coverage, but the Obama administration also pushed for payment reform, a focus on preventive medicine and quality improvements, according to an article from The New York Times, and many of those initiatives are likely to continue.

Here are three healthcare industry trends and reforms that should survive a repeal of the ACA, according to the publication:

A focus on early intervention and community health: The White House under Obama has pushed for greater emphasis on the social determinants of health and has used grants to encourage providers to identify Medicare or Medicaid patients that may have unmet needs, according to the article. Hospital and ER “super-users” are a significant burden on the health system, and many have unmet complex social needs. The health law also pushes providers to meet quality benchmarks, and patients with complex social needs may make those goals harder to reach, according to the article. However, efforts to improve community health are likely to remain even if the law is repealed, the NYT reports.

Alternative payment models: Under the ACA, the Centers for Medicare & Medicaid Services has pushed for payment reform, such as bundled payments for joint replacement surgeries. Though some providers are skeptical about the long-term benefits of some new payment models, according the article, the momentum away from fee-for-service care is unlikely to die with a repeal of the ACA. Industry organizations have called for President-elect Donald Trump to back value-based care, and it’s likely that the transition will continue under his administration.

Emphasis on care coordination: The healthcare law encourages team-based care and better coordination among physicians and other outside agencies that may connect patients to social services. This includes ensuring that patients are connected to primary care at discharge, as patients who most often make repeat hospital visits and incur unneeded costs may have limited access to primary care physicians. One example of success, according to the article, is at Indiana University Health Methodist Hospital in Indianapolis, which sees 12% fewer inpatients than it did in 2013 thanks in part to such initiatives.

Original article can be accessed here.

BY DOUG HOOTEN, MBA AND JONATHAN D. WASHKO, MBA, NREMT-P, AEMD ON JAN 1, 2017

Demonstrating high performance and high value is becoming increasingly important to our evolving healthcare environment and changing community expectations. The financial sustainability—and perhaps even the very survival—of EMS may hinge on our ability to prove the services we provide are valuable.

Defining value in EMS has been relatively elusive, as clinical, operational and fiscal performance measures are often disparate from one system to another. But there are common hallmarks of high performance that any EMS agency can use to demonstrate value to stakeholders.

The Academy of International Mobile Healthcare Integration (AIMHI)—an association of EMS agencies committed to providing high-performance and high-value EMS and mobile healthcare services—is excited to partner with EMS World to produce a yearlong series of articles that will discuss the attributes of high-performance/high-value EMS system design and operations. The series will include topics such as:

• Attributes of high-performance EMS;
• International models of EMS system design;
• Using data to maximize operational efficiency;
• Financial analysis and new economic models;
• IT trends and cybersecurity in EMS;
• Managing a diverse workforce;
• Working with elected and appointed officials;
• Developing stakeholder relationships;
• Case studies and lessons learned in remote deployment centers.

The goal of the series is to assist EMS agencies in creating high-performance EMS processes and help demonstrate value to local community stakeholders.

—Matt Zavadsky, MS-HSA, EMT, Chief Strategic Integration Officer, MedStar Mobile Healthcare, Ft. Worth, TX

EMS systems of today, regardless of their design, face unprecedented challenges. Changing stakeholder expectations and rising financial pressures are driving a need to demonstrate that they provide value. Recent local and national media stories illustrate this shift in expectations and challenge the value equation the EMS profession has used for years.1–7

“Police transport a good bet for shooting victims, study finds”

“Need an ambulance? Why you may not want the more sophisticated version”

“Think the ER is expensive? Look at how much it costs to get there”

“Modesto rejects $1M firefighter paramedic grant”

“Lockport plans to auction off ambulances, cut fire staffing minimum”

“Kalispell voters reject extra taxes for EMS”

“Is the current model for public safety service delivery sustainable?”

EMS agencies that desire to be successful in this rapidly changing environment need to demonstrate value in new ways by delivering high-performance EMS (HPEMS) as the first step to proving high-value EMS (HVEMS). There are generally three main hallmarks of HPEMS: clinical proficiency, operational effectiveness and fiscal efficiency. These hallmarks must be leveraged in a way that balances what is known as the EMS success triad: patient care, employee well-being and long-term financial sustainability. The Academy of International Mobile Healthcare Integration (AIMHI) has articulated several key attributes of a high-performance EMS system that help achieve these three hallmarks:

1. Sole Provider

Clinical proficiency—As a sole provider, an EMS agency will generally be able to maintain a high utilization of the EMTs and paramedics operating within the system. Higher utilization provides the opportunity to refine critical clinical skills such as patient assessment and effective clinical care. Additionally, a single source of quality oversight for all emergency and nonemergency calls helps ensure every provider, regardless of the type of service they provide, shares common credentialing and quality improvement processes.

Operational effectiveness—A single provider can also maximize operational effectiveness for the system. A patient awaiting transport to a skilled nursing facility from Acme General Hospital can be efficiently transported by the ambulance that just brought a chest pain patient into Acme General’s emergency room. The same unit that transports the patient to the SNF can then be posted to provide temporal or geospatial coverage to that area. Having multiple ambulance providers operating in the same market generally leads to underutilized resources and makes the system less operationally effective.

Fiscal efficiency—The provision of 9-1-1 service is expensive, and the reimbursements more challenging. A sole provider can balance the generally lower-cost, higher-reimbursement nonemergency services to help offset high-cost, low-reimbursement 9-1-1 services. A single layer of utility-like cost structure minimizes the financial impact to the taxpayer and other payers. Further, the operational effectiveness of the sole provider, as explained above, helps reduce the overall cost of the EMS system by preventing multiple infrastructure costs and lower utilization.

2. External Accountability

Clinical proficiency—Holding yourself externally accountable for clinical care helps improve the care provided by identifying areas of potential improvement, coming up with a plan for improvement, implementing the plan and evaluating the results. Some EMS agencies are financially incentivized for demonstrating compliance with scientifically proven clinical bundles of care for conditions such as STEMI, stroke, trauma and hypoglycemia.

Operational effectiveness—External accountability for performance measures like extended response times, unit hour utilization, lost unit hours, employee turnover and mission failures encourages the EMS agency to continually improve these metrics.

Fiscal efficiency—Similarly, reporting and being held accountable for financial measures such as cost per unit hour, cost per call, cost per transport, revenue per transport and revenue per unit hour encourages EMS agencies to improve these measures, as well as benchmark their performance to other similar agencies.

3. Control Center Operations

Clinical proficiency—Controlling your own resources helps ensure your units are appropriately utilized, increasing the clinical proficiency of your field EMTs and paramedics. If another agency is controlling the placement and deployment of your units, it is more difficult to assure appropriate utilization.

Operational effectiveness—As with clinical proficiency, relying on another agency to control your assets may reduce operational effectiveness and make it harder to achieve the correct balance between supply and demand.

Fiscal efficiency—Relinquishing control of your assets to another control center operator may increase costs through less effective asset utilization and lost unit hours.

4. Revenue Maximization

Clinical proficiency—Employing system design and business practices that maximize revenue generation within the EMS system allows the provider greater ability to invest in training, equipment and medical oversight that improves clinical proficiency. For example, FirstPass, a valuable tool for near-real-time clinical quality metrics, requires a significant resource investment. The ability to invest in a system like FirstPass is enhanced when the agency maximizes revenue generation.

Operational effectiveness—The same is true for investing in tools and processes to achieve operational effectiveness. Examples could include an investment in software to predict call volume and locations; dedicated departments that stock, maintain and redeploy ambulances with a high degree of reliability; and sophisticated computer-aided dispatch systems designed to maximize resource utilization.

Fiscal efficiency—Clearly collecting the appropriate fees for the services you provide helps make the system more financially sustainable and could even reduce the tax subsidy burden. This is common in some EMS-based fire agencies that provide nonemergency transfer services as a way to increase revenues.

5. Flexible Production Strategy

Clinical proficiency—Effectively matching supply to demand helps ensure enough EMS resources are on duty to handle larger call volumes while minimizing the number of idle units and amount of nonproductive time. This again helps assure field providers are using their clinical skills regularly to maintain proficiency. It also helps prevent burnout (too many calls per provider) and rustout (too few calls per provider).

Operational effectiveness—Using a flexible production strategy helps maintain a healthy and manageable unit utilization through the day and year, making the system more operationally effective.

Fiscal efficiency—Matching supply to demand improves the financial efficiency of the system by minimizing the expense of excess capacity.

6. Dynamic Resource Management (DRM), System Status Management (SSM)

Clinical proficiency—As with the other attributes, moving resources within the system to cover anticipated demand helps enhance utilization and consequently improve providers’ clinical proficiency. It may also help reduce utilization in high call volume areas and prevent burnout.

Operational effectiveness—Having the right resources in the right locations can significantly improve operational effectiveness. If you know there are high-volume areas in your jurisdiction, dynamically deploying resources from low-volume areas allows for enhanced service delivery.

Fiscal efficiency—Matching supply to demand is a first step in achieving fiscal efficiency. The second step is to have those resources in the right places. DRM allows moving available resources throughout the system to meet anticipated call volume. Combining a flexible production strategy with DRM has a significant impact on effectively using your on-duty resources.

The EMS Success Triad

The EMS success triad is a philosophy and business compass that can be adopted within any EMS system type, and its importance is highlighted in any HPEMS system. The triad includes a constant balancing of:

Patient care—When we speak of patient care, we must think beyond the clinical aspects of care and also include the value aspects such as patient satisfaction, patient safety, customer service, response time and service reliability, and outcomes.

Employee well-being—EMS is a service business, and service businesses are founded on their people. EMS must acknowledge this and build systems and processes that acknowledge the impacts of lean design on its teams. Issues such as adequate breaks, workload balancing, employee engagement, just culture, trust, employee safety systems, work-life balance, schedules and scheduling, compensation strategies, organizational and mission passion and decision making involvement are just a few areas EMS must work to improve.

Long-term financial sustainability—Every decision made within an EMS organization has a cost that impacts the triad in some fashion. These costs must be accounted for and balanced. Cost is a relative term and not necessarily financial in nature (e.g., impacts on patient care and employee well-being). No matter the type of business structure or operational philosophy an EMS system has, the concept of “no margin, no mission” always applies. Long-term business, financial and other cost impacts must always be kept in check if an EMS system is to remain sustainable.

While not every EMS agency or community will be able to employ all the attributes of HPEMS, we are convinced many EMS providers can use some of these principles to demonstrate the value they bring to their community.

In next month’s column we’ll focus on providing high-value EMS.

About AIMHI

AIMHI represents high-performance emergency medical and mobile healthcare providers in the U.S. and abroad who deliver care to more than six million people over more than 43,000 square miles and responding to nearly a million calls annually.

Formerly known as the Coalition of Advanced Emergency Medical Services (CAEMS), AIMHI changed its name in March 2015 to better reflect its members’ dedication to promoting high-performance ambulance and mobile integrated healthcare systems.

Member organizations include high-performance EMS systems in locations such as Oklahoma City and Tulsa, OK; Fort Worth, TX; Richmond, VA; Pinellas County, FL; Charlotte, NC; Niagara, ON, and the province of Nova Scotia, Canada; New York, NY; Little Rock, AR; Davenport, IA; Three Rivers, IN; and Reno, NV. Find more information on AIMHI at www.aimhi.mobi.

References

1. Avril T. Police transport a good bet for shooting victims, study finds. Philadelphia Inquirer, 2014 Jan 8.

2. Sun LH. Need an ambulance? Why you may not want the more sophisticated version. Washington Post, 2015 Oct 12.

3. Rosenthal E. Think the E.R. Is Expensive? Look at How Much It Costs to Get There. New York Times,2013 Dec 4.

4. Valine K. Modesto rejects $1M firefighter paramedic grant. Modesto Bee, 2016 Oct 5.

5. Prohaska TJ. Lockport plans to auction off ambulances, cut fire staffing minimum. Buffalo News, 2014 Aug 27.

6. Loper B. Kalispell voters reject extra taxes for EMS. Daily Inter Lake.

7. Matarese L. Is the Current Model for Public Safety Service Delivery Sustainable? ICMA Publications.

Doug Hooten, MBA, is the chief executive officer of MedStar Mobile Healthcare in Fort Worth, TX. He has over 37 years of experience in EMS, having served as senior vice president of operations and regional director for American Medical Response, CEO of the Metropolitan Ambulance Service Trust (MAST) in Kansas City, and in a variety of leadership roles with Rural/Metro in South Carolina, Georgia, Ohio and Texas. He has expertise in change management, cost optimization, process improvement and clinical excellence. Doug is the president of AIMHI, serves as a board member for the American Ambulance Association and is a member of the National EMS Advisory Council (NEMSAC). 

Jonathan Washko, MBA, NREMT-P, AEMD, is the assistant vice president for Northwell Health’s Center for EMS and leads numerous innovation efforts to improve patient care, employee well-being and the long-term financial sustainability of EMS systems. He volunteers as a board member with the American Ambulance Association, NAEMT, AIMHI and NYMIHA and also serves as a member of the EMS Compass initiative, working to develop standardized industry measures, as well as an advisor to the Promoting Innovation in EMS (PIE) project. Reach him by e-mail at jwashko@northwell.edu.

Original article can be accessed here.

Bundles of joy are the focus of one of the latest efforts to implement bundled payments.

Seeking to spur widespread adoption of alternative payment models, or APMs, the federally affiliated Health Care Payment Learning and Action Network has set its sights on the high-volume admissions related to maternity and newborn care. Combined maternal and newborn stays represent more than 20 percent of all hospital stays, according to the Agency for Healthcare Research and Quality.

HCPLAN is a collaborative network of public and private stakeholders working to advance the federal government’s goal that 50 percent of all health care payments will be through alternative payment models by 2018. The network’s clinical episode payment work group has identified maternity care — along with elective joint replacement and coronary artery disease — as a top priority for episode-based payments.

Work group members see plenty of opportunities for improvement in maternity and newborn care. The U.S. cesarean section rate is high — more than 30 percent of births, according to the World Health Organization — despite the expense and potential danger to mom and baby. More than 9 percent of births are pre-term, including many early elective deliveries, which increases the need for neonatal intensive care. The nation’s infant and mortality rates are high, and racial/ethnic disparities for infant outcomes are disturbing.

Geisinger Health Plan has used the bundled-payment approach for maternity care at Geisinger Health System for six years — and with good results, says John B. Bulger, D.O., Geisinger’s chief medical officer for population health. Early elective deliveries almost immediately dropped to zero when the obstetrics department started to focus on processes of care. That resulted in fewer C-sections and reduced NICU use.“It is a win-win-win because the baby is healthier, happier, the mother is healthier and happier, and the population is healthier and happier because it is less costly to the system,” he says.

Geisinger’s perinatal care bundle, available only for low-risk pregnancies, includes all prenatal, labor and delivery, and postpartum care for the mother only; the baby’s care is not covered in the bundle.

Despite Geisinger’s success, its particular approach has not been widely adopted. A handful of payers and health systems are experimenting with maternity care bundles, but most are waiting for somebody else to figure out best practices. The first challenge is the sheer length of the episode.

“We feel pretty strongly that an episode should include prenatal, postpartum and — ideally — 30 days of newborn care,” says Brynn Rubinstein, senior manager for Transform Maternity Care at the Pacific Business Group on Health. “It’s really hard to navigate all of the providers that a woman and baby might see, and all of the other conditions related to pregnancy, or unrelated to pregnancy, and how to include those in the episode.”

Rubinstein, who is working with plans and purchasers to implement the recommendations outlined in HCPLAN’s white paper on maternity care episode payments, says purchasers are tired of the variation in cost and quality of maternity and newborn care.

“While there are many obstacles to navigate, they are all challenges that can be overcome,” she says. “It may take a few years, but they can absolutely be overcome, and we need to start today.”

Original article can be accessed here.

 

Left: Professor Freddie Lippert and the team from Copenhagen EMS, Denmark

Right: Paramedic Students from the Australian Catholic University, Canberra

Brazilian Trauma Surgeon, Dr Rod DeOlivera at the start of his Pan American Trauma Society Observership

FOR IMMEDIATE RELEASE

Contacts:

Rob Lawrence

rlawrence@raaems.org

804 205 2557

Richmond December 19, 2016 — As 2016 draws to a close, the Richmond Ambulance Authority (RAA) is reflecting on one of its busiest years ever, not only in terms of call volume, but also the number of visitors who made their way to Richmond.  In 2016, RAA received international visitors in 16 separate visits from 12 countries on five continents.

RAA takes much pride in being ‘a major stop on the EMS World tour’ and in 2016, welcomed a range of visitors wishing to view RAA operations. Norwegian and Finnish Health ministry members spent time with RAA leadership to compare and contrast data and performance measuring processes.  The entire Norwegian EMS performance monitoring and management system draws some of its roots from RAA’s way of doing business.

One of RAA’s aims as a 501c3, Not for Profit organization is to use its own learning and experience in the pursuit of high performing operational and clinical EMS to raise the bar of global EMS. This was evident in the summer when it hosted the leaders of Rwanda’s (Africa) SAMU Ambulance service for a week’s master class in EMS operations.  SAMU’s Jean Camarade said, “Our time in RAA was a lifetime experience and undoubtedly will have an impact on ongoing quality improvement process of ambulance system in Rwanda. If you are a manager or clinical professional and want to learn from about world class EMS, your next stop should be RAA.”

RAA has also been central to the Pan American Trauma Society Observership program and in 2016 hosted visits from trauma surgeons and medical students from Central and South America for two- to three-week attachments to understand how a high value EMS system operates and take lessons back to assist with EMS development in their own countries. Dr. Rodrigo Gonçalves de Oliveira, a Sao Paulo, Brazil, surgeon said, “It was an amazing experience. The opportunity to learn from the best helps us to identify the gaps on our service, allowing us to propose changes to the entire system.”

RAA has also educated and influenced medical, paramedic and healthcare administration students. Individuals and groups from the Australian Catholic University campuses based in Canberra, Sydney and Brisbane enjoyed their RAA learning experience.  The largest group of visitors every year is from the Masters in Healthcare Administration class from Taiwan’s Kaohsiung Medical University (KMU).  Medical student Maria Jose Jaramillo from Quenca, Ecuador, said, “Every person at Richmond Ambulance Authority taught me something, not only high quality prehospital care, but also team work, kindness and love to every patient they take care of. I consider it one of the best experiences I’ve had by far, and I’ll keep this team forever in my heart.”

RAA’s international visit coordinator, who also began his own RAA career after an international visit from the UK, COO Rob Lawrence said, “We learn as much as we give with every visit and make lifelong friendships with those members of our international RAA family.  Our staff certainly enjoys the opportunity to share their experiences, whether it is a surgeon from Sudan or a student from Sydney.”

As for the full count, RAA received visitors from Australia, Brazil, Chile, Denmark, Ecuador, Finland, India, Japan, Norway, Rwanda, Sudan and Taiwan.

About the Richmond Ambulance Authority
In 1991, the Richmond City Council and the city manager implemented an Emergency Medical Services (EMS) system that placed the patient first and guaranteed its performance to the City’s residents.  Today, the Richmond Ambulance Authority responds to approximately 200 calls per day and transports, on average, 140 patients per day.  RAA’s emergency response times are among the fastest in the nation with ambulances on the scene of life threatening emergencies in less than 8 minutes and 59 seconds in more than 90% of all responses.  RAA is one of only 22 EMS agencies in North America accredited by both the Commission on the Accreditation of Ambulance Services and the National Academies of Emergency Dispatch.  RAA is also a Commonwealth of Virginia Accredited Dispatch Center.  For more information, see www.raaems.org.

The CMS on Wednesday launched two new consumer-oriented websites that publish information about the quality of inpatient rehabilitation facilities and long-term care hospitals, lengthening its list of Compare websites amid a broader push in healthcare to increase transparency about quality and engage patients in their care.

The CMS also said it would update the overall quality star ratings on its Hospital Compare website, by refreshing data derived from patient feedback and from timely and effective care measures. In those star ratings, hospitals are assigned one through five stars, with five representing the highest quality. The CMS will also incorporate five new oncology measures into the Cancer Hospital Reporting Program and add readmissions after coronary artery bypass graft surgery to the Readmissions Reduction Program.

“At the CMS, one of our top priorities is to help individuals make informed healthcare decisions for themselves or their loved ones based on objective measures of quality,” Dr. Patrick Conway, acting principal deputy administrator and chief medical officer for the CMS, and Dr. Kate Goodrich, the director of CMS’ Center for Clinical Standards and Quality, wrote in a blog post Wednesday. Using the CMS’ Compare websites, “individuals can compare the quality of health care providers, facilities, and health plans, highlighting that people have a choice in their care,” they added.

Among healthcare stakeholders and experts, the Compare websites have proved controversial, especially Hospital Compare. Transparency advocates have praised the CMS’ ongoing efforts to publish data and inform consumers, but industry groups have pushed back by questioning the accuracy and precision of these ratings and the methodology behind them.

“I think it’s exciting that the CMS is updating the Hospital Compare website, and I appreciate that they are becoming even more current in the data they’re using to report,” Leah Binder, president and CEO of the Leapfrog Group, said of Wednesday’s updates. “We think consumers can really understand it and use it.”

The new websites on long-term care and inpatient rehabilitation facilities constitute “a breakthrough,” Binder added. “Certainly as the population ages and so many of us worry about our parents and grandparents, this is really helpful.”

In the past, industry groups have vigorously opposed the CMS’ initiatives to publish quality data and have gotten Congress on their side. In July, when the agency published its star ratings for overall hospital quality, the American Hospital Association voiced concerns that “the current ratings scheme unfairly penalizes teaching hospitals and those serving higher numbers of the poor.”

A study published in JAMA in November found that star ratings for hospitals were affected by their locations and surrounding socio-economic conditions.

The new Compare websites for long-term care hospitals and inpatient rehabilitation facilities will report quality measures: the percentage of residents or patients with new or worsened pressure ulcers, and unplanned readmissions, for any reason, within 30 days after discharge.

Original article can be accessed here.

Payment and care delivery innovation have long held bipartisan political support, the Health Care Transformation Task Force said Tuesday.

The Health Care Transformation Task Force called on the incoming Trump administration in a letter sent Tuesday to continue efforts to replace fee-for-service payment models with value-based care.

The task force, which includes patients, payers, providers and purchasers in its ranks, notes in the letter (PDF) that payment and care delivery innovation have long held bipartisan political support, and asked that President-elect Donald Trump, Vice President-elect Mike Pence and leaders in Congress make it clear to the industry that the support will continue.

“Given the significant industry investment and strong progress to date, we urge the new Administration and Congress to send signals of support and encouragement so this transition can be sustained,” the task force wrote. “This is not the time for policymakers to waiver [sic] or reverse course, which would send a negative message to the industry and chill ongoing transformation efforts.”

The consensus of the task force’s 43 member organizations—which includes six of the 15 largest health systems in the country and big-name payers such as Aetna and Blue Shield of California—is reflected in the letter. As healthcare costs continue to soar, the high expense becomes unsustainable for both businesses in the industry and consumers, they wrote, and the letter offers several key ways the incoming administration can show its commitment to lowering healthcare costs.

The task force’s work is an example of the individual private sector leadership that Trump and Republicans have extolled, they wrote, but despite individual groups working hard to continue transforming care delivery and payment models, progress will be stymied if the Centers for Medicare & Medicaid Services doesn’t also signal that it is on board.

Sustainable value-based payment models are only possible “by aligning private sector and public sector efforts,” according to the letter. Policymakers can remove red tape hindering the private sector to improve this, they wrote, but that alignment is key. In particular, they point to the Center for Medicare & Medicaid Innovation as a source—a public-sector entity that has made great strides in payment and care delivery transformation.

A likely decrease in regulations under Trump and a Republican-controlled Congress may help foster other industry innovation as well.

Original article can be accessed here.