News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,513 news reports have been chronicled, with 44% highlighting the EMS staffing crisis, and 37% highlighting the funding crisis. Combined reports of staffing and/or funding account for 80.7% of the media reports! 163 reports cite EMS system closures/takeovers, or 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 Protected.xlsx

  • 12 Feb 2024 7:26 AM | Matt Zavadsky (Administrator)

    While this article focuses on hospitals, the same issues face EMS agencies.

    Medicare historically has reimbursed less than the cost of providing the level of EMS care local community’s desire. An increasing Medicare payer mix and decreasing commercial payer mix places further economic pressures on EMS agencies.

    The article highlights service level changes hospitals are implementing to decrease costs, while maintaining focus on patient outcomes. So too, EMS agencies, and their communities, should identify service level changes that reduce costs, while maintaining patient outcomes.

    Notable quotes from the article:

    The aging of the baby boomers means Medicare enrollment growth is expected to exceed that of other major payers, at 7.8% annually from 2025 to 2031, the Centers for Medicare and Medicaid Services estimates. Yet many health systems are unprepared to manage the wave of Medicare beneficiaries.

    Providers that don't take measures to avoid high-cost care will see their margins erode, especially as Medicare and Medicare Advantage reimbursement rates wane and as the number of relatively more lucrative commercially insured patient population declines, experts said.

    ------------------------

    Medicare is booming, and providers are bracing themselves

    ALEX KACIK

    February 12, 2024

    https://www.modernhealthcare.com/providers/medicare-medicaid-surge-tampa-general-hospital-memorial-hermann

    Tampa General Hospital decreased sepsis mortality rates by nearly 10%, reduced emergency department utilization by close to two-thirds and slashed more than $1 million in costs over a two-year period.

    The hospital set up a command center that uses predictive, artificial intelligence-backed analytics that flags potential early indicators of diseases like sepsis and tracks a patient's treatment. Catching the warning signs earlier and standardizing care have helped keep patients out of the hospital, improve outcomes and reduce expenses.

    The command center is one of Tampa General's multi-year efforts aimed at better controlling the cost of care and improving quality for the influx of patients aging into the Medicare program.

    “We need to manage a new world order [as payer mix shifts] from commercial insurance to Medicare,” said John Couris, president and CEO of Tampa General. “We’ve been anticipating this and working for the last few years to take friction out of the patient experience.”

    The aging of the baby boomers means Medicare enrollment growth is expected to exceed that of other major payers, at 7.8% annually from 2025 to 2031, the Centers for Medicare and Medicaid Services estimates. Yet many health systems are unprepared to manage the wave of Medicare beneficiaries.

    Providers that don't take measures to avoid high-cost care will see their margins erode, especially as Medicare and Medicare Advantage reimbursement rates wane and as the number of relatively more lucrative commercially insured patient population declines, experts said.

    “This shift puts hospitals and health systems into an immense financial compression,” said Thom Bales, a principal at consultancy PwC. “The simplest recourse is to go back and renegotiate contracts with private payers, and that isn’t sustainable.”

    Medicare patients make up about half of health systems’ inpatient care. That share has stayed relatively constant from 2006 to 2022, inching up from 47.7% of hospitals’ annual inpatient hospital days to 49.2% during that time, according to American Hospital Association data.

    As hospitals’ patient mix skews more toward Medicare, hospitals have treated fewer commercially insured patients. Commercially insured and self-pay patients as a percentage of annual inpatient hospital days has dropped from 33.4% in 2006 to 27.8% in 2022, according to AHA data. The patient mix delta between Medicare and private insurance is expected to widen over the next several years.

    AHA is pushing back against policies, such as site-neutral payments that would equalize Medicare reimbursement for some low-acuity care provided at hospital outpatient departments, ambulatory surgical centers and physician offices, under the premise that Medicare payments do not cover the care costs. Melinda Hatton, general counsel and secretary at the association, cited a recent AHA analysis that concluded Medicare paid hospitals 82 cents for every dollar they spent caring for Medicare patients in 2022.

    “An aging population will continue to exacerbate these challenges,” Hatton said. 

    Hospital margins, in large part, hinge on care for the commercially insured. The decline in the commercially insured patient population, combined with commercial insurers’ cuts to Medicare Advantage and continued contraction in Medicare payments, have caused providers to restructure their workforce and operations, particularly in rural and low-income communities. 

    “If you are in a geographic market full of people who are aging and where young people are moving away, you have a problem,” said Jeff Goldsmith, president of consultancy Healthcare Futures. “Ultimately, it’s a public policy problem.” 

    Hospitals and health systems can better manage the changes through wrap-around care models that help patients manage housing, transportation, nutrition and other social needs, taking on financial risk through alternative payment models, directing more care to outpatient facilities, consolidating certain services and delegating less complex care and administrative work to lower-level staff, industry observers said.

    Some health systems are trying to proactively head off expensive, resource-intensive care by improving the patient experience and adding outpatient sites.

    For example, at Tampa General, the hospital implemented a nurse navigator program in June 2019. The navigators help patients book follow-up appointments, answer clinical questions, explain medication, facilitate transportation and connect them with support services such as nutrition and housing programs. As a result, the number of care referrals booked jumped 80% from 2022 to 2023, Tampa General's data shows.

    Meanwhile, the health system continues to add small clinics and urgent care centers across Florida. Healthcare providers cannot expect patients to come to sprawling outpatient hubs, Couris said. 

    “When you are trying to break even on Medicare, you can’t necessarily afford a $100 million outpatient center,” he said. “The economics of healthcare are shifting, and we have to shift with it.”

    Outpatient expansion and managing Medicare patients are top of mind for HCA Healthcare too. The Nashville, Tennessee-based hospital chain bought 41 urgent care centers in Texas from FastMed in 2023, and has a "large development pipeline" of outpatient facilities in 2024 and 2025, executives said during a Jan. 30 earnings call.

    HCA CEO Sam Hazen has noted the importance of controlling spending and care coordination, particularly among its Medicare population. Medicare admissions grew 2.1% in 2021, 3.4% in 2022 and 4% in 2023, he said on the call.

    Memorial Hermann tripled its urgent care footprint in 2023. The nonprofit health system based in Houston, in partnership with GoHealth, has opened 30 urgent care centers, which have helped free up capacity at its Memorial Hermann's emergency departments, Chief Financial Officer Alec King said. 

    Also, Memorial Hermann has been consolidating services such as obstetrics and neurology into hospitals that specialize in those areas. Taking low-volume services out of certain hospitals and putting them into a centralized location has improved quality and reduced costs, King said.

    "It is not efficient for every hospital to be a center of excellence for every service," he said.

    Health systems across the country are considering consolidating services, said Michael Corbett, director of healthcare consulting at LBMC. "Nearly every conversation we’ve had with clients is focused on consolidation of services," he said.

    Providers are focused on boosting efficiency of specialty care given that most healthcare dollars flow toward a subsection of high-needs patients. The costliest 5% of Medicare beneficiaries accounted for nearly half of 2020 Medicare fee-for-service spending, according to a July report from the Medicare Payment Advisory Commission.

    Cancer diagnosis and treatment has garnered attention from the federal government because of the disproportionate expense burden on the Medicare program. The Centers for Medicare and Medicaid Services on Nov. 2 created new billing codes for cancer patient navigation services as part of President Joe Biden’s Cancer Moonshot Initiative.

    In addition, the Center for Medicare and Medicaid Innovation in July launched a risk-based payment model called the Enhancing Oncology Model. Participating physician group practices can earn a performance-based payment, or owe CMS a performance-based recoupment, if total expenses over a six-month period exceed a certain threshold.

    “A lot of our [health system] clients are seeing an increase in Medicare and Medicare Advantage patients and looking at value-based care as one way to potentially break even,” said Rick Kes, a healthcare senior analyst at accounting firm RSM. “This is the tip of the iceberg of Medicare because of the demographic shift of people aging into the program.”

    Still, some are taking a wait-in-see approach to Medicare care management strategies, he noted.

    “Some health systems are so big that they have some opportunity to weather these financial challenges for some time,” Kes said. “Others do not have that luxury.”


  • 6 Feb 2024 10:05 PM | Matt Zavadsky (Administrator)

    EMS agencies, like the rest of the healthcare system, face significant challenges with the ongoing, increasing drug shortage of essential medications.

    Thought you all might like to see the recommendations communicated today from the American Hospital Association….

    ------------------------------

    Source:

    https://www.aha.org/testimony/2024-02-06-aha-comments-house-committee-ways-and-means-examining-chronic-drug-shortages-united-states

     

    Statement of the American Hospital Association for the 
    Committee on Ways and Means of the U.S. House of Representatives 
    “Examining Chronic Drug Shortages in the United States” 
    February 6, 2024

    On behalf of our nearly 5,000 member hospitals, health systems and other health care organizations, and our clinician partners — including more than 270,000 affiliated physicians, 2 million nurses and other caregivers — and the 43,000 health care leaders who belong to our professional membership groups, the American Hospital Association (AHA) thanks you for the opportunity to submit comments to the House Committee on Ways and Means regarding the important topic of drug shortages in the United States.

    America’s hospitals and health systems have long been concerned about shortages of a wide range of drugs used to treat patients. Of particular concern to hospitals are the cascading impact of drug shortages on patients and the heightened stress on scarce hospital resources. Shortages can adversely affect patient care by causing delays in treatment, increasing the risk of medication errors and requiring the use of less effective alternative treatments. As a result, diseases that are curable or manageable for most patients, such as childhood leukemia, may not be able to be treated effectively.

    When a drug is in shortage, hospitals must find an alternative drug to provide their patients. This process of finding and procuring an alternative drug can result in significant costs to the hospital. An analysis published in 2019 estimated that drug shortages result in at least $359 million annually in additional labor costs to hospitals.1 This comes on top of the estimated $200 million annually that hospitals and health systems spend paying higher prices to acquire alternative therapies.2 Due to the increased cost and necessity of treating patients in a timely manner, especially in cases of cancer and other serious illness, it is important to ensure the pharmaceutical supply chain is protected and priority drugs are identified and given special attention so that continual access is ensured for patients.

    However, it has become increasingly clear that our national pharmaceutical supply chain is fragile; this fragility poses significant risk to the patients and communities served by America’s hospitals and health systems. Various businesses make up the pharmaceutical supply chain, including suppliers, manufacturers, distributors and group purchasing organizations. A disruption anywhere in the chain can create prolonged difficulties in pharmaceutical supply acquisition for providers, which can directly affect their ability to treat patients.

    Exacerbating these difficulties is the “lean” or “just-in-time” framework of supply chain operations. There is effectively little buffer when disruptions occur. Distributors, manufacturers and health care providers have pursued this just-in-time supply chain approach with the goal of more affordable health care by lowering costs; however, during large scale emergencies and other disruptions in supply, the risks and added costs of such a strategy is clear — when those disruptions occur, providers often have little or no notice and can be left scrambling to acquire products necessary to care for the sick and injured.

    A 2019 report from the Food and Drug Administration’s (FDA) Drug Shortages Task Force found there are three major root causes for drug shortages.3

    1. Lack of incentives to produce low margin drugs. Manufacturers of older generic drugs, in particular, face intense price competition, uncertain revenue streams and high investment requirements, all of which limit their ability to invest in resilience.
       
    2. The market cannot identify and preferentially buy from those with better quality management practices. All manufacturers must meet regulatory requirements for adherence to the FDA’s Current Good Manufacturing Practices (CGMP), which set expectations for company processes to be allowed to do business in the U.S. marketplace. Some companies do more than simply conform to these requirements. They take additional steps intended to ensure a reliable supply of the drugs manufactured at their facilities. Currently, purchasers, including hospitals and health systems, have only limited information to assess the state of quality management of any specific drug manufacturing facility and have little information linking the drug products they buy with the facilities where they were manufactured. The lack of information does not enable the market to reward drug manufacturers for mature quality management, back-up manufacturing capabilities or risk management plans, nor does it penalize manufacturers that fail to invest in modernization of their equipment and facilities to ensure a reliable supply.
       
    3. Logistical and regulatory challenges make it difficult for the market to recover after a disruption. Over the past two decades, the drug supply chain has become longer, more complex and more fragmented as companies have located more production overseas and increased the use of contract manufacturers. Although typical markets would respond to a shortage by increasing production, the complexity of the supply chain, and logistical and regulatory challenges, can limit the ability of drug manufacturers to do so. When companies wish to increase production, they may have to obtain approvals from multiple different national regulatory bodies and/or find a new source of active pharmaceutical ingredients (APIs). If a new manufacturer wants to enter the U.S. market and start selling a drug in shortage, the manufacturer must first develop and file an application with the FDA and await its approval.

    To mitigate these challenges, strengthening the supply chain is crucial. A focus on increasing manufacturing redundancy, diversifying where raw materials are sourced and where products are manufactured, and “fattening” the overall supply chain will provide significant improvements. It will allow the supply chain to withstand expected and unexpected fluctuations in the supply of, and demand for, pharmaceutical products and protect it against future public health emergencies and natural disasters.

    Supply chain issues can adversely impact patient care by delaying treatment, worsening patients’ health outcomes or requiring patients to switch to non-optimal treatment regimens. Congress should act to strengthen the ability of the pharmaceutical supply chain to respond when there is an emergency that creates a sudden rise in demand for medications or a significant disturbance in the supply chain that threatens the availability of critical medications. We recommend that Congress consider providing additional authorities to the FDA to mitigate and prevent drug shortages, such as by developing and disseminating manufacturing quality ratings that could enable hospitals and Group Purchasing Organizations (GPOs) to choose to do business with more reliable manufacturers, sending a market-based signal to support a reliable supply chain, and expanding the agency’s authority to require manufacturers to notify the agency about unusual spikes in demand of essential medications. Congress could also consider expanding the authority of the FDA to require manufacturers doing business in the U.S. to have an emergency response plan that anticipates likely disruptions in the manufacture of critical drugs, describes what steps would be taken to rapidly restore production and to run drills practicing putting those steps in place. These could be embedded in the CGMP requirements.

    Specifically, the AHA recommends that Congress enact legislation including:

    1. Diversifying manufacturing sites as well as sources of critical raw materials to ensure supply chain sustainability. Currently, the U.S. relies heavily on both China and India for the API and key starting materials (KSMs) necessary to manufacture pharmaceutical products. Further, many manufacturers of these products utilize manufacturing facilities located in both China and India. The overwhelming reliance on a limited number of countries for these pharmaceutical products necessary to care for patients in the U.S. raises serious concerns and poses significant risks to patients and burden on health care workers should a disruption occur. Congress should encourage redundancy in the supply chain through policy initiatives focused on spurring diverse sites of production, including where possible, onshore or near shore manufacturing of critical API and KSMs.
       
    2. Increasing end-user inventories and incentivizing additional cushion. The current just-in-time approach to supply chain logistics functions creates a hazard that becomes a reality during a significant supply chain disruption or emergent need to surge care delivery. Steps need to be taken to “feed” the supply chain with the goal of ensuring enough product is available, or capable of being made available, when demand increases. For example, supporting an increase in end-user inventory of critical medications as well as supplies held across the existing manufacturing and distribution infrastructure in the U.S. will help add necessary capacity to deal with interruptions in the availability of a critical drug. These actions may decrease the need for large national and state stockpiles, which can be difficult to manage and maintain, and present significant operating costs, product expiration and waste issues.
       
    3. Requiring the FDA to develop ratings of the quality management processes of drug manufacturers which are predictive of supply chain and manufacturing vulnerabilities and make these quality ratings publicly available.
       
    4. Requiring drug manufacturers to disclose to the FDA the locations where their products are manufactured, including contract manufacturer locations, as well as the locations from which they source KSMs, API and excipients used in their finished products, in order illuminate the extent of vulnerability for a product and to allow the development of targeted supply strengthening measures.
       
    5. Requiring drug manufacturers to notify the FDA of unusual spikes in demand of essential drugs to allow the agency to take steps to mitigate or prevent any impacts on availability and prevent potential shortages.
       
    6. Requiring the FDA to identify those essential drugs, including their KSM, API and excipients and component parts, that should have increased domestic manufacturing capacity to improve the resilience of the U.S. drug and device supply chain and make recommendations to incentivize their production.

    The AHA has been supportive of several bills that have sought to address supply chain issues which we believe will help address the issue of drug shortages. For example, this year, the AHA supported the Mapping America’s Pharmaceutical Supply (MAPS) Act (H.R. 6992) in the House, which would require the Department of Health and Human Services to update its essential medicines list and create a database to help predict vulnerabilities in the U.S. pharmaceutical supply chain.4

    We thank you for the opportunity to submit comments the House Committee on Ways and Means regarding drug shortages and look forward to continuing to work with you on this important issue.


  • 26 Jan 2024 4:31 PM | Matt Zavadsky (Administrator)

    Interesting issue – Many communities have not only done away with dual-paramedic units, but also any paramedics, opting for tiered ALS/BLS deployment models, when quality Emergency Medical Dispatch is used to appropriately triage calls, based on patient condition, since BLS care is appropriate for a large % of EMS requests.

    ------------------

    ‘Extremely unsafe’ lack of ambulance service in Multnomah County is unacceptable, Portland fire chief says

    Jan. 25, 2024

    By Austin De Dios | The Oregonian/OregonLive

    https://www.oregonlive.com/crime/2024/01/extremely-unsafe-multnomah-county-ambulance-services-unacceptable-says-portland-fire-chief.html

    Interim Portland Fire Chief Ryan Gillespie is the latest official imploring Multnomah County commissioners and health officials to address dangerously slow ambulance response times by changing the staffing model the county imposes on its ambulance provider.

    “The shortage of ambulances is putting the community’s lives in jeopardy and it is also putting our firefighters’ lives in danger,” Gillespie wrote to Dr. John Jui, the county’s medical director, and Aaron Monnig, its health office operations manager, in a letter dated Jan. 23.

    Gillespie joins Multnomah County Commissioner Sharon Meieran, an emergency room doctor, and Portland Commissioner Rene Gonzalez, who oversees the Fire Bureau, in demanding that county officials pilot a program to staff ambulances with an EMT and a paramedic, instead of two paramedics, as they do now. Meieran submitted a proposal to change the staffing requirement Dec. 14.

    Multnomah County has contracted with American Medical Response to send ambulances to emergency medical calls since 1995 but is unique among public agencies in requiring two paramedics per ambulance. AMR officials have said that dropping the requirement would allow them to put more vehicles on the road and respond to more emergencies faster.

    County officials recognize the growing problem of slow response times. In November it fined AMR over $500,000 for failing to meet 911 response time requirements spelled out in its contract with the county, which include arriving within eight minutes for emergency calls. But those same officials disagree about whether a shift to EMT staffing would solve the issue.

    Multnomah County health officials have insisted ambulances need two paramedics because that has helped the county maintain one of the highest cardiac arrest survival rates in the country, according to a November statement.

    Refusing to pilot this model “is irresponsible at best,” Gillespie wrote.

    During the snowstorm that pounded the city last week, Gillespie said that a firefighter broke several bones while battling a blaze. But no ambulances were available at the time, so firefighters transported the firefighter themselves, Gillespie wrote. That’s not something they can do for everyone.

    In the early morning hours of New Year’s Eve, firefighters responded to a call of someone with chest pain. No ambulance was available to respond, a status known as “Level 0,” and firefighters worked with TriMet staff to take the man to the hospital on a bus, as first reported by KOIN 6. The driver, Joe Wiggins, and other TriMet employees won praise in a TriMet board meeting Wednesday, but the man could have died had the situation been more dire.

    The problem requires immediate action, Gillespie said.

    “This is extremely unsafe for the patients and for the firefighters providing medical care as these vehicles are not licensed, nor set up to transport critical patients,” Gillespie wrote.

    Shane Dixon Kavanaugh contributed to this story.


  • 25 Jan 2024 11:36 PM | Matt Zavadsky (Administrator)

    Nice to see a community seeking proposals for evidence-based innovation in their EMS system!

    ------------------------

    Change Sought for County Ambulance Response System

    By Larry Altman

    January 25, 2024

    https://www.independentnews.com/news/regional_and_ca/change-sought-for-county-ambulance-response-system/article_bdb20e9a-bb2c-11ee-af73-a38bde2b440e.html

    REGIONAL — Alameda County officials have opened the bidding process for a new ambulance service contract, asking prospective providers to create a system that would make it unnecessary to transport all patients to emergency rooms.

    The idea, said Lauri McFadden, emergency medical services (EMS) director for the county, is to eliminate the “one size fits all approach,” where every patient who calls 911 is taken to a hospital, even if that is not required.

    McFadden called the idea a “significant shift in how we’re approaching 911 ambulance response.” Residents in Livermore, Pleasanton, Dublin and Sunol all receive ambulance service through the county’s contract, currently with Falck Northern California.

    “The new system is designed to deliver the right care at the right place based on the patient’s acuity, which can mean that in some low-acuity cases patients will receive medical and other treatment at places other than the county’s emergency rooms,” McFadden told The Independent. “The county hopes this will help reduce the impact of the time ambulances must wait between calls.”

    McFadden said the new approach will enable health professionals to provide necessary care, whether in a hospital emergency room, at the scene, or by connecting the patient to other care outside the emergency response system.

    Patients not needing hospitalization could be connected to a care provider on the phone or referred to a service that would deploy mental health providers.

    “Our goal is really to be able to offer the appropriate level of care for each unique call,” McFadden said. 

    According to the county’s “Request for Proposal (RFP)” issued Jan. 11 to open the bidding process for a new ambulance service contract, the EMS system will “appropriately prioritize” lower acuity 911 calls where a life is not threatened. 

    “Not all EMS callers are necessarily patients who require EMS,” the document says. “Many 911 calls involve situations that are not life threatening and do not require an immediate EMS response or indeed any emergency response at all.”

    The change would free up ambulances for true emergencies, it says.

    During the last year, Livermore and Pleasanton officials have criticized Falck Northern California for delays in responding to calls to assist Livermore Pleasanton Fire Department. According to LPFD data, Falck failed to meet expected response times 7.2% of the time on calls requiring a priority response — those with lights and sirens — from May to September.

    Livermore City Manager Marianna Marysheva and Pleasanton City Manager Gerry Beaudin recently wrote a letter to Falck officials to express their concerns and met with them as well.

    The issue of response times is occurring at the same time the county opened the process for other EMS companies to bid for the contract. Falck’s contract expires in 2025. In a statement to The Independent, the city managers did not directly comment on whether they believe the change in policy would improve emergency response times.

    “The cities of Livermore and Pleasanton receive EMS service through a contract with Alameda County,” Marysheva and Beaudin said in a statement. “The county received input from partner cities in the development of the RFP that includes a system redesign for all emergency medical response/transport. The cities are looking forward to service improvements through this new contract. “

    Potential providers have until August to submit their applications. Whoever wins the job, which would be determined by the Board of Supervisors, would take over service between April and July 2026.

    McFadden said in most cases, ambulance providers bill a patient’s insurance for the cost of transport. Not requiring a trip to the emergency room could save the patient money.

    “While cost savings to the consumer may certainly be a byproduct of the RFP, it was not a driving factor in its design.”

    McFadden called the system design change unique in California. She said it was developed through a multiyear process that included public meetings.


  • 17 Jan 2024 9:11 AM | AIMHI Admin (Administrator)

    January 17, 2024 – Irving, TX We didn't need emergency warning devices to get where we were going - a motor vehicle crash without serious injuries. We tried to change lanes and were hit from behind, sideswiped, and pushed across the road. We expected people to yield to us, but the bright flashing lights and sirens contributed to distracting the driver of the car as he was trying to get around us. I still to this day believe we wouldn't have gotten crashed if we were driving without the use of the emergency warning devices.

    The reality is when lights and sirens are on, the risk of crash increases by over 50%.  Weekly, we hear  reports of ambulance crashes that impact providers, patients, and the public.  

    The National EMS Quality Alliance has released Improving Safety in EMS: Reducing the Use of Lights and Siren, a change package with the results, lessons learned, and change strategies developed during the 15-month long Lights and Siren Collaborative It will assist EMS organization in making incremental improvements to use of lights and siren on a local and systematic basis. "The best practices that have emerged from this project will allow every agency, regardless of service model or size, to more safely and effectively respond to 9-1-1 calls.” says Michael Redlener, the President of the NEMSQA Board of Directors.

    "By utilizing less lights and sirens during EMS response and transport, our efforts have shown measurable increases in safety. The EMS community and the general public will surely benefit from the now-proven tactics provided by this partnership,” added Mike Taigman, Improvement Guide with FirstWatch and faculty leading the collaborative.

    More about the Collaborative and participating agencies can be found in the change package and on the NEMSQA website.

    About the National EMS Quality Alliance

    The National EMS Quality Alliance (NEMSQA) is the nation's leader in the development and endorsement of evidence-based quality measures for EMS.  Formed in 2019, NEMSQA is an independent non-profit organization comprised of stakeholders from national EMS organizations, federal agencies, EMS system leaders and providers, EMS quality improvement and data experts as well as those who support prehospital care with the goal to improve EMS systems of care, patient outcomes, provider safety and well-being on a national level.

    NEMSQA
    Sheree Murphy
    smurphy@nemsqa.org
    315-396-4725


  • 3 Jan 2024 3:56 PM | Matt Zavadsky (Administrator)

    AMR Wins Big in Showdown with Santa Barbara County Fire

    Judge Rules in Favor of American Medical Response in Its Ambulance Service Lawsuit Against County

    By Nick Welsh

    Tue Jan 02, 2024

    https://www.independent.com/2024/01/02/amr-wins-big-in-showdown-with-santa-barbara-county-fire/

    In a punishing legal opinion — both in terms of length and detail — Judge Donna Geck ruled that American Medical Response (AMR) ambulances will continue to provide emergency medical response services throughout Santa Barbara County at least until July 16, expressing undisguised skepticism throughout her 33-page opinion at the procedural gyrations undertaken by the County Board of Supervisors to award the lucrative ambulance contract to the County Fire Department instead. 

    Absent Geck’s ruling to approve the temporary injunction, County Fire would have taken over the county’s ambulance service contract as of March 1. As part of her ruling, Geck ordered AMR — which has enjoyed a near total countywide monopoly for more than 41 years — to keep on providing that service at least until July, at which point, a proper trial can be conducted, and the underlying issues hashed out. (That process, it should be noted, could take as long as five years.) 

    Geck’s order qualifies as a judicially ordered “time-out” in a years-long campaign launched by fire chiefs throughout the county to take over the ambulance contract. Because they — unlike AMR — are not a private corporation beholden to stockholders, they have argued, they can field more ambulances at any given time and deliver quicker response times for less money. What AMR transfers back to corporate headquarters by way of profits, they argued, can be plowed back into the community to underwrite such programs as “co-response units” in which public safety personnel team up with mental-health professionals to alleviate the stress and strain imposed on law enforcement. 

    Sadly, for County Fire Chief Mark Hartwig, the fire chiefs who support him, and the four county supervisors who supported them all, none of that was considered by the special panel empowered to review the competing bids submitted by AMR and County Fire. In fact, AMR scored 300 points higher than County Fire. County Fire appealed not once but twice and lost both times.

    The supervisors responded by changing the bidding process to circumvent state laws that apply to exclusive ambulance contracts; they declared the contracts to be “non-exclusive” and enacted an ordinance that enabled them to award multiple contracts based on the “community benefits” promised by the provider. Judge Geck found the verbiage surrounding those benefits to be so amorphous as to be meaningless and said so several times. 

    She also noted that at the end of the day, County Fire ended up with the sole contract. As an exclusive contract awardee, she argued, the state laws — passed in 1980 and 1984 — designed to protect local communities from the downside of market monopoly power should have been observed. That law requires all exclusive ambulance contracts to be reviewed by the local Emergency Services Administration; in this case, Geck concluded, it was not. 

    State Attorney General Rob Bonta had weighed into the case as well, expressing serious concern in a friend-of-the-court brief that key state safeguards had been bypassed. This was the first time, his brief noted, that such an approach had been deployed. Should it succeed in Santa Barbara, his office made clear, it could establish a precedent. In that regard, Bonta is not wrong; statewide and nationally, there’s growing interest by local fire agencies to provide ambulance service. All eyes are, in fact, on Santa Barbara. 


  • 3 Jan 2024 3:48 PM | Matt Zavadsky (Administrator)

    Interesting…

    --------------------------

    Has the fire service reached a tipping point? Readers weigh in.

    The FireRescue1 community considers what is driving high stress and staffing challenges

    January 02, 2024

    https://www.firerescue1.com/staffing/has-the-fire-service-reached-its-tipping-point-readers-weigh-in

    With the fire service facing a perfect storm of stressors, we once again asked the critical question, “What do firefighters want?” The short answer revealed through the more than 2,100 participants in the 2023 survey: stress relief and staffing.

    The What Firefighters Want digital edition featured the flagship article, also lead by a question – “Are we at a fire service tipping point?” – by Dr. Reginald Freeman, who explained that while firefighters feel generally positive about the job, they report high stress, and many have considered leaving their organization. Freeman evaluates some of the possible reasons for this and concludes his analysis with this statement: “Servant leadership and transformational leadership emulation is not common throughout the fire service. We have plenty of people in positions of authority, but that certainly doesn’t automatically qualify them as leaders.”

    Freeman’s article resonated with FireRescue1 readers, many of whom shared their thoughts on the fire service tipping point on Facebook.

    Following is a snapshot of the top comment themes. Join the conversation.

    Wanted: Strong leadership

    “Real firefighters and true leaders rarely move past the company officer level. The guys who don’t understand the job at the rank and file and have poor leadership skills always seem find a way to promote up to administration.”

    “Real leaders should make the commitment to a higher rank. Some seem to, but the majority don’t. … I can understand why guys that should promote, don’t promote. It’s comfortable where they’re at and you’re really taking a chance.”

    “It’s a very specialized position. Too often we just hand the Chief’s position to someone because they are well liked. It takes more than just being liked at a company level to be the Chief. I also think, and would assume you would agree, each department has its own issues to address when it comes to finding a Chief.”

    Not-wanted: EMS

    “After 26 years of full-time fire service, I can definitely say EMS is the cancer. No one wants to say ‘no’ to the abusers of the system. It single handedly kills morale. People who call 100+ times a year with no problem are the real reason people no longer care. Fix this and fix the problem.”

    “Get rid of EMS and keep it separated from firefighting and you will have more applicants for both.”

    Political problems

    “The disrespect we get from politicians on both ends of the spectrum is spirit crushing. As long as the boss keeps his job by keeping the politicians blissfully unaware of the FD, there is no impetus to improve the work conditions and preparedness of those of us on the line.”

    “Politics seems to get in the way at every level.”

    “I get frustrated a lot and more and more as I get older. However, this job has given me so much and yes at times it has taken things from me. However, it’s a job I still love and no chief or politicians will take that from me.”

    The job has changed

    “Used to be that a public pension and benefits were well worth it. Now the benefits have been reduced and the pension isn’t as great. Plus, EMS has become the biggest part of career fire departments’ call volume. Stress, overwork, pay not keeping up with inflation, all play a part. As far as volunteering, it is hard to get people to commit the time for free when they have bills to pay. I always ask, why is firefighting the one job that people expect to be done for free? Because some people want to be firefighters so bad that they will do it for free.”

    “I would say it has less to do with the runs/station life and the ‘actual job’ and more to do with the crap we put up with from city and admin. In the 12 years I’ve been with my city, we have changed computer programs 3 times. And each time we are told the preplans and such will transfer. Each time it doesn’t then we have to do all that work again … and since it’s new software we can’t access the old stuff so we need to research everything again leading to more and more apathy towards getting good info. We’ve moved away from in person hands-on training to favor computer training. There is more office/desk work than actual ‘fun’ work. It’s not the same job it used to be, and I get why people retire because they don’t want to do it anymore.”

    “The increasing call load. Population booms outpacing the resources of law enforcement, fire/EMS, and available hospitals. Declining interest from the newer generations to do the job resulting in staffing shortages. Forced overtime leading to divorces. Dealing with an increasingly hostile and unreasonable public. Politicians from either of the dominant two parties sliding public safety to the back burner.”

    “Time is the first and worst when it comes to [volunteering] … When you look at how many hours you’re going to have to spend in a classroom right off the bat, you look at your work schedule, and this is where it ends for a number of them. … Someone who’s already limited on their time would probably be the last to make it from home when the pager goes off. Considering the days of the volunteering are coming to an end, it was very easy for the local governments to step in if they were not already, and demand changes be made. Since many fire companies around the country are community supported, it would have been a better thought to retain what we had at the time, versus making dramatic changes, and hoping everyone understands and rolls with them.”

    Do you agree with these comments? Join the conversation.


  • 27 Dec 2023 7:36 AM | Matt Zavadsky (Administrator)

    Based on the publisher/author, this may be a touch ‘self-serving’, but certainly something EMS agency leaders, personnel and communities should continually research for enhanced clinical care and operations.

    Many High-Performance/High-Value EMS agencies, such as MedStar, and other AIMHI member agencies, are using machine learning and big data analytics for applications such as temporal and geospatial resource deployment, clinical treatment advances, and EMS response plans based on presumptive emergency medical dispatch determinants that are done by well trained and quality assured call-taking personnel.

    To highlight the emerging roles for AI in EMS, the NAEMT Board of Directors will be holding its January winter board meeting at the Arizona State University’s AI Center, learning about potential AI applications for EMS.

    ---------------------------------

    The Role of Artificial Intelligence in Pre-hospital Care

    December 26, 2023

    https://anyuakmedia.com/the-role-of-artificial-intelligence-in-pre-hospital-care/#gsc.tab=0

    Artificial Intelligence (AI) has been making waves in various industries, and now it is revolutionizing the field of emergency medicine. In particular, AI is playing a crucial role in pre-hospital care, transforming the way emergency medical services (EMS) respond to emergencies. With its ability to analyze vast amounts of data and make accurate predictions, AI is enhancing decision-making, improving patient outcomes, and ultimately saving lives.

    One of the key applications of AI in pre-hospital care is in the field of dispatching. Traditionally, emergency calls are routed to dispatchers who gather information from the caller and determine the appropriate response. However, this process can be time-consuming and prone to human error. AI algorithms, on the other hand, can quickly analyze the caller’s information, identify the severity of the situation, and dispatch the appropriate resources accordingly. This not only saves valuable time but also ensures that the right level of care is provided from the moment the call is made.

    Once EMS personnel are on the scene, AI continues to play a vital role. AI-powered triage systems can quickly assess a patient’s condition and prioritize treatment based on the severity of their injuries or illnesses. By analyzing vital signs, symptoms, and medical history, these systems can provide EMS personnel with real-time guidance on the best course of action. This not only helps in delivering prompt and appropriate care but also reduces the risk of errors or delays in treatment.

    In addition to triage, AI is also being used to assist EMS personnel in making critical decisions during emergencies. For example, AI algorithms can analyze data from various sources, such as medical records, lab results, and imaging scans, to help diagnose conditions or predict complications. This can be particularly valuable in situations where time is of the essence, such as cardiac arrests or trauma cases. By providing EMS personnel with accurate and timely information, AI empowers them to make informed decisions that can significantly impact patient outcomes.

    Furthermore, AI is enabling EMS personnel to better monitor patients during transport. AI-powered monitoring systems can continuously analyze vital signs, detect changes in condition, and alert EMS personnel to potential complications. This allows for early intervention and prevents adverse events during transit. Additionally, AI algorithms can also provide real-time feedback and guidance to EMS personnel, ensuring that they are delivering the most effective care throughout the journey.

    The integration of AI in pre-hospital care is not without its challenges. Privacy and security concerns, as well as the need for extensive training and education, are some of the hurdles that need to be addressed. However, the potential benefits far outweigh the challenges. AI has the ability to enhance decision-making, improve efficiency, and ultimately save lives in pre-hospital care.

    In conclusion, AI is transforming the field of emergency medicine, particularly in pre-hospital care. From dispatching to triage, decision-making, and patient monitoring, AI is revolutionizing the way EMS personnel respond to emergencies. By leveraging the power of AI, emergency medical services can provide faster, more accurate care, leading to improved patient outcomes. As technology continues to advance, the role of AI in pre-hospital care is only expected to grow, further revolutionizing emergency medicine and saving more lives.


  • 17 Nov 2023 8:16 AM | Matt Zavadsky (Administrator)

    An outstanding report from the Minnesota EMS Regulatory Board (EMSRB) relating to the economic condition of EMS agencies in Minnesota!

    Highlights and excerpts can be downloaded here:

    Summary - Highlights - Minnesota EMSRB EMS Economic Report - 2023.pdf

    The full report can be downloaded here:

    Financial Evaluation of Minnesota's Ground Ambulance Industry - 2023.pdf

    Outstanding work by Dylan J Ferguson, the Executive Director of the MN EMSRB, and his team for compiling and publishing this report!

    ---------------

    Furthermore, the report underscores the harsh reality that ambulance services often fail to recover the actual costs of providing their services. With a minimum of 62% of billable responses failing to recoup their true expenses, EMS providers face a substantial fiscal gap. This shortfall translates to a financial loss ranging from $34.47 to $463.44 for every Medicare or Medicaid response, a situation that is economically unsustainable in the long term. Addressing this issue necessitates a multifaceted approach, including a comprehensive review of billing practices, potential reimbursement adjustments, and strategies to enhance the efficiency of operations without compromising the quality of care.

    In light of these findings, it is evident that action is required to ensure the continued availability of high-quality emergency medical services to our communities. Stakeholders in the EMS sector, including government agencies, healthcare institutions, and advocacy groups, must come together to address these challenges.

    Operational Cost Per Transport: Operational costs per transport have surged, with an increase ranging from 55% to 189% since 2010. This escalation in expenses signifies the financial challenges faced by ambulance services in providing efficient and accessible healthcare transportation.

    Insurance Billables and Payments: Ambulance services reported $1.2 billion in insurance billables but received approximately $450 million in insurance payments during the reporting period [a 37.5% collection rate]. The discrepancy between billables and actual payments raises questions about reimbursement rates and financial viability of ambulance services throughout the state.

    Financial Loss: Alarmingly, 72% of reporting ambulance services reported some level of financial loss when comparing operational expenses to insurance revenues. This highlights the financial vulnerability of EMS providers, especially in light of increasing costs.


  • 16 Nov 2023 8:57 AM | Matt Zavadsky (Administrator)

    Shannon did a great job with this report!  Another example of the crisis facing EMS across the U.S. 

    Rural communities have the greatest challenge, but urban communities are facing similar challenges…

    ----------------------------

    Your Ambulance Is on the Way. ETA: 65 Minutes.

    Rural patients can wait an hour or more for emergency responders from strained services

    By Shannon Najmabadi

    November 16, 2023

    https://www.wsj.com/us-news/your-ambulance-is-on-the-way-eta-65-minutes-0431facd

    MERRIMAN, Neb.—Call 911 in this northwest Nebraska town, and the ambulance responding will likely be coming from South Dakota.

    If that crew isn’t available, the ambulance might drive from Valentine, Neb., 60 miles and a different time zone away. Or from Gordon, where the all-volunteer staff includes employees of a grocery store, bank, veterinary office and farmer’s co-op.

    “You’re looking at an hour or longer for a response,” said Rose Chappell, the last emergency medical technician in Merriman, which had to shut down its ambulance service. 

    This patchwork has become the norm in many parts of America, putting some people at greater risk of death or serious injury as rural residents are getting older and small hospitals are closing.

    Buck Buckles, a rancher, said the Merriman ambulance service picked him up after he fell off a horse in 2015, at age 74, breaking a shoulder and seven ribs. 

    “If I had still been laying there waiting for an ambulance to come from Valentine, 75 miles away, or Hyannis, 70 miles away, I might have been dead,” he said. 

    At least 4.5 million people nationwide live in an ambulance desert, where they are farther than a 25-minute drive from an ambulance station, according to a 2023 study. In Nebraska, more than 80% of emergency medical providers are volunteers working in sparsely populated areas where there are too few calls to justify having full-time staff, according to a 2019 study.

    “I think that the majority of the American people do not understand how different it is out there,” said Andy Gienapp, deputy executive director of the National Association of State EMS Officials.

    Rural ambulance services have been strained by a largely unprofitable business model, the pressure of the pandemic and recent struggles to hire people willing to undertake extensive training and work a high-pressure job for free, emergency medical personnel say. 

    Most state and local governments aren’t required to fund ambulance services the way they do law-enforcement offices.

    In Gordon, a town 30 miles west of Merriman, Neb., volunteers say they regularly leave their jobs midday or wake up in the middle of the night to respond to 911 calls.  

    More than 55 ambulance providers have closed since December 2021, according to a log of news reports compiled by the American Ambulance Association and the Academy of International Mobile Healthcare Integration.

    As departments close their doors, there is no agency “required to step up and fill that gap,” said Micheal Dwyer, a volunteer firefighter and emergency medical technician with Arlington Fire and Rescue in Nebraska. 

    Merriman’s ambulance service is the first in Nebraska to close due to lack of a workforce, said Allan Urlis, spokesman for the state’s Department of Health and Human Services. The state, which is conducting an assessment of emergency medical services statewide, has offered grants to replace rural ambulances and reimburses some education and training costs.

    Ambulance services are funded by a mix of patient bills, donations, taxes and fees. In some places, emergency medical services are provided by cross-trained firefighters, private companies or hospital employees. 

    Industry experts say patient bills alone can’t cover the cost of providing ambulance services in a rural area—where emergency medical officials might respond to 100 calls a year but still require hundreds of thousands of dollars to buy and fuel ambulances.

    Medicare, a federal health insurance plan for seniors and some people with disabilities, and Medicaid, a joint state and federal program for those with low incomes, typically don’t reimburse the full amount charged for an ambulance ride, those experts say. Medicare typically doesn’t pay for an ambulance if the patient isn’t transported to a hospital.

    “We don’t control the calls we get, and we don’t deny calls,” said Michael Christensen, chief executive officer of the hospital in Martin, S.D., 18 miles north of Merriman. Grandma might have a bruise after falling down the stairs, he said—a 911 call the ambulance likely wouldn’t be paid for if the woman is treated at the scene—or “Grandma might have something horribly wrong—she fell down, banged her head and has a closed head wound that will kill her in an hour.” 

    The pressure on ambulance services comes as many are seeing increased demand. 

    Christensen’s hospital owns an ambulance service that responds to 911 calls across 2,000 square miles, including parts of two Indian reservations, three economically distressed South Dakota counties and a swath of Nebraska. The ambulance’s nine volunteers—paid $2 an hour to be on call—now regularly treat people who call 911 for minor ailments.

    “We get phone calls because people in our area don’t have cars,” said Judi Claussen, who works in the hospital’s radiology department and volunteers for the ambulance service with her husband, a city councilman, and her daughter, the hospital’s lab technician.

    Merriman is surrounded by sand hills and ranches. Its population shrank from 128 residents in 2010 to 87 residents in 2020, according to the U.S. Census Bureau. The local school and a senior center have closed, the dance hall has a broken window, and a sign at the beauty salon on the town’s main street says it is open one day a week. 

    Chappell said she joined the town’s ambulance service in the early 2000s, when it had a crew of about 10 people. Over time, some of the Merriman ambulance volunteers grew old. Others moved away. Younger residents didn’t sign up. The ambulance service had little community involvement and ineffective management, a 2017 assessment found. 

    By 2017, the service was down to Chappell and one other emergency medical technician. He resigned. Chappell was uncomfortable with answering calls by herself. The ambulance went into storage. It hasn’t responded to 911 calls in more than five years.

    Chappell and members of the Merriman ambulance board have written letters, placed radio ads and made calls soliciting volunteers. Some people said they would sign up—including two people over age 70—but none followed through with completing the 150 to 200 hours of required training. This year, the ambulance board agreed to disband. The board is trying to sell its ambulance.

    Neighboring ambulance districts answer emergency calls in Merriman, but the distance and reality of having volunteer staff with separate day jobs can eat into crucial medical response time, local responders say.

    “It might take an hour to get out to the patient and an hour back,” said Nancy Hicks-Arsenault, interim CEO of the hospital in Valentine, where the ambulance service has 28 volunteers and covers a county larger than the state of Connecticut. 

    “That golden hour of treatment is already exhausted,” Hicks-Arsenault said. 

    The current crisis stems in part from the industry’s decadeslong reliance on volunteers, whose free work subsidized the largest cost of running an ambulance service, said Gienapp, with the national emergency medical services association. 

    Fewer people are volunteering now, in part because rural populations are shrinking and remaining residents are older; adults 65 and older are the age demographic most likely to need ambulance services, studies show.

    With fewer volunteers shouldering the work, small ambulance crews can flame out from the stress of being on call around the clock or from seeing community members in medical distress. 

    In Gordon, a town 30 miles west of Merriman, volunteers say they regularly leave their jobs midday or wake up in the middle of the night to respond to 911 calls. 

    “You’re running every call and we’re seeing a lot of really, really bad things,” said Alyssa DeHart, who volunteers with her husband Nick. “And then, we’re the only ones that are doing this.”

    “There’s no one coming to help us.”


© 2024 Academy of International Mobile Healthcare Integration | www.aimhi.mobi | hello@aimhi.mobi

Powered by Wild Apricot Membership Software