Opportunities Facing EMS: Reimbursement for Additional Care

opportunities' for EMS

Dan Sullivan, the founder of The Strategic Coach Inc. and creator of the Strategic Coach® Program, developed a methodology for assessment named D.O.S., which stands for Dangers, Opportunities, and Strengths.

Opportunities offer the possibility to gain something, strengths encompass our unique skills and abilities, while dangers refer to things we are afraid of losing. In the upcoming blog series, EMERGICON will utilize this methodology to assess the Emergency Medical Services industry and offer insight on how to mitigate dangers, capitalize on opportunities, and develop the strengths that are most impactful.

Opportunity: EMS Reimbursement for Additional Care

Dubbed a new model of healthcare, mobile integrated healthcare (MIH) and community paramedicine (CP) enable emergency services personnel to make a difference in new ways. Communities that implement these programs find benefits for patients, healthcare payers, and the EMTs/paramedics themselves.

All too often, people call 911 for non-emergency medical needs. In Fort Worth, for example, a 2009 MedStar study revealed the daunting reality of nearly $1 million in ambulance costs used by 21 people for 800 visits. Just in one year. This not only wastes money but also diverts critical resources from those who actually need emergency services.

Mindsets started to shift when healthcare payers were rated on the quality of care versus the quantity of care. The healthcare industry is shifting to collaboration and coordinated care between hospitals, nursing homes, and doctor’s offices. This new model decreases costs for healthcare payers as non-emergency visits to emergency departments decrease and offers additional revenue opportunities for EMS agencies. The Emergency Triage, Treat and Transport (ET3) model, started in 2019, allows for Medicare reimbursement for ambulance transports to alternate destinations, rather than emergency departments.

Community paramedicine also benefits the paramedics themselves. As EMTs and paramedics make routine visits to patients’ homes, they can help people with complex chronic conditions learn how to manage their medications and symptoms. It helps paramedics feel more supported and valued by using their skills and resources to solve healthcare problems in the community. Avoiding burnout is certainly critical as Texas faces a shortage of paramedics, as we discussed in our blog, “Dangers in EMS: Shortage of Paramedics.”

Looking to the Future

According to the Texas EMS Alliance’s publication, EMS 3.0: Explaining the Value to Payers, Emergency Medical Services (EMS) can fill in the gaps in the continuum of care with 24/7 medical resources. This diversifies the revenue stream for emergency service agencies with additional value-added services such as community paramedicine, 911 nurse triage, and ambulance transport alternatives.

What is your perspective on the new opportunities around EMS reimbursement for additional care? Join the conversation on Facebook and LinkedIn.

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