healthcare transformation and fire service ems mark stevens ba, emtp
Post on 25-Dec-2015
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Primary Care
Specialty Care
Ambulatory Care
Emergency Dept
Urgent Care
Nursing Home
Home Health
Pharmacy
Hospitals - 2007Physicians - 2009
Reporting“Failure to submit data for FY2007 and beyond results in a
2%decrease in Medicare reimbursement.”…
(Additional impact after Oct 1, 2012.)
17 Clinical care measures in 5 categories: (AMI, Heart failure, Pneumonia, HC assoc infection, Surg improve)
8 Consumer assessments: (doc/nurse communication, staff responsiveness Pain mgmt, Cleanliness/quietness of environ.)
Physicians: 3 Financial incentive plans
- Quality reporting (199)- Electronic Prescribing- Electronic Health Records
2011
2012
2013
2014
2015
2016
2017
2018
2019
Quality Reporting
1.5% 1.5% 1.5% 1.5% -1.5%
- 2% - 2% - 2% - 2%
Electronic Prescribing
1% 1% 0.5% 0% 0% 0% 0% 0% 0%
E-Health Records
Spec amt
Spec amt
Spec amt
Spec amt
-1% -2% -3% -4% -5%
- Quality Measures- Accreditation/Certification- Electronic Records- Consumer Satisfaction- Efficiencies
EMS/Ambulance
HealthcareInformationExchange
Labs
Hospitals
Pharmacy
Physicians
GovtMedicaid/Pub H
Payers
Consumers
Clinics
EMS
The first call of the day was a 43 yo male that was
found laying in the front yard of a residence. I was
able to find the pt’s medical hx of seizure, and his
last ER visit to OUMC.
SMRTNET was used to confirm pt’s information she provided to me. Pt stated she had no
allergies, however SMRTNET found allergies in hx. Upon questioning pt remembered “yes” to
allergic to…
Health Information Exchange
EMSA, Oklahoma City
80% of HC $’s spent on 20% of people
Known causes and preventable.
Current direction will bankrupt State/Country
Oregon’s “Triple Aim” (HB3650)
-Improve lifelong health of all Oregonians.
-Increase quality, reliability and availability of care for all Oregonians.
-Lower or contain the cost of care so it is affordable for everyone.
Oregon Health Policy BoardHB3650
CCOWork grp
GlobalBudgetWork grp
MetricsOutcom
eQuality
CMSIntegratio
nWork grp
Health Homes
HospitalsHealth Homes
Food Mart
Specialty Clinics
Food Mart
Specialty ClinicsHealth Homes
Hospitals
Clinic
ClinicAccountable Care Organization
Health Plan Health PlanHealth Plan
http://www.emmisolutions.com/medicalhome/pcpcc/english.html
The “New Normal”
Integration of EPCR
Hospital records
Bundling
No Money
AlternateDestination
Never Events
EMS Agenda for the Future
Alternate funding
http://www.youtube.com/watch?v=Z1SBgCL1qTg
Non-Traditional Health Workers
Team: Community Health WorkersPeer Wellness SpecialistsPersonal Health Navigators
Training: Core CompetenciesCross-cultural communication/liaisonGroup/family dynamics, Advocacy skills,Knowledge of resources, Needs assessment
*Opportunity
“Community Paramedic”
UK – Dispatch, NonTraditional & MD
Toronto – CREMS
U.S. – Minnesota, Eagle CO, MedStar, Wake Co, Nebraska… Tucson, TVF&R, King Co
Scope of Practice
Training Programs
Medical Liability (next legislative session)
CMS Innovation Challenge Grant
Local CCO activity/relationships
Non-Traditional Training opportunities
Nursing Associations
Protocols & Scope of Practice
Things to watch for
Things to watch (know your numbers)
Call breakdown:- Dry runs (# should drop)- No Pays (# should drop)- Freq caller (# should drop)- Number of transports to ED
Evaluate:- Effect on operations/staffing- Transport revenue- Alternate destinations- Innovative ways to get right resource/right pt- Alternate revenue streams
What should we be doing?
- Be aware of state/local changes- Support medical liability changes for EMS- Build relationships (CCOs, Medical Homes, hospital)- Market the value of EMS- Assess degree of involvement for your agency- Performance-based culture- Electronic charting (Image Trends)
Value of EMS
- We are healthcare providers.- Infrastructure for quick response to anywhere in our community.- EMS can assess/direct to alternate destination.- We can “fill the gaps” and support CCOs.- Clinics in fire stations?- Preventative health fairs?- Work under medical authority, QI.- Lessen hospital readmissions- Participate in care plans
What should we be doing?
- Think Innovation..right resource/pt/time- Accountability: Not just about response time-Work smarter (deployment, resource/demand)-Develop people for expanded roles-Become integrated with healthcare systems-Position external stakeholders to be advocates
Diversify Revenues/Efficiencies
Training ServicesCommunication ServicesOcc HealthBillingVehicle maintenanceConsolidate medical directionShare cost savings with payors
CMS Innovation Challenge Grant
- First grant for EMS eligibility- $1 – 30 million/grant- Three years to be self-sustaining
Portland metro area (4 counties)
-Dispatch triage (EMD & Nurse)-Alternate destination for 9-1-1 response-Post hospital discharge followup
TestimonyRelationships/networkEHC GovernanceResourcesLinksLegislation
www.ofcaems.org
Your EMS Section
Serenity Prayer
God, grant me the serenity to accept the things I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
Resources
www.health.oregon.gov
www.ofcaems.org
www.hitsp.org
http://communityparamedic.org
www.wecadems.com/cp.html
www.medstar911.org/community-health-program
www.wakegov.com/ems/staff/app.htm
http://www.emmisolutions.com/medicalhome/pcpcc/english.html
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