Friday, December 6, 2013

Community Paramedicine and “The Little Guy”

The Buzz…
Read anything EMS-related today and you’ll probably see that Community Paramedicine is all the buzz. In fact, it’s a bit worn out already as a topic and this “thing” that it is hasn’t even hit full stride.

There’s no doubt that anyone in EMS can see that changes are coming…again. You’re not looking close if you don’t see it on the horizon.

EMS in the U.S.A. has seen many changes, if you’ve been in the game for a while.

Over the last three to four decades, especially, modern EMS has become so much more than any of us could even have imagined. Think back when a couple of nervous paramedics (remember when pre-hospital ALS was new too?) hit the streets to test their wings with those fancy portable heart monitors with the monochrome screens and did the unthinkable by sinking a breathing tube down someone’s throat in the field!

We’ve come a long way since then, for sure.

AND versus OR
EMS is at another one of those crossroads. We can feel it and we’ll accept it because we have no choice.

Community Paramedicine will be the evolvement of a system that has been completely built on treatment AND transport into one that will most likely morph into treatment OR transport.

When we boil it all down that’s what comes to the surface. Somehow, EMS will be empowered to help the patient make a decision on whether or not he/she receives just some kind of maintenance treatment in the field by following an algorithm or decision-making tree about when or if the patient is ultimately transported to a facility for further care.

And…of course…there may be some kind of payment structure (at least we hope) to accommodate those decisions and pay for all of this to happen. In the end, patient care is always primary for those of us who are purists but the realists in all of us know that the bus is driven by who pays the bill and how much will be paid to adequately support the system.

Having said all of this for background, the foundation for this post arises out of our concern for what happens to the “little guy” in all of this.

Define “Little”
The descriptive word “little” implies size.

In this case, we don’t think it’s all about size but rather it’s going to be all about location and connection.

Everything we’ve listened to or read, up until today, regarding Community Paramedicine seems to be centered on a fairly robust EMS system that is tied to a metro-area sized facility or health system based cooperative care model. Kudos to those who conduct their pre-hospital operations in that kind of cooperative environment. It must be awesome to have those kinds of amazing resources at your disposal.

But, there are those EMS systems in a majority of areas of the United States that don’t have those kinds of systems. They range from small, rural, off-the-beaten-path systems to areas where socioeconomic demographics can barely support a pre-hospital system period, let alone one that now calls upon a reallocation of resources when there barely are any resources to reallocate.

Many EMS systems in the United States operate in areas where the hospital systems can barely keep their doors open, let alone somehow work to pay for a yet-to-be-determined pre-hospital system that doesn’t necessarily translate into their desperate need for life-sustaining revenue (even if the Community Paramedicine program will keep them from being dinged for readmissions.)

If the money isn’t there….it just isn’t there.

When charity care approaches six-, seven-, eight-digit dollar amounts, can hospital administrators focus on savings if there isn’t any money to be saved in the first place? The question is hypothetical because we don’t work in the inpatient world, but it would seem to be a valid question to us looking on from the outside to the inside.

Show Us the Money!
So, with all the buzz talk about Community Paramedicine and working and forming Accountable Care Organizations, no one yet- outside of those nicely robust partnerships that are talking up their initial successes- has stepped up to show us the money!

Doctors, in their journals, are calling for changes. Politicians are talking, but then again, that’s all politicians do in most cases (there are good ones that believe in EMS, but the majority??)

But, talking isn’t acting and talking doesn’t pay the bills!

We have read with complete frustration regarding EMS systems that are jumping on the bandwagon with statements like, “We’re moving forward with our Community Paramedicine program as a ‘value added’ benefit to the community.”

Define “value added”…we contend this is giving away services and heck we already do that to the “nth” as any one of us in EMS know. We can’t vet out who’s going to pay or not on the emergency side, so we act now and collect later and unfortunately since we can’t get blood from a stone, in some cases, we end up giving away our services.

So now we’re going to give more? As long as we give more, in our humble opinion, we’ll not be receiving more because we’re demonstrating that we can give more without receiving more!

The Point
The point to this post is not to be negative to change. Change is good and we think a re-evaluation of EMS can be good.

But there has to be a plan to pay for it.

If all this Community Paramedicine is going to be good for the healthcare system as a whole, then why can’t we once and for all do something to commit to pay for it all and include all pre-hospital EMS models in the process?

EMS is more than about the well-funded demographic area EMS organizations that command the stage on blogs and webinars. EMS is more than about pre-hospital provider entities that are connected to a robust health-care system with lots of funding.

EMS in the United States also includes rural areas where the closest major facility can be 80, 90, 100 miles away. EMS in the United States also includes areas of the Country where most persons live at or below the poverty level. EMS in America includes funding that is grossly below the costs to provide the service when 60% and 70% of an agency’s funding is coming from pitiful Medicare and even more-pitiful Medicaid coffers and where there’s no tax base to offset the funding gap.

EMS in many parts of America is about keeping the wheels going constantly just to keep the garage doors from closing permanently…so where is all the extra time, funding, staff, resources…you name it….going to come from to do all this Community Paramedicine in these areas?

We’ll figure it out…
So while The White House and Congress spar over reports and analysis that makes no sense in the real world, EMS will figure it out because we always do.

But, for once wouldn’t it be nice if our “leaders” could see the bigger picture while the bureaucrats that move to the beat of the politicians’ drum beat recognize that EMS is important and needs to be supported both with policies that make sense and with a funding model that isn’t built on a wing and prayer?

If all of you want this to happen, all of us in EMS need you to step up to the plate and tell us NOW how you intend for us to make it happen.

Again….show us the money and create a model that EMS, EVERYWHERE….large, small, poor, rural, super-rural, urban, municipal, private, non-profit, fire-based…..EVERYWHERE… can live on to insure that the best care possible is on the street 24/7.

When someone finally paints that picture on the canvas then we’ll jump on the rah-rah bandwagon.

Until then, we stand on the sidelines ready and waiting to support the cause.

An Advocate
Enhanced Management Services is more than a billing company. By extension of our clients, we advocate from time-to-time for changes in the system to make sense. Sometimes a good billing contactor can partner with their EMS clients to pose thought-provoking questions which we hope will be echoed across our client “nation” and arrive at the ears of those responsible for making the decisions that affect the future of EMS.

We know our clients provide the best pre-hospital services in the Country. We’re here to support you. Just contact Pam or Heidi in Client Services if we can assist you with your billing program questions.

If you’d like to become part of our client family and your billing office isn’t quite the advocate you had hoped they would be, reach out to contact our Business Development Manager, Chuck Humphrey at or by calling him toll-free at (800) 369-7544, Extension 108.

This is one bandwagon you don’t want to miss!
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