Defining Value in Healthcare: The Role of EMS

This article was originally published by EMSWorld News and Medlert Inc. 

Under the Affordable Care Act, hospitals, as well as physician groups starting in 2015, are being rewarded or penalized by Medicare based on scores on value-based metrics such as clinical outcomes, patient experience, and efficiency. [1]

Part of the push for higher-quality care focuses on eliminating hospital readmissions for the same problem within a short period of time. Nationally, hospital penalties for preventable readmissions are predicted to hit $756 million in 2014, [2] and will likely have a trickle down effect in many other health industries, including the ambulance service industry.

As healthcare moves toward a value-based payment system, the ambulance service industry is being pushed to define its own value-based metrics within the context of an integrated healthcare system.

“The time is rapidly approaching, whether we like it or not, when EMS will be required to report outcome-based, quality metrics based on demonstrated clinical practices that make a difference in patient outcomes in order to be eligible for payments,” writes Matt Zavadsky, director of public affairs for Ft. Worth-based MedStar Mobile Healthcare in a recent article. [3]

Defining Value in EMS
The ambulance service industry can follow the model offered by the Medicare requirements of hospitals and define value in terms of patient experience and clinical outcomes. Zavadsky takes a step in this direction by suggesting several sample value metrics:

• The percentage of calls where EMS arrives on scene in <10 minutes for a suspected ST elevation myocardial infarction (STEMI) patient,
• The percentage of STEMI patients who are given an ECG and it is sent to the receiving healthcare facility in <3 minutes,
• The percentage of stroke patients who were last seen as normal more than six hours before and are taken to a comprehensive stroke center, or
• The percentage of patients surveyed who would recommend the EMS team to friends or family.

EMS Brings Value to the Healthcare System
These types of value metrics are important, but the value of EMS and ambulance services in an integrated healthcare system can encompass more than measuring patient satisfaction and clinical outcomes. Ambulance services bring value not just to patients but also to the healthcare system as a whole.

The ambulance service industry’s ability to survive and thrive in the future will revolve, in part, on its ability to articulate its value to healthcare providers, healthcare organizations, hospital systems, and payers, as well as patients and family members. This demands out-of-the-box thinking from the ambulance services industries leadership.

The Shift to Non-Acute Care
“I think what’s changing is that EMS systems are being recognized as just as valuable for the lower acuity, non-acute, unplanned care as they are on the high acuity, acute, unplanned care in terms of navigation,” says Ed Racht, MD, chief medical officer for American Medical Response.

How can the value of ambulance services be described and measured in terms of the profession’s unique ability to help patients navigate an increasingly complex system?

Finding New Ways to Measure Value
The value-add of ambulance services lies not just in the capacity to respond to emergencies, but also in the potential to offer basic community healthcare. New models are deploying EMS professionals to respond to chronically ill patients, who often demand a bulk of the healthcare system’s resources.

EMS must articulate its value in terms of cost-savings for healthcare systems, provider and patient satisfaction, and clinical outcomes. This can be accomplished when an EMS team:

• Offers more cost-effective, out-of-hospital care,
• Helps a patient and hospital avoid costly ER admissions by appropriately triaging a patient to an urgent care or primary care alternative,
• Connects with a patient in her home and helps remedy social and economic factors that affect care compliance, such as taking medication, and
• Reviews a patient’s care plan with him immediately post-hospital discharge to help prevent unnecessary readmission.

The value of EMS & ambulance services could also be measured by:

• The percentage of patients who report improved experience when offered the option of a community paramedic home visit within 24 hours versus waiting for care in the emergency room,
• The percentage of patients not readmitted to the hospital post-hospital discharge when offered regular home visits by an EMS team,
• The percentage of patients appropriately diverted from the ER to urgent or primary care alternatives,
• The percentage of patients treated in the home and not necessitating transport or hospital admission, and
• The percentage of chronically ill patients showing improved health outcomes when supported by the EMS team to navigate the healthcare system.

To read more about defining EMS’s value in an integrated healthcare system, download the whitepaper, “The Future of the Ambulance Service Industry: Value-Focused, Consumer-Driven & Mobile-Savvy,” which includes “8 Ways Better Technology Platforms Can Improve Ambulance Services.”

References

1. Pay-for-Performance. Health Affairs policy brief. October 11, 2012. Available at: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=78.

2. Medicare Cuts Payment for Hospital Admissions as Penalties Rise. Money News. August 4, 2014. Available at: http://www.moneynews.com/Personal-Finance/Medicare-payment-hospital-admissions/2014/08/04/id/586802/.

3. Zavadsky, M. Is EMS Next to Transition to Medicare’s Value-Based Payment Model? JEMS. Sept. 2014. Available at: http://www.jems.com/article/administration-and-leadership/ems-next-transition-medicare-s-value-bas.