How Do You Define Value in EMS?

This blog was originally published by Medlert Inc.

Next week, at the American Ambulance Association’s annual conference, Medlert Inc. will release a new whitepaper, “The Future of the Ambulance Service Industry: Value-Focused, Consumer-Driven, & Mobile-Savvy.”
 
Drawing on a series of interviews with industry experts and research on trends in healthcare and mobile tech, the paper posits that the ambulance service industry can thrive in the future, if it embraces change.
 
One of those changes is a clear determination and articulation of the value of EMS and ambulance services within the new healthcare environment.
 
Last week, I spoke with Matt Zavadsky, Director of Public Affairs at MedStar Mobile Healthcare in Ft. Worth, Texas about how to define value in EMS and the ambulance service industry.
 
“When we talk about defining value, we have to remember what audience are we talking to,” said Zavadsky. Zavadsky, a leading expert in mobile integrated healthcare, is an advocate of new care models in EMS as well as new ways of defining the value of EMS and ambulance services within an integrated healthcare system.
 
Audience Matters When Defining Value
Zavadsky was quick to point out that EMS serves many groups: patients, providers, healthcare organizations, and hospitals. Each group’s understanding of value may differ.
 
“If you are a patient, you perceive value as having your pain relieved or your breathing difficulty resolved. But the patient’s perspective on value may be different than the payer’s perspective,” said Zavadsky. “The payer may say, ‘What money have you saved me? How have you made an impact on the economics of caring for this patient?’ ”
 
Meeting Clinical Standards Reliably Is A Value-Add
Zavadsky pointed out that as healthcare providers, one of the value-adds of EMS is the reliable compliance with clinical bundles that have been proven to make a difference in patient outcomes.
 
“For example, when a person’s having an ST-elevation MI, what percentage of the time are we compliant with getting them aspirin, pain control, and a twelve-lead transmission to the hospital, and taking them to a STEMI center?” said Zavadsky. “With STEMI, stroke, hypoglycemia, asthma attack, we should be able offer very high reliability of intervening with the right clinical care.”
 
Payers Are Looking at Other Definitions of Value
EMS’s value add isn’t only in compliance clinical standards of care. Zavadsky pointed out that in the changing healthcare environment, healthcare payers are interested in understanding other ways EMS and ambulance service teams add value to the healthcare system.
 
“This means looking at how many times we have averted the necessity for the patient to receive high-dollar healthcare services such as an ER admissions/readmission,” said Zavadsky. “We need to be looking at what we have done to bring the payer value instead of just being a conveyance mechanism from point A to point B.

Response Times Don’t Demonstrate Real Value
By Zavadsky’s estimation, EMS is thirty years behind in measuring and demonstrating value because of the industry’s reliance on response time as a measure of value.
 
“The only reason that we measure response times is because it’s the only measure we’ve ever taken any time to evaluate and because it’s easy,” said Zavadsky. “But, response times don’t make a lick of difference in the patient’s outcome.”
 
Pay-For-Performance Pushing Change on EMS
With healthcare moving rapidly towards a value-based payment system, EMS and the ambulance must define new and better value-based metrics.
 
“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,” wrote Zavadsky recently in a JEMS article.
 
Biggest Changes Needed in EMS
I asked Zavadsky what he sees as the three biggest changes needed in EMS.
 
“First, I think we need to recognize that we are healthcare providers, and we have to be taught as healthcare providers. This means we have to get away from a 750-hour training program, recognize paramedics as a true profession, which might require 3,000 hours or a bachelor degree program.”
 
“Second, we need to track data that matters and record outcomes,” said Zavadsky. “Finally, we need to be reimbursed for the work that we actually do, not just for transporting patients.”