The Future of Healthcare, Healthcare Costs, and EMS
This blog was originally published by Medlert Inc.
Earlier this year, the Commonwealth Fund compared the US healthcare system with 10 other countries using measures such as equity, quality, efficiency, and access. The US ranked last in 5 out of 12 categories and last overall, despite spending between 30-60% more per capita compared with the other countries on the list. It’s a disappointing return on investment for the 18% of the US GDP that is put toward healthcare every year.
There are many new tools and platform being built to make the healthcare system more efficient and cost-effective, and on many fronts, change is coming quickly to healthcare. The EMS industry is poised to take lead role in those changes.
In an earlier blog, we discussed the push coming out of The Institute for Healthcare Improvement‘s Triple Aim initiative to build a stronger health system by focusing on:
- Better patient experiences,
- Better population health, and
- Lower per capita healthcare costs.
Why should this matter for emergency medical services professionals?
A Focus on Eliminating Waste in Healthcare
Wasteful spending, including low quality care, accounts for an estimated $765 billion or one-third of the US healthcare bill, according to The Institute of Medicine.
As a part of the Affordable Care Act of 2012, hospital readmissions penalties went into effect. Starting in October 2013, readmissions penalties applied to Medicare patients readmitted to hospital within 30 days of an initial stay for treatment for a heart attack, heart failure, or pneumonia. In October 2014, the penalties will also extend to patients admitted for chronic obstructive pulmonary disorder or total hip or knee replacement.
These penalties are aimed at financially punishing hospitals that offer poor quality care, which can quickly land a patient back in the hospital.
This push to eliminate this wasteful spending is hitting hospitals hard.
In 2013, Medicare payments to 40% of US hospitals dropped by a total of $227 million. Those fines are expected to rise. The latest estimates suggest that Medicare payments for hospital admissions will drop another $756 million in 2014.
How does healthcare reform affect EMS?
Although paramedics and EMS professionals are not the primary drivers of high-cost, low quality healthcare, EMS experts predict that healthcare reform could be a tremendous opportunity to reconfigure the role of EMS within an integrated healthcare system.
(For example, see: Healthcare Reform Seen as Unparalleled Opportunity for EMS)
Steve Wirth, one of the nation’s leading EMS attorneys, points to mobile integrated healthcare (MIH) as a model for keeping patients out of the hospital and lowering hospital readmissions. MIH models can also offer greater continuity of care and provide patients with easily accessible primary care services and follow-up care.
(See also: A New Charge for Paramedicine: Keep Patients Out of the Hospital, an interview with Steve Wirth)
Why mobile integrated healthcare?
Data shows home healthcare can lead to better patient outcomes. One study from North Shore University Hospital in New York found that among more than 400 patients post-heart surgery, those that did not receive home healthcare post-surgery were three times more likely to pass away or be readmitted to the hospital.
Heart surgery patients who received home healthcare after surgery from a nurse practitioner were significantly less likely to end up back in the hospital within the first month post-discharge.
This kind of positive outcomes data is feeding a growing interest and investment in these new models of care. Mobile integrated healthcare with EMS and/or nursing professionals can offer greater continuity of care, more hands-on help, and cut down on the need for the most expensive form of care: in-patient hospital care.
MIH Programs Launching All Over US
A number of these programs are being piloted or have launched in the US. For example, see:
- Paramedics may start making house calls, on the California Emergency Medical Services Authority home health pilot program,
- How MedStar’s Mobile Integrated Healthcare Program Restored Patient’s Hope
- How 4 cities are making community paramedicine work for them,
Glenn Leland, Chief Strategy Officer, at Pro-Transport-1, a San Francisco-based ambulance transport company, sees mobile integrated healthcare using EMS teams as one of the keys to relieving the economic pressures now being placed on hospitals.
“If you step back and look at what’s going on with healthcare reform, the Affordable Care Act, and other initiatives, much of the focus is on hospitals. Hospitals are going through the majority of the change to improve the efficiency of our healthcare delivery system,” said Leland. “ In fact, EMS is attempting to solve some of the economic efficiency of the Medicare program as it relates to readmission of patients. I see the economic pressure on hospitals as a key, driving pain point for EMS in the future.”