How will Trump effect EMS?

Arovetli

Forum Captain
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Because you're making unsupported statements. Once again, this isn't an exercise in colourful rhetoric; you can't just throw fancy words around and expect people to take it for face value. And no, you really cannot choose two in this particular case - people who already chose their healthcare plan before ACA came into play, are now forced to pay twice. Only so these mice who couldn't or wouldn't choose before, can have their own little cookie.

You seem to take a particular liking for communist/libertarian ideas (this is me extrapolating from your previous posts), so here's a quote for you: 'Freedom Lies In The Recognition Of Necessity'. I don't recognize any necessity to financially support people who won't do it themselves, am I free to choose/not to choose ?

I take a fancy in spirited debate and the presentation of all sides. I'm happy to play devils advocate if it helps readers to see both sides and choose which suits them.

What fancy words did I throw around that you take objection to?


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Qulevrius

Nationally Certified Wannabe
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Ha. Sorry mate, I'm not playing this game with you. If you cannot be arsed to re-read your/mine priors, we have nothing to discuss.
 

Arovetli

Forum Captain
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I tell you what. This is a great discussion. Let's keep it going.

It's been a really busy day and to be honest I've kind of lost track of the convo, so maybe we can start over with this:

I'll adopt the position that:

EMS hurts itself far worse than a president or government might, due to lack of national cohesive leadership, organization, buy in of the rank and file, technician level training standards, fraud, lack of representation in acadamia, etc.

Pooling of resources and allocation at the Federal government is not a bad thing

Mixed economic models seem to work best



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EpiEMS

Forum Deputy Chief
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Just to expand on this - let's pretend for a moment that we actually want to treat the disorder, instead of addressing the symptoms.

Sadly, I feel like we don't even have good enough data on the problems to even start addressing symptoms. All I've got is comparative EMS systems and assumptions that things that hold elsewhere (i.e. the rest of healthcare) would hold for EMS. Research is #1 on my agenda.
 

Arovetli

Forum Captain
439
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Ha. Sorry mate, I'm not playing this game with you. If you cannot be arsed to re-read your/mine priors, we have nothing to discuss.

Ok. Have a great night. All the best.


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OP
OP
ExpatMedic0

ExpatMedic0

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I am not claiming to be a businessman, but looking at the current system strictly as a business model, isn't it financially dismal, outdated, and inefficient? Customer calls for an ambulance - ambulance shows up - ambulance takes the customer to the emergency department of the hospital - the customer is treated by an emergency doctor and released. Let's face it, a significant portion of these people doesn't even need an emergency ambulance. Many of these bills go unpaid or are reimbursed at terrible rates

1. Dispatch could have criteria to refuse an ambulance regardless of what the customer wants and directly help schedule them an appointment with their primary care provider in some cases.
2. An ambulance shows up and finds no life-threatening emergency, refuses to transport patient regardless of what they want.
3. Instead of going to the emergency department by ambulance, they go to their primary care provider or are scheduled to have a community paramedic integrated into their care or are tied into the appropriate channels of the healthcare system some other way.

People who truly are having an emergency, would, of course, go through the current system.

The obvious issues here are the liability, education, and reimbursement/funding models...
 

EpiEMS

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1. Dispatch could have criteria to refuse an ambulance regardless of what the customer wants and directly help schedule them an appointment with their primary care provider in some cases.
2. An ambulance shows up and finds no life-threatening emergency, refuses to transport patient regardless of what they want.
3. Instead of going to the emergency department by ambulance, they go to their primary care provider or are scheduled to have a community paramedic integrated into their care or are tied into the appropriate channels of the healthcare system some other way.

People who truly are having an emergency, would, of course, go through the current system.

The obvious issues here are the liability, education, and reimbursement/funding models...

It genuinely seems like other countries have at least gotten part of this right. The UK, for example, with all their problems, at least has more treat-and-release and telephone triaging, I'm given to understand.

For what it's worth, I think EMS in the U.S. is generally put together in a terrible ad-hoc fashion not aligned to what the actual needs are...so I think what you're getting at is much more rational, especially for a municipal or government provision (or subcontracted out to a private organization by a government agency but not at a "payment for transport" type of rate, more like at a "fee for providing EMS response plus performance incentives for appropriate provision of service").
 

DrParasite

The fire extinguisher is not just for show
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I am not claiming to be a businessman, but looking at the current system strictly as a business model, isn't it financially dismal, outdated, and inefficient? Customer calls for an ambulance - ambulance shows up - ambulance takes the customer to the emergency department of the hospital - the customer is treated by an emergency doctor and released. Let's face it, a significant portion of these people doesn't even need an emergency ambulance. Many of these bills go unpaid or are reimbursed at terrible rates

1. Dispatch could have criteria to refuse an ambulance regardless of what the customer wants and directly help schedule them an appointment with their primary care provider in some cases.
2. An ambulance shows up and finds no life-threatening emergency, refuses to transport patient regardless of what they want.
3. Instead of going to the emergency department by ambulance, they go to their primary care provider or are scheduled to have a community paramedic integrated into their care or are tied into the appropriate channels of the healthcare system some other way.

People who truly are having an emergency, would, of course, go through the current system.

The obvious issues here are the liability, education, and reimbursement/funding models...
In a perfect word, you are 100% correct. But you hit on the 3 obvious issues: Liability, education (which I don't think is as bad as people make it out to be, but I digress), and funding.

How many dispatch agencies want to be on the front page of the paper as the agency that refused the ambulance on a person who died? The fact that they would have died regardless is irrelevant, as is the fact that despite calling for a hangnail, the person experienced a completed unrelated cardiac issue 2 days afterwards.

Ditto the ambulance, person A call for an ambulance, for a boil, gets denied transport, and then while walking to the cab, gets hit by a car and dies. Family's lawsuit get quoted in the newspaper: if the ambulance hadn't refused to transport my loved one, he would still be alive!!

How do you get funding for your community paramedicine program? It doesn't generate any revenue, but it does keep people out of the ER and prevent them from being transported by EMS, so those entities are losing out of the billable activities.

Don't get me wrong, I completely agree with what you are saying, but without a completely system overhaul, including a stable funding source, I don't see anything happening. Too many people are ok with business as usual, because it serves their own selfinterests
 
OP
OP
ExpatMedic0

ExpatMedic0

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I agree, and yes a complete system overall would be needed. However, we might get just that. Love it or hate it, the ACA was a big change. I think with the incoming administration some components of the healthcare system are going to change for better or for worse, including the ACA. If it was to change any liability and reimbursement issues which affect EMS, we could see monumental changes.
 

Tigger

Dodges Pucks
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How do you get funding for your community paramedicine program? It doesn't generate any revenue, but it does keep people out of the ER and prevent them from being transported by EMS, so those entities are losing out of the billable activities.
As an aside our community paramedic program actually turns a small profit and we do bill patients who use it. It does save downstream costs so it is in local health networks interest to pay us for our services to save them money later.
 

EpiEMS

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local health networks interest to pay us for our services to save them money later.
And also Medicaid, Medicare, and insurers (one day)!
 

EpiEMS

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Tigger

Dodges Pucks
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Plausible - I just don't know if the AAA's incentives are truly aligned with the incentives of prehospital care providers individually/as clinicians.
They are a start. My chief does a lot of work with them working on rate confirm and also sits on our state's Medicaid rate review committee. Realistically we are going to be a reimbursement based service for a while (which is bad), so reimbursement reform is sorrily needed.
 

EpiEMS

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They are a start. My chief does a lot of work with them working on rate confirm and also sits on our state's Medicaid rate review committee. Realistically we are going to be a reimbursement based service for a while (which is bad), so reimbursement reform is sorrily needed.

That's a fair point - I don't want to totally dismiss them. But I will say that we should be cautious - they have stakes in the existing (transport based) system.

Reimbursement reform is definitely something to look at as a temporizing measure.
 

Tigger

Dodges Pucks
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That's a fair point - I don't want to totally dismiss them. But I will say that we should be cautious - they have stakes in the existing (transport based) system.

Reimbursement reform is definitely something to look at as a temporizing measure.
Sure, but we will always transport people, no matter the service model. Maybe less people, but that need is not going away.
 
OP
OP
ExpatMedic0

ExpatMedic0

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EMS is the gatekeeper to the healthcare system in many ways in many systems around the world, it could be in the u.s. also, but reimbursement and funding is definitely something that would need to change.
 

EpiEMS

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Sure, but we will always transport people, no matter the service model. Maybe less people, but that need is not going away.

Certainly true! That being said, transport is a type of treatment, just like splinting or defibrillation. Thus, should we not be billing by the procedure or by the ICD (as determined by the receiving facility) like every other type of practitioner?
 

Tigger

Dodges Pucks
Community Leader
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Certainly true! That being said, transport is a type of treatment, just like splinting or defibrillation. Thus, should we not be billing by the procedure or by the ICD (as determined by the receiving facility) like every other type of practitioner?
Yes, which is why the AAAs initiative is important. We are a transport benefit and not a provider benefit and that prevents us from billing for what we do.
 
OP
OP
ExpatMedic0

ExpatMedic0

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Exactly, I don't know all the details but it sounds like a step in the right direction
 
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