EMS IN THE ERA OF HEALTH CARE REFORM

Headnote

Collaborating to reduce costs and improve care

Despite a tremendous diversity in how emergency medical services (EMS) are provided in communities around the country, most U.S. EMS systems remain focused on responding quickly to serious accidents and critical emergencies, even though patients increasingly call 911 for less severe or chronic health problems.

Reimbursement schemes have also failed to adjust, as most EMS agencies receive payment from insurers based largely on transportation to the hospital, rather than the health care services provided.

Simply put, the existing EMS response model has failed to evolve as community needs for emergent and non-emergent health care delivery have changed. Recent efforts in health care to improve quality and reduce costs, including the Affordable Care Act, pose significant challenges to the existing EMS response model.

Health care payers have become increasingly unwilling to reimburse for services that fail to prove their value. As a consequence, EMS agencies will soon be required to demonstrate their worth like never before. At the same time, local governments continue to confront the economic realities of stagnant and even shrinking budgets.

It's critical for city and county managers to know that despite these challenges, the changing health care landscape also presents opportunities for EMS systems to evolve from a reactive to a proactive model of health care delivery-one that better meets the needs of their communities by preventing unnecessary ambulance transports, reducing emergency department visits, and providing better care at a lower cost.

Health Care Reform

Triple Aim. During the past decade, economists and policymakers have largely abandoned the belief that better health outcomes could only be achieved through increased spending. Instead, changes to the health care system, including some of those created by the Affordable Care Act, are now based on the Institute for Healthcare Improvement's Triple Aim Initiative, which suggests that it is possible to simultaneously improve the patient experience, reduce health care costs, and improve the population's health.1

Fee for quality versus fee for service and value-based payments. Currently, most of health care works like a restaurant menu: The more you order, the more you (or your insurer) pay. Unlike a restaurant, however, consumers often don't know whether the services are any good, are often ignorant of the costs, and sometimes aren't...