What if Mobile Integrated Healthcare is not the Fire Service Holy Grail? David S. Becker

Just a Question? Let’s have a discussion…..

Disclosure Not here speaking on behalf of any of the organizations I am associated with. No conflicts of interest No payments received

Noted EMS Historian Mark Twain Truth #1 Get your facts first, then you can distort them as you please Truth # 2 Whenever you find yourself on the side of the majority, it is time to pause and reflect

Discussion Objectives To discuss some of the less talked about considerations of MIH-CP that could dramatically impact the decision to implement these programs. To look at the philosophical, financial, and legal aspects of an MIH-CP program. To address some of the myths associated with the discussion on MIH-CP To let Fire Departments know it is OK if they choose to NOT implement any of these program in their department.

My Positon MIH-CP They can be of benefit to your community The service delivered can assist in access to healthcare In some cases, the prevention activities can reduce EMS and healthcare workload. They can help navigate patients to alternative destinations

My Positon MIH-CP These programs are NOT for the majority of fire service agencies. 29,800 fire agencies (estimated) 21,283 EMS agencies (according to NHTSA/NAEMSO-2011) If 500 fire departments would adopt = 1% 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Despite the Predictions that this is the NEXT evolution of EMS The Future of EMS will not morph into just using community paramedics that don’t transport The zealots preaching about MIH are not telling you the whole story 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Much of the whole MIH-CP was based on the ACA The prediction was to move to population-based management Now things are different 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP There is NO evidence (yet) to show these programs make a long-term difference 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

There is NO national model for either of these programs My Positon MIH-CP There is NO national model for either of these programs 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP There is NO national training standard, scope of practice, core competencies, or education standards for either of these programs like there is for EMS 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP How do these programs affect your workforce? Is this what they signed up for? How much discussion was there on their roles? How much education did they receive? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

Reimbursement, if received, is on a voluntary basis—Not Mandatory My Positon MIH-CP Reimbursement, if received, is on a voluntary basis—Not Mandatory 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP One of the premises is that these programs reduce EMS workload and the number of times an ambulance is needed for transport. How does that affect your Revenue? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Does the Fire Service have an obligation to fund programs like MIH or CP as a part of public safety? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Despite the hype—It is RARE for an agency to generate revenue over expenses 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Finances 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Consider these costs into the developing and implementing: Needs Assessment Training Costs – Initial and On-going Billing Vehicles Equipment/Supplies 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Consider these costs into the developing and implementing (cont): Data Collection Dispatch 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Consider these costs into the developing and implementing (cont): Start-up Readiness Insurance Program Management 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

Where does the Revenue piece of the puzzle come from? My Positon MIH-CP Where does the Revenue piece of the puzzle come from? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Many hope to have pre-paid payments from insurance or medical facilities to “manage” the pre-hospital aspect Voluntary or Mandatory? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Grants? How long will any of these last? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Contracts? When reimbursement is voluntary is this a sustainable method of revenue? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Braided Funding Is anyone using this method? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Private Payer Billing ? What would this look like? What amount can you expect to reasonably collect? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Revenue Does anyone think Medicare (CMS) is going to change the fee-for-service model for ambulance reimbursement? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Legal Considerations Scope of Practice Recognized with your state? Defined by your organization? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Legal Considerations Scope of Practice Training records that demonstrate an expanded area of assessment and/or treatment 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Is either of the program names right? Not all of these programs are mobile Not all program involve(or need) just paramedics 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

My Positon MIH-CP Don’t just hop on the train (or bus) of MIH because the department next to you is trying to deliver this service Does your community really need you (the fire service) to provide these services? 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

Resources: HRSA Community Paramedicine Evaluation Tool 2012 https://www.hrsa.gov/ruralhealth/pdf/paramedicevaltool.pdf 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

Emergency Medical Services v/s Paramedicine SoapBox Emergency Medical Services v/s Paramedicine 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO

Questions– Further Discussion? Thanks 29,800 Fire Departments 21,283 EMS Agencies according to NHTSA/NASEMSO