Healthcare Transformation and Fire Service EMS Mark Stevens BA, EMTP

Primary Care Specialty Care Ambulatory Care Emergency Dept Urgent Care Nursing Home Home Health Pharmacy

Hospitals Physicians Reporting “Failure to submit data for FY 2007 and beyond results in a 2% decrease in Medicare reimbursement.”… (Additional impact after Oct 1, 2012.) 17 Clinical care measures in 5 categories: (AMI, Heart failure, Pneumonia, HC assoc infection, Surg improve) 8 Consumer assessments: (doc/nurse communication, staff responsiveness Pain mgmt, Cleanliness/quietness of environ.)

Physicians: 3 Financial incentive plans - Quality reporting (199) - Electronic Prescribing - Electronic Health Records Quality Reporting 1.5% -1.5%- 2% Electronic Prescribing 1% 0.5%0% E-Health Records Spec amt -1%-2%-3%-4%-5%

- Quality Measures - Accreditation/Certification - Electronic Records - Consumer Satisfaction - Efficiencies EMS/Ambulance

Healthcare Information Exchange Labs Hospitals Pharmacy Physicians Govt Medicaid/Pub H Payers Consumers Clinics EMS

The first call of the day was a 43 yo male that was found laying in the front yard of a residence. I was able to find the pt’s medical hx of seizure, and his last ER visit to OUMC. SMRTNET was used to confirm pt’s information she provided to me. Pt stated she had no allergies, however SMRTNET found allergies in hx. Upon questioning pt remembered “yes” to allergic to… Health Information Exchange EMSA, Oklahoma City

80% of HC $’s spent on 20% of people Known causes and preventable. Current direction will bankrupt State/Country

Oregon’s “Triple Aim” (HB3650) -Improve lifelong health of all Oregonians. -Increase quality, reliability and availability of care for all Oregonians. -Lower or contain the cost of care so it is affordable for everyone.

Oregon Health Policy Board HB3650 CCO Work grp Global Budget Work grp Metrics Outcome Quality CMS Integration Work grp

ome/pcpcc/english.html

Public Safety Public Health Community Health M ES Future Current Concepts

The “New Normal” Integration of EPCR Hospital records Bundling No Money Alternate Destination Never Events EMS Agenda for the Future Alternate funding CL1qTg

Be at the table Be on the table

Table 3: Geographic Distribution by Health Profession (2010) - Adjusted to add EMS data Dentists Dental Hygienists Dietitians Physicians Physician Assistants Registered Nurses Nurse Practitioners Certified RN Anesthetists Clinical Nurse Specialists Licensed Practical Nurses Certified Nursing Assistants Occupational Therapists Occupational Therapy Assistants Pharmacists Certified Pharmacy Technicians Physical Therapists Physical Therapist Assistants First Responders EMT-Basic EMT-Intermediate EMT-Paramedic Total First Responder/EMT Statewide2,5592, , ,8491, ,33216,6741, ,2284,4922, ,5541,0012,9459,397 Baker Benton Clackamas , , ,187 Clatsop Columbia Coos Crook Curry Deschutes , Douglas Gilliam Grant Harney Hood River Jackson , Jefferson Josephine Klamath Lake Lane , , Lincoln Linn Malheur Marion , , Morrow Multnomah , , , , ,099 Polk Sherman Tillamook Umatilla Union Wallowa Wasco Washington , , , Wheeler Yamhill Additional EMS Resources not associated with a specific county (i.e. law enforcement, National Guard, Fire Marshal, etc.) 1, ,665

Non-Traditional Health Workers Team: Community Health Workers Peer Wellness Specialists Personal Health Navigators Training: Core Competencies Cross-cultural communication/liaison Group/family dynamics, Advocacy skills, Knowledge of resources, Needs assessment *Opportunity

“Community Paramedic” UK – Dispatch, NonTraditional & MD Toronto – CREMS U.S. – Minnesota, Eagle CO, MedStar, Wake Co, Nebraska… Tucson, TVF&R, King Co Scope of Practice Training Programs

Medical Liability (next legislative session) CMS Innovation Challenge Grant Local CCO activity/relationships Non-Traditional Training opportunities Nursing Associations Protocols & Scope of Practice Things to watch for

Things to watch (know your numbers) Call breakdown: - Dry runs (# should drop) - No Pays (# should drop) - Freq caller (# should drop) - Number of transports to ED Evaluate: - Effect on operations/staffing - Transport revenue - Alternate destinations - Innovative ways to get right resource/right pt - Alternate revenue streams

What should we be doing? -Be aware of state/local changes -Support medical liability changes for EMS -Build relationships (CCOs, Medical Homes, hospital) -Market the value of EMS -Assess degree of involvement for your agency -Performance-based culture -Electronic charting (Image Trends)

Value of EMS -We are healthcare providers. -Infrastructure for quick response to anywhere in our community. -EMS can assess/direct to alternate destination. -We can “fill the gaps” and support CCOs. -Clinics in fire stations? -Preventative health fairs? -Work under medical authority, QI. -Lessen hospital readmissions -Participate in care plans

What should we be doing? - Think Innovation..right resource/pt/time - Accountability: Not just about response time -Work smarter (deployment, resource/demand) -Develop people for expanded roles -Become integrated with healthcare systems -Position external stakeholders to be advocates

Diversify Revenues/Efficiencies Training Services Communication Services Occ Health Billing Vehicle maintenance Consolidate medical direction Share cost savings with payors

CMS Innovation Challenge Grant -First grant for EMS eligibility -$1 – 30 million/grant -Three years to be self-sustaining Portland metro area (4 counties) -Dispatch triage (EMD & Nurse) -Alternate destination for response -Post hospital discharge followup

Shifting emphasis of medical care from crisis intervention to prevention.

Don’t forget our mission… Reduce lives lost Reduce pain & suffering

Testimony Relationships/network EHC Governance Resources Links Legislation Your EMS Section

Serenity Prayer God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference.

Resources