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

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

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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

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

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. Resources:
HRSA Community Paramedicine Evaluation Tool
29,800 Fire Departments
21,283 EMS Agencies according to NHTSA/NASEMSO

34. 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

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