1. Prehospital committee March 2018
Nathan Jung, EMT-P
Director of EMS Relations – HCA Gulf Coast Division

2. Today’s Topics Texas Ambulance Supplemental Payment Program
Strokes – A Deeper Dive
Stroke Facility Options
Emergent Large Vessel Occlusion
Severity Scores & Assessments

3. Texas Ambulance Supplemental Payment Program
Developed to aid governmental EMS agencies with the cost of providing emergency & non-emergency transports covered by Texas Medicaid
$294 million paid out over five years
$4.9 million paid out to RAC-R agencies
1.67% of the total amount
Payments made annually in September
Galveston County averages $575,000 each year
Uses Include
Capital Expenses
Grant Matching Requirements
Debt Payments/Reduction
Additional Information

4. RAC-R Agency Supplements
FY 2016
FY 2015
FY 2014
FY 2013
FY 2012
Beaumont EMS
$321,928.25
$ -
Dickenson EMS
$154,974.74
Galveston County Health District
$636,224.53
$517,948.86
$678,175.72
$576,216.69
$470,873.55
Pearland Fire Department
$571,971.16
$558,188.28
$29,702.66
Texas City Fire Department
$382,354.56
$28,112.93
RAC-R Total
$2,067,453.24
$1,104,250.07
$707,878.38
State of Texas Total
$103,419,192.87
$70,798,354.07
$69,623,200.92
$30,555,608.04
$19,919,320.20

5. RAC-R Agency Supplements
Initial participation was low
FY 2016 saw the most highest number of agencies participating
FY 2016 also say the supplement contribution nearly double from $1.1 million to $2.06 million for RAC-R agencies

6. Texas Supplement Contributions
Significant growth from $19.9 million to $103.4 million between FY 2012 to FY 2016
Continues to be renewed and funded, however, it is known how long this will continue
Can be a real funding boost to some agencies that face funding challenges

7. RAC-R Collection Percentage
Despite increasing funding RAC-R agencies combined see only about 2% of the total contribution pool
Galveston & Pearland account for the majority share of this

8. Galveston County Health District
Averaging $575,000 annually
Used to help offset aggressive capital expenditure spending during my tenure
Prevented any increase on tax payers
Allowed for more proceeds to be directed to meet wage increases
Used third party contractor to complete cost report on behalf of agency

9. Strokes – A Deeper Dive

10. Strokes – A deeper Dive GETAC Stroke Committee – February 2018
Elected not to recommend a bypass transport protocol for ELVO patients
Recall previous discussion –
Comprehensive Stroke Centers – Limited
Not all agencies are able to transport to a comprehensive stroke center
Which stroke severity tool is the best?
What are the differences?
How good is EMS at identifying a stroke?
How about an ELVO?
Should we slow down and walk through this a little more?

19. DSHs Reports & EMS Data
During February 2018 GETAC Meeting it was discussed that 2016 data would be released to RACs to provide to agencies

20. 2016 RAC Stroke Report
RAC-Q was one of the leading RACs for strokes and RAC-R still had a noticeable amount.
RAC-Q Cases: 9,304
RAC-R Cases: 1,250

24. 2017 Texas Stroke System Report

25. Arrival Method
EMS is the most common method of arrival to the hospital for a stroke patient overall

26. Arrival Method
Starting in 2008 EMS saw a decline in the number of stroke patients through 2012
has remained flat despite the number of stroke patients increasing
The data “missing” or “unknown” peaks in 2012 and then declines

27. Advance notification
Reporting 53.5% of EMS transports had a stroke activation
Does this data set exclude transfers?
Why the decline in activations starting in 2012 and falling sharply in 2015 & 2016?

28. ELVO & Stroke Scales
Colleen Kehr
Hesham Morsi, MD