1. Healthcare Transformation and Fire Service EMS Mark Stevens BA, EMTP

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

5. Hospitals - 2007 Physicians - 2009 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.)

6. Physicians: 3 Financial incentive plans - Quality reporting (199) - Electronic Prescribing - Electronic Health Records 201120122013201420152016201720182019 Quality Reporting 1.5% -1.5%- 2% Electronic Prescribing 1% 0.5%0% E-Health Records Spec amt -1%-2%-3%-4%-5%

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

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

9. 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

10. 80% of HC $’s spent on 20% of people Known causes and preventable. Current direction will bankrupt State/Country

11. 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.

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

13. http://www.emmisolutions.com/medicalh ome/pcpcc/english.html

15. Public Safety Public Health Community Health M ES Future Current Concepts

16. The “New Normal” Integration of EPCR Hospital records Bundling No Money Alternate Destination Never Events EMS Agenda for the Future Alternate funding http://www.youtube.com/watch?v=Z1SBg CL1qTg

18. Be at the table Be on the table

19. 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 Statewide2,5592,36945110,82291835,8491,9553071463,33216,6741,0301992,2284,4922,4005788974,5541,0012,9459,397 Baker9732461033101967222041832927161082 Benton43541927337901430163332192768460820711653160 Clackamas24223832828482,3681695842691,2931355223946525298386521123851,187 Clatsop25215768331207027195103214519526703627159 Columbia222011865211011310110133711212861773188 Coos343251359701281638242118225783111401024333218 Crook590175924101644008125534331665 Curry1191272871210236520412113101211942 Deschutes11911614502851,599917412544057492147167284322011201475 Douglas51545231249964950894981754211538114114055119355 Gilliam000100300090001003165024 Grant43181401001620015308376354 Harney32010145510431003820993324 Hood River19 2817212950141137210192032348938118 Jackson13011619590452,02012968186938546106227164192820381171483 Jefferson861213103810355207115164292683 Josephine60457152175564013111151714139854120 913140182 Klamath3746315511441280336240902862326381142542219 Lake23110152110451102721162516663 Lane20926226917733,31015535143802,05680152154522704665238163312778 Lincoln262247714324201014317080205026449852134189 Linn45581115613676199388562203471103843011032130302 Malheur23146642726781058168312949102172810358 Marion22418035706632,654991533181,91985121463361575010233957249747 Morrow000631800011400021062512447 Multnomah7425641723,74922910,62666578767953,548286506131,06153014626702283431,099 Polk15 166154201514502526019331258811883190 Sherman000103100000000001112014 Tillamook972406137121013562213179316561322107 Umatilla4236511710485351304528171183525816591762154 Union1416266021020004098521026135822191261 Wallowa331111644306550035310116320 Wasco14180771229616004222991132823628451222107 Washington323321531,4061235,0352098193081,41915022313746357575657563295989 Wheeler010323000090000102125019 Yamhill464811184106222310160366186337853145414718116335 Additional EMS Resources not associated with a specific county (i.e. law enforcement, National Guard, Fire Marshal, etc.) 1,63719811,665

20. 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

21. “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

22. 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

23. 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

24. 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)

25. 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

27. 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

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

29. 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 9-1-1 response -Post hospital discharge followup

30. Shifting emphasis of medical care from crisis intervention to prevention.

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

32. http://health.oregon.gov

33. Testimony Relationships/network EHC Governance Resources Links Legislation www.ofcaems.org Your EMS Section

34. 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.

35. Resources www.health.oregon.gov www.ofcaems.org www.hitsp.org http://communityparamedic.org www.wecadems.com/cp.html www.medstar911.org/community-health-program www.wakegov.com/ems/staff/app.htm http://www.emmisolutions.com/medicalhome/pcpcc/english.html