Washington`s Gone EMS Wild!

I've been in the EMS industry nearly 30 years and have seen a couple of times when there was a lot of political activity in the nation's capital revolving around EMS. This year is shaping up to be the most active and complicated year for EMS in Washington, DC, that I've ever witnessed. Here is a brief rundown on some of the issues and interested players. Use caution so you don't find yourself drowning in a pool of acronyms.

The Big Issues

• Permanent Medicare ambulance transport funding to fix years of under-reimbursement
• Federal death benefits for EMS practitioners who die in the line of duty
• Reduce requirements for Medicare Physician's Certification Statement for medical necessity
• A designated lead agency for EMS
• Dedicated grant funds for EMS agencies
• Quality improvement and research programs
• Federal specifications for ambulances
• Driver training requirements for EMS vehicle operators and alternative patient destinations.

The federal EMS oversight agency issue is worthy of an additional note. Most people watching this issue believe Congressional action is needed to designate the lead agency for EMS. Others believe the president already has authority to place EMS in the Department of Homeland Security. Most of the concern in this arena is over two things. The first is money. EMS providers want more access to dedicated federal grant funds. Second is the debate over whether EMS is daily provision of healthcare or a public safety function of government.

The Federal Administration

There are major issues involving the Center for Medicare and Medicaid Services regarding permanent Medicare funding solutions for ambulance services and reducing the requirements for when a Physician's Certification Statement (PCS form) is needed.

There are also administrative issues being debated regarding which federal agency should be the primary EMS oversight agency. The front-runners include: National Highway Traffic Safety Administration Office of EMS (NHTSA EMS), Department of Homeland Security/Federal Emergency Management Agency (DHS/FEMA), and the Department of Health and Human Services (DHHS). Long shots could include the Centers for Disease Control and Prevention (CDC), which includes the National Institute for Occupational Safety and Health (NIOSH), or maybe a brand-new agency. As the debate continues, the Federal Interagency Committee on EMS (FICEMS) has been created. More on FICEMS and the National EMS Advisory Council later.

United States Congress

The U.S. House of Representatives and Senate have legislative authority to promulgate new or amend existing laws. Current legislative initiatives before Congress include: Medicare ambulance relief bill in the Senate, known as S. 424, and Medicare Ambulance Access Preservation Act that has been offered in the House. Its language is the same as that in the Senate bill.

These companion bills would implement a 6% increase in the Medicare ambulance fee schedule for ambulance transports originating in urban and rural areas. It would also extend the 22.6% base payment for transports originating in super-rural areas for five years beginning in 2012.

The Dale Long Act, named after a Vermont EMS practitioner who died in the line of duty, was passed by the U.S. Senate as an amendment to an aviation bill in February. It was reintroduced as a stand-alone bill as well. The Dale Long Act has a long way to go in the House and then to the president before becoming law. If it becomes law, the Dale Long Act would expand coverage under the Public Safety Officer (Death) Benefit (PSOB) program to include paramedics and EMTs who die in the line of duty and are employed by a nongovernmental, non-profit EMS agency. The current federal death benefit is approximately $315,000 for survivors.

The Field EMS Quality, Innovation, and Cost-Effectiveness Improvement Act of 2010 (H.R. 6528) addresses many high-level EMS issues in a consolidated attempt to fix numerous challenges, such as a lead agency, dedicated funding, an EMS trust fund and grant programs, improved quality and research programs and funding for the National EMS Advisory Council.

The Stakeholders

There are many special interest groups weighing in on the current EMS issues, including:

• National Association of Emergency Medical Technicians (NAEMT). This is the largest advocacy group for EMS practitioners of any type of licensure in the world, boasting 34,000 members and an active e-mail list of approximately 75,000;
• The American Ambulance Association (AAA) represents the interests of ambulance service providers across the country;
• Large multistate and small ambulance providers: AMR, Rural/Metro, Acadian, Community EMS, TransCare, Superior, Lifeguard, large air ambulance providers and other companies. These entities have a lot at stake with any federal regulatory changes and are watching the issues and events closely;
• National Association of EMS Physicians (NAEMSP) is an association of doctors and other professionals providing leadership and promoting excellence in out-of-hospital EMS;
• American College of Emergency Physicians (ACEP) supports quality emergency care and promotes the interests of emergency physicians and their patients;
• National EMS Management Association (NEMSMA) assists EMS leaders, managers and other professionals interested in improving the performance of EMS processes, providers and systems;
• International Association of EMS Chiefs (IAEMSC) supports, promotes and advances the leadership of EMS response entities and advocates for the EMS profession;
• National EMS Labor Alliance (EMSLA)--a group interested in issues related to EMS labor;
• International Association of Fire Chiefs (IAFC)--the advocacy group for fire chiefs;
• International Association of Firefighters (IAFF)--a labor union representing paid fire/EMS practitioners;
• National Association of State EMS Officials (NASEMSO)--the state EMS directors group;
• National Fire Protection Association (NFPA)--a standards-setting group currently involved in ambulance design standards;
• Air ambulance companies and associations including national flight nurses and national flight paramedics;
• Federal Interagency Committee on EMS (FICEMS). Created by 42 U.S.C. 300d-4, FICEMS is a group originated by the secretaries of Transportation, Health and Human Services and Homeland Security to ensure coordination between federal agencies involved in local, state, regional or tribal EMS and 9-1-1 system regulatory issues. FICEMS also has CDC and U.S. Fire Administration representation, along with Indian Health Services, EMS for Children (EMS-C) and one state EMS representative. Their meetings have become "standing-room-only" events.

The Switzerland Factor

Advocates for EMS (AEMS) is a coalition of major EMS organizations founded in 2002. Its four major board members include NAEMT, NAEMSP, NASEMSO and NAEMSE. The Advocates are dedicated to promoting, educating and increasing awareness among EMS decision-makers in Washington and supports all providers of EMS.

AEMS is a large and diverse group of interested constituents and groups that advocate for EMS issues. The Advocates try to reach consensus among the various groups in order to present a unified position to federal staff and lawmakers.

You

There has never been a more important time when EMS practitioners need to be watching and engaging in what is going on in Washington. Don't be content to sit on the sidelines as a spectator. Attend EMS on the Hill Day events, and learn more about influencing government at this year's EMS World Expo. Then you can confidently become engaged in shaping the future of your industry.

*There are many other interested stakeholders beyond those mentioned. The author apologizes in advance for any omissions. Various association websites were accessed for descriptions of their mission statements. Thanks to Tristan North and Kurt Krumperman for preliminary review of the article.

C.T. "Chuck" Kearns, MBA, is a Florida EMT and paramedic employed by Community EMS, a multi-state national provider of ambulance, consulting and logistics services. Chuck is the former chair of the Florida EMS Advisory Council, and currently serves on the Board of Directors for the National Association of EMTs (NAEMT), the Board of Directors of the Commission on Accreditation of Ambulance Services (CAAS) and is the EMS representative on FEMA's National Advisory Council. Chuck also serves on ACEP's Culture of Safety Committee, the American Ambulance Association's Medicare Working Group and EMS World's editorial advisory board.