Healthcare Policy Development

During his 20-plus-year career, Gregg Margolis has been at the forefront of efforts to improve and innovate in EMS. He has served as an assistant professor of health and rehabilitation sciences at the University of Pittsburgh’s Center for Emergency Medicine and as associate director of the National Registry of EMTs. Along the way, he played key roles in several national projects including the EMS Education Agenda for the Future, the National EMS Scope of Practice and the National EMS Education Standards projects.
In September 2009, Margolis became the first EMS professional to be awarded a Robert Wood Johnson Health Policy fellowship and spent a year working on Capitol Hill as part of Sen. Jay Rockefeller’s (D-WV) health team. While there he met Nicole Lurie, MD, the assistant secretary for preparedness and response. “We started a conversation about how we could leverage various aspects of federal policy to help build a more resilient and prepared healthcare system,” Margolis says. “She started a new division—the Division of Health Systems and Health Care Policy—and that’s what I have been fortunate enough to have the opportunity to ramp up.” In January 2011, he left EMS for the newly created federal post.
The following excerpted interview can be found in its entirety on the Best Practices in Emergency Services website at emergencybestpractices.com.

What insights did you gain during your year on Capitol Hill?
When I started the fellowship, I was pretty unaware of the complexities of the federal policy process. I found that, by and large, our elected officials are well informed and well intentioned. Quite frankly, they are not portrayed particularly well in the media. One example is during the healthcare reform conversations, President Obama called a number of leaders of the legislative branch to the Blair House for an eight-hour summit. It was a bipartisan meeting that included 20 or so members of Congress. We spent weeks getting ready for that meeting. It was a deep conversation on many of the subtle nuances of the proposed legislation, and I was really amazed at how well everybody in that room had a grasp of these incredibly complicated issues.

Is EMS being held back by not having a lead federal agency?
That’s a complicated issue. I’m impressed at the amount of interest in the Department of Health and Human Services, and in particular the Office of the Assistant Secretary for Preparedness and Response, for figuring out the best way to provide support and to help EMS as an integral and essential part of the healthcare system. I’m impressed at how people here recognize EMS as a unique combination of healthcare and public health, public safety, homeland security, transportation issues, communications issues and research issues.

What are the types of issues you’re going to tackle in your new position?
We know that healthcare systems that are strong, efficient and effective are the ones that respond best when stressed by disasters or public health emergencies. Conversely, healthcare systems that are strained have great difficulty surging when they need to because of disasters or public health emergencies. The Health Systems and Health Care Policy division is going to focus on how to incorporate emergency preparedness into all aspects of the healthcare system, including EMS and hospitals.

Are there any particular changes under way as a result of healthcare reform efforts that EMS agencies could participate in?
Accountable care organizations (ACOs) are one of the ways that are being looked at to improve quality while decreasing healthcare costs. ACOs are based on the fundamental premise that coordinated care and a long-term relationship between the patient and primary care physician, and close collaboration between the physician, specialty care and a variety of other more holistic approaches that involve prevention, nutrition, weight management and smoking cessation, all improve health. In an ACO, a group of physicians and hospitals will take responsibility for a group of patients and will be incentivized on the outcomes. One of those outcomes might be to reduce unnecessary ER visits or hospital readmissions.
The logical question is, what can an EMS role in an ACO be, if any? I could envision a hospital identifying a patient who is at high risk of readmission, and in the event they don’t have a regular source of healthcare, contracting with EMS to stop by 12 hours after discharge and make sure the patient has all their medications, that they’re in a safe environment, that they understand all of their post-care instructions.
EMS is in the community. It’s a mobile health resource. It’s not a replacement for other sorts of interventions, but many of these things are not being done in a coordinated way right now. There are going to be plenty of incentives and plenty of work for everybody all centered around improving patient care and outcomes and reducing costs.
Jenifer Goodwin is an associate editor of the monthly newsletter Best Practices in Emergency Services.