Letter from America: Reversing the Flow of Good Ideas
Rob Lawrence is chief operating officer of the Richmond Ambulance Authority in Virginia. Before coming to the U.S., he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He writes a regular “Letter from America” column for the UK publication Ambulance Life. This column is reprinted with permission from Ambulance Life.
It is often said that what happens in the United States is taken on in the UK a few years later. However, this west-to-east trend in the ambulance and EMS arena is about to be well and truly bucked.
With the advent of the Affordable Care Act, AKA Obamacare, and another four-year team for President Obama, the realization is coming home to roost that the face of healthcare is changing. Under new proposals, for example, hospitals can be fined for patient readmission within 30 days and face a reduction in Medicare reimbursement. The potential financial loss is forcing hospitals to create initiatives to reduce readmission.
I had the privilege before Christmas to attend the American Ambulance Association Annual convention. The theme of the event was "Conquering Healthcare." The conference was dominated with the need to prepare for Obamacare and restyle our industry away from pure Emergency Medical Services to the delivery of "mobile healthcare," as we become the last health and social care safety net in the new world order.
The initiatives currently being "invented" here give me a personal sense of deja vu. Programs, processes and procedures adopted by the ambulance trusts to survive in a National Healthcare model on the increase here as more and more U.S. services look to the UK for a lead. "Hear and treat" or "treat and release" are phrases now being spoken with an American accent.
In Fort Worth, TX, MedStar EMS, a high-performance EMS system much like Richmond, is pioneering the delivery of prehospital alternatives to the emergency department, reaching beyond traditional ambulance service delivery to meet the needs of patients and financial stakeholders. MedStar's community paramedicine project works with frequent emergency services users to help them find more appropriate sources for their healthcare needs. The agency reports that more than 190 patients are enrolled in this program and graduated patients experience an 80%+ reduction in emergency service use.
MedStar's Congestive Heart Failure program visits patients at home to educate them on the best ways to manage their disease and keep them connected with their GP. If necessary, in-home dieresis can be administered to prevent emergency department visits and hospital admissions. MedStar reports that none of the at-risk patients enrolled in the program since June 2012 have had an ED visit or readmission.
MedStar's Observation Admission Avoidance program works with ED doctors, case managers and payers to provide an in-home alternative to overnight hospital admissions and get patients safely to their GP appointments the next day. Their Hospice Revocation Avoidance program works with patients and families to ensure the patient's wishes to pass away at home are met by providing episodic care in the home when patient's families need support during the critical hour. Only one out of 25 patients enrolled in this program required a hospital admission.
Does some of the above sound familiar? MedStar’s Director of Public Relations Matt Zavadsky will be the first to tell you that the majority of the ideas were modeled on and sourced out of the UK. To get further ahead of the curve and future-proof their organization, Medstar has also added the name MedStar Mobile Healthcare.
Further North in New York, North Shore EMS, operationally led by former RAA staff member Jon Washko, is creating a system where EMS staff conduct screening visits for hospital-based primary care physicians, roughly translated this means community paramedics conducting the GPs house calls.
With the new year here, there is a sense of a new beginning out of necessity to adapt to the changes inbound via the ACA and it will only be a matter of time before "admission avoidance" becomes a mantra here too. If anyone on the east bank of the pond wanted to start "A Letter from the UK" to folk here on their current experiences in delivering these types of mobile and prehospital healthcare programs, now is the time to do it. I'm sure the interest here would be high and the readership vast. I can be contacted at rlawrence@raaems.org if you are up for a publishing challenge.
Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA three years ago to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob Joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations.
