When EMS Leaders Talk

What do top EMS leaders talk about when they get together to discuss the future of the profession? Sure, there are the usual deliberations about system design, budget limitations and leadership strategies, but the conversation has gotten a lot more interesting since healthcare reform. These days, innovative mobile integrated healthcare (MIH) programs, reimbursement and patient experience are more likely to dominate the discussions.

For nearly 10 years, the place EMS leaders have gone to share their experiences, network and discuss the future has been the Pinnacle EMS Leadership Forum. Several key issues emerged at the most recent gathering in Scottsdale, AZ. Not surprisingly, MIH took center stage. More than 700 senior chiefs and executives learned about some successful MIH and community paramedic programs around the country, but they also received ample warnings about jumping into the “solution of the day.”

“[MIH programs] must be moved forward with care, caution and due regard for implications,” said Jay Fitch, PhD, president of the emergency services consulting firm Fitch & Associates and host of the event.

Before a program is launched, a community needs assessments and healthy collaboration with other healthcare partners must be undertaken. That takes a significant amount of preparation, said Andrew Rand, CEO of Advanced Medical Transport, a multistate not-for-profit EMS system in the Midwest. Even if an agency isn’t ready to launch a program, there are building-block strategies to prepare. In addition to a needs assessment and collaboration, these include engaging the community, preparing EMS crews for nontraditional work and preloading the technology. “You don’t need to get a seat at the table—you need to earn a seat at the table,” Rand said.

A common thread in nearly every session was the importance of data. “Data is driving healthcare reform,” said Brenda Staffan, healthcare innovation project director for the Regional EMS Authority (REMSA) in Reno, NV. She provided preliminary results for her organization’s Centers for Medicare & Medicaid Services (CMS) Health Care Innovation Grant. REMSA was one of the original 107 organizations (out of the more than 3,000 applicants) to receive a coveted Round 1 innovation grant. Staffan said that although the results are preliminary, the project has been a success. “We are increasing access to quality care in a safe and reliable way. We are definitely making progress to achieve our goals. As we continue to put systems in place, we expect even better results,” she said.

Patient Experience

By far the hottest topic was the issue of patient experience. It’s not unusual for EMS leaders to look to other healthcare professions for examples of how a profession can evolve—or at least to avoid the same pitfalls. Hospitals have been the leaders in this area. In their world, said Brian LaCroix, CEO of Allina Health EMS, a Minnesota hospital-based EMS system, the patient experience is measured by a Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Although for years many hospitals conducted their own patient satisfaction surveys, there were no common metrics or national standards for collecting and publicly reporting this information.

Since 2008, HCAHPS (pronounced “H-caps”) has allowed valid comparisons to be made across hospitals locally, regionally and nationally. Patients can research hospitals the same way they can research restaurants. Speaker after speaker noted that similar types of research would be coming to EMS, especially since patient experience is part of the Triple Aim for measuring healthcare quality. “There’s skin in the game for the first time with regard to the patient experience,” LaCroix said. He warns that EMS should be proactive and build a similar system before someone else builds one for it. “We ought to drive that,” he said.  

Growing Leverage

No discussion of EMS is complete without a deep conversation about financial margins. As Medicare funding is reduced and fee-for-service is rapidly dismantled in favor of episodic care, EMS leaders have moved past their “doing more with less” discussions and are exploring alternative reimbursement options. From payers to hospitals, everyone is beginning to recognize the financial implications of the prehospital experience, in part because of the role of EMS in affecting downstream medical costs. This presents an opportunity for EMS, said Glenn Leland, MBA Pro Transport-1’s chief strategy officer. For the first time, instead of being a commodity, EMS has some leverage.

Leland offered practical suggestions for those negotiations. He said payers, such as insurance companies and the government, are too price-sensitive and often too difficult to deal with—instead, he suggests negotiating with health facilities and nursing professionals to leverage services. Because EMS provides an efficient alternative and unique experience, it’s well positioned to take advantage of the opportunity healthcare reform affords. However, it will take some preparation. “We have to be a different kind of provider to help them adjust to change,” Leland notes.

Several speakers offered examples of programs that lower costs and improve patient care. In Mesa, AZ, the fire department has incorporated its change in philosophy—from emergency care delivery to community care—into its name: The Mesa Fire and Medical Department is the recipient of a Round 2 CMS Innovation Grant to implement a program that adds two transitional response vehicles and two community care units to its 20 ALS engines and five ALS medic units.

The department’s medical director, Gary Smith, MD, offers a caveat to agencies considering realigning to fit more closely with the ideals of healthcare reform: If EMS agencies expect to be paid for performance, “our performance has to improve,” he said. How patients are managed and the quality of care they receive must be consistently high. He notes that the service provided a year ago won’t be good enough today. He also advocates for advanced certification and licenses for firefighters.

Leadership in Development

For some EMS leaders, Pinnacle is like old home week—a chance to catch up with colleagues, learn and network. For others, like Mathias Duschl and Andreas Rohner, advanced care paramedics from the Rettungsdienst Spital Lachen (EMS Hospital) in Lachen, Switzerland, attending is a mission. They used vacation time and their own money to come to Pinnacle.

“We have a lot of clinical conferences [in the German-speaking region of Europe]. There are no real, dedicated leadership conferences,” Duschl said. “What makes this conference different is [that] you see how leadership is in development. In Switzerland, Germany and Austria, it’s about management, not leadership. We’ve learned this.”

Much of what they heard applies to their situation at home. “Same issues. Different country,” Duschl said. However, one looming issue facing Switzerland is a critical shortage of physicians. “Half of family physicians will retire in the next 5–10 years. Only one third will be replaced,” he said. “This will have a significant impact on EMS.” Duschl and Rohner came to the U.S. looking for ideas. “In Europe, we’ve been called to take a look over the rim. That’s what we are doing here,” Rohner said.

Teresa McCallion, EMT, recently served as the associate editor of Integrated Healthcare Delivery.