Looking Forward: A Preview of EMS in 2016

2015 saw EMS continue to evolve both operationally and clinically to fit within the new healthcare environment, embrace practice-changing research, and offer opportunities to partner with our public health and law enforcement partners. But what are the big areas of change we can expect in 2016? What areas should keep you, the EMS leader, up at night if you are not strategizing for the future? Read on to see what should be on your must-consider list:

Mobile Integrated Healthcare-Community Paramedicine (MIH-CP)

2016 will see significant movement forward in the field of MIH-CP, including multiple state regulatory entities trying to catch up with MIH by introducing various statutory modifications and The Board for Critical Care Transport Paramedic Certification (BCCTPC) launch of the Certified Community Paramedic (CP-C^®) Exam. The future of MIH, and whether it remains a lasting force in EMS as opposed to a footnote, will be based on the funding of these various initiatives and whether they can move from current patchwork funding to a more consistent, stable, long-term funding mechanism. To learn more about MIH, see EMSWorld.com/integrated-healthcare.

Performance measures

The EMS Compass initiative, a collaborative project funded by the National Highway Traffic Safety Administration (NHTSA) Office of EMS and spearheaded by the National Association of State EMS Officials (NASEMSO), is putting together performance measures for EMS agencies. The first measures, released in 2015, focused on stroke patient assessment, care and transport. EMS performance measures have the potential to show how well an agency is doing in terms of clinical care, operations and finances. These measures, which will no doubt assist in informing the public and various elected officials, also hold the possibility of allowing for better system-to-system performance measurement. Whether these peer-reviewed measures will impact any future funding by mandating EMS agencies utilize them remains to be seen. Find out more about this critical initiative at emscompass.org.

Funding

Recent efforts in healthcare to improve quality and reduce costs, including the Affordable Care Act, pose significant challenges to the existing EMS response and reimbursement model, known as the fee-for-service model. Healthcare payers have become increasingly unwilling to reimburse for services that fail to prove their value. As a consequence, EMS agencies will soon be required to demonstrate their value, and they will potentially be reimbursed based on a fee-for-quality model. This ties in well with the MIH initiative, as hospitals will be negatively impacted financially by patients who are transported back to their facilities for readmission. As this isn’t a battle-tested concept yet, it is key for leaders to keep their eyes and ears open, as its impact will be financial and potentially operational.

High-impact incidents

Sadly, there are more and more instances of active shooter incidents occurring, and with these incidents comes the reality that EMS will have to continue to partner with law enforcement and other stakeholders to better understand their specific roles. We have already seen the establishment of programs like the Tactical Combat Casualty Care (TCCC) and the Certified Tactical Paramedic Examination (TP-C) offered by the Board for Critical Care Transport Paramedic Certification. 2016 will undoubtedly see further application of these programs, as more and more providers and systems move to expand their capabilities to handle these types of responses. Does your EMS agency participate in active shooter drills? If the answer is no, and your local law enforcement agencies are doing them, why aren't you a component? Some applicable information about EMS role at active shooter events is available in this whitepaper.

Mega-merger

2015 saw one of the largest commercial EMS providers in the U.S., American Medical Response (AMR), purchase one of its main competitors, Rural/Metro. As there is now one less large commercial EMS provider in the mix, this translates into various markets where AMR could potentially be the only bidder for an RFP. There are other areas, such as economies of scale, the benefits of having a large-scale, country-wide workforce, and even the potential of this move allowing a more rapid expansion of AMRs MIH initiative, where this merger could see significant advances for the areas where AMR operates and will operate in the future.  2016 will shed more light on the various implications of this merger and see additional seismic activity in the form of other mergers. 

Evidence-based medicine for EMS providers

The National Association of EMS Physicians (NAEMSP) has long been a strong proponent of the development and implementation of prehospital protocols based on evidence-based medicine. 2015 saw the development of various documents and initiatives, such as the pediatric-specific Pegasus project, based on evidence-based medicine. 2016 will see various systems—local, regional, and hopefully state—take these foundational documents and initiatives and adopt them for their own individual use. The National EMS Guidelines are available here.

Public accountability

Never in the history of EMS has it been clearer that our communities are holding us accountable for all sorts of information ranging from staffing patterns and response times, to pensions, and including the education/training levels of our providers.  This overall accountability translates into a 2016 where EMS providers will continue to be examined in many ways not previously available. EMS leaders need to embrace the media in a progressive manner in order to educate the public and decision-makers while also embracing best practices. Some applicable examples come from the Richmond Ambulance Authority (RAA), which aggressively utilizes social media including Facebook and Twitter to highlight its agency’s accomplishments.

There is no doubt that the EMS world will be impacted by many things in the year 2016. The areas outlined above are just a few of those EMS providers, supervisors, managers, and executives need to keep on their collective radar screens to stay ahead of the curve and assure their EMS agencies are at the top of their games.

Yogi Berra once said, “It ain’t over, ‘til it’s over.” I am sure there will be other areas not focused on in this article that will impact our EMS systems. It is up to us, as EMS leaders, to keep our eyes open and prepare for these updates to the EMS industry in 2016 and beyond.

Raphael M. Barishansky, MPH, MS, CPM, is a solutions-driven consultant working with EMS agencies, emergency management and public health organizations on complex issues including leadership development, strategic planning, policy implementation and regulatory compliance.

He has previously served as the Director of the Office of Emergency Medical Services (OEMS) at the Connecticut Department of Public Health (2012-2015), as well as the Chief of Public Health Emergency Preparedness at the Prince Georges County, Maryland Health Department (2008-2012).

A frequent contributor to and editorial advisory board member for EMS World, he can be reached at rbarishansky@gmail.com.