NHTSA | Office of EMS Director Jon Krohmer, MD, to Retire

NHTSA Office of EMS Director Jon Krohmer, MD, to Retire Later this Year

After 15 years of federal service, including the last five leading the National Highway Traffic Safety Administration Office of EMS, Jon Krohmer, MD, will be retiring in November.

During his tenure as director, Dr. Krohmer and the NHTSA Office of EMS team oversaw a number of milestones for the profession, including the creation of EMS Agenda 2050; major revisions to the National EMS Scope of Practice Model and the National EMS Education Standards; and improvements in the collection and use of EMS data through the expansion of the National EMS Information System. Soon after the onset of the coronavirus pandemic, Dr. Krohmer was tapped to lead the prehospital/911 team as part of the Federal Healthcare Resilience Task Force.

“Dr. Krohmer’s tenure at NHTSA—especially over the last year and a half as EMS clinicians have faced one of the greatest public health challenges in generations—has been marked by real advances for the profession, thanks in no small part to his leadership,” said Nanda Srinivasan, NHTSA’s associate administrator for research and program development. “He was a true advocate at the federal level for state, tribal and local EMS systems, EMS clinicians, and patients.”

Prior to joining NHTSA, Dr. Krohmer had decades of experience as a local EMS medical director, initially in his home state of Michigan. His EMS career began as an EMT with a volunteer rescue squad. Like many EMS professionals, he was inspired by the television show Emergency! and by the emergence of the relatively new field of emergency medicine. He entered medical school at the University of Michigan knowing he wanted to make EMS his career. After becoming involved in EMS at the state and national level, he also served as president of the National Association of EMS Physicians from 1998 to 2000. In 2006, he came to Washington to serve as the first deputy chief medical officer for the Department of Homeland Security Office of Health Affairs and served in several other DHS roles before joining NHTSA in 2016.

“Working alongside EMS clinicians and the people who support them at local, state and national levels has been a privilege and a heck of a lot of fun,” said Dr. Krohmer. “The decision to leave NHTSA was difficult, but it’s made easier knowing that the team in the Office of EMS, our colleagues throughout the federal government, and leaders of EMS at state and local levels are committed to improving the lives of people in their communities and will continue to advance EMS systems everywhere.”

NHTSA will launch a national search for a new director for the Office of EMS.

“The example set by Dr. Krohmer will serve as a great model for the next director,” said Associate Administrator Srinivasan, “and the team of dedicated public servants at the Office of EMS has the experience and expertise to ensure a smooth transition.”

Third Annual EMS Employee Turnover Study

The American Ambulance Association (AAA) and Newton 360, an EMS-based performance management software platform, have joined forces to conduct the third annual survey of employee turnover in the EMS industry. This study was first conducted in 2018 and repeated in 2019.  The study was not conducted in 2020 due to the COVID-19 global pandemic.

The COVID-19 pandemic presented significant challenges for EMS organizations and the EMS workforce. The EMS workforce rose to the challenge and battled the disease, despite the workforce shortages that have plagued the EMS profession for nearly a decade. EMS organizations stepped up by offering innovative solutions to public health crises, including establishing testing and vaccinations sites around the country, suggesting that EMS employers and employees are prepared to expand their role to include greater provision of preventive services and community-based healthcare. However, there was also an economic impact to many organizations as call volume decreased and the costs of providing services significantly increased.

The study evidences a need to embark upon a larger initiative to collect data on the EMS workforce in the U.S.  The EMS profession has been struggling with unprecedented workforce shortages for over a decade. The pandemic only exacerbated this shortage and highlighted our need to better understand the drivers of workforce turnover. Additionally, the need for EMS professionals is predicted to increase significantly by 2030.  In part, because of the recognition of the valuable education, training, and experience individuals working in the emergency medical services field offer in other healthcare settings.

This study is an important step in understanding the causes and scope of turnover in EMS.  We recommend that you carefully read and review the results of this study.  Additionally, you should compare your data with the results of this study and discuss with your leadership team.  To assist in the effort to attain greater insight to the factors driving turnover in EMS, we recommend that you systematically collect data on your organization’s workforce, including the reasons for turnover.  Lastly, we urge EMS leaders to encourage participation by all EMS provider types in the effort to collect and analyze EMS workforce data.

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Preliminary Calculation of 2022 Ambulance Inflation Update

Section 1834(l)(3)(B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation.  This update is referred to as the “Ambulance Inflation Factor” or “AIF”.

The AIF is calculated by measuring the increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending with June of the previous year.  Starting in calendar year 2011, the change in the CPI-U is now reduced by a so-called “productivity adjustment”, which is equal to the 10-year moving average of changes in the economy-wide private nonfarm business multi-factor productivity index (MFP).  The MFP reduction may result in a negative AIF for any calendar year.  The resulting AIF is then added to the conversion factor used to calculate Medicare payments under the Ambulance Fee Schedule.

For the 12-month period ending in June 2021, the federal Bureau of Labor Statistics (BLS) has calculated that the CPI-U has increased by 5.39%.

CMS has yet to release its estimate for the MFP in calendar year 2022.  However, assuming CMS’ projections for the MFP are similar to last year’s projections, the number is likely to be in the 0.4% range.

Accordingly, the AAA is currently projecting that the 2022 Ambulance Inflation Factor will be approximately 5.0%. 

Cautionary Note Regarding these Estimates

Members should be advised that the BLS’ calculations of the CPI-U are preliminary, and may be subject to later adjustment.  The AAA further cautions members that CMS has not officially announced the MFP for CY 2022.  Therefore, it is possible that these numbers may change.  The AAA will notify members once CMS issues a transmittal setting forth the official 2022 Ambulance Inflation Factor.

EICC Pediatric Emergency Champion Program

From the Emergency Medical Services for Children Innovation and Improvement Center

September 1, 2021 – June 30, 2022

Purpose

This collaborative will develop individuals who are interested in improving the quality of pediatric care at your EMS agency, ED/hospital, or within your region. We will provide resources, example practices and networking opportunities at no cost to help push forward any effort for pediatric improvement.


What is a PECC?

A Pediatric Emergency Care Coordinator (PECC)–sometimes referred to as a pediatric champion or pediatric liaison–is a term that the EMSC program uses to refer to any individual who has a particular interest in or responsibilities related to pediatric emergency care. Sometimes this individual is dedicated solely to this role. However, depending on the pediatric volume of the EMS agency or hospital, this person may take on the PECC duties in addition to other responsibilities (e.g., educator, trauma coordinator, etc.). Various roles and responsibilities are often given to a PECC but common responsibilities include ensuring the availability of pediatric equipment, supplies and medications, pediatric education/training and advocating for pediatric considerations to be included in protocol/policy development.


Who should participate

Anyone that is interested in improving pediatric readiness within your EMS agency, ED/hospital, or within your region, to include EMSC State Partnership Programs. You do NOT need to have any formal pediatric training, or a title related to pediatric care. You already have everything you need to participate…an interest in pediatric emergency care


Why join?

We know that the presence of an individual with an interest in pediatric emergency care is strongly correlated with improved outcomes for children. No effort to improve pediatric emergency care is too small to make an impact. This collaborative will have a broad scope. No matter where your starting point is, we will provide you with tools to improve. There is no cost to participate, and you will have the opportunity to earn continuing education or Maintenance of Certification Part 4 credit. Learn more…


How it works

The collaborative will occur in two parts. During the first half, we will explore seven pediatric readiness areas of focus, evaluate your agency or ED/hospital level of pediatric readiness, and identify areas for improvement. In the second half, we provide coaching and tools to help you develop an improvement project. Learn more…


Location

All collaborative activates will be conducted online and through virtual meetings.

Learn More

Study | Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation

Thank you to Dr. John Russell of Cape County Private Ambulance for sharing this resource.

Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting

Hilary A. Hewes, Andrea L. Genovesi, Rachel Codden, Michael Ely, Lorah Ludwig, Charles G. Macias, Patricia Schmuhl & Lenora M. Olson (2021) Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting, Prehospital Emergency Care, DOI: 10.1080/10903127.2021.1942340

Abstract

Objectives: Treating pediatric patients often invokes discomfort and anxiety among emergency medical service (EMS) personnel. As part of the process to improve pediatric care in the prehospital system, the Health Resources and Services Administration (HRSA) Emergency Services for Children (EMSC) Program implemented two prehospital performance measures -access to a designated pediatric care coordinator (PECC) and skill evaluation using pediatric equipment-along with a multi-year plan to aid states in achieving the measures. Baseline data from a survey conducted in 2017 showed that less than 25% of EMS agencies had access to PECC and 47% performed skills evaluation using pediatric equipment at least twice a year. To evaluate change over time, the survey was again conducted in 2020, and agencies that participated in both years are compared.

Methods: A web-based survey was sent to EMS agency administrators in 58 states and territories from January to March 2020. Descriptive statistics, odds ratios, and 95% confidence intervals were conducted.

Results: The response rate was 56%. A total of 5,221 agencies participated in both survey periods representing over 250,000 providers. The percentage of agencies reporting the presence of a PECC increased from 24% to 34% (p= <0.001). However, some agencies reported that they no longer had a PECC, while others reported having a PECC for the first time. Fifty percent (50%) of agencies conduct pediatric psychomotor skills evaluation at least twice/year, a 2% increase over time (p = 0.041); however, a third (34%) evaluate skills using pediatric equipment less than once a year. The presence of a PECC continues to be the variable associated with the highest odds (AOR 2.15, 95% CI 1.91–2.43) of conducting at least semiannual skills evaluation.

Conclusions: There is an increase in the presence of pediatric care coordination and the frequency of pediatric psychomotor skills evaluation among national EMS agencies over time. Continued efforts to increase and sustain PECC presence should be an ongoing focus to improve pediatric readiness in the prehospital system.

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HHS | $103mm for Healthcare Workforce Resiliency and to Address Burnout

FOR IMMEDIATE RELEASE
Contact: HHS Press Office
202-690-6343
media@hhs.gov

HHS Announces $103 Million from American Rescue Plan to Strengthen Resiliency and Address Burnout in the Health Workforce

Today, the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced the availability of an estimated $103 million in American Rescue Plan funding over a three-year period to reduce burnout and promote mental health among the health workforce. These investments, which take into particular consideration the needs of rural and medically underserved communities, will help health care organizations establish a culture of wellness  among the health and public safety workforce and will support training efforts that build resiliency for those at the beginning of their health careers.

“The Biden-Harris Administration is committed to ensuring our frontline health care workers have access to the services they need to limit and prevent burnout, fatigue and stress during the COVID-19 pandemic and beyond,” said HHS Secretary Xavier Becerra. “It is essential that we provide behavioral health resources for our health care providers – from paraprofessionals to public safety officers – so that they can continue to deliver quality care to our most vulnerable communities.”

Health care providers face many challenges and stresses due to high patient volumes, long work hours and workplace demands. These challenges were amplified by the COVID-19 pandemic, and have had a disproportionate impact on communities of color and in rural communities. The programs announced today will support the implementation of evidence-informed strategies to help organizations and providers respond to stressful situations, endure hardships, avoid burnout and foster healthy workplace environments that promote mental health and resiliency.

“This funding will help advance HRSA’s mission of developing a health care workforce capable of meeting the critical needs of underserved populations,” said Acting HRSA Administrator Diana Espinosa. “These programs will help to combat occupational stress and depression among our health care workers as they continue their heroic work to defeat the pandemic.”

There are three funding opportunities that are now accepting applications:

  • Promoting Resilience and Mental Health Among Health Professional Workforce – Approximately 10 awards will be made totaling approximately $29 million over three years to health care organizations to support members of their workforce. This includes establishing, enhancing, or expanding evidence-informed programs or protocols to adopt, promote and implement an organizational culture of wellness that includes resilience and mental health among their employees.
  • Health and Public Safety Workforce Resiliency Training Program – Approximately 30 awards will be made totaling  approximately $68 million over three years for educational institutions and other appropriate state, local, Tribal, public or private nonprofit entities training those early in their health careers. This includes providing evidence-informed planning, development and training in health profession activities in order to reduce burnout, suicide and promote resiliency among the workforce.
  • Health and Public Safety Workforce Resiliency Technical Assistance Center – One award will be made for approximately $6 million over three years to provide tailored training and technical assistance to HRSA’s workforce resiliency programs.

To apply for the Provider Resiliency Workforce Training Notice of Funding Opportunities, visit Grants.gov. Applications are due August 30, 2021.

Learn more about HRSA’s funding opportunities.

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Letter to Senate HELP Committee Leadership on Provider-Type Equity

The Honorable Patty Murray
Chair, United States Senate Committee on Health, Education, Labor and Pensions

The Honorable Richard Burr
Ranking Member
United States Senate Committee on Health, Education, Labor and Pensions

Dear Chairwoman Murray and Ranking Member Burr:

The American Ambulance Association (AAA) appreciates the opportunity to provide suggestions for bipartisan legislation to improve medical preparedness and response programs. The AAA is the primary association for ground ambulance service suppliers/providers, including governmental entities, volunteer services, private for-profit, private not-for-profit, and hospital-based ambulance services. Our members provide emergency and non-emergency medical transportation services to more than 75 percent of the U.S. population. AAA members serve patients in all 50 states and provide services in urban, rural, and super-rural areas. As the National Highway Transportation Safety Administration identified in its 2013 report on emergency services, EMS-only systems – such as our members – provide the vast majority of emergency ambulance services throughout America.

Our members are often the first health care teams to encounter patients who are sick and/or suspect they might have COVID-19. In addition to responding to 911 emergencies and transporting patients to appropriate destinations, they are also being asked to provide health care services within their existing State-defined scope of practice without transporting patients to help reduce hospital surge, as well as to protect high-risk patients from potential exposure to COVID-19. State and Local governments and public health authorities are also enlisting ground ambulance organizations to assist with testing suspected COVID-19 patients. In addition, ground ambulances provide important medical transitional care for patients moving between facilities in both emergency and non-emergency situations.

During this pandemic, our members have experienced first-hand the gaps in the public health infrastructure and the medical preparedness and response systems and programs. One of the most frustrating aspects of the current system has been the lack of recognition and support for communities that contract with non-governmental ground ambulance providers/suppliers in everything from federal grant programs to the distribution of personal protective equipment for EMTs and paramedics.

Many of the federal grant programs triggered during the pandemic have fallen short of their promise because the statutes and regulations governing them do not recognize non-governmental ground ambulance providers/suppliers as eligible entities. This distinction remains confusing because in other areas of health care, federal grant programs are accessible by private, for-profit health care providers and suppliers.

Outdated statutes and regulations often assume that first responders are governmental or not-for-profit entities and ignore the decisions of State and Local governments to contract with private ground ambulance providers/suppliers to provide 911 or equivalent services. As others have recognized, “State and Local officials know what works best in their communities – what works best in New York City may be much different than what works in rural Tennessee.”1 The federal government should respect these local decisions and support all first responders.

An example of this problem arose early during the COVID-19 pandemic. The FEMA public assistance grant program reimburses first responders for PPE and other expenses related to the response to COVID-19. When public and private non-profit emergency ambulance providers/suppliers sought direct reimbursement under the program, they were turned away. Private emergency ambulance providers/suppliers were required to have a State or Local government agency apply on their behalf. As State and Local governments responded to the public health emergency, it was understandably difficult for them to allocate resources to work through the application process on behalf of their contractors.

This differential treatment impacts communities across the United States, including those in Arkansas, California, Colorado, Florida, Georgia, Indiana, Louisiana, Massachusetts, Mississippi, Nevada, New York, Oregon, Texas, and Wisconsin, among others.

In contrast to statutes like the one government FEMA allocations, the Homeland Security Act of 2002 (6 U.S.C. § 101) includes language that recognizes the decision of State and Local governments to contract with private not-for-profit and for-profit ground ambulance providers/suppliers within the definition of “emergency response providers.”

The AAA urges the Congress to adopt the Homeland Security Act definition of “emergency response providers” throughout the U.S. Code as applicable. Such language will help to make sure that when funding is available to help State and Local governments prepare and respond, the allocation mechanisms governing the funding permit all types of first responders, including non-governmental ground ambulance providers/suppliers, to access the dollars quickly and with minimal burden.

Recommendation

The Committee should carefully review federal public health programs and revise them as necessary to ensure that the funds may be used to support both non-governmental and governmental ground ambulance providers/suppliers to ensure that all communities, regardless of their individual decisions related to the entities operating their EMS systems, have federal funds to support their response efforts during public health emergencies.

On behalf of the AAA, I want to thank you for your ongoing support of EMS and ground ambulance providers/suppliers, as well as the leadership demonstrated by your work to prepare for the next pandemic. Over the years, the Congress has consistently recognized the vital and unique role that ground ambulance providers/suppliers play in protecting their communities and providing mobile health care services. In light of the lessons learned during this pandemic, we encourage you and your colleagues to revise antiquated language that no longer represents the innovations and progress that have led to State and Local governments to rely upon ground ambulance providers/suppliers, including non-governmental organizations.

The AAA and its volunteer leaders would welcome the chance to discuss this recommendation. We would also be pleased to participate in any fact-finding discussion or hearing that the Congress plans to host to better understand how the problems experienced during the current pandemic can be avoided in the future. Please do not hesitate to reach out to Tristan North at (202) 486-4888 or tnorth@ambulance.org, or Kathy Lester at (202) 534-1773 or klester@lesterhealthlaw.com to schedule a time for further discussion.

Sincerely,

Shawn Baird
President, American Ambulance Association
Vice President of Rural Services, Metro West Ambulance

1The Honorable Lamar Alexander, “Preparing for the Next Pandemic” White Paper” 4 (June 9, 2020).