Kaiser Health News: REMSA Paramedics Steer Non-Emergency Patients Away From ERs

Innovation in Reno
REMSA program empowers EMS, helps patient outcomes, and cuts costs.

Yesterday Kaiser Health News reported that AAA member organization Regional Emergency Medical Services Authority (REMSA), is serving its community in innovative ways that reduce healthcare costs and improve patient outcomes. Initiatives led by REMSA CEO Jim Gubbels empower Reno paramedics to lower the number of preventable emergency room visits and close gaps in primary health care.

Using a $9.8 million federal grant, [REMSA CEO Jim Gubbels’] agency launched three different projects. In addition to providing paramedic home visits and offering patients options besides the ER, the agency started a nurse-run health line to give people with health questions another number to call in non-emergency situations.

An early evaluation by the University of Nevada, Reno, which was based on insurance claims and hospital data, shows that the projects saved $5.5 million in 2013 and 2014. They helped avoid 3,483 emergency department visits, 674 ambulance transports and 59 hospital re-admissions, according to the preliminary data. The federal government plans to do its own evaluation.

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Spotlight: Paul Pedersen

Paul Pedersen
Sierra Vista, Arizona, USA
Managing Partner at Arizona Ambulance Transport
Director Region 5, AAA Board

Tell us a little about yourself.
I was born and raised in Berkeley, California. I have a wife and two grown children, and enjoy traveling.

How did you come to work in the industry?
After 20 years in law enforcement and five years in public safety communications, I became general manager for Rural/Metro in southern Arizona. I subsequently co-founded our company, Arizona Ambulance Transport, in 2000.

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Spotlight: Scott Moore

Scott Moore
Somerville, Massachusetts, USA
Scott’s LinkedIn Profile
Director of Human Resources at Cataldo Ambulance Service
Co-Chair, Education & Membership Committee at AAA

Tell us a little about yourself.
I grew up twenty minutes north of Boston, MA. I have a wife, Marianne, and two daughters, Emily (9), and Elise (7). I have been in EMS for 25 years and have worked as a Call Fire-Fighter in my town for the last 10. I have a bachelor’s degree in psychology and a Juris Doctor from Suffolk University Law School.

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Ambulance Open Door Forum, April 22, H.R. 2

CMS held its latest Ambulance Open Door Forum on April 22. It started with the following two announcements:

– H.R. 2 was signed into law extending the temporary ambulance adjustments through December 31, 2017. The adjustments are 2% (urban pick-ups), 3% (rural) and 22.6% (super rural).

– For free standing facilities, use the “P” modifier if the facility is not part of the hospital and use “H” if it is hospital-based.
Following these announcements, there was a Question and Answer period. Most of the questions were not answered on the call and the caller was asked to submit their questions to CMS, or was told to ask their Medicare Administrative Contractor or was told to appeal the denied claim referenced in their question. A few were answered, as follows:

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Senate Delays Vote on SGR Repeal Package

Early this morning after completing action on a FY 2016 Senate Budget Resolution, Senate Majority Leader Mitch McConnell (R-KY) announced that the Senate would not act on legislation (H.R. 2) to permanently repeal the sustainable growth rate (SGR) formula for physicians until after the Easter recess. H.R. 2 includes the 33-month extension of the temporary Medicare ambulance increases. Senate Majority Leader McConnell had sought consideration today of H.R. 2 under unanimous consent which requires the support of all 100 Senators. There were objections to the expedited vote and thus the Senate is now expected to consider the bill when it returns on April 14.

The temporary Medicare ambulance increases expire on March 31. However, contractors have a standard requirement to hold all Medicare claims for 14 days before making payment. The Centers of Medicare and Medicaid Services (CMS) has issued a notice to contractors formally directing them to utilize this hold. So if the Senate does complete action on H.R. 2 on April 14 there will be no need for reprocessing any claims for the retroactive increases. Should action on H.R. 2 be delayed further, Congress could do a short-term extension or simply allow the provisions to expire for a short period of time. Senate Majority Leader Mitch McConnell and Senate Minority Leader Harry Reid (D-NV) have both stated they would like quick consideration of H.R. 2 when the Senate returns.

We will continue to keep you posted of new developments.

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Recognition of EMS Personnel Licensure Interstate Project

Mar 27, 2015

In one of the most labor intensive projects of national significance in its history, the National Association of State EMS Officials brought industry partners and experts in the field of interstate compacts together over the last two years to develop model legislation for states’ consideration and enactment. The “Recognition of EMS Personnel Licensure Interstate CompAct” (“REPLICA”) final model legislation is attached and was distributed to State EMS Directors and State EMS Medical Directors earlier this week. EMS is at the leading edge of a growing wave of medical disciplines’ national bodies of state regulatory agencies that have discovered that interstate compacts are a novel yet time tested way to solve the pervasive dilemma of providing appropriately credentialed individuals from other states the legal ability to practice under specified conditions, introduce unprecedented accountability related to those personnel, and create means of information sharing among states that have never existed before.

In order to become a member of the compact, a state must introduce the attached as a piece of legislation, enact it without any substantial changes, and the Governor must sign it into law. The Federation of State Medical Boards (FSMB), the members of which include your state medical board(s’) Executive Director(s), has also just completed a model interstate compact to streamline physician licensure across state lines. Information about the FSMB initiative and a link to download their model compact can be found here. These initiatives would dovetail nicely as companion bills and solve interstate practice issues for both EMS personnel and their medical directors concurrently.

At its annual meeting last month, the Council of State Governments (CSG) Board of Directors passed a resolution supporting the establishment of REPLICA and encouraging its member jurisdictions to consider adoption as an “innovative policy solution”. You can view and download the resolution here.

The record set for adoption of a new compact in recent years was by 11 states in the first legislative cycle following model compact distribution, and just within the last few months, the number of compacts in use by all 50 states grew to four, and most have DC and territories as members as well. Your legislators or legislative services staff may be more comfortable communicating with CSG, in which case their contact person is Crady deGolian, Director of the CSG National Center for Interstate Compacts via cdegolian@csg.org or by telephone at 859-244-8068. CSG houses comprehensive information about interstate compacts here.

NASEMSO is grateful to the US Department of Homeland Security for the resources that made this possible, and all of the national organizations who contributed time and expertise during this process. Most specifically, we are indebted to the states of Colorado, Idaho and Maryland, and the Commonwealths of Kentucky and Virginia for generously making state EMS office staff with notable expertise in legislation drafting and personnel licensure available to be heavy lifters in the project.

View the final model legislation.

House Votes in Favor of Permanent Doc Fix, Bill Moves to the Senate

Earlier today, the U.S. House of Representatives voted in favor of H.R. 2, doing away with Medicare’s sustainable growth-rate formula and passing a permanent doc fix. The 392-37 vote was overwhelmingly bipartisan. As we reported on March 24, thanks to our champions on Capitol Hill, a 33-month extension of the temporary Medicare ambulance increases was included in the bill. If enacted, the bill would extend the deadline for expiration of Medicare ambulance relief from March 31 until December 31, 2017.

The Senate still needs to pass the bill and is working on a short time-line before they adjourn for recess. Senate Republicans and Democrats have expressed concerns about different aspects of the bill so it is unclear whether the chamber will consider H.R. 2 before it recesses. It is also uncertain if Congress would pass a short-term extension to give the Senate more time or if CMS would be required to formalize its 14-day claim hold policy should H.R. 2 not be enacted before March 31.

In addition to Medicare ambulance relief, the package also includes language from the Protecting Integrity of Medicare Act (H.R. 1021) expanding the current prior authorization pilot programs on repetitive BLS non-emergency ambulance transports in South Carolina, Pennsylvania and New Jersey. Starting in January 2016, the bill would expand the programs to Delaware, DC, Maryland, North Carolina, West Virginia and Virginia. The program would then expand nationwide starting in January 2017.

The AAA will continue to push for the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745). S. 377 and H.R. 745 would make the current temporary ambulance increases permanent and place our industry in a strong position moving forward for data-driven reforms to the ambulance fee schedule. S. 377 and H.R. 745 would also address fraud and abuse with repetitive BLS non-emergency dialysis transports. While a similar program to the current pilot programs. The prior authorization within S. 377 and H.R. 745 would apply only to dialysis transports and would institute additional safeguards to ensure timely prior authorization for medically necessary transports.

I want to thank all AAA members, staff and consultants who continue to work tirelessly on extending essential Medicare ambulance relief. We will keep you posted of new developments.

House SGR Repeal Package Contains Ambulance Relief Extension

Earlier today, House Republican and Democratic leadership released the complete package (H.R. 2) for a permanent fix to the physician fee schedule. I am happy to report that the AAA through our champions on Capitol Hill was successful in getting a 33-month extension of the temporary Medicare ambulance increases included in the bill. If enacted, the bill would extend the deadline for expiration of Medicare ambulance relief from March 31 until December 31, 2017.

The House is scheduled to consider H.R. 2 on either Thursday or Friday prior to adjourning for the two-week Easter recess. The bill is currently expected to pass the House with bipartisan support. Senate Republicans and Democrats have expressed concerns about different aspects of the bill so it is unclear whether the chamber will consider H.R. 2 before it recesses. It is also unclear if Congress would pass a short-term extension to give the Senate more time or if CMS would be required to formalize its 14-day claim hold policy should H.R. 2 not be enacted before March 31.

The package also includes language from the Protecting Integrity of Medicare Act (H.R. 1021) expanding the current prior authorization pilot programs on repetitive BLS non-emergency ambulance transports in South Carolina, Pennsylvania and New Jersey. Starting in January 2016, the bill would expand the programs to Delaware, DC, Maryland, North Carolina, West Virginia and Virginia. The program would then expand nationwide starting in January 2017.

The AAA continues to push for the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745). S. 377 and H.R. 745 would make the current temporary Medicare ambulance increases permanent and place our industry in a strong position moving forward for data-driven reforms to the ambulance fee schedule. S. 377 and H.R. 745 would also address fraud and abuse with repetitive BLS non-emergency dialysis transports. While a similar program to the current pilot programs, the prior authorization within S. 377 and H.R. 745 would apply only to dialysis transports and would institute additional safeguards to ensure timely prior authorization for medically necessary transports.

We will keep you posted of new developments.