Wall Street Journal: Paramedics Aren’t Just for Emergencies

Yesterday’s Wall Street Journal featured several promising community paramedicine programs, as well as some great quantitative results.

“Paramedics are a readily deployable, nimble, clinically trained resource who can help close a gap in American health care,” Dr. Schoenwetter says…

From March 2014 to June 2015, the Geisinger mobile health team prevented 42 hospitalizations, 33 emergency department visits and 168 inpatient days among 704 patients who had a home visit from a paramedic, Geisinger calculates. In the case of heart-failure patients, hospital admissions and emergency-room visits were reduced by 50%, and the rate of hospital readmissions within 30 days fell by 15%. Patient satisfaction scores for the program were 100%.”

Read the full article on wsj.com. (Hat tip to Matt Zavadsky.)

Spotlight: Kathy Lester

Kathy Lester, MPH, JD
Washington, DC
Healthcare Consultant to AAA

Tell us a little about yourself, please.

I am from Indianapolis, Indiana.  I graduated from Warren Central High School, best known for being the high school of Jane Pauley and Jeff George.  My undergraduate degree is from DePauw University.  I had a double major in biology and English literature, with a minor in violin performance.  I also loved philosophy and political science course and was the editor-in-chief of the college newspaper.  I received my JD from Georgetown University Law Center and my Master of Public Health (MPH) from The Johns Hopkins School of Public Health and Hygiene, now known as the Bloomberg School of Public Health.

After law school, I clerked on for The Honorable Michael S. Kanne on the U.S. Court of Appeals for the Seventh Circuit.  I have also worked in all three branches of government.  In addition to the courts, I worked on the Hill for Sen. Richard G. Lugar (R-IN) and in the General Counsel’s Office at the Department of Health and Human Services.

My husband and I met while both working for Senator Lugar.  He retired from the Senate after 20+ years.  We have two children and are trying to succeed in having tropical fish survive for more than a few months.

When and how did you get involved with AAA?

I began working with the AAA several years ago when we began developed recommendations for a quality program.  I believe my first meeting with the group was in Las Vegas.

How do you help AAA?

Currently, I assist on the public policy issues.  This includes working with the Congress to protect the add-ons, as well as develop payment reforms to create stability for Medicare rates.  I help to draft materials for the Hill and legislative language.  As part of this effort, I help with developing more comprehensive Medicare reform recommendations.  I also assist with the regulatory agenda and engage with Centers for Medicare and Medicaid Services (CMS) and other federal agencies.  In addition, I continue to work on quality structural and measurement issues.

What is your typical day like?

Unpredictable and fun!  My days vary greatly.  I can find myself on the Hill or driving to Baltimore to meet with CMS.  I also spend a lot of time talking with AAA members and the staff team.

What are the biggest challenges you foresee for our industry?Any tips or last thoughts?

[quote_right]

It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.

[/quote_left]All of healthcare is at a crossroads.  While federal policymakers have successfully reduced spending in the Medicare program, the focus for the foreseeable future will be how to reduce the cost of providing services.  It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.

For ambulance providers and suppliers in particular, there is great promise in the innovative payment models, because they would most likely recognize the high quality of health care services provided by ambulance providers and suppliers.  However, there is also the potential that ambulance services could become subordinate to larger provider organizations.  As this debate unfolds, it is critically important that data drive any reforms and that the industry look carefully at how programs such as value-based purchasing, the Medicare quality reporting programs (facility compare websites and the five star rating programs), and coordinated/integrated care models have worked for other Medicare providers.  At the end of the day, ambulance providers and suppliers need to understand their care and cost models and articulate use these data points to develop meaningful and sustainable reform options.

Health Affairs shows “frequent flier” needs taper over time

Last week, Health Affairs published a study on the so-called “super utilizers” of the healthcare system, those who are in and out of emergency rooms with such frequency that their need for readmission is nearly assured.

The researchers found that these folks have an intense need that tapers off over time. Of the 1,682 identified as such, just 28 percent fell into the category after 12 months. Baseline spending decreased from $113,522 per capita to $47,017 the following year when they were enrolled in a program to help them stay on top of their health. The study, performed by the medical center Denver Health, analyzed nearly 5,000 patients and found that 3 percent were accounting for 30 percent of adult charges between May 1, 2011 and April 30, 2013.

Read the full article in the Dallas/Fort Worth Healthcare Daily.

ambulance membership

Update: House & Senate Approve Veterans Health Care Choice Act

Yesterday, the House of Representatives voted overwhelmingly to approve H.R. 3236, the Surface Transportation and Veterans Health Care Choice Improvement Act. Update 2:16 p.m. on July 30: The Senate approved the legislation today, and it is now headed to the President’s desk for signature.

Among its provisions, the bill would allow the Department of Veterans Affairs (VA) to use $3.3 billion from the Veterans Choice Fund to pay for care provided to veterans by non-VA providers between May 1 and October 1, 2015 under the VA’s community care programs.

H.R. 3236 also would require the VA to develop a plan to consolidate all non-VA programs into a single “Veterans Choice Program” and to submit a report on the plan to Congress by November 1, 2015. Among its provisions, the plan must include the structuring of the billing and reimbursement process; a description of the reimbursement rate to be paid; and an explanation of the processes to be used to ensure that the Secretary will fully comply with the federal Prompt Payment Act.

Further, H.R. 3236 would make a number of changes to the current Veterans Choice Program, including: eliminating the requirement that a veteran be enrolled in the VA health care system by Aug. 1, 2014 in order to participate; allowing the VA to expand the number of non-VA providers that may offer medical services; waiving the program’s wait-time eligibility threshold if clinically necessary for the veteran; and allowing veterans residing within 40 driving miles of a VA medical facility to use non-VA services if the VA facility does not have a full-time physician on staff.

M. Todd Tuten is a Senior Policy Advisor at Akin Gump Strauss Hauer & Feld, LLP.

Acadian Ambulance High School Champions Livonia

Acadian’s High School Champions Program Leads the Way

Founded in 1971 in with just eight staff and two vehicles, Acadian Ambulance has grown over the years to more than 4000 employees with a fleet of 400 ground ambulances, helicopters, fixed-wing airplanes, and van and bus transports. Their territory has expanded from Lafayette Parish, Louisiana, to stations spanning large swaths of Louisiana, Texas, and Mississippi.

How does such a large and varied service feed their talent pipeline? In addition to many other strategies, Acadian is leading the industry in its efforts to engage young adults in EMS through its High School Champions program, a division of their National EMS Academy.

Porter Taylor, Acadian's Director of Operations
Porter Taylor, Acadian’s Director of Operations

To learn more about the ins-and-outs of the program, AAA caught up with Porter Taylor, Acadian’s Director of Operations. Taylor has been in EMS for 29 years, since he joined Acadian Ambulance as a college sophomore. “I love making a difference in people’s lives. When I was working on a unit it was the patient, and now, almost 30 years later, it is the employees that I love helping.”

Establishing High School Champions was not a linear path. Initially, Acadian would send medics to career fairs and school functions to introduce the field and promote its National EMS Academy (NEMSA) as an opportunity after graduation. “There are a lot of technical grants out there, and a critical staffing need for EMS in general. We wanted to create an avenue for educating students about the benefits of becoming EMTs to support our staffing needs long term,” said Taylor.

Although these medic visits were effective, Acadian wanted to expand the fledgling program’s scope and reach. He began visiting area high schools and meeting with school boards and directors more than a year ago to build relationships and explore opportunities. The partnerships he built added another facet to the High School Champion initiative wherein Acadian continues to promote NEMSA, coupled with an effort to get the schools to incorporate an EMT program as an elective prior to graduation. “[I wanted] to introduce them to our company and our support of this technical career path. My goal was to let the teachers and technical program directors know that Acadian has jobs for their students upon the successful completion of the program. Once students turn 18, Acadian will be able to offer them a rewarding  position with good pay and benefits and with continuing education opportunities.”

Acadian Operations Manager Justin Cox was instrumental in the implementation at Livonia High School, a recent addition to the program. In concert with his professional know-how, Cox had a personal connection to the school—his thirteen year old daughter attends Livonia.

Collaborating with the administration, Acadian now works with schools like Livonia to introduce EMS career paths at the end of high school, a time when students are making key choices about their futures. Students can start the EMT training program as an elective prior to graduation and take the national certification exam upon turning 18. Students spend 2-3 hours 3 days a week, during their junior and senior years preparing. “It is a joy to work on this program,” said Taylor, “It is a privilege to help young people make a career choice that is full of rewards.”

Does your service have a great program that is making a difference in your area? Let us know in the comments section below, or email ariordan@ambulance.org.

CMS Extends Ambulance Enrollment Moratoria

On July 25, 2015, CMS issued a notice extending the temporary moratorium for enrollment of new ambulance suppliers in the Texas counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller, as well as in Philadelphia and the surrounding counties of Bucks, Delaware, Montgomery (Pennsylvania), Burlington, Camden and Gloucester (New Jersey). This notice will appear in the Federal Register on July 28, 2015.

Spotlight: Reviving Responders Suicide Prevention

AAA caught up with Amy Young of CareFlite, group leader of an Ambulance Service Manager program team project on EMS suicide prevention. This project resulted in the creation of www.revivingresponders.com.

The Project Team

As part of the February 2015 Ambulance Service Manager (ASM) class, seven of us were randomly assigned to groups and asked to complete a project in ten weeks with team members spread across the United States. Our research we presented our data to the ASM class as part of the requirements for graduation.

All told, the seven members of our group have a combined total of 92 years of service in EMS. Many started as EMTs and worked up to Paramedic status, some began as volunteers, and the rest came to EMS as a second career. Nonetheless, we are all driven by ambitious personalities, our ability to make a difference, our desire to provide meaningful patient care, and the opportunity to work with other public service providers. The group consists of the following people:

Our group decided on a topic that was both personal and something we hoped could make a significant impact on the EMS culture. We chose to do a survey about the prevalence of critical stress amongst EMS and evaluate why suicide rates of EMS providers is on the rise.

The Shocking Survey Results

[quote_left]37% of providers across the nation who responded to our survey had contemplated suicide, and 6.6% of those respondents have actually attempted to take their own lives.[/quote_left]Our EMS specific-survey was open for 40 days, resulting in 4,022 responses from all 50 United States plus Guam, the District of Columbia, American Samoa, and Puerto Rico. When we closed the survey, we were hit with a hard reality: that EMS suicide numbers were skyrocketing and the programs available to help were not sufficient. Our data shows that 1,383 of the 4,022 (37%) providers across the nation who responded to our survey had contemplated suicide, and 6.6% of those respondents have actually attempted to take their own lives.

The survey data shows that respondents working in an EMS culture that does not support the mental wellness and does not encourage the use of formal support institutions like Employee Assistance Programs (EAPs) and Critical Incident Stress Management (CISM) are substantially more likely to contemplate and/or attempt suicide. Additionally, respondents that don’t come from an EMS culture of support and encouragement are much less likely to seek help when they need it, and are much less likely to engage in helpful support.

The also survey measured the effectiveness of formal support institutions like EAPs and CISM. The results startlingly showed that these support institutions were rated as being either “Very Helpful” or “Extremely Helpful” by the respondents that use them. After hearing so many stories about how inept an EAP counselor was or what a “waste of time” that CISM session turned out to be, we expected these numbers to be much, much lower.

In other words, we discovered a very significant prevalence of suicidal ideation in the EMS provider community. We discovered that EAPs and CISM have room for improvement, but do not fall as short of the mark as we originally perceived. It appears, however, that a very significant component to the prevalence and severity of stress in the EMS culture to include suicidal ideation and attempt is the EMS culture itself.

For us, these results brought a whole new meaning to the project. We named our team Reviving Responders, because we realized we need to revive ourselves if want to continue reviving others. A few group members had even experienced suicide by fellow associates in their organizations. [Team member] Monique Rose said, “I was exposed to this issue following a close call involving the resuscitation of the guys in my department. During this time our department struggled to process the tragedy, and I became aware of the flaws in the system while working through some of my own demons.”

CDC. (2012). www.cdc.gov. Retrieved from Centers for Disease Control and Prevention.

How You Can Help

First and foremost, recognition and acknowledgement. As leaders, we cannot afford to be timid about this. If we see one of our own in distress, we must step out of our comfort zone and have the difficult conversations. It will be hard. This is a very dominant and proud profession, and we may not have our staff lining up to say they are struggling. Leaders need tolearn to recognize the warning signs and say something before it’s too late. Really, it should be the responsibility of every single person in EMS to notice subtle changes in individual behavior or work ethics.

Second, employers must be supportive, and offer an environment that supports employee well-being and mental health.

Last, employers should help change the culture of EMS across the board by providing the appropriate resources and ensuring they are available all the time and for as long as the service is needed.

How the Ambulance Industry Can Help

[quote_right]There is no question that field providers are not inherently equipped to deal with the stressors of the profession.[/quote_right] The ambulance industry needs to own the fact that we do not have adequate culture of support for providers to deal with suicide. There is no question that field providers are not inherently equipped to deal with the stressors of the profession. Coping skills for these stressors need to be taught to providers, and providers need to realize that receiving assistance with those skills is acceptable. The irony of the matter here is that many cultures in the industry are in direct opposition to the idea of getting help to deal with the stressors in EMS. As industry leaders, we are responsible for the tone of our respective divisions, and as such have the ability to steer culture. Our data suggests that taking steps to move culture towards one of support for providers’ mental well-being will be far more effective than attempting to reform the current state of CISM and EAP.

With projects like Reviving Responders and ASM, the word is spreading quickly. If we shift the culture, we can reduce the stigma that surrounds this topic. Think about it this way—if we can’t take care of our providers, how do you expect them to take care of patients? As an industry, we must be serious and promote access to various types of resources as no single type will work for everyone.

Most importantly, we must expand our education curriculum to include acknowledgment, recognition, and coping mechanisms far beyond the current single chapter “well-being of the provider” in all our literature.

Final Thoughts

Please speak up so we can help. Reviving Responders is our group’s effort to continue working towards a solution. Right now we are partnering with multiple entities around the U.S. to compile a list of suitable resources tailored to EMS and public safety as a whole. We hope that by sharing our stories others will be encouraged to speak up.

One great resource is Safe Call Now, 206-459-3020, which provides a confidential 24-hour crisis referral service. Safe Call Now allows public safety employees to speak with mental health professionals that are familiar with our line of work , as well as  public safety professionals who understand and can relate. We have more resources available on our website, www.revivingresponders.com..

MedStar Helps Reunite Baby, Mom After Tragic Crash

(Details and video courtesy of Fox 4 News and Medstar.)

On June 25, Sergeant Colby Bozo and his wife Kristen were driving home when their vehicle was struck by a stolen car being pursued in a police chase. Sadly, Colby Bozo was killed on impact, and Kristen, then 37 weeks pregnant, was very seriously injured and required an emergency caesarian section.

AAA member MedStar Mobile Healthcare, in coordination with John Peter Smith Hospital, and Cook Children’s Hospital surprised Kristen by arranging for her to see her newborn baby for the first time. Staff took a detour to Cook Children’s Hospital during mom’s ambulance transfer from JPS in Fort Worth to Baylor Rehabilitation Center in Dallas.

George Church, a MedStar Operations Supervisor who helped coordinate the reunion, said at the time, “I’ve been in EMS a long time, and there are very few moments that get to me any more—this one got to me.”

Great job, MedStar, JPS, and Cooks Children’s!

Video from Fox4News.com

Supporters of Kristen and the baby are invited to donate at a Fund.ly page.