HHS OIG Issues Advisory Opinion Permitting Community Paramedicine Program Designed to Limit Hospital Readmissions On March 6, 2019, the HHS Office of the Inspector General (OIG) posted OIG Advisory Opinion 19-03. The opinion related to free, in-home follow-up care offered by a hospital to eligible patients for the purpose of reducing hospital admissions or readmissions. The Requestor was a nonprofit medical center that provides a range of inpatient and outpatient hospital services. The Requestor and an affiliated health care clinic are both part of an integrated health system that operates in three states. The Requestor had previously developed a program to provide free, in-home follow-up care to certain patients with congestive heart failure (CHF) that it has certified to be at higher risk of admission or readmission to a hospital. The Requestor was proposing to expand the program to also include certain patients with chronic obstructive pulmonary disease (COPD). According to the Requestor, the purpose of both its existing program and its proposed expansion was to increase patient compliance with discharge plans, improve patient health, and reduce hospital inpatient admissions and readmissions. Under the existing program, clinical nurses screen patients to determine if they meet certain eligibility criteria. These include...
During its October meeting, the Medicare Payment Advisory Commission (MedPAC), reviewed Medicare’s current policies related to non-urgent and emergency care, as these topics relate to the use of hospital emergency departments (EDs) and urgent care centers (UCCs). The Commission is examining this topic because the use of ED services in recent years has grown faster than that of physician offices. At the same time, the share of ED visits that are coded as high acuity has increased. The Commission is exploring Medicare beneficiaries’ use of EDs and UCCs for non-urgent services. In addition, the Commission is analyzing ED coding to determine if the increase in coding high-acuity visits reflects real change in the patients treated in EDs. This slide deck shows the potential savings Medicare could realize if beneficiaries shift certain care to the UCC setting. During the meeting, the staff sought feedback from Commissioners for developing next steps. This topic will likely continue to be addressed in future meetings. From the perspective of ambulance payment reform, the observations made by the Commissioners and staff would also seem to support incorporating scope-appropriate ambulance services in the context of community paramedicine or treatment at the scene with referral. While additional work...
EMS has always been the forefront of medicine, delivering care to the sick and injured in various roles dating as far back as the Civil War. It has come a long way from the days of horse and buggy. Yet, where are we going now? One look at the trajectory of Nursing indicates where we are headed. When Nursing first started, the profession was comprised of caring women who were viewed and treated as indentured servants, subservient to the male dominated physicians. Nursing evolved when the “servant” became educated. What followed were thousands of women beginning to diagnose, conduct research and improve outcomes in the healthcare field. Soon thereafter, they broke free of the care assistant model they were in. I see EMS following the same path. The ambulance industry started out as transporters, with a curriculum that was adopted and funded by the Department of Transportation (DOT). The industry has roots in DOT, Police Departments, Fire Departments and the military, but are truly physician extenders that should be firmly rooted in Health Departments. EMS is now developing a language, doing research, obtaining national accreditation for our schools, even supporting continuing education with CAPCE. But we need to do more. (more…)
As a current mobile integrated health provider, we recognize the values of an MIH program which most importantly provides quality patient care to those in need, often in the comfort of their own homes. This is often done under the direction of the patient’s primary care physician in conjunction with the patient’s healthcare team. This allows for the patient to maintain their quality of life while receiving the medical attention they need—and ultimately reducing the healthcare expenses of hospitalization.
Ron Quaranto—Cataldo Ambulance’s Ron Quaranto on Mobile Integrated Health
COO, Cataldo Ambulance Service
Join Patrick “Sean” Tyler, executive vice president and chief operating officer of Fallon Ambulance Service, on September 28 for Alternative Pathways to Care: The Massachusetts Experience. Alternative Pathways to Care: The Massachusetts Experience Speaker: P. Sean Tyler, Fallon Ambulance September 28 at 2:00 PM ET $99 for Members | $199 for non-Members REGISTER NOW► EMS systems around the US have historically been incentivized by Center for Medicare and Medicaid (CMS), private insurers and other payers to transport all patients encountered through accessing 911 emergency call systems, to an acute care facility emergency department (ED). The reimbursement model for ambulance services in place currently only provides payment for transport of any patient to a state licensed ED according to CMS. The changing healthcare system in the US, through the Affordable Care Act (ACA) 2010, looks to healthcare systems and contractors to provide healthcare at a lower cost. CMS is prescribed, as part of the ACA, to test innovative delivery models to reduce program expenditures…while preserving or enhancing quality of care furnished to individuals.” This session will review the concepts and programs of implementing a modified system of care whereas trained EMS providers, under the supervision of a physician Medical Director, can transport patients experiencing a (more…)
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.)
Barriers to Understanding In all healthcare settings, successful communication with patients and families depends on awareness of three key barriers to their understanding and compliance: Cultural Barriers: Understanding western medicine and the U.S. healthcare system is a challenge for many of us, but it is especially problematic for recent immigrants and refugees. 72% of U. S. population growth in the next 20 years will come from immigrants, or the children of immigrants. Limited English Proficiency: The number of people who spoke a language other than English at home grew by 38 percent in the 1980s and by 47 percent in the 1990s. While the population aged 5 and over grew by one-fourth from 1980 to 2000, the number who spoke a language other than English at home more than doubled. Low Health Literacy: While poor understanding of the health care system and difficulty understanding health care instructions may be associated with language and cultural barriers, low health literacy is also found in patients who are proficient in English and who share the common U.S. culture. This latter group may be especially at risk of having their low health literacy go unrecognized. 90 million “mainstream” Americans cannot understand basic health information. (more…)