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 needs to be done by the ambulance community before these services can be incorporated into the Medicare reimbursement program, discussions like the one at MedPAC last week, show the importance of getting the details right so that ambulance services can be part of new payment models likely to be considered.
The American Ambulance Association is leading the effort with the Medicare program to develop appropriate models that account for the cost of providing services through sustainable reimbursement rates, rather than the use of temporary grants. We are also focused on ensuring services align with the scope of practice laws. Led by the Payment Reform and the Medicare Regulatory Committees, our efforts include regular meetings and discussions with leaders at the Centers for Medicare & Medicaid Services, as well as key Members of Congress. Follow us on Facebook and Twitter to learn more about our ongoing efforts.
I was born in Muskogee, OK and currently live in Tulsa, OK. I received my nursing degree from Connors State College and my bachelor’s degree in English from Northeastern State University. I began working at Muskogee County EMS as a paramedic 24 years ago, have moved through the ranks over the years, and have held my current title of Compliance Officer for about 12 years. When I’m not doing EMS, I am the Director of Nurses at Kids’ Space, a child advocacy center in Muskogee.
I’m married to Steve Williamson, CEO/President of EMSA, and between us we have 7 children and 6 grandchildren.
It’s always a challenge. Nothing is ever the same. I enjoyed being a paramedic because it was always different and no two patients were alike. Even though I’m now in administration and I’m dealing with Medicare, Medicaid, and insurance and regulatory issues and legislation, it is still never the same between days. I never feel like I have everything figured out, so there’s always a challenge in my job.
The EMS industry as a whole has so many challenges, but my biggest professional challenge would be making sense of some of the laws, regulations and rules that govern how we operate and how we get paid. Also, dealing with the bureaucracy and taking a simple concept, such as “we provide medical care,” and trying to get people in Congress and the legislature to understand that we’re not a supplier, but a provider. Translating all of that into simple, real-world language that everyone can understand so we can all be on the same page – that is a challenge.
I don’t really have a typical day! I’m very fortunate that, because I travel so much and because I have to be in different places, my schedule is very flexible and I’m able to work from home a lot. But typically when I go into the office, I can tell in the first five minutes if it’s going to be one of those days that I’m not going to sit down at all, or one of those days where I’ll have blocks of time to sit down and be productive. I try to talk to the medics every morning, and I talk to our Director and do a brief overview every morning and deal with any problems that may have occurred. My day is a constant interaction with the other administrators, the staff, and the medics, and can be a lot of running around.
I feel as though we as an organization (Muskogee County EMS) are light years ahead of so many other ambulance services because we get the information and the education that we need so easily. We can stay on the forefront of what is happening legislatively with Medicare and Medicaid regulatory issues, and we are in such a better position as a company and as a business because we have access to frontline information and top-of-the-line education. With AAA, industry experts are just a phone call or an email away. I cannot imagine trying to do my job and be effective at all without the education, the experts, and the ability to contact people who can help at a moment’s notice. I cannot imagine doing my job without having access to the AAA.
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