Emergency Medical Services: Consequences

We all know that with opportunities and challenges there are always consequences—sometimes good, sometimes bad. This certainly applies in EMS, and occasionally the decisions we make result in life-or-death consequences. We must continually assess our organizations, programs and processes to ensure we mitigate any negative consequences to the best of our ability while striving to provide outstanding patient care.

Many fire and EMS agencies across the country are readily embracing community paramedicine, mobile integrated healthcare, advanced practice paramedic and programs like FDCARES. While I see great benefits from all of these programs, I also wonder if we've considered all of the potential consequences of each one.

First and foremost is cost recovery. Yes, the Center for Medicare and Medicaid Services has provided a considerable amount of grant money for these types of programs, but still hasn't said it plans to change the current reimbursement model. We believe the Center will eventually, but agencies need to ensure they can cover these costs until a funding source becomes available.

Accountable care organizations (ACOs) also have a stake. ACOs could spend a small amount of money to save a lot when it relates to emergency care. However, they too must determine the best way to cover their costs, and they may not be willing to pay what fire and EMS agencies currently charge.

A more looming issue for me is in system capacity. We know that our EDs and hospitals are overcrowded, and the programs above may provide a means to offload these patients into other care pathways, thereby reducing overall costs. While we're seeing an increase in the number of freestanding EDs, we also know we'll see a decrease in the number of primary care physicians in the coming years.

Since we don't want to transport patients unless necessary, who then are we going to refer these patients to if no physicians are available? We also want to be able to divert patients with mental-health issues into the mental-health system, but again, we know that these systems are underfunded and understaffed. In addition, depending on where you live, the distance between you and a major hospital or metropolitan area may exacerbate these problems.

We've been quick to jump into these programs, and there are plenty of opportunities nationwide to learn about and understand their benefits and complexities. As we move forward, we need to thoroughly examine the other pieces of the healthcare puzzle to ensure that what we build is sustainable.

I would hate to see a significant amount of money invested into these programs only to find out in the near future that our ability to provide these services is hampered by the lack of providers or system capacity. We could quickly end up back in a position of having to transport every patient to the ED, thereby negating all of the time, money, and effort spent trying to solve this current day problem.

That would indeed be a very negative consequence.

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