The healthcare system in our country is undergoing tremendous change. Driven by unsustainable costs, policy makers are reengineering healthcare in significant ways.
Since EMS is part of the healthcare delivery system and the fire service is the biggest provider of prehospital emergency-medical care, these changes are going to affect us. The implementation of the Patient Protection and Affordable Care Act has and will continue to drive major changes in how, when and where we our healthcare needs are met.
Much has been written already about the potential impact of the ACA on the fire service and EMS. Some experts advocate for a sweeping change in out-of-hospital care, and fire service EMS systems must adapt or die.
Some see a mandate for us to move into new types of out-of-hospital healthcare delivery. Some see the changes as a threat to our very existence and look to the future with a great deal of fear.
I don’t look at the changes before us as a threat or something to be afraid of. I also don’t think there's a mandate for us to do anything. The two words that come to mind as I think about the changes to the healthcare delivery system before us are opportunity and choice.
The healthcare delivery system in our country is going to change. Our previous system and the costs that go with it were unsustainable and something had to be done, regardless of the politics. However, what it means to local fire departments is something that's highly variable depending on the specifics of your local circumstances.
What role do you currently play in the healthcare delivery system? What's your relationship with hospitals, physicians, nurses and other key healthcare providers? Are there alternative sites for healthcare delivery? What excess capacity, if any, do you have in your fire department delivery system?
What are the community politics? Would it be good news or bad that the fire department might offer other healthcare services? Would folks in your community be as willing to invite you into their homes to help them with routine stuff in the same way they do now in emergency situations?
What are the economics of your system? What is you payer mix?
The answers to these questions will be different in every community. In some cases, very different. That means the answer to the "so what?" question is also going to be different.
In some cases, the stars will align and it will be a brilliant idea for the fire department to get involved in delivering other forms of out-of-hospital healthcare and transportation services. In other cases—I believe the vast majority of cases—it will result in no changes at all. We'll continue to respond to 9-1-1 calls for assistance and transport patients to the emergency room.
The important point for fire service leaders right now is that we're at a decision point about one of our most significant services. It's your responsibility as a fire service leader to educate yourself about the issues, apply them to your community and your situation, and either make a choice or help your bosses choose wisely about the your department's role going forward. You can’t afford to ignore this.
The IAFC EMS Section has provided educational materials available on its website, and these issues will feature prominently at Fire-Rescue Med—the largest fire service EMS conference in the nation—in Washington, D.C., in early May. I encourage you to take advantage of these educational opportunities.
The IAFF has also produced great materials on this subject. You really don’t have an excuse for not understanding it.
The critical point here is that this is a time that calls for fire service leadership—from you! What are you going to do with the opportunity?
Chief William R. Metcalf, EFO, CFO
President and Chairman of the Board