American Health Care Act and EMS

Sandog

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For those of you that have yet to peruse the over 2000 pages of legal globbidy gook also known as the American Health Care Act, or more popularly known as Obamacare.

How do you see Obamacare impacting EMS here in the good ol US of A? My casual stroll through this ungodly monstrosity of a document leads me to believe that many things will change for EMS, and I expect the mighty dollar will influence most changes coming down the pre-hospital pipeline.

A copy over from another thread:

Emergency/Trauma Regionalization – Law directs the Secretary of HHS, acting through the Assistant Secretary for Preparedness and Response (ASPR), to award at least four multi-year contracts or competitive grants to support pilot projects that design, implement and evaluate innovative models of regionalized, comprehensive and accountable emergency care and trauma systems.

Trauma Centers – Law requires the Secretary of HHS to establish three programs to award grants to qualified public and Indian trauma centers that would assist in defraying substantial uncompensated care costs; further the core missions of trauma centers (including addressing costs associated with patient stabilization/transfer, trauma education/outreach, coordination with local/regional trauma systems, essential personnel and other fixed costs, and expenses associated with employee/non-employee physician services); and provide emergency financial relief to ensure the continued/future availability of trauma services.

Emergency Medicine Research – Law requires Secretary of HHS to support federal programs administered by NIH, AHRQ, HRSA, CDC and other agencies involved in improving the emergency care system to expand and accelerate research in emergency medical care systems and emergency medicine, including: (1) the basic science of emergency medicine; (2) the model of service delivery and the components of such models that contribute to enhanced patient health outcomes; (3) the translation of basic scientific research into improved practice; and (4) the development of timely and efficient delivery of health services. In addition, the Secretary of HHS is required to support research to determine the estimated economic impact of, and savings that result from, the implementation of coordinated emergency care services.

If you care to torture yourself, you may view the full Obamacare text at the following link:
http://www.hhs.gov/healthcare/rights/law/

I also found this section interesting as it will impact EMS as it pertains to transport:

‘‘
(A) submits data to the National EMS Information System, the National Trauma Data
Bank, and others;
‘‘(B) reports data to appropriate Federal
and State databanks and registries; and
‘‘(C) contains information sufficient to
evaluate key elements of prehospital care, hospital destination decisions, including initial hospital and interfacility decisions, and relevant
health outcomes of hospital care

This new law will have a dramatic shift in the EMS model as I see it, what say you?
 
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Sandog

Sandog

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Just to get the ball rolling, I think from what is in the last paragraph I quoted, that where you transport a patient to will be assessed as to cost and efficiency. In rural areas this may not be a big deal, but in larger cities this will be an issue. Change is coming.

Also, with grant money being issued for pre-hospital care, this may bring about changes to improve our EMS system, so it may bring about positive changes as well. Looking at it from the cup half full sorta thing. :cool:
 

Carlos Danger

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I also found this section interesting as it will impact EMS as it pertains to transport:
(A) submits data to the National EMS Information System, the National Trauma Data Bank, and others;
(B) reports data to appropriate Federaland State databanks and registries; and
(C) contains information sufficient to evaluate key elements of prehospital care, hospital destination decisions, including initial hospital and interfacility decisions, and relevant health outcomes of hospital care

This new law will have a dramatic shift in the EMS model as I see it, what say you?

I am trying to be optimistic, but really I don't see much reason to think this will be a good thing for EMS, in terms of positively affecting educational opportunities or salaries.

From what I've read / heard in the media, a large percentage of the regulations are still being written. Regulatory agencies (HHS) will likely have a lot of leeway under the law to write rules that suit their vision, so I suppose it could end up being positive, but it could also end up going the other way.

The rest of healthcare has been dealing with the "pay for performance" stuff for a while now, and generally finds it to be a pain in the arse. What it really means is "justify what you do, and if you can't show that something improves outcomes, you won't be paid for it". Being that it is difficult to link EMS interventions to eventual outcomes, I'm just not sure how this is going to wash out.

What if it comes down to EMS only being able to bill for evidence / outcome based interventions? What then happens to ALS in general?

I think the one thing that is certain is that healthcare dollars will become much tighter over the coming years. That's not good for anyone trying to make money in healthcare.
 
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Sandog

Sandog

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The rest of healthcare has been dealing with the "pay for performance" stuff for a while now, and generally finds it to be a pain in the arse. What it really means is "justify what you do, and if you can't show that something improves outcomes, you won't be paid for it". Being that it is difficult to link EMS interventions to eventual outcomes, I'm just not sure how this is going to wash out.

The purse strings will be tightened to be sure, but on the positive note, grant money is being issued for research into pre-hospital care and this may set forth a end of outdated procedures and create new more useful procedures. This money may also find the lacking in the current EMS teaching curriculum as it applies to the basic and create a new standard.

One thing for sure is, we will see changes that will influence the way EMS is today.

Just talkin out my arse but I do predict changes, some good, some bad.
 

ffemt8978

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I am trying to be optimistic, but really I don't see much reason to think this will be a good thing for EMS, in terms of positively affecting educational opportunities or salaries.

I challenge anyone to name one government program of this scale that actually succeeded and did what it was supposed to do without any negative side effects.
 
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Sandog

Sandog

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I challenge anyone to name one government program of this scale that actually succeeded and did what it was supposed to do without any negative side effects.

How about FDR's New Deal?

I don't think any program can be implemented that will not have deleterious side effects on some.
 

ffemt8978

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How about FDR's New Deal?

I don't think any program can be implemented that will not have deleterious side effects on some.

The New Deal has some issues that are still being felt today...but that is another topic for another forum.

We all know there are going to be side effects of any government program...my concern is the ones that aren't readily apparent since they won't show up for some time and are usually worse than the initial faults of the program.
 

mgr22

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So far, this is the most rational discussion of the Affordable Care Act I've seen.
 

ExpatMedic0

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Check out this very brief story from JEMS titled "How the Affordable care act will change EMS"
http://www.jems.com/article/administration-and-leadership/how-affordable-care-act-will-change-ems

Also this article from last month titled "Report From the First EMS World Mobile Integrated Healthcare Summit"
http://www.emsworld.com/article/11186907/mobile-integrated-healthcare-summit-report

The articles speak briefly about ACO's, what changes we may expect which will effect EMS's call volume, reimbursement methods, and most importantly new opportunities for EMS such as Mobile Inter-graded Health care.

So far, this is the most rational discussion of the Affordable Care Act I've seen.
Yeah I agree, I think as long as everyone's keeps there personal political opinions to themselves, and we discuss how this may effect us as an industry from a professional standpoint, we should be good.
 
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Wheel

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So far, this is the most rational discussion of the Affordable Care Act I've seen.

Well we're only on the second page.

Honestly though, the ACA will have a lot of effects that no one knows about yet, just because of how large the document is. There will be loopholes and changes and people gaming the system. Hopefully it will make an avenue for motivated folks in ems to make some strides towards improvement.
 

unleashedfury

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Just to get the ball rolling, I think from what is in the last paragraph I quoted, that where you transport a patient to will be assessed as to cost and efficiency. In rural areas this may not be a big deal, but in larger cities this will be an issue. Change is coming.

Also, with grant money being issued for pre-hospital care, this may bring about changes to improve our EMS system, so it may bring about positive changes as well. Looking at it from the cup half full sorta thing. :cool:

We already experience this, as a patient with minor injuries or complaints can go to the local, community hospital.

Where as patients who need a specific unit. Cath Lab, Stroke Center, or a Level 1 trauma, can go further to the appropriate facility.

If we transport beyond our local facilities we need a real good reason,


I can see how getting more funding for Pre Hospital studies can improve EMS as a whole but until the effects take place most of us may already be nearing the end of our careers.
 

Christopher

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For those of you that have yet to peruse the over 2000 pages of legal globbidy gook also known as the American Health Care Act, or more popularly known as Obamacare.

What is this "American Health Care Act" you speak of? Getting the "legal globbidy gook" correct starts with getting its name correct.

Did you mean the Patient Protection and Affordable Care Act (PPACA)? (amended in 2010 by the Health Care and Education Reconciliation Act)
 

Christopher

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What do you guys think of its effect on volunteer fire and EMS personal? Check out this and let me know

"Its unintended effect on volunteer firefighters"

Read more: http://medcitynews.com/2013/12/obam...-effect-volunteer-firefighters/#ixzz2miZMdvPH

As a board member for a volly department I think it is nothing but FUD. Fear, Uncertainty, and Doubt. If that rep even gave half a crap about the fire service or volunteers, he would present rational legislation to solve this problem. Alas, I doubt he'll do much besides, "fight for the little guy," and stir up an already animated base.

Keep in mind this is a problem which has existed for years prior to this, just most volunteer departments have run roughshod of labor standards. This is not because they're maliciously doing it, rather through sheer ignorance of the law.

If a department is just now realizing this because of the health law, well...I welcome them to the real world. FLSA and the IRS have a far different interpretation of what constitutes an employee than they do.

As for your question of will volunteer organizations be "forced" to qualify their volunteers as "employees" for the purpose of health care insurance...I'm going to repeat what one of the gentlemen said in the article: "I'm not terribly concerned about it."
 
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Sandog

Sandog

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What is this "American Health Care Act" you speak of? Getting the "legal globbidy gook" correct starts with getting its name correct.

Did you mean the Patient Protection and Affordable Care Act (PPACA)? (amended in 2010 by the Health Care and Education Reconciliation Act)

And yet you seem to know what I was referring too, thanks for the correction professor.:rolleyes:
 
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