How will Trump effect EMS?

ExpatMedic0

MS, NRP
2,237
269
83
Not trying to be political here. I am just looking at this from a neutral and EMS specific standpoint. How do you think Trump being elected will affect EMS? I read an interesting article on EMS1 regarding it (link below) and one thing that was mentioned was that APA will be scraped. The APA appears to be one way that community paramedic programs where be funded for example, and also lead to reimbursement changes for many agencies.

http://www.ems1.com/ems-management/...mpaign=EMS1Member&cub_id=usr_TPB3cm65TdffwRib
 

Akulahawk

EMT-P/ED RN
Community Leader
4,923
1,321
113
The "Affordable" Care Act will likely be repealed and replaced. That won't be an overnight process and getting things right should be the primary driver when they put everything back together. In the short term, I don't think Trump will have much of an effect upon EMS. In the long run? It all depends upon what the legislators want to do and if Trump will go for it.

I do, however, see this as an opportunity for actual stakeholders to do something the right way from the top instead of passing a new set of laws and make everyone find a way to make it work. This is an opportunity that could very easily be missed.
 

Arovetli

Forum Captain
439
19
18
Honestly, nobody...and I mean NOBODY, has a clue. ACA and MACRA might be in jeopardy, putting a HUGE damper on community paramedicine. And by huge damper, if MACRA and the ACA get gutted, Medicaid block grants get gutted, CP projects will get gutted.
 

Summit

Critical Crazy
2,691
1,312
113
Who knows... probably not a lot.

An extreme repeal of ACA could result in some increase volume when people lose coverage that gets primary care and switch to the ER/911. But doesn't seem that likely.
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
I am just looking at this from a neutral and EMS specific standpoint. How do you think Trump being elected will affect EMS?

Thanks for posting - I think this is a thoughtful question that we should all be asking.

ACA repeal/replace seems possible. Given that we have evidence suggesting that Medicaid coverage may even increase ER usage, I'd posit that insurance status and ER/911 EMS usage are related - but the correlation between coverage status and use is not necessarily in the direction we'd posit (i.e. we would expect that people with insurance seek care before a PCP manageable problem worsens to become an ED-needed problem, but in actuality, they may use the ER more from the outset).

Regulatory rules being rolled back is possible, but the bureaucracy is slow (and so is Congress). So we may see some longer-term effects, it would be hard to imagine any effects in, say, the first 100 days (though I could very well be wrong).

About the rest - labor force size, taxes, etc., I'd need to do a nice thinking session to really puzzle through it.
 

Arovetli

Forum Captain
439
19
18
Epi- wasnt there some data showing Medicaid was working at managing long term care better than other options? It's been a year or so since I last checked so idk.


Sent from my iPhone using Tapatalk
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
Epi- wasnt there some data showing Medicaid was working at managing long term care better than other options? It's been a year or so since I last checked so idk.


Sent from my iPhone using Tapatalk

Could certainly be. I've seen data saying that Medicaid is more efficient - but that isn't necessarily a complete accounting, if you will, because Medicaid is a more than a bit more liberal with payments (albeit lower ones) than private insurers are. I found some interesting research on dual-eligibles, but I didn't find anything on Medicaid managing LTC better than others.

KFF has a nice briefer on Medicaid-funded LTC.
 

Arovetli

Forum Captain
439
19
18
Not trying to be political here. I am just looking at this from a neutral and EMS specific standpoint. How do you think Trump being elected will affect EMS? I read an interesting article on EMS1 regarding it (link below) and one thing that was mentioned was that APA will be scraped. The APA appears to be one way that community paramedic programs where be funded for example, and also lead to reimbursement changes for many agencies.

http://www.ems1.com/ems-management/...mpaign=EMS1Member&cub_id=usr_TPB3cm65TdffwRib

Just released:

https://assets.donaldjtrump.com/_landings/contract/O-TRU-102316-Contractv02.pdf

Fully Repeal Obamacare. *sings* it's the end of community paramedicine as we know it...yes it's the end of community paramedicine as we know...
 

EpiEMS

Forum Deputy Chief
3,815
1,143
113
Fully Repeal Obamacare. *sings* it's the end of community paramedicine as we know it...yes it's the end of community paramedicine as we know...

Probably (politically) harder to do than we may think, on the face of it. ACA contains things that many people approve of or benefit from (regardless of whether the ACA is good/bad).

Community paramedicine could survive, in isolated spots, I'd wager, and some agencies (AHRQ?) may have funding for it.
 

Arovetli

Forum Captain
439
19
18
For sure, and I'll wager the stuff already in effect stays, but the future stuff for pop health bill payments gets canned...there's still spots where CP makes sense but not on a broad scale....


Sent from my iPhone using Tapatalk
 

Arovetli

Forum Captain
439
19
18
There's still some big grants for rural health that could fund projects...what program am I thinking of? The FQHC thing....


Sent from my iPhone using Tapatalk
 
OP
OP
ExpatMedic0

ExpatMedic0

MS, NRP
2,237
269
83
It's expensive transporting people to the hospital all the time. I think the CP programs have demonstrated significant healthcare savings in many systems. I would think that maybe some private insurance company's would support it.
 

NysEms2117

ex-Parole officer/EMT
1,946
909
113
I have not paid much attention to his policies, however lets all remember we can take a step back. its not a dictatorship, Congress still has a ton of power, and personally i do not think will "allow radical change". Interpret this as you may.
**THIS IS MY OPINION PLEASE DO NOT TAKE THIS AS A PERSONAL ATTACK ON ANYBODY.**
 
OP
OP
ExpatMedic0

ExpatMedic0

MS, NRP
2,237
269
83
I believe the house and senate are all republican majority now. I am not sure how wide the divide is within the party on healthcare issues... but I guess we will see.
 

NysEms2117

ex-Parole officer/EMT
1,946
909
113
I believe the house and senate are all republican majority now. I am not sure how wide the divide is within the party on healthcare issues... but I guess we will see.
Your correct, it is a republican majority, but they still won't want to just start deleting things. They are still sensible(ish), anything with politics is a blind dart throw... To be honest, its who gets into who's pockets. Trying not to get off topic here either, however while this is a valid topic, personally i do not think anything "radical" will happen, then again i have not read descriptive articles on what he plans to do.
 

Qulevrius

Nationally Certified Wannabe
997
545
93
Your correct, it is a republican majority, but they still won't want to just start deleting things. They are still sensible(ish), anything with politics is a blind dart throw... To be honest, its who gets into who's pockets. Trying not to get off topic here either, however while this is a valid topic, personally i do not think anything "radical" will happen, then again i have not read descriptive articles on what he plans to do.

Staying on the topic of CP, it simply comes down to who's gonna pay for it. Ultimately, it has little to do with ACA and a lot to do with specific budget allocated to certain population groups. Without going into too much detail, ACA was nice on paper and oh-so-much uglier in person, because it started pushing for a socialist model of healthcare in a non-socialist country.

People who ever dealt with socialism of any kind (i.e. not the armchair experts who read the theory, but those who actually experienced it) know exactly how that works - over 30% income tax, mind-boggling bureaucracy, and particularly in medicine - immediate non-threatening care, but very few accessible specialists. The biggest issue with ACA is that it is extremely prone to abuse, especially with the # of people who are either exempt of taxation due to income, receiving government subsidies or otherwise exploiting the system. Right now, it is us who's paying for their 'free' medical care and their 'free' community paramedicine. And we also have to haul them to the ER. The irony, it's very real.
 

Tigger

Dodges Pucks
Community Leader
7,844
2,794
113
The implementation of the ACA led to an expansion in Medicaid (and Medicare to an extent) payor groups. This year our service's payor mix was 72% Medicaid/Medicare. Our self pay is down to less than 5%. Which is great, except that Medicaid and Medicare reimburse so far below cost. So low in fact, that we actually made more money off our self pay patients by developing payment plans with them and/or sending them to collections. An increase in insurance coverage did not lead to an increase revenue for us, though that is not really an ACA issue. Medicare/caid rates were always below market value, it just hit us harder.

As for our community paramedic program, it would not exist without the ACA. We subcontract with the regional Medicaid contractor, and they would likely not have the budget to pay us without the ACA. Though the mental health mandate that brought about our involvement is state based, the Medicaid contractor was the only entity large enough to take that on.

It's expensive transporting people to the hospital all the time. I think the CP programs have demonstrated significant healthcare savings in many systems. I would think that maybe some private insurance company's would support it.
Readmission avoidance programs are a result (in my opinion) of the ACA. These have the potential to be the source of funding for many community paramedic programs. When the fines finally become too expensive for the healthcare networks and they need the manpower for relatively simple readmission avoidance programs, CP programs can be the answer. We have struggled with getting their buy in so far as there really isn't that much evidence of non-hospital affiliated services reducing readmission. But in my district, there is minimal to no home healthcare. We are the only healthcare provider in the area, who else will they turn to?

Staying on the topic of CP, it simply comes down to who's gonna pay for it. Ultimately, it has little to do with ACA and a lot to do with specific budget allocated to certain population groups. Without going into too much detail, ACA was nice on paper and oh-so-much uglier in person, because it started pushing for a socialist model of healthcare in a non-socialist country.

People who ever dealt with socialism of any kind (i.e. not the armchair experts who read the theory, but those who actually experienced it) know exactly how that works - over 30% income tax, mind-boggling bureaucracy, and particularly in medicine - immediate non-threatening care, but very few accessible specialists. The biggest issue with ACA is that it is extremely prone to abuse, especially with the # of people who are either exempt of taxation due to income, receiving government subsidies or otherwise exploiting the system. Right now, it is us who's paying for their 'free' medical care and their 'free' community paramedicine. And we also have to haul them to the ER. The irony, it's very real.

We've been paying the low income population's healthcare costs for decades. When people don't pay their bills, the costs get passed along. One way or another that's going to continue, I'd prefer if my money was used efficiently.
 

Qulevrius

Nationally Certified Wannabe
997
545
93
We've been paying the low income population's healthcare costs for decades. When people don't pay their bills, the costs get passed along. One way or another that's going to continue, I'd prefer if my money was used efficiently.

My sentiment as well. But I'd rather not have to pay too much for those who don't feel like paying for themselves.
 

Carlos Danger

Forum Deputy Chief
Premium Member
4,510
3,234
113
We've been paying the low income population's healthcare costs for decades. When people don't pay their bills, the costs get passed along. One way or another that's going to continue, I'd prefer if my money was used efficiently.

As a pretty staunch libertarian and fiscal grinch, this is a tough pill for me to swallow. But it is true. Many people simply will not do what they need to do to take care of themselves, and unless we are prepared to start taking ICU patients who can't pay their bill outside to be dumped in the street, or refuse to let people who obviously really need care from entering the ED without cash payment in advance, then there has to be government programs to pay for their care.

I don't know what the answer is. It certainly isn't the ACA. The ACA wasn't even truly a healthcare bill, it was a horribly irresponsible, hyper-partisan power grab that I'm not convinced was even intended to work as advertised. The biggest problem we have is that our healthcare system has gotten to monstrously complicated, and all of the new programs just add to the mishmash of programs and increase the complexity.

I don't know what Trump's healthcare plan is, or how it will affect EMS. Repealing the ACA would be a good start, but it has to be more than that. I think there have got to be lots of free-market(ish) ideas that if nothing else, would at least slow the rise of costs for a while.
 
Last edited:
Top