IAFC Webinar Focuses on Staying Ahead of the ACA Curve

In a time of constant change, looking ahead is essential for keeping up to date.

The International Association of Fire Chief’s Feb. 17 webinar PPACA 2016: The Train Coming Down the Tracks focused on the changes the Affordable Care Act will bring to EMS in 2016.

Michael Metro, a retired chief deputy at the Los Angeles County Fire Department and Ed Racht, the chief medical officer at American Medical Response, spoke on how the ACA continues to affect EMS.

One of the main themes of the webinar was how the ACA will change revenue sources in EMS. Metro says one of the biggest changes in this regard is a switch to value based purchasing and fee-for-service payments.

The Director of Health and Human Services says the goal is to have 85% of all entities that use Medicare have fee-for-service payments tied to quality or value by 2016, and 90% by 2018.

Metro says the NHTSA is developing key performance indicators for EMS to help adapt when this change comes. One of the biggest indicators is efficient use of health care resources.

This is a big area where EMS can improve, Metro says. For example, some statistics show 50% of patients do not necessarily need an ambulance or to be transported to the emergency room when they call for paramedics. Sending minor patients to the emergency room via ambulance is not great for this efficient use of health care resources grade, Metro says.

There have been steps in the direction to correct this already, Metro says. Mobile integrated healthcare and community paramedicine programs are becoming more popular across the country. A recent report from NASEMSO says 19 states have between one and 25 agencies operating some sort of MIH or CP services. NAEMT has also highlighted 135 programs that are fully developed nationwide.

Racht says the metrics to measure EMS effectiveness are largely already in place.

“One thing that’s a big part of the ACA is transparency,” Racht says. “Part of that is having accountability measures.”

Currently, the measures mostly tackle hospitals or physicians, but Racht says they easily could expand in the future to include EMS agencies.

One of the main factors driving the change to MIH and CP programs was fines for unplanned readmission within 30 days of discharge from a hospital, which was implemented under the ACA, Racht says.

Racht notes that fines have escalated over the past four years, and a new metric that gauged readmissions for all parts of the hospital, not just certain programs, caused leaders to look for a way to change care.

Another key point of the webinar was how the ACA affects funding in EMS.

Metro rallied against a common misconception: Because the ACA forced more people to be insured, revenue would increase for EMS agencies. He says this isn’t necessarily the case.

Metro says the cost of transport is more than what Medicare pays, and much more than what Medicaid pays. However, commercial insurance usually covers most of the cost.

Since the ACA was implemented, there has been a 5% increase in the number of people covered by Medicaid, and a 2.5% decrease in the number of people covered by commercial insurance. This has resulted in less revenue for EMS agencies, Metro says.

The other main points presented in the webinar were the ACA’s effect on the EMS mission, the ACA’s impact on benefits and labor contracts and understanding aggressive changes in the healthcare climate.

Moving forward, Metro says some of the key points for EMS to adapt to changes brought by the ACA are to develop patient care databases so you can effectively assess the care you deliver, and make sure that database is compliant with federal standards.

Metro also says to develop the correct mindset.

“Does your care make a difference? Does it change patient outcomes?” Metro asks.

To watch the full webinar, click here. Visit the IAFC website for more information on the group.