The AAA’s New President Has a Lot of Big Plans

If you think you have a lot on your plate in 2017, think again—unless your name is Mark Postma, incoming president of the American Ambulance Association.

While honored to be the new man at the AAA’s top, Postma will have to balance his national commitment against his “day jobs” as chief operating officer of Sunstar EMS in Pinellas County, Fla., and vice president of Paramedics Plus, which operates in South Dakota, Indiana and California.

The secret of this balancing and juggling act is quite simply to “hire good people”—a major lesson to all from this established leader.

ACA Uncertainty

Postma’s presidency coincides with the installation of another national leader, President-Elect Donald Trump. The accompanying potential for very real adjustment in the political direction EMS has seen in the last eight years is not lost on him.

“All indications are telling us that there is going to be a repeal of the ACA. However, it sounds like it’s going to start off slowly, then continue to move through as [we develop] an understanding of what the ACA or new product will look like. We expect this understanding will develop later on this year or perhaps a year from now, and we anticipate a repeal of the ACA and more refinement down the road,” Postma said in a recent interview.

In addition to new challenges on Capitol Hill, Postma and the AAA will continue to lobby in support of sustainable revenue for EMS providers. Issues such as the 2%, 3% and 22.6% “add-on” payments for urban, rural and super-rural areas remain a key issue. Many elected advocates who have supported past AAA lobbying initiatives remain in post, as Postma notes: “The good news is that a lot of our champions—our senators, our members of Congress—have actually been promoted with this change that’s going on in Washington,” he says. “We look at it as a good thing, as those still working in the capital understand our agenda and what we’re trying to do.”

Reimbursement for all services rendered is foremost in Postma’s mind as he focuses on moving the EMS world from supplier to provider status. Traditional EMS delivery is classified by CMS as a transportation service, and Part B payment is only achieved via transportation to hospital. To advance and progress, reimbursement needs to be available for mobile integrated healthcare (MIH)-based services that conduct “arrival avoidance” and get the patient into an appropriate care pathway that may not involve secondary care.

As both evidence and motivation to support positive change, we need information, data and market intelligence—hard fact on the finances required to deliver efficient and effective ambulance services across America. Postma is a key proponent of cost data collection to develop a big-picture approach to take to the Hill. With a new administration of big business leaders in key posts, it is critical for ambulance services to be armed with spreadsheets of data that substantiate important advocacy points.

“Several studies done by different agencies and the government show our current costs exceed Medicare and Medicaid reimbursement,” he says. “However, we have to get a cost data collection system for all providers to continue to be able to go to Washington and discuss further payment reform based on data.”

While Postma admits it may be painful for some organizations, it is necessary that we understand what the costs are within the industry and use them to good effect.

Safety and More

It is clear that Postma is seeking to keep the wheels of the AAA turning at a high rate of productivity. Future mobility and safety remain high on his agenda. Having just handed over the chair of the Commission on Accreditation of Ambulance Services (CAAS), he brings with him an enthusiasm to adopt the CAAS Ground Vehicle Standard (GVS). This standard identifies the minimum requirements for new automotive EMS ground ambulances built on the original equipment manufacturer’s chassis that are prepared by the OEM for use as an ambulance. Vehicle and occupant safety is a high priority in the development of both organizational and industrywide cultures of safety. With a competing standard in NFPA 1917, state offices of EMS must now choose a construction and use standard that will tell organizations what to budget for in the future and manufacturers what to construct.

With his presidency Postma will also put together three new task forces: one to examine BLS nonemergency patient transport; one to shape how the AAA communicates; and one to assist small providers. As with any organization, communication is a major strategy area, and Postma has identified that the AAA can make some improvements. “We are probably a little behind the game on how we communicate with our members,” he says. “We are going to work on leveraging more of the new ways people communicate to get their feedback on our industry.”

Developing a task force to focus on small providers is also no bad thing; 75% of EMS agencies in America deliver fewer than 1,000 billable Medicare runs annually. Postma hopes not only to assist them with their billing hurdles, but also HR and back office needs. The AAA has developed programs to provide this much-needed assistance.

Collaboration

As Postma takes the first small steps in his two-year journey at the head of AAA, he is looking to take other organizations along in partnership. In the first year of a new federal government with perhaps a different viewpoint than what we have seen in the last eight years, collaboration is vital. Now is not a time for silos among our alphabet soup of national EMS groups

“We are going to work on building better alliances with other EMS associations like NAEMT, NASEMSO, NAEMSP, CAAS and NEMSMA, to name a few,” Postma says. “We want a closer alliance with these organizations so we can work together on the issues that face our industry.”

In addition to analyzing the AAA’s strengths, weaknesses and opportunities, Postma is also very aware of the threats facing both the organization and the industry as a whole. He contends the biggest is reimbursement. As an industry we must finance the cost of readiness; the ability to pay staff; the requirement to have up-to-date equipment, practices and procedures; and the ability to keep our doors open for business. If reimbursement shows diminishing returns, one of the tenets of the Triple Aim—the ability to deliver safe, effective, patient-centered, timely and equitable care—may suffer. The main threat must therefore be treated seriously and countered robustly.

For the next two years, there will never be nothing to do for Mark Postma. He has a massive agenda and much business to do. This will require him to pursue current legislation to a successful conclusion, lead the development of AAA, foster the creation and maintenance of strategic partnerships and alliances for the betterment of the industry as a whole, and drive industry change, all while navigating Trump’s new world order.
Without a doubt a lot is about to change in 2017, but if ever there were a president up for the challenge—one who will knock down, not build, walls—Mark Postma seems that leader.

Rob Lawrence is chief operating officer of the Richmond Ambulance Authority. Before coming to the USA in 2008 to work with RAA, he held the same position with the English county of Suffolk as part of the East of England Ambulance Service. He is a graduate of the Royal Military Academy Sandhurst and served in the Royal Army Medical Corps. After a 22-year military career in many prehospital and evacuation leadership roles, Rob joined the National Health Service, initially as the Commissioner of Ambulance Services in the East of England. He later served with the East Anglian Ambulance Service as director of operations. He is also a member of the EMS World editorial advisory board.