EMS Predictions: Payment Reform

ESO Staff

Each year, experts from ESO review the most current information from its large collection of customer-submitted data, firsthand field experience and industry research to create a predictions publication for three key areas: EMS, Fire, and Hospital.

The 2019 EMS Predictions, which is free for download on the ESO website, examines the top four predictions that will most likely affect the EMS industry in the year to come, including a prediction regarding continued discussion on EMS payment reform and quality metrics.

Payment Reform in the EMS Industry

In 2019, industry trends suggest a continued conversation regarding payment for alternatives to emergency department transportation, telemedicine, and the addition of quality metrics from the Centers for Medicare and Medicaid Services (CMS) for EMS. Specifically, bidirectional video telemedicine will play an emerging role for EMS providers, to assist in a more sophisticated manner with transport and destination decisions.

Additionally, quality metrics in a manner similar to other sectors of healthcare are likely being seriously considered for the EMS arena. These will likely include the administration of aspirin for patients with potential cardiac chest pain or administration of betaagonist for patients with moderate to severe bronchospasm.

Alternatives to ED Transport

A popular point of discussion currently taking place is how to improve efficiencies by better directing patients who call 9-11 to the appropriate destination, recognizing the fact that this might not be the nearest emergency department. For example, there are more than 7.4 million mental health–related ED visits in the U.S. every year, and of these, approximately 30 percent arrive by ambulance. Unfortunately, due to a deficit in dedicated inpatient psychiatric beds, patients experiencing a psychiatric crisis often remain in the ED for hours or even days. This can be extremely hard on the patient, not to mention add significant workload and backlogging for ED staff.

Some EMS agencies are taking proactive action to make their transports more efficient for both the patient and the destination facility, by building a local network of “alternate destinations” and developing screening protocols to support their decision making process. For example, REMSA Health based out of Washoe County, Nevada now has 16 participating alternative local destinations including urgent care centers, clinics, and other medical facilities as options to receive care. Its alternative destination transport program includes locally-developed protocols for low acuity, intoxicated, and psychiatric patients, as well as a rigorous clinical quality assurance program with medical director oversight and special training for all field medics.

Integrating Telehealth

Another tool being explored for improved efficiencies and care – especially for populations in rural areas and homebound patients – is the use of telehealth, or the remote delivery of health care services and clinical information. While many industries like banking and or shopping today function easily without in-person interaction, health care has lagged a bit due to the ingrained tradition of “hands-on” health care. However, the options of augmenting in-person care – rather than completely replacing it – are becoming more popular and efficient.

According to the Council of Accountable Physician Practices (CAPP) – a group that recently published a primer on the adoption of telehealth practices – potential telehealth technologies can be divided into three broad categories:

  • Audio, visual, or web-based technologies that facilitate two-way, real-time communication between patients and providers (or between individual providers within a care team)
  • Remote monitoring that allows providers to remotely observe patients in real-time; for example, a video camera that allows a physician to monitor ICU patients
  • Asynchornous “store and forward” technology that transmits information from patients to providers; for example, an automatic email sent to a physician that includes a patient’s blood pressure data from a wearable device

Additionally, the potential for telehealth integration into ambulances could offer increased communications and improved outcomes. “Smart” emergency response vehicles are becoming increasingly popular, from automatic vehicle location (AVL) and computer aided dispatch (CAD), to traffic signal prioritization and communication with headquarters and hospitals. It’s not a huge leap to envision how telehealth may play a larger role in onsite EMS care in the future.

The Value of Quality Metrics

In a time where everyone is looking for improved efficiencies and better insight into operations, quality metrics will unsurprisingly continue to be a key element of improving emergency care. Knowing what is working well and identifying gaps can not only increase your teams efficiencies but also help you deliver more consistent positive outcomes. It can help you better train your team and address issues, from an individual level all the way up to organizational protocols and SOPs.

While record keeping has traditionally varied across the board for EMS agencies – from hand-written notes to computer-based documents – today’s technologies can make recording and maintaining digital records easier than ever. For example, custom step-by-step forms on a handheld device can be utilized onsite to ensure digital patient records are fully complete for ED handoff, easing the transition and making post-transport review more efficient. Additionally, “bidirectional” software utilized by hospitals and EMS agencies makes it easier for hospitals to share back patient outcomes with agencies, rather than the team simply wondering what happened to a particular patient after transport.

Finally, personnel management tools can make maintaining your staff much more simple and efficient, allowing you to record anything from vaccine records to training hours. You can set up alerts for renewals and easily review employee stats. All of these digital tools helps ensure your team not only stays in compliance but is ready to report and respond to any new industry requirements. This increased transparency, and a more efficient operating organization, also makes your agency more attractive for partnering with hospitals and payers in your area.

Suggested Actions

With this view of the future of the EMS industry, agencies can begin taking steps now to ensure they are prepared to keep pace and excel in the future setting of emergency care. Two potential actions to take today include:

  1. Exploring grant opportunities, such as the Telehealth Network Grant Program, through the Department of Health and Human Services, which provides funding to establish telehealth programs in rural or underserved population areas.
  2. Leverage software, like ESO’s Quality Management module, to conduct QA/QI reviews and ensure you’re providing appropriate feedback to EMS crews, establishing baselines for protocol development, and charting changes in ePCR documentation.


To read the additional EMS predictions for 2019, including topics on changes to controlled substance rules, provider wellness and safety, and more, download the EMS predictions now.


Leave a comment

Leave a Reply

Your email address will not be published. Required fields are marked *