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    Paramedics fight to combat ED visits, readmissions


    Financial drivers

    Mark Zavadsky, director of public affairs for MedStar Mobile Healthcare, a private community paramedicine company that provides services for payers and providers, says EMS teams have traditionally only been paid for transporting patients to the hospital or ED, with no reimbursement for patients treated on the scene without transport.“So we transport them to pay our employees and that’s just silly,” Zavadsky says.

    Now, hospitals and payers are using incentives from the ACA earned through lower ED admissions and hospital readmissions to change the reimbursement structure. “Any health system migrating to a population health strategy has to recognize that all their efforts can be thwarted by the patient with a quick call to 911. As systems consider how best to transition to value-based care, they should take a serious look at their local EMS agencies as partners in the process,” Swayze says.

    There are two ways MedStar gets paid, Zavadsky says. One is payment by the provider for the reduction in expenditures (such as through incentives earned by the hospital for reducing readmission rates). The second is payment by large independent practice associations who work with CPs to manage high utilizers in the home setting to keep them from coming into the ED if they don’t need it.

    Some payers are also starting to pay capitated rates each month on high utilizers, paying CPs to respond to these calls and help the patient and payer avoid a costly transport, ED visit, and perhaps hospital stay. Twenty percent of the savings is paid to MedStar, Zavadsky says. “That makes sense to me. It reinforces to the patient that these things should be addressed by their doctor,” he says.

    Filling an unmet need

    Zavadsky says that patients who are surveyed after hospital stays say they only understand their discharge instructions 40% of the time. They may have questions that only come up after they leave the hospital, then forget by their next appointment. These things that can lead to ED visits and readmissions.

    “It’s not that they want to be noncompliant, it’s just that they don’t know any other way to be. Nobody has the time to sit with that patient in an area that’s comfortable for that patient and explain,” says Zavadsky. “We’ve put 3,000 to 5,000 patients through these [CP programs] and 80% of what we’re doing with these patients isn’t clinical. It’s educational.”

    Zavadsky says his agency has tracked 475 patients using the CP mobile healthcare services for 24 months and found that EMS calls were reduced by about 55% in patients enrolled in the CP program. That translates to an estimated $8 million cost savings to health systems thanks to the change in the patient’s utilization of services. That estimate, Zavadsky says, is based on ED facility payments and Medicare cost savings and isn’t inclusive of additional costs for lab work or specialist care.

    Rachael Zimlich is a writer in Columbia Station, Ohio.

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...


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