New Developments in the MA EMS Scandal

And so it begins...

http://www.lowellsun.com/todaysheadlines/ci_17956891

My questions are simple. Where was MA DPH OEMS to police these classes? Where are the ethics of those involved in offering these classes? Where are the ethics involved in the persons "taking" these classes?
While it has been many years since I have held an EMT license (5, which I gave up voluntarily) and even more since I came off the road (6), I don't remember trying to just sign a roster. While the classes are sometime ridiculous, especially if you are a working EMT or Medic, the state mandates that we take the courses. Perhaps we have come to the point in the EMS System that a test out option should be given.
I say this knowing the blow back it will receive, however, why does one need to freshen up a skill they use everyday?

 I feel a "one chance only" test would demonstrate the appropriate level of \competency to all levels of EMS providers, if the test was required to be taken on a regular (2 year) basis. If you do not pass the test after your first attempt then you are required to take the refresher course.

The fact that the state is pointing fingers at the instructors and EMT's with out looking at the system that is in place shows that they are not willing to accept the fact that the system, as defined now, is flawed. It is the states responsibility to protect its' citizens. If they are only recognizing the failure now, how many other times has this occurred through out the history of EMS in MA and the country? Nurses have a Board to review all credentials. Doctors have a Board to review credentials. Perhaps it is time that OEMS started acting like the rest of the healthcare world and pulled their heads out of the bucket.

A Financial Life Saver...for now

Yesterday, President Obama signed the SGR Fix Bill (MedPage Article) into law.  What this bill does, among many other things, is save the EMS industry from a potential 3% loss on reimbursement rates for 2011. It also ensured that doctors would not take a 25% cut in 2011.  Through diligence in Washington by many EMS and health care related groups we are all able to weather the budget storm that will continue to ravage the entire health care system due to the implementation of "Obama-care". 

This is a band-aid on the wound that is the national health plan.  Until the SGR is truly fixed we will continue this cycle every year. I implore every person to reach out to our senators and representatives to help them understand that the system is just that, a system.  A shortfall in any one area will have a dramatic effect on the system and will result in failures that we can only estimate.

Running a hospital: Push pins give a safety and quality update

Notice the second picture lower right hand corner. If they have this challenge, why not reach out to the people and groups who are the experts in patient transitions? Part of the patient/bed flow process is getting the patient and information to where it needs to be effectively, safely, appropriately and in a timely manner. EMS is part of the system and can help with the challenges these facilities face, if only one would be willing to listen and be a leader in creating a culture of change....

Running a hospital: Push pins give a safety and quality update: "#IHI It is not a scientific survey, but these push pins give a sense of what's working and what's not in process improvements in the health ..."

ACOs? Who are they keeping Accountable?

Accountable Care Organizations, or ACOs, are a new trend that has been emerging in the healthcare industry.  The idea is simple enough; build a complete healthcare system that will make the patients' flow through the maze of cross continuum of care simplified.  Hospital systems will include not just hospitals any more but also LTAC's, SNF's, Hospice, VNA and a large and varied range of services for the rehabilitation and post acute care settings.

The article written by Kip Sullivan (The History and Definition of Accountable Care Organizations) gives the best definition and explanation of the ACO idea.

My concerns are these; what patient services are the ACOs not going to directly provide and what sort of “Accountability” will they require from the vendors that they contract with?  Will there be a control in place for patient care?  Will there be standardize reporting systems so all parts of the ACO, internal or external, are rating the patient satisfaction, outcome and care on a 1 for 1 basis? Will CMS actually set up standardize information on what establishes the cost of any given service that it pays for, so a true price can be placed on the service for equitable reimbursement, regardless of the vendor or facility? Will CMS force the ACOs to have multiple vendors for similar services or will the ACO be a “one-stop-shop”, disregarding the growing and popular trend of an educated patient choice?

The fact that the evolution of health care in the United States is so rapid leads me to believe that these standards are only in their infancy of development. ACOs can be successful, if these, plus many other concerns are appropriately discussed, prior to the implementation of ACOs in the healthcare marketplace.

EMS in Healthcare

Plain and simple.  EMS is Health care.  Despite the fact that many of the services are included with the municipal services, they are still a integral part of the total health care system.  We face many of the same challenges that hospitals feel with pressures on quality, choice, payor reform and performance measures.  We also deal with heavy government regulations (granted I feel many of these are necessary to guarantee public safety), tax concerns and severe public scrutiny. 

In effort to give full disclosure I am a current employee of a private ambulance company that does both emergent and non-emergent ambulance work in the greater Boston, MA area.  The start of this Blog is to open a forum for discussion in the EMS field on health care reform, EMS regulations and the need for a national standard as well as any other topic of interest that relates to our field and the interaction we have with other areas of Health care.