Emsaac Affordable Care Act Committee December 4, 2012 Report

Emsaac Affordable Care Act Committee December 4, 2012 Report

EMSAAC AFFORDABLE CARE ACT COMMITTEE DECEMBER 4, 2012 REPORT

Members:

Nancy Lapolla, Pat Frost, Tom Lynch (Chair), others to be added as interested

Committee Goals:

Review and analyze impacts of the Affordable Care Act (aka Healthcare Reform) on California EMS

  • Identify risks and opportunities for EMSAAC/LEMSAs
  • Develop an assessment tool to assist LEMSAs in assessing impacts to local systems
  • Develop recommendations to EMSAAC, including a strategy to capitalize on the opportunities and minimize the risks

Healthcare Reform Possible Impacts on EMS:

Projected 30 million newly insured in U.S., approximately 2 million in California

  • Potential decreased revenue to private ambulance providers
  • Shifting percentages of “self-pay” and commercial insurance to Medi-Cal rates
  • CAA projections approximately 2.5% in each category
  • Reduction in funding to support local EMS systems including non-transport first responder providers
  • Initial and possibly long term increased utilization of EMS, both prehospital and emergency department utilization
  • Increased “bed delay” secondary to increased EMS utilization due to gaps in the availability of “medical homes” for community to access primary care
  • Increased pressure from hospitals and other frequent users of interfacility ambulance transports services, e.g., SNFs, on LEMSAs with EOAs that include interfacility to allow “open market”
  • Contract ambulance providers seeking authorization for rate increase, county subsidies or county payments for certain transports that counties may be contractually exempt from currently, e.g, 5150 transports or indigents
  • Contract ambulance providers seeking increased ambulance response times standards
  • Increased pressure from fire services to allow entry into the 911 and interfacility transportation market due to current availability of Federal funding to offset difference between amount received and actual costs for ambulance transportation
  • Progressive decrease of ambulance reimbursement affecting sustainability of service providers and reducing EMS/Fire subsidies as payers align with CMS to “cap” payment for 911 transport services as “payment in full”

Opportunities for EMSAAC/LEMSAs:

  • Fully leverage implementation of Emergency Medical Dispatch
  • Alpha level, determine appropriate resource response
  • Omega level, including partnering with existing nurse referral networks for call screening and patient routing, etc.
  • Adjust resource deployment on all 911 calls
  • Potential development of new delivery models utilizing fully implemented EMD
  • Development of partnerships with EMS system stakeholders (e.g., health plans, hospitals, ACOs) to develop new revenue streams to support new “value based” reimbursement of patient populations
  • Catalyst for EMS system redesign including;
  • Development of “Community Paramedicine” programs
  • Modified response configurations
  • Alternative 911 patient destination
  • Modified or new revenue streams
  • “Value Based” EMS Systems
  • EMSAAC to take a leadership role in legislative changes to paramedic venue of practice and ambulance destination regulation sections to assure LEMSA approval of implementation of any system changes or new programs
  • EMSAAC to take a leadership role in identifying new revenue streams for EMS providers and LEMSAs
  • Formation of new partnerships with allied system stakeholders
  • Conceptualize other EMS system changes such as the development of “Telemedicine and Telehealth” programs

Risks to EMSAAC/LEMSAs:

  • Loss of revenue sources to sustain and support traditional EMS System configurations e.g., CMS will not pay for “preparedness”
  • Loss of EMS system control including, EOAs, providers, and approval of new programs such as “Community Paramedicine”
  • Other stakeholders driving regulation changes that leave LEMSA approval out
  • Loss of LEMSA relevance
  • Missed opportunity to take a true leadership role and develop new partnerships

Proposed EMSAAC Action Items:

  • Draft and support legislation to allow for alternative destinations and paramedic venue of practice as approved by the LEMSA
  • Develop a standard EMS system (LEMSA) survey that focuses an analysis of financial aspects of the impacts of Healthcare Reform using a pre-implementation baseline and as a future resource tool to evaluate the true financial implications on:
  • Transport providers including 911 and interfacility
  • First responders, non-transport
  • Emergency Departments and other potential receiving facilities, e.g., clinics
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