NFPA Journal - January/February 2020 - 65

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care professionals who just happen to
be in fire stations. Instead of going out
and preventing fires, they are out there
preventing 911 calls."

FOLLOWING THE MONEY

Despite her recent travails, Tammy
offers a weary smile when she sees
Abbott at her door. He makes her laugh
with a few jokes and encouraging
words before taking Tammy's vitals. He
asks about her blood sugar, and they
chat about the medicines she's been
prescribed. They discuss her upcoming
follow-up appointments with a specialist, and Abbott writes out a couple
of taxi vouchers that she can use the
next day to get to and from her doctor's
office. In less than 10 minutes, we're
out the door.
The visit I witnessed was a sharp
contrast to how EMS has historically
dealt with chronically sick patients.
Since modern EMS began in the 1970s,
the famous motto for most ambulance
companies has been "you call, we
haul"-meaning if you call 911 for any
reason, they'll give you a ride to the
emergency room. In fact, in most cases
the ambulance ride continues to be the
only thing that insurers pay EMS to do.
For many years, this financial
arrangement-"bring patients to the
hospital, or don't get paid"-has led
to a predictable outcome: no matter
how minor a patient's ailment, almost
anybody who calls 911 for a medical
situation is brought straight to a hospital emergency department, even
when another approach would almost
certainly be better for everyone. In the
last decade, however, strong economic
forces throughout the health care
industry have slowly begun to reshape
this inefficient and expensive system.
"The reality is that all of this transformation of EMS into something other
than 'You call, we haul' is about the
money," Zavadsky said.
Since the passage of the Affordable
Care Act in 2010, hospitals have been
financially incentivized to reduce their
patient readmissions rates. If the same
person is readmitted to the hospital
for a cause that is deemed preventable
by Medicare and Medicaid, the hospital isn't paid and can be fined. At the

GETTING GOING

A new NFPA guide offers a primer on how to launch
a mobile integrated health care program
The new NFPA 451, Guide to Community Health Care Programs, is a
comprehensive document aimed at helping all EMS, fire-based and otherwise,
smartly develop a successful mobile integrated health care (aka community
paramedicine) program. "The guide has a very generic title because MIH and
community paramedicine programs are broadly defined in nature and scope,"
said John Montes, the NFPA staff liaison for the project. "Each are dependent
on the needs of the community, the local regulatory environment, and the
capabilities of the local health and EMS systems."
The document includes direction for planning, implementing, and evaluating
these programs, including:
» The core elements of an effective
process for developing community
health care program governance.
» A systematic approach to conducting
a community and EMS system needs
assessment, and how a new community
health care program could fit in.
» Contracts and partnerships with
various segments of the health
care industry, and related financial
modeling.

same time, insurers are unnecessarily
spending billions of dollars on frivolous and preventable ER trips when
lower-cost home visits from a nurse
or skilled paramedic would be more
effective. For those and other reasons, most health professionals now
acknowledge that it's a lot cheaper
and just as effective to treat low-acuity
patients at home or at a doctor's office
rather than
NFPA.ORG/
an emergency
EMSREVOLUTION
room.
Read the new NFPA 451,
Meanwhile,
Guide for Community
EMS
systems
Health Care Programs.
across the
Read the 2018 survey
country are
of MIH and Community
Paramedicine programs
on the brink
by the National
of collapse.
Association of EMTs.
Local news
stories from Toledo to San Diego tell
of overworked and underfunded EMS
agencies buried under an ever-increasing volume of 911 calls. According to
a recent article in EMS World, it's not
uncommon in some understaffed agencies for a single ambulance to make 20
or more runs per day, causing crews to
work almost nonstop during a 24-hour
shift. To add insult to injury, many of
these EMS systems are barely financially viable.

» Medical oversight and quality
management of a community health
care program.
» Strategies for developing and
maintaining stakeholder relations.
» Relevant health information technology
and communications technology
needed for a successful community
health care program.
» Chapters on equipment and facilities,
delivery models, and program
implementation.

Before launching its MIH program
in 2009, MedStar Mobile Healthcare
was sending an ambulance to every
call, even for something as benign
as a patient with foot blisters, said
Zavadsky, MedStar's chief strategic
integration officer. "And we were rarely,
if ever, getting paid for those services
because they didn't meet medical
necessity for an ambulance," he said.
"We were eating those costs."
Out of pure self-preservation, EMS
agencies have been forced to find
another way. "Our health care system
is bankrupting our country, our public
service budgets, and our public safety
budgets," Zavadsky said. "EMS providers across the country need to figure
out, in an economically finite world,
how we can bring more value in order
for us to maintain relevance."

BENDING THE CALL VOLUME CURVE

All of those factors were in play in 2014
when SAFD began exploring ways to
manage its way out of a familiar conundrum. "We weren't getting any more
ambulances, but the call volume was
going way up," said Michael Stringfellow, the EMS division chief at SAFD.
When he and others began digging into the department's data, the
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NFPA Journal - January/February 2020

Table of Contents for the Digital Edition of NFPA Journal - January/February 2020
