Loyal Customer
Program
for
Your Emergency
Medical Services & Fire Department
By Alan Perry
Introduction
The EMS
& Fire Department is aware of the growing momentum affecting the
delivery of pre-hospital EMS as a result of general healthcare reform and
specifically the Patient Protection and Affordable Care Act. The department would
like to begin working on solutions that are easiest to achieve and can be
accomplished without major changes to existing policy or major program
development. The department realizes that the healthcare environment is
becoming more dynamic and that the department, and any new ideas, must be
flexible and adaptable. EMS systems are frequently misused and abused by a
small portion of the patient population; the premise of this program is that
this unnecessary and unproductive behavior can be easily corrected without any
major changes to or normal operational pattern by simply providing a little
patient and public education among this target group. Ideally this program will
include the voluntary cooperation of the loyal customer, their primary care
physician and the EMS provider. It will incur no additional cost for the EMS
agency, and may actually prove to save money by avoiding unnecessary and
unbillable transports. It will have the added benefit of being an anchor point
for validating efficacy through research allowing expansion of the program if
needed to address hospital re-admission rates and other targets of the Patient
Protection and Affordable Care act.
Program Development
·
Quantify the problem
·
Identify the stakeholders
·
Develop a policy, procedure & infrastructure
·
Conduct a pilot study
·
Analyze the data
·
Get stakeholder feedback
·
Monitor the results, seek continuous improvement
Quantifying
the problem
We all have
our suspicions about the number of patients that routinely misuse and abuse the
911 EMS system, we know their names, where they live, and what their primary
complaints are. In order to prove that a change in our system is having the
intended effect we must know exactly what the problems is, the number of
transports, the number of patients, the primary complaints must all be
documented and analyzed to produce a measurable problem. Typically most EMS
systems do not do anything about this type of problem until it becomes a major
issue, due to this and the changing shifts and personnel the problem may be
greater or lesser than imagined. A quick and dirty way to accomplish this might
be to conduct a retrospective analysis of EMS calls identifying specific
addresses, patients and chief complaints to produce a good starting point. A
better way would be to add a few targeted questions such as: Do you have a pcp?
When were you in the hospital last for this problem? Do you have any means of
transportation? These examples of questions could be used to flag your potential
loyal customer for review.
Identifying
the stakeholders
You, your
providers, the patient, the patients physician, your OMD and your chief officer
are all stakeholders in this immediate process and should be heard before a
plan is developed, again after it is finished, and ongoing as it is implemented
and refined. For this to work, everyone needs to be happy with the process and
the intended results. There may be other parties you will need to involve such
as public and/or mental health and your state or regional EMS office. You must
explain in basic terms what you hope to accomplish, a reduction in misuse and
abuse of the 911 EMS system, and ask each what your agency can do to achieve
that goal that can fit within the confines of a public and patient education
program.
Developing
policy, procedure and infrastructure
After
quantifying the problem and collecting stakeholder input you can begin the
process of creating an outline of your program’s policies, procedures and
infrastructure needs. Your research will identify what the specific problems
may be, your program should be targeted to achieve improvement in those
specific areas and also seek to improve the experience for patients and
providers. A mechanism must be in place
to fully record and document the presenting problem, what interventions were
done, and ultimately whether or not the situation improved. Privacy policies
and law will need to be examined to determine what data can be used to identify
loyal customers and track their progress. Voluntary participation of the
patient and the patient’s primary care physician will likely be needed to avoid
any legal problems. The role of the provider will most likely be that of a
health coach, monitor and recorder working in partnership with the patient’s
physician and/or your OMD. A schedule or process must be created and supported
for providers to perform routine or PRN health checks and follow-up. The same
data used to identify your problem will be used to document it effectiveness
Do a Pilot
Study
Start with a
small area, a single station or district with a clear problem that this program
should be able to address. Train your personnel, identify and enroll your
patients and physicians and kick it off. This is a good time to be hands-on,
check with the providers and see how it went for them, with the patient and
make sure it was a positive experience, and with the patients physician. They
all must be satisfied with the way it is working or it must be modified.
Document every contact with your usual PCR. Collect all the relevant NEMSIS
data and any pertinent data relevant to your program objectives. Once you have worked the bugs out of your
program in the pilot (3-6 months minimum) you should have enough data to
determine if it can be applied to the rest of your system or expanded to others.
Analyze the
Data
Within 3-6
months you should have enough data to determine if your program is having the
intended effect, and you may have identified several new target populations/sub-populations
as well. If your program is producing the intend result you must be able to
prove it with the data before expanding or continuing with it. If the results
are mixed or show no/negative change try to identify why, this is a good time
to go back to those stakeholders to discover where the program may have failed
and get good suggestions about how to improve it. Make sure you are measuring
the right metrics, any improvement in patient outcomes, healthcare experience
and cost reduction are meaningful and positive results.
Stakeholder
Feedback
Go back to
your original stakeholders and any new ones you may have discovered, revisit
the initial objectives of the program of reducing EMS system misuse and abuse
by your loyal customers. Are there any concerns now? Are there any suggestions
for improvement? Are there any unforeseen outcomes or consequences? Is everyone
happy? Any concerns or negatives here must be addressed before the program can grow, your stakeholders
will remain your primary source of feedback about the performance of your
program, they will be of great value in maintaining the program’s
responsiveness and relevance as circumstances change.
Monitor the
results, seek continuous improvement
Once your
program is up and running you will still have to go through much of this
process again as new information becomes available allowing you to tailor your
approach to each new patient, refining and validating new approaches that
produce better or more efficient results. If successful you will hopfully draw
the attention of our healthcare partners who may seek to involve you with their
patients as well or borrow ideas from your program. Keep in mind that it must
be a dynamic program that can adapt to the needs of the patient, the providers
and the requirements of local, state and federal law. Continuous Quality
Improvement (CGI) will keep your system effective, efficient and popular with
your stakeholders.
Summary
A Loyal
Customer program is an easy to achieve first step for 911 EMS systems that are
not sure where to go or what to do next in the face of healthcare reform and
the Patient Protection and Affordable Care Act. Instead of waiting around for
healthcare changes to be forced upon us, it seems prudent to start taking some
positive action that will improve the quality of our service and the outcomes
of the patients we serve. A by-product of positive action is public support,
goodwill, and increased pride among your workforce for being proactive.
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