Are we Ready for Mobile Integrated Healthcare?
by Alan Perry
12/25/2013
edited 6/24/2018
In 2013, The Tidewater Regional EMS council Medical Operations Committee convened a work-group for the purpose of exploring MIH/community paramedicine options for our region. Included in the group were a number of local EMS service managers and chief officers, TEMS officials, Hospital system liaisons and a few field providers such as myself. below is a letter I wrote to the group after meeting for several months, when it became clear it would no go anywhere this time around. From the beginning I had concerns about inclusion of stakeholders who were conspicuously absent from our meetings and our collective view of their importance in our process. At the time we had an opportunity to move our region forward into a new era of EMS practice, one that is now sweeping the country with some outstanding results.
I have been examining Mobile Integrated Healthcare (MIH) and
most of its variations since I was first exposed to the concept in the context
of Accountable Care Organizations (ACO’s) nearly six years ago. This occurred
while studying its application in reaction to changes in Oregon State law at
that time, in a hospital based EMS system. It seemed to be a perfect fit, since
the entire process was contained within a single organization.
Over the past five years I have examined other systems
outside our state, and looked at the Patient Protection and Affordable Care Act
(ACA) in some detail. I don’t think we can deny that the ACA was the driving force for community paramedicine and MIH. Do we understand fully enough
what the intended goals of the legislation are? Do we have a specific goal for
where we will fit in?
At that time I think it was clear we did not. Initially we failed to bring stakeholders in so we could develop a better sense where gaps existed and where collaboration could be possible, as a result the process failed.
At that time I think it was clear we did not. Initially we failed to bring stakeholders in so we could develop a better sense where gaps existed and where collaboration could be possible, as a result the process failed.
In our region the majority of Emergency Medical Services
(EMS) are provided by the Fire Service,Volunteers and Municipal EMS. We have the added challenge of having multiple competing
hospital systems. We all have our own internal challenges, our own
perception of where best to start, and are bound by our Operational
Medical Director’s (OMD’s) and the Virginia Department of Health (VDH) position
in the matter. Are we all at a place where we can state honestly that we are meeting
and exceeding the needs of our patients and providers by providing the best
evidence-based care and public education, without the additional burden of MIH?
If we continue to press forward into a new and uncharted area of service
without first mastering our current responsibilities we are in essence putting
lipstick on a pig.
My greatest fear is that MIH will take away from resources
needed to properly train and maintain our emergency response capability, our
core service. This same concern is voiced by officials in the Department of
Transportation in response to suggestions that EMS be moved from there to the
Department of Health and Human Services. Their fear and mine is that it will
degrade and take away from the core services we are expected to provide for
trauma and emergent medical care. Would a better use of these resources and
time would be to invest them in areas where we already know they will have a
positive impact on our performance and patient outcomes, namely public
education and provider training?
It seems to me, and perhaps also the VDH, that MIH is a
unique and separate service, outside the normal definition of EMS. Perhaps more
closely related to Home Healthcare. In the evolution of the healthcare system
locally, as attempts are made to comply with the ACA and the financial
pressures it brings, I believe many of the larger institutions will take on the
roles of ACO’s and improve patient outcomes, without the assistance of EMS,
through better patient education and follow-up. EMS agencies and this council
are not in a position to influence the decisions made by these large businesses
that now have significant financial incentives to change the way they do
business in a radical way. In this economic view we cannot hope to be the tail
that wags the dog.
When this work-group first met I suggested that we seek input
from the stakeholders immediately to determine our direction. I also suggested
that we have some clear areas that we can start working on that we already own
the responsibility for; Public education and provider support. I would be
pleased if we could get back to those points in the near future.
When we successfully meet with our partners and the other stakeholders and honestly discuss the possibilities for improving population health, healthcare experiences and reduced costs, I hope we will be better prepared to adapt to need without any preconceptions. New opportunities present themselves with each new day, private insurers and legislators are changing the environment to allow MIH and Community Paramedic programs to become a reality with hope of sustainability.
When we successfully meet with our partners and the other stakeholders and honestly discuss the possibilities for improving population health, healthcare experiences and reduced costs, I hope we will be better prepared to adapt to need without any preconceptions. New opportunities present themselves with each new day, private insurers and legislators are changing the environment to allow MIH and Community Paramedic programs to become a reality with hope of sustainability.
Respectfully,
Alan
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