Sunday, November 17, 2013

Can you hit a moving target?

Can you hit a moving target?

Alan E. Perry
November 17, 2013

Anyone can tell you that in order to hit a moving target you must compensate for the motion of the target and the trajectory of the object you intend to hit in with. It can be tricky enough when you know the values for these variables, compensating for them, leading your target and adjusting for elevation, windage, air density and gravity. It is nearly impossible, except for dumb luck, to accomplish a hit if one or more of these is not known, or worse is constantly changing. This is the circumstance EMS leaders are finding themselves in as they try to grasp concepts like community paramedicine, mobile integrated healthcare and all of their variations being explored throughout this country and elsewhere.

EMS is no stranger to change; it began in 1967 with an article titled Death in a Ditch, our growth as a viable public safety essential service, the 1996 EMS Agenda for the Future, its follow-up implementation guide and the 2007 EMS at the Crossroads describing the future of healthcare. We can’t say we didn’t see the changes coming; many organizations have been quietly and productively working at solving problems, filling service gaps and improving the quality of their services for many years. The rest of us are now staring at the ambulance barreling down on us and trying to decide which way to run.

The Patient Privacy and Affordable Care Act (ACA) is not new, it has been around and its consequences known for several years. This is the latest variable added to the changing world of EMS, many of its objectives are compatible with the needed changes to EMS that were recognized in 1996, yet we have still not acted on the majority of them. These were once stationary goals that EMS alone sought to achieve, we are now so far behind that the change is now being pushed down on us from the Federal Government! What has happened to us? We are so worried about studies, stakeholders, regulations and politics that we can’t even do the simple and easy things we have known we need to do for decades.


So, about that target, what is it? Do you want to just look good, or actually do good? We know that better patient outcomes are at the top of the list closely followed by greater healthcare system integration and lower costs, all identified in 1996 but now also required to obtain the objectives of the ACA. We have now lost the initiative; hospitals are improving readmission rates on their own, hospice and home health care organizations are filling the gaps between primary care and the hospital more fully, both are reducing costs and improving the quality of care for the patient. It may be that EMS will not play much of a role in this new system as we had hoped despite finally coming up with innovative ways of delivering care.


Let’s not forget the taxpayer, citizen’s and city managers out there, will they support increased services and increased expenses for EMS systems to duplicate services they have until now thought to unimportant to develop on their own? Will you be able to convince hospital administrators that you can do a better job than they of reducing readmission rates? Will your regulatory bodies allow you to expand your roles in the face of all the other changes going on in healthcare at the moment? Can all this be done quickly enough to even make a difference, or will you be driven to provide whatever services all these other parties decide you are competent to perform? As you can see we are not just trying to hit a moving target, we are trying to hit multiple moving targets that are rapidly changing direction, as it sits I think we will go home empty handed unless we change our way of thinking and our tactics.

I suggest that we go back to basics, clean up our house, and begin working on developing real and meaningful strategies that will improve the quality and value of our services whether or not we can develop new ways of delivering that service. Work on developing your staff, cultivate your leaders, and train your providers with the best programs available.  Educate your public, policy makers and stakeholders. The true value of public education is severely underappreciated by EMS, look at the outcome, and resources, dedicated to public education in fire prevention, why is EMS any different. This is a target we can hit.

Be Safe,

Alan

Tuesday, November 12, 2013

TEMS Community Paramedicine Workgroup Meeting 11-12-2013

Tidewater EMS Council
Community Paramedicine Workgroup
November 12, 2013

1305       Welcome and Introductions

                Review of meeting notes from October 11, 2013
·         Accepted-unofficial

                Updates from EMS symposium meetings and classes
·         VAOEMS advisory board- (Jeff Meyer) Chesterfield program will start up next month. Their focus is on frequent flyers/loyal customers, an education program and the CHF patient population. They will start training next month with a two week course involving social services, CIT training, and rounds with a cardiologist visiting CHF patients. The program will use 3 FT paramedics and one program manager. They seem to be going for the same type of service we are trying for.
·         Home health challenge; license or not? OEMS is waiting on opinion from AG office. The advisory board has not yet met with Home-Healthcare providers. Individual agencies may get their own license but are taking a “wait and see” approach.
·         State workgroup- (Tom Schwalenberg) State workgroup is still in the “trying to figure it out” phase.
·         MEDSTAR- (Thom Schwalenberg) Met with Director of Med-Star. Examined the Med-Star process and what they learned. They started dialog with stakeholders got their foot in the door and facilitated a collaborative vs. adversarial relationship to identify service gaps in the community.
               
                General Discussion
·         Are we headed toward a regional CP program or and individual agency approach, a single call, single service may work better.
·         Council may consider a coordination role for a regional program with a central dispatch point following a nurse triage of each call with other alternative destinations using EMD.
·         We should examine MEDSTAR and RAA nurse triage systems.
·         RAA is no longer doing this due to problems with their system.
·         (Melody Siff) Wilmington and other systems have had growing pains- we should expect the same.
·         Hospice patients should also be considered.

                Education/Awareness Sub-Group
                MOC Presentation discussion
·         Need to add hospice patients to proposal.
·         Community Paramedic curriculum may be available locally if adopted. Distance learning is available approx. cost is $3000 per student.
·         Need to provide examples of successful programs to demonstrate what it will look like, what they did and why it worked.
·         Recommendation will be to develop a regional program.
·         Benefits of program are: Single contact point, greater efficiency, improved agency cooperation, Shared patient data.
·         Needs to be condensed to a 10 minute presentation
·         Need to define what “community paramedicine” is, what the pros/cons are locally, and provide a recommendation.
·         Legal and regulatory concerns related to expanded role vs. expanded scope, this is where we are today.
·         Concerns that workgroup is setting program up for an adversarial vs. cooperative pathway for the regions program by not getting stakeholders involved in the process yet.
·         (Travis) We need to get all involved parties input first- before moving forward.
·         (Schwalenberg) Informally, this information is being communicated.
·         (Foster) Is there potential for TEMS/PEMS cooperation?
·         Can this presentation be given to OMD’s?
·         This presentation must include an advisory that the next step must be identifying all of the stakeholders, educating them and do GAP analysis.

Regional Community Paramedicine Model (handout)
·         Document submitted to group for review and comment
               
                Review of data supporting scope of problem
·         Readmission reports; handouts for Bon Secours data (Travis), CGH data (Schwalenberg).
·         CHF patients with readmissions from Portsmouth, Chesapeake, Norfolk. Data is unconfirmed due to inconsistent coding
·         Data seems to suggest the problem is real but may be declining
·         Various hospitals have taken independent actions themselves which have had a dramatic effect on the significance of the problem.
·         Data from agencies going to Travis for case studies

                Committee Reports       
                None

                OEMS Report
                None

                Old Business
·         Will this workgroup request from MOC to be formalized as a committee?
·         Will wait to see what/how the group and data are received.
·         Stakeholder sub-group will be Jennifer Foster, Darren? And Liz?

                New Business
·         OMD meeting will receive community paramedicine update information.
·         MOC presentation will not be presented to OMD meeting.

                Good of the order
               

1438       Adjournment


Next meeting will be December 5, 2013 at 1300 in the TEMS conference room.