Calif. Seeks To Implement Paramedic, EMS Worker Pilot Programs -AND- Berwick: Get rid of Medicare 3-day rule

Wed Sep 18 20:56:34 PDT 2013

August 29, 2013

Calif. Seeks To Implement Paramedic, EMS Worker Pilot Programs

California Healthline

California's Emergency Medical Services Authority and the Office of Statewide Health Planning and Development seek to develop community paramedicine programs that would expand paramedic and EMS worker responsibilities to help fill gaps in health care services, HealthyCal reports.

Details of Programs

Similar programs already have launched in other states -- including Colorado and Texas -- that give paramedics responsibilities that typically are handled by primary care providers.

Christopher Montera -- assistant CEO of the Western Eagle County Ambulance District in Colorado, which has piloted a community paramedicine program -- said that area paramedics' responsibilities under the program include:

• Blood tests;
• Neonate visits; and
• Medication reconciliation.

Montera said that so far in the program's first year, it has saved $1,250 per visit in health care costs for each of its 29 patients over 97 visits.

EMSA officials say that they plan to test the programs in up to 12 locations statewide beginning as early as summer 2014.

Implications

Observers say that the programs have the potential to positively affect both rural and urban populations.
According to HealthyCal, community paramedicine initiatives in rural areas are more likely to focus on bringing health care services to underserved populations, while programs in urban areas are more likely to focus on closing health care gaps.
Reaction
Mike Taigman, an EMS expert, said, "That kind of community relationship and geographic coverage along with the clinical training and competence that they have makes paramedics another resource to the rest of the health care system."
Lou Meyer of EMSA said that community paramedics "in no way tak[e] the place of a registered nurse or a doctor."
However, critics of the programs argue that the state lacks proper funding to implement community paramedicine, which would include costs for providing additional education for paramedics and EMS workers and other expenses (Matthews, HealthyCal, 8/28).

September 3, 2013

Berwick: Get rid of Medicare 3-day rule

Fierce Healthcare

The simmering controversy over observation care might reach a boiling point now that Don Berwick, M.D., former administrator for the Centers for Medicare & Medicaid Services, has jumped into the fray.

When Berwick, who is now an official candidate for Massachusetts governor, led Medicare from July 2010 to December 2011, he considered eliminating Medicare's three-day payment rule for hospitals, a position he reinforced during a recent interview with The Boston Globe.

"The patient ends up holding the bag, and that's not fair or appropriate," he told the newspaper, adding that "Medicare should get rid of that rule."

With the three-day payment rule, Medicare intended to give doctors 24 hours to 48 hours to assess whether a patient should be admitted to the hospital or go home. However, observation stays at hospitals often exceed CMS guidelines, with 8 percent of Medicare patients having observation stays lasting longer than 48 hours in 2011, up from 3 percent in 2006, according to the article.

Heeding calls to end the three-day rule, U.S. Representative Joe Courtney, (D-Conn.) filed legislation three years ago that would get rid of the distinction between inpatient and observation status, allowing patients who spend at least three days in a hospital--no matter the classification--to qualify for coverage if doctors deem rehabilitation care necessary, the Globe noted.

To help end the controversy surrounding observation status, last month CMS finalized the Hospital Inpatient Prospective Payment System (IPPS) rule to clarify when a patient should be admitted to the hospital, determining observation care should not exceed "two midnights."

Courtney told the Globe the new IPPS rule could help but is no solution. That rule also got flak from teaching hospitals for unintentionally banning residents from admitting patients.

Akin to Courtney's plan, some patients want the observation care label removed entirely, and they're going to legal lengths to make it happen. A group of Medicare patients filed a lawsuit against U.S. Department of Health & Human Services Secretary Kathleen Sebelius to eliminate the term, FierceHealthFinance previously reported.

Bryan Sloane
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

Contact us at: calaaem.news.service1 at gmail.com

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