Jumpline magazine OCT 2022-pages - Flipbook - Page 22
22
Paul D Blake, Ret.
Treasurer
ET3 - The Future is NOW
This is not my title for a remake of the famed 1982 movie
“ET: The Extraterrestrial”. This is about putting MDFR “Back
on the Map.” The map I speak of is our place within the fire
service where we were known as “innovators within the fire
service.” Back in the day we wore jumpsuits. We had ALS
engines pushing clot-busters prior to the arrival of rescues.
That was then replaced in 2007 with the introduction of the
“STEMI” network. For whatever reason we lost that touch.
We went from being the innovators to the “no” in innovation.
ET3 may very well be our opportunity to get back on the map.
I had the opportunity to sit in on a presentation regarding
ET3. So, what is it? It stands for Emergency Triage, Treat,
and Transport. It’s basically managing the thousands of medical calls to which we respond to and managing them without
transporting them to a hospital. Note, this is an article full of
abbreviations. So, QRX as there is MTF.
A few years ago, MDFR was approved to participate in a
system called ET3. It took several years for the federal government to realize what anybody knew
after just a few days in operations. That
is, many of the calls we operate are
not true medical emergencies. That
they did not fall into the, as Bill Gustin
would say, “Shot, stabbed, or bleeding
profusely.” When you look at the list
of providers chosen to take part in this
unique program, you will see that fire
department-based EMS systems are
the minority and very few of the firebased EMS systems are our size to
begin with.
In late 2020, before ET3, alternate
transport destinations appeared on
EPCRs (rescue reports). The actual
program itself, came to life in October
2021 with the release of Procedure-53. Operations saw this
through the Telehealth component (staffed by Cleveland Clinic personnel) and the training of rescues to transport to select
“Alternate Destination Partners” (ADP), specifically UM/JMH
Urgent Care facilities.
It is estimated that the ratio of patients to primary care physicians is 1,243 to 1. Perhaps this explains why when you
book an appointment first thing in the morning you must still
wait an hour to see your doctor. This also explains why 9-1-1
is a convenient way to summon street doctors to their homes.
Our street doctors would then make a diagnosis to patients,
based on who knows what, with just one year of paramedic
training, versus an actual doctor with many years of schooling
and with access to diagnostic testing.
In 2021 we had 43,456 patients who refused to be transported, despite our advice to seek definitive care at the emergency room. It is not known why they chose not to be transported
(refusals). There were another 27,486 that were evaluated
and not transported (no transport required). These tens of
thousands of calls may be our opportunity to use a Telehealth
feature. Telehealth provides access to a real doctor via the
tablet who then offers a possible diagnosis and treatment option based on the assessment of our personnel. By facilitating this improved option, (MDFR) receives payment for these
calls for which we currently do not receive any compensation.
While we could continue “business as usual” and either
transport BLS patients or leave them at home, there is a twist
to ET3; the proliferation of Self-Insured Managed Healthcare
Plans (SIMHP). These programs cover hundreds of thousands of patients in South Florida, and they are looking to develop prehospital and out-of-hospital care programs to better
control their costs. This means they are either looking to build
competing models to EMS or to work with the fire departments like MDFR. So our “business as usual” either evolves
in partnership w SIMHPs or we accept a reduced role in EMS
over time as competing services are introduced.
CMS (Centers for Medicare and Medicaid Services) contracts with SIMHPs to manage a set number of patients.
The SIMHPs are responsible for all patient care along with
all associated costs of care. They instruct their participants
to call their Telehealth hotline for non-life-threatening issues.
They discourage their participant from calling 9-1-1 for minor
illnesses. When a participant dials
the Telehealth hotline, they are asked
questions much like 9-1-1 dispatchers
ask with the MPDS (our current dispatch question/guide). Based on the
information provided, they may send
a private ambulance to assess them
and relay the results of their exam to
the physician. Under the current system, when this same participant dials
9-1-1 for the same complaint, they
may end up being transported to an
ER and the SIMHP is responsible for
all of those costs, which translates to
high cost BLS care.
Another opportunity is working with
local hospitals to keep patients from
having to return to the hospital. The Hospital Readmission
Reduction Program (HRRP) was created by the 2010 Affordable Care Act and began in October 2012 as an effort
to make hospitals pay more attention to patients after they
leave. Readmissions occurred with regularity. For instance,
nearly a quarter of Medicare heart failure patients ended up
back in the hospital within 30 days in 2008, and policymakers
wanted to counteract the financial incentives hospitals had in
getting more business from these return visits. Hospitals are
penalized for readmission of patients by Medicare. CMS levies financial penalties against hospitals for too many patients
returning to the hospital after treatment. The hospitals would
provide our community paramedics with their “frequent fliers,”
and we would check on them to ensure they are complying
with their discharge instructions.
We have additional forthcoming changes that will either be
challenges or opportunities:
The first such change is already all around us – there are
urgent care centers and free standing EDs throughout our
community. Urgent care locations are a convenient way for
a person to seek medical care, sometimes in lieu of visits to
a primary care physician. This isn’t necessarily a bad thing.
Instead of calling 9-1-1, they go to their neighborhood urgent
care. If they need to be transferred to a tertiary care hospital,
October 2022 | JUMPLINE Magazine
