The magnitude of what’s in store for EMS organizations in the next few years is coming to light. New operational approaches, service delivery methods and payment models, along with other government policy changes, present substantial risk to the way EMS agencies operate, plan cash flow and receive reimbursement. When considering opportunities such as moving into a mobile integrated healthcare program (MIHP) or community paramedic project, it is critically important that agencies execute well. A “ready, fire, aim” approach will not lead to a successful outcome for the agency or for our profession as a whole.

Evaluating risk

Risk assessment is a data-intensive step requiring involvement from executives; financial, clinical and operational managers; and caregivers. Functioning as a team, these experts can identify high-risk intersections associated with operations, relationship management, expense and revenue generation. For example, there are multiple clinical and administrative considerations. Clinical issues include the development of caregiver competencies and understanding regulatory authority and medical control. From an administrative perspective, leaders must develop a business case for making the transition from a volume culture to a value culture, and determine how to cost-effectively implement technology, to name just a few hurdles.

Prioritize actions

With the highest risk areas identified, the team can begin the prioritization of issues and opportunities based on factors unique to their market and system design. Assigning a priority level to every process or procedure will allow the agency to determine how and when to best expend resources. Planning for organizational structure changes, technology acquisitions and training for both caregivers and customers are all required to better prepare for a different service model.

Track performance

Many agencies would be well served by implementing a comprehensive analytics package now to help monitor performance benchmarks. Detailed metrics must be collected at every step of the service cycle to ensure that the agency is capable of producing the documentation required by accountable care organizations (ACOs).

Fragile organizations today remain primarily focused on financial metrics rather than using a more balanced approach that incorporates process improvement, customer satisfaction and development of caregivers within the organization. These four factors are the basis of today’s balanced scorecards. Managing the agencies’ performance will become more critical under new delivery models such as community para-medicine programs that are contemplated for EMS under healthcare reform. While the balanced scorecard is a well-accepted way to report key performance indicators, more agile organizations increasingly use business intelligence software capable of alerting executives at trigger thresholds and other occurrences that are designed to help achieve the principles of the Triple Aim.

Developed by the Institute for Healthcare Improvement (IHI), the Triple Aim objectives are: (1) improve health of the population by encouraging a better awareness of health status; (2) enhance the patient experience, and; (3) provide the best possible (evidence-based) care while lowering per capita costs. The IHI Triple Aim is elegantly simple, yet will be extraordinarily complex to achieve. It is clear why analytics software is a wise investment.

Compare results

Being able to measure clinical, operational and financial benchmarks—such as outcome data, utilization, change trends, days in accounts receivable review, and denials against peer organizations—is essential to operating a high-reliability EMS system. Comparative analytics, as opposed to internal tracking, can reveal the degree of an organization’s competitiveness and how it matches up against best practice standards. As we move into new service lines such as MIHP, comparative analytics are even more important given there is no organizational history against which to compare performance. It is vital to frequently compare metrics of similar size and type entities as the transition to new service delivery models occurs.

Looking ahead

While payment models are changing, there has been some comfort expressed that more individuals will likely have some form of insurance offered through the exchanges. Unfortunately for EMS, many of these plans have high deductibles. That fact, coupled with falling transport volumes, could spell trouble for non-agile agencies. Thoughtful planning for the future is required.

Not everyone shares that view. One chief I recently spoke with said: “I’m not worried. The community knows we save lives and will support us no matter what happens with healthcare reform.”

Risk assessment is a data-intensive step requiring involvement from executives; financial, clinical and operational managers; and caregivers.

So where’s the real risk, you ask? One transport agency we are working with recently experienced a double-digit decrease in Medicare transports. It seems that the region’s ACO did an outstanding job in working with its members, physicians and nursing homes to re-direct patients to alternative care and significantly reduced the need for ambulance transport. Operating costs for the agency did not go down but its patient mix (and reimbursement) has changed significantly in recent months.

The real risk for EMS agencies in turbulent times is complacency. Be ready to demonstrate value. The consultant’s crystal ball on exactly what will happen with healthcare reform initiatives after the mid-term elections remains murky. My confident EMS chief could be right. But, as the impact of reform on EMS becomes clearer, my advice is to have the data ready.