By Mike Metro
There has been a lot said about the Affordable Health Care Act (ACA). There may be some minor changes to the bill, but the train now has left the station. What this bill means for the health care industry is a little clearer as opposed to what it means for the fire/EMS industry, but much can be gleaned from the principles contained in the bill.
The ACA language demands increased efficiencies and that will impact the fire service. Accountable care organizations, or ACOs, also will drive those efficiencies. So from a strategic perspective, the fire service must find the answers to a critical question: What do we do for Mrs. Smith when she calls 911 versus what we do to Mrs. Smith.
In many organizations, less than half of the 911 EMS calls require paramedic intervention and an emergency room visit. These patients just need access to appropriate medical care.
Yet with the paradigm shift in our patient populations, our service delivery model has not changed. We still transport patients who don't need emergent treatment in an ambulance, which is the second most expensive form of transportation (second only to the space shuttle). We then take them to the emergency room, which is about the most expensive segment of medical care. Once our non-emergent patients get to the emergency room, they often wait two, three or more hours to be seen. That is what we do to Mrs. Smith.
So the question remains: What can we do for Mrs. Smith?
If Mrs. Smith has a non-emergent illness or injury, does she need an ambulance? Does she need to go to an emergency room? Does she even need a 5-minute response time? Can the health care system continue to pay for that type of service? The answer to the latter question is most certainly no. We must innovate and do things for Mrs. Smith instead of do things to her.
America's fire service must innovate if we expect to remain relevant as the new age of the ACA comes to pass. For today's patient populations, we must categorize our patients who call 911 and develop a system that provides the right person and number of persons with the right training; with the right equipment; with the right vehicle; and in the right time.
This will take a paradigm shift in our mission and our culture, but it is a change we must make. The ACA and ACOs may well drive us to this. I would much rather design our future than become a victim of it.
In my next blog, I will address how to determine the right time and vehicles to provide such care to patients. In the meantime, stay safe.
Mike Metro is the chief deputy for the Los Angeles County Fire Department with 37 years in the fire service. He currently serves on the executive board of the International Association of Fire Chiefs' EMS Section.