The dawn of a new year traditionally generates a spate of resolutions that usually are borne of a desire to change the way we conduct our lives or do business. On that note, forward-thinking fire chiefs might want to examine how emergency medical services are being delivered by their agencies, as this year could be a turning point. That’s because the future of pre-hospital medicine will be about cost effectiveness. Government and the insurance industry will be looking to see whether our actions really make a difference — a financial difference. It no longer will be enough to provide quality care. Going forward, EMS also must be able to demonstrate that it is reducing healthcare expenses.

There are three events that bear watching in 2012, as they could make this a watershed year for EMS. One concerns the roughly $1 billion that the U.S. Department of Health and Human Services plans to release for EMS projects that support non-traditional methods of delivery. It is a substantial amount of money that rivals the appropriations made for the FIRE Grants. The goal of this initiative is to reduce the financial burden on Medicare and Medicaid. Make no mistake: this is the future of EMS, which will be marked by focused efforts designed to reduce costs and make better use of every healthcare dollar, the amount of which continues to shrink.

As a result, a much greater emphasis will be placed on outcomes and measurable results. In the future, fire and EMS agencies will find it more difficult to get reimbursed for the services they provide or to receive grant money. They will have to demonstrate that they not only are effective, but also cost-effective — and they will have to back up their claims with facts. Consequently, chiefs need to start thinking in terms of outcomes, as opposed to responses. Providing EMS in the future won’t be a matter of doing more with less — it will be a question of doing it at all.

Unfortunately it all comes down to money and as it becomes scarcer, today’s fire service — in the majority of cases — doesn’t find itself in a defensible position with factual information to make the case that it is providing outcome-based EMS. What is unfortunate about this is that the IAFF more than two decades ago tried to get fire-based EMS on board with a quality initiative.

Despite the creation of a robust list of validated measurement criteria, the effort didn’t receive much buy-in, from either management or personnel. This truly was a missed opportunity to refocus fire-based EMS on quality and not on quantity. Had this initiative taken root, we’d have 20 years of data and the medical industry would be coming to us for best practices. In other words, fire-based quality initiatives would be setting the standard — not responding to it.

Another related event worth watching concerns the proposed rule changes that would ensure that future Medicare and Medicaid reimbursements are based on outcomes. This is not a new phenomenon, as physicians and hospitals have been under limited outcome-reimbursement strategies for years. For instance, Press Ganey is an assessment of the customer/doctor experience, with reimbursements affected by cumulative scores.

So how would this work in the fire service? Let’s say that fire department “A” takes a patient who is in congestive heart failure with pulmonary edema to the hospital; meanwhile fire department “B” transports another patient with an identical condition. Fire department “A” puts an endotracheal tube into its patient, who has to be put on a ventilator, while fire department “B” puts its patient on a CPAP device. The outcome is that patient “A” stays in the hospital for almost a week days while patient “B” stays for just two days.

Because Medicare and insurance only pays for four days of hospital confinement, fire department “B” would receive full reimbursement for its transport. However, fire department “A” would only get 50% of its bill because it selected a therapy that resulted in a longer hospital stay. The agency will have to agree to this penalty or risk being dropped as a Medicare provider. Most fire and EMS agencies cannot afford such an event. The silver lining to this is that the Houston Fire Department already has demonstrated that the approach can save the medical system hundreds of thousands of dollars each year.

Finally, it will be important to keep tabs on a bill that was introduced into Congress last October by Rep. Timothy Walz (D-Minn.). Dubbed the “Field EMS Quality, Innovation, and Cost Effectiveness Improvement Act of 2011,” H.R. 3144 seeks to ensure high-quality, cost-effective EMS systems. An interesting aspect of the legislation is that it would place EMS into a newly formed Office of EMS and Trauma that would exist within the HHS. This is important because some of the brightest people in pre-hospital medicine already are working under the auspices of the HHS, and because such a maneuver would result in EMS providers being forced to live by many of the standards that exist within the healthcare system.

It is important too because a move into HHS would bring EMS closer to where the money is — and there is big money in this bill, as it would establish the EQUIP and SPIA grants. The essential goal of the legislation is to integrate EMS into the nation’s health system, promote service quality and fund innovation. More than $200 million is being designated for EQUIP grants that will be distributed from 2013–2016. The grant program is designed to promote excellence in all aspects of field EMS by enhancing the quality of patient care through evidence-based practices. The money can be used to sustain field EMS providers 24/7 and to establish innovative clinical practices. This also includes medical equipment for training related to innovative approaches.

In addition, another $4 million for EMS quality projects also would be authorized, as would $40 million to fund the SPIA grants that are designed to improve EMS system performance at the state and local levels. This money can be used to enhance data collection, field EMS education, disaster care and trauma collection. Finally, $15 million will be set aside for projects that would cover everything from clinical education to EMS management training and bridge courses. All in all it is a significant boost to fire-based EMS.

As a new year begins, the future for fire-based EMS will hinge on innovation and accountability. Embrace these concepts and the result will be in line with the Chinese Year of the Dragon, which calls for much success and happiness in 2012.

Bruce Evans is the deputy chief for the Upper Pine Fire Protection District in Bayfield Colo. He also is an adjunct faculty member for the National Fire Academy’s EMS and injury prevention courses.