What is in this article?:
The Patient Protection and Affordability Care Act, commonly known as Obamacare, provides numerous opportunities for fire-based EMS. What will those opportunities look like? Check out these 10 affected areas.
President Obama signed the Patient Protection and Affordability Care Act (PPACA) into law more than three years ago. Segments of private-sector EMS already have restructured their deployment models and drafted comprehensive changes to their operation plans. They now are waiting on healthcare market timing to implement their plans (in some cases nationwide).
Fire-service leaders may be asking themselves, “How does the PPACA affect my fire department?” This will be answered at the local level. Within the national framework of healthcare systems are a number of regional and local healthcare markets. What matters most to individual fire departments are the healthcare system changes coming to you locally. We will not all be faced with the same threats or opportunities. As they should, the changes you need to address will have more to do with specific healthcare challenges that face the citizens you protect, not an aggregate of the national healthcare picture.
There will be significant threats facing the fire service as a result of the PPACA, and it is the responsibility of fire service leaders to protect their community from these threats. I will address these threats in a future article. The intent and goal of this article is to elaborate on the many opportunities that exist for local fire service leaders to mount a response to the PPACA. Any negative impact your jurisdiction will face is directly affected by the amount of action, or inaction, fire service leaders have taken in direct response to the PPACA over the past three years — and most importantly, in the next 12to 18months.
Anyone who has studied an overview of PPACA as it relates to the fire service has seen that the act provides numerous. What exactly do those opportunities look like? Remember, in order to maximize the opportunity within your jurisdiction, significant work will need to be conducted locally.
This article will address 10 specific areas that can be built upon as a direct result of the PPACA. Within the context of these areas, ask yourself at least the following questions before determining your course of action:
- Who are the stakeholders/decision-makers from the local healthcare community with whom I need to engage in the collective process?
- How are private-sector medical agencies positioned to respond in my area?
- What will the local fire-service response look like three, five and 10 years from now?
- In which of these opportunities will your department play an integral role? Keep in mind, if you decide not to make a decision, the private sector will likely make it for you.
- What are the revenue opportunities for the fire service and who will hold the purse strings?
- What community assets does my organization possesses that will contribute to the local healthcare system?
The basic intent of the PPACA is to provide healthcare coverage to as many Americans as possible. In so doing, the concept of accountable care organizations (ACOs) are being implemented nationwide. These ACOs will be responsible for monitoring and controlling reimbursement to healthcare providers. In most systems, the ACO will be a local hospital or a system of hospitals. The PPACA will be using the leverage of the Medicare and Medicaid funding to incentivize changes. Fee for service is a practice that the healthcare industry will be incented away from, while the system will incent toward demonstrations of quality, prevention, cost-savings and patient-centered outcomes.
The opportunities created by the PPACA are best approached together, under the context of system thinking. While each could be identified, implemented and improved upon, the PPACA is an all-encompassing structural overhaul of the U.S. healthcare system. Therefore, an appropriate response from a fire-based EMS system is a comprehensive structural overhaul maximizing the benefit of the strengths of PPACA while minimizing the negative impacts to your organization and community.