Illinois Patient Navigator Pilot Program Successfully Redirects Non-Emergent Patients

In today’s rapidly changing healthcare environment, many EMS organizations (and EDs) find themselves squeezed between mandates to provide services and reimbursement rules that only provide payment for “medically necessary” services. Often, 9-1-1 calls for service come from individuals whose conditions don’t require emergency care, but nonetheless must be transported by EMS to the ED. The losses from these non-reimbursable transports are a significant threat to EMS financial viability, create unnecessary stress on EMS staff, and divert resources away from legitimate medical and trauma emergencies. One approach to address this problem has been to explore ways to reduce the number of medically unnecessary or inappropriate calls and to collaborate with transit and healthcare providers to provide access to more appropriate non-emergency services. The potential for a more integrated role for EMS was outlined in “Innovation Opportunities in EMS,” a 2013 white paper drafted by the Departments of Health and Human Services and Transportation.1 A major component of the model proposed in this paper was to develop systems to divert low-acuity patients away from EDs and into patient-centered medical homes. EMS is often the first point of contact between individuals and the healthcare system, and as such, EMS is well-positioned to intervene in a meaningful way that can improve the delivery of health services while reducing overall downstream costs. Several EMS agencies in u...
Source: JEMS Administration and Leadership - Category: Emergency Medicine Authors: Tags: Mobile Integrated Healthcare & Community Paramedicine Administration and Leadership Source Type: news