by Diane Calmus, Government Affairs and Policy Manager, National Rural Health Association
How we pay for healthcare is changing. This is an opportunity to make improvements to rural healthcare including EMS. But this cannot be expecting more services for less compensation.
EMS plays an essential role in rural communities. Seventy-four percent of the rural EMS workforce is volunteer providers with limited resources. Rural EMS cares for patients longer and with higher-acuity patients. While only 20% of Americans live in rural areas, 60% of trauma deaths occur there due to more traffic accidents and hazardous occupations. The opioid abuse crisis has hit rural America particularly hard, with 45% higher opioid-related overdose deaths in rural areas. In this challenging environment, rural EMS provides excellent lifesaving care.
Unfortunately, access to care in rural America is becoming more challenging, increasing the workload for rural EMS providers. Seventy-six rural hospitals have closed since 2010, and 673 additional rural hospitals are vulnerable to closure. These closures mean increased travel distance and time without additional resources. With an aging population that is sicker and poorer, rural America’s need for EMS will increase.
NRHA believes that legislation is needed to fix the access issue. The Save Rural Hospitals Act, H.R. 3225, helps stem the tide of closures by creating a new provider type called the Community Outpatient Hospital (COH), a facility with a 24/7 ED and outpatient services but no inpatient beds. EMS is an essential part of the success of this new provider type, which is why additional dedicated grant funding for rural EMS is included. EMS will need to partner to get patients to the ED and to transfer patients who need inpatient care or a level of care not available at the COH.
The move toward value has created new models such as Accountable Care Organizations (ACO) and patient-centered medical homes (PCMH). Current payments only pay for emergency transport to the ED; however, rural ACOs and PCMHs can partner with EMS to triage patients and pay to provide the care needed by the patient instead of just what is allowed by the payment methodology. Community paramedicine programs can be a part of this, though far too many rural communities do not have paramedics. However, EMTs can also be leveraged to connect patients with providers to ensure patients receive the right – least invasive and costly – treatment. In an emergency when time is of the essence, improvements in telehealth and connectivity will improve outcomes by connecting patients with doctors directing care sooner.