Rural and Frontier EMS and Rural and Frontier EMS and Trauma SummitTrauma Summit

Steven HirschOffice of Rural Health Policy (ORHP)

Health Resources & Services Administration (HRSA)U.S. Department of Health & Human Services (HHS)

May 21, 2008

NAEMT Members Overwhelmingly NAEMT Members Overwhelmingly Support Federal EMS OfficeSupport Federal EMS Office

“An overwhelming majority of EMS professionals responding to a recent survey agree that Congress should establish a federal EMS entity similar to the US Fire Administration that would raise the profile of emergency medical services (EMS) in the nation’s capitol and improve federal response to large-scale disasters.”

National Association of Emergency Medical Technicians, (NAEMT) June 14, 2006

A New EMS Resource

http://www.ems.gov/

The Office of Rural Health Policy The Office of Rural Health Policy (ORHP)(ORHP)

• Created in 1987 by Congress to address the problems that arose from the implementation of the inpatient Prospective Payment System (PPS), which led to the closure of an estimated 400 rural hospitals.

• Advises the Secretary and the Department of Health and Human Services on rural issues.

• Administers grant programs, makes policy recommendations, and supports research on rural health.

The Rural Hospital Flexibility (Flex) The Rural Hospital Flexibility (Flex) Program Program

• The Balanced Budget Act of 1997 (BBA) established the Flex Program and it was reauthorized in 2003.

• The Flex Program consists of two separate components:• A State grant program administered by ORHP to

support the development of community-based, rural, organized systems of care in the participating States.

• Cost-based reimbursement for certified Critical Access Hospitals (CAH)

The LegislationThe Legislation

• “The Secretary may award grants to States… for the establishment or expansion of a program for the provision of rural emergency medical services.”

Flex Program GoalsFlex Program Goals

• Development of State Rural Health Plan (SRHP)

• Designation of Critical Access Hospitals (CAHs) in the State

• Development and Implementation of Rural Health Networks

• Improvement and Integration of EMS Services

• Improving Quality of Care

Where are the CAHs? Where are the CAHs?

• There are 1,292 CAH hospitals, currently certified as of December 17, 2007

• The number of CAHs per State ranges from 4 to 84.

• Five States (CT, DE, MD, NJ and RI) do not have certified CAHs.

State Flex Programs: EMSState Flex Programs: EMS

• States have supported:• EMS Personnel Training• Leadership Development• Improved Rural Trauma and Critical Care

Capacity• EMS Needs Assessments• Development of a Self-Funded Liability

Product for EMS Providers

Early Flex EMS InitiativesEarly Flex EMS Initiatives

• A large number of states proposed establishing pre-hospital data collection systems and purchasing computer hardware and software to support these data systems.

• Several states used Flex Program funds to help implement EMS billing systems.

• A few states used Flex Program funds to help develop regional EMS systems or to encourage integration of the local ambulance service and the CAH, including CAH ownership of the ambulance service.

Early Flex EMS InitiativesEarly Flex EMS Initiatives

• Training initiatives. Clinical training in all aspects of emergency care for EMS personnel, hospital personnel, and medical directors, as well as training in management, billing, and data entry, were by far the most popular EMS activities carried out by the states.

• EMS needs assessments. In general, these assessments measured EMS system performance, identified problem areas, and developed strategies to respond to these problems.

State Flex Programs: State Flex Programs: Required ObjectivesRequired Objectives

• EMS• Trauma and EMS systems (State, regional or

community) assessment(s).• Trauma center designation of CAHs.• Support of CAH Trauma Team Development.• Improving EMS Medical Direction.• Support of EMS agencies in efforts of

recruitment/retention, reimbursement and restructuring.

Flex EMS Activities 2004-2005Flex EMS Activities 2004-2005PRIMARY EMS ATTRIBUTE NUMBER OF ACTIVITIES (%)

Integration of Health Services 96 (40.2)

EMS Research and/or Evaluation 22 (9.2)

Legislation and Regulation 3 (1.3)

System Finance 3 (1.3)

Human Resources 31 (13.0)

Medical Oversight 4 (1.7)

Education Systems 32 (13.4)

Public Information, Education, and Relations 6 (2.5)

Prevention 0 (0.0)

Public Access 1 (0.4)

Communication Systems 0 (0.0)

Clinical Care and Transportation Decision / Resources 4 (1.7)

Information Systems 11 (4.6)

Unclassified 26 (10.9)

TOTAL 239 (100.0)

Emergency Medical Services (EMS) Activities Funded by the Medicare Rural Hospital Flexibility Program Flex Monitoring Team Briefing Paper No. 8, February 2006.

Flex EMS objectivesFlex EMS objectives

1. Trauma and EMS systems (State, regional or community) assessment(s);

a) Employment of HRSA’s Benchmarks, Indicators, and Scoring (BIS) approach

b) Facilitated Trauma System Development

2. Trauma center designation of CAHsa) Conduct State strategic planning and systems

development to address weaknesses identified by the BIS assessment;

b) other weaknesses

Flex EMS objectives (cont.)Flex EMS objectives (cont.)

3. Support CAH Trauma Team Developmenta) Rural Trauma Team Development (RTTD)

courses

b) Comprehensive Advanced Life Support (CALS) courses

4. Improve EMS Medical Direction a) Training courses for Medical Directors other

weaknesses

Flex EMS objectives (cont.)Flex EMS objectives (cont.)

5. Implement mechanisms to support EMS agencies in efforts of recruitment/retention, reimbursement and restructuring

a) Recruitment & Retention i. Implement evidence-based recruitment and retention

programs Improve EMS Medical Direction

b) Reimbursement i. Training in comprehensive EMS agency budget processes

ii. Participation of EMS agencies in group buying and billing programs

Flex EMS objectives (cont.)Flex EMS objectives (cont.)

5. Implement mechanisms to support EMS agencies in efforts of recruitment/retention, reimbursement and restructuring

c) Restructuring i. Facilitation of BIS processes for EMS at the local and

regional level

ii. Rural EMS Manager leadership and management training

iii. Development of Systems and Pilot programs to better utilize prehospital care personnel in meeting the health care needs of rural communities in cooperation with state EMS offices.

Some Example ObjectivesSome Example Objectives

• Trauma and EMS Systems: Host a Facilitated Trauma System Development consultation and site visit by the American College of Surgeons

• Collaborate with the State EMS Regulatory Board to review and customize materials from the National Association of EMS Physicians and Critical Illness and Trauma Foundation; encourage Regional EMS Programs to sponsor State or national EMS Medical Director Training Courses.

Some Example Objectives (cont.)Some Example Objectives (cont.)

• Pre-hospital HIT demonstration project for CAH ambulance systems CAH and local EMS share pre-hospital

information electronically by 2009. In 2008, identify CAH and ambulance system, software program/process for project

Contact InformationContact Information

Steven Hirsch

Office of Rural Health Policy

5600 Fishers Lane, 9A-55

Rockville MD 20857

(301) 443-0835, Fax (301) 443-2803

shirsch@hrsa.gov

www.ruralheath.hrsa.gov