ACA and EMS
The implementation of the Affordable Care Act (ACA) is sure to change the way EMS operate in the coming years. Accountable Care Organizations (ACO), for instance, are now responsible for overseeing how reimbursements are paid out to those agencies that provide health care -- and at the same time they are responsible for gauging whether or not quality care is delivered by providers (Koury et al., 2014). This is a tall order for a new functioning body and the ACOs tasked with these orders will have an indirect impact on how EMS operates. To see how that impact will be effected, an examination of the ACOs and hospitals interact requires examination -- because it is that interaction that will inevitably alter the way in which the EMS goes about their business. This paper will examine the relationship between the ACA, ACOs, hospitals and EMS and show how an EMS Administrator might prepare for the changes. Specifically, this paper will discuss the ACA legislation, what Emergency Care means, how insurance coverage is a factor in impacting EMS, where revenues come into play, how sustainability will be a factor to consider over the long-run (with ACA co-ops already closing their doors, the long-run outlook is having a decidedly short-run impact), and how healthcare integration will alter EMS. This alteration will be the main focus of the paper.
ACA Legislation
One of the most direct ways in the ACA legislation impacts EMS is the awarding of "competitive grants for regionalized systems for emergency care response" (ACA, 2010, Sec. 1204, 124 STAT., p. 518). These grants go to provide monetary support to local or regional pilot projects "that design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems" (ACA, 2010, Sec. 1204, 124 STAT., p. 518). Emergency services is defined as service that provides "acute, prehospital, and trauma care" (ACA, 2010, Sec. 1204, 124 STAT., p. 518). These monies for pilot projects are reserved precisely for networks of care providers, who form an integrated emergency services care plan complete with transports, facilities, tracking resources, and an interfacility data management system that "submits data to the National EMS Information System" among various other agencies (ACA, 2010, Sec. 1204, 124 STAT., p. 519). In short, the legislation states that the federal government will grant money to health care providers who work to integrate EMS, hospitals, and tracking services and uniting these entities under a single umbrella. Holding that umbrella will be the federal government, which will collect the data and evaluate the variables that impact prehospital care as well as outcomes related to interfacility actions. The ACA thus sets up local and regional actors to be integrated into a federalized system of care. This may be viewed as akin to what the state governments of the original thirteen colonies underwent when the ratification of the U.S. Constitution presented itself as fact: the matter of states' rights vs. federal authority would no longer be a question -- the federalization of power was made a reality by the consolidation expressed in the Constitution. In the ACA legislation, consolidation is the driving force, and the federal government is the pivot upon which health care providers will turn. As for EMS, the concept of emergency care will likewise undergo a federalization and take on new meaning and new dimensions as a result.
What Emergency Care Means
and How Healthcare Integration Will Change the EMS
Emergency Care according the ACA is that type of service which provides acute, prehospital and trauma care for individuals. However, as the legislation is enforced and regional and local providers begin to integrate and compete for federal grants, this definition is likely to incorporate new concepts and be expanded to fit the needs of the ACOs which will monitor the quality of care delivered by integrated health providers, including EMS. With new oversight comes new expectations and a need to conform to new standards and regulations. EMS, for instance, will be expected to alleviate the pressure placed upon hospitals to ensure that quality of care expectations are being met (Ludwig, 2013). This will include obliging EMS to make home calls to patients post-discharge for up to three days in order to reduce the risk of complications arising and patients needing to be re-admitted. Re-admittance is a factor that will serve as a red flag to ACOs and cause hospitals to lose reimbursement funds that would otherwise be granted them through the ACA.
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