The utilization of telehealth in Emergency Medical Services (EMS) has the potential to revolutionize how care is delivered prior to hospital admission. By providing video visits between the patient and provider, EMS can work with clinics, hospitals, and health systems to best evaluate whether a transfer is necessary, and what care the patient requires. Avoiding unnecessary readmission cuts superfluous costs to the health system and ensures that EMS is used most efficiently.
CMS Launches Emergency Triage, Treatment, and Transport (ET3)
EMS plays an essential role in the prehospital management of nearly 240 million 9-1-1 callers each year. While most 9-1-1 calls are not urgent or high-risk, they still require the same resource-intensive response as a true emergency. Before ET3 (detailed below), typical EMS protocol required the transport of 9-1-1 patients to the Emergency Department (ED) and lacked the incentive to transport patients to other more appropriate destinations. As a result, resource costs were high due to unnecessary transport and ED care for non-urgent primary care patients.
Earlier this year, the US Centers for Medicare & Medicaid Services (CMS) announced the launch of an innovative pilot program and a change in reimbursement for EMS called ET3. The goal of ET3 is to help redesign emergency triage, treatment, and transport, aiming to improve the quality of care and lower the costs associated with emergency care incidents.
Under ET3, CMS will reimburse ambulance providers for:
1. Transportation of patients to an alternative destination, like an urgent care clinic or primary care provider’s office.
2. Provision of treatment in place with a qualified healthcare practitioner, whether at the scene or using telehealth.
In Practice: Telehealth and EMS
In 2015, researchers teamed up with Houston’s Fire Department to launch ETHAN, a program designed to measure the efficacy of using a combination of telemedicine, social service pathways and alternative ways of transportation for patients who did not require an ED visit. The study was an observational cohort study over a four-year period (2015-2018) that included all patients treated by tele-EMS in counties across Houston. The patients included in the program were those with primary care-related complaints, with the most common being “abdominal pain,” “sick,” “injury/wound,” and “other pain.” Physicians working in the Houston Emergency Center screened the identified patients remotely via video.
If both the physician and the patient agreed that their symptoms and condition were non-emergent, the physician would pursue one of three pathways with EMS:
1. Provide a taxi ride (a non-emergency ambulance transfer) to the ED for conditions difficult to address in a primary care office;
2. Referral with a taxi ride to a primary care physician appointment made by the emergency physician;
3. Non-transport and delivery of aftercare instructions
Over 12 months, EMS providers enrolled 5,570 patients and compared them to a control group of patients with similar conditions who did not participate in the study. Of the patients included in the ETHAN program, 18% were transported to the ED vs. 74% in the control group. EMS crews were reported to have returned to services 44 minutes faster for the ETHAN patients. Researchers were able to conclude there was no difference in clinical outcomes or patient satisfaction for either of the groups.
The Houston Fire Department's telehealth program reported an estimated savings of $1.771 million in direct costs during the most recent year and over $4.712 million since the program began. These cost savings are for the agency alone and don't factor in hospital-related cost savings from ED visits avoided.
Life EMS’ Ambulatory Program with HRS
Health Recovery Solutions (HRS) recently launched an innovative telehealth program with Life EMS Ambulance, a nationally recognized provider of emergency and mobility services to provide better patient outcomes while reducing healthcare expenditures and improving the overall quality of life for patients and their caregivers. Within the program, Life EMS has been able to manage nearly 100 patients per quarter, helping to reduce unnecessary costs and allocate the proper resources to provide the most appropriate care to their patients.
Patients with low priority conditions can be immediately and remotely evaluated through secure video conferencing technology instead of facing a long wait time in an ED, exacerbating its congestion. Telehealth technologies allow hospitals and health systems to screen incoming patients, referring the life-threatening cases to on-site staff while other non-acute cases can be treated through video calls, remote care or referring these patients to other services. Telehealth utilization in emergency departments provides physicians with real time information to more accurately triage patients, ultimately maximizing workflow efficiency.
References:
- https://www.nena.org/page/911Statistics
- https://www.jems.com/articles/2019/04/tele-ems-improves-productivity-and-reduces-overall-costs.html
- https://www.columbiasouthern.edu/blog/january-2019/looking-forward-why-telemedicine-needs-to-be-a-bi
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5102597/