With caution and determination, leaders can leverage services that help their organization achieve the triple bottom line and thrive on value-based payment models – or, if it serves their organization better, create an in-house ambulance service to achieve those goals. In addition to capital expenditures, operating an ambulance service requires other investments. More than ever, regulators are focused on emergency services` compliance with billing rules and data protection laws. Education, quality management and logistics also require resources. A hospital system must balance these costs with the potential benefits of direct control over these services, which it believes reduces liability or the risk of being caught up in a compliance issue due to the negligence of an external organization. At the same time, employees in the hospital`s billing, compliance and quality departments may not be familiar with the requirements for ambulance operations and clinical care, and may require additional training. More and more patient care is taking place outside of the hospital, and patient navigation and logistics are becoming even more important as healthcare providers prepare for the widespread adoption of value-based payment models. Hospitals and health systems need to objectively analyze whether the organization`s emergency departments – whether internal or contract – are helping to achieve hospital or system objectives effectively and efficiently. A hospital or system must consider a number of factors when deciding whether to create or use emergency departments: the demographics of its community, the local competitive ambulance landscape, and the importance of direct control over the quality of care and patient experience. Other factors include the investments needed to develop an ambulance fleet, the emergency medical service model in the region, and how emergency services can influence market dynamics.
However, the hospital system found that timely service was an issue for its multi-contract ambulances, which also served other hospitals and communities. Ambulances could not quickly get patients out of hospitals and into their homes or care facilities in rural areas, which became a flow problem for hospitals. Hospital officials realized that they still had to transfer patients from remote facilities to the anchor hospital and, after a review, found that using a single transportation provider made more sense. Example 2: A large multi-hospital system in an urban centre on the East Coast used contract ambulance services to move patients between its hospitals. The system relied on a sophisticated control center to monitor bed availability and distribute ambulances accordingly. In order to control quality and save money, the system management considered installing the emergency services in-house. Leaders conducted an independent study on emergency services, which created a model for best practices in use and deployment. However, after the analysis, the leaders made the decision to renegotiate their ambulance supplier contract instead of developing their own internal transport service. As part of the contract negotiations and to improve conditions, managers added specific performance indicators and additional safeguards for the organization. These safeguards allow entry-level fees for vehicles and equipment to help contracted emergency services better meet system requirements.
The following case studies show how hospital systems have deployed ambulance services in the way that best meets the objectives of the system: If hospital and health system managers decide that a third-party agreement for ambulance services best suits their objectives, they should consider including six elements in the contract: at the national level, a number of forward-thinking ambulance services are adopting new and innovative models, including community paramedic and alternative destination transportation programs to help hospitals and systems achieve their patient care goals. These models often provide paramedic-managed home care and chronic disease management. For hospitals, these new models of care can help avoid 30-day readmissions and increase patient satisfaction. As healthcare evolves rapidly, hospital and health system leaders are increasingly focusing on how to customize existing service lines to achieve better patient outcomes at lower costs. Ambulance services offer unique opportunities to help leaders address these and other dimensions of the triple bottom line. Many hospitals and systems choose to create their own ambulance services to have more control over patient care and transportation and reduce costs. However, deciding to own and manage an ambulance service or contract with an external organization is more complicated than many healthcare executives realize – and can have a downstream impact on outcomes and costs. Example 1: A growing health system in the Southeast recently decided to offer its ambulance services and use a single system-wide provider. The hospital system had provided ambulance services and special transportation to one of its locations. In addition to these transportation services, the hospital system also had contracts with other emergency services, including agreements for air transportation. Finally, when negotiating contractual agreements, health organizations should carefully consider the contracts of the emergency service. For example, leaders must ensure that their organization does not run the risk of conflicting with OIG regulations.
Executives should also avoid committing Medicare/Medicaid fraud by accepting a discounted price or agreement with the entrepreneur that could be considered a bribe or volume inducement. Christine Zalar, B.S.N., M.A., is a founding partner at Fitch & Associates in Platte City, Mo. Jay Fitch, Ph.D., is President and Founding Partner of Fitch & Associates….