Emergency
Medical Services: Phase One
Keypoints -
Briefing
Emergency Medical Services: Phase One
Background
Ø Key legislation establishing regulation of emergency medical services (EMS) in Connecticut was enacted in 1967, 1974, and 1980.
Ø
Ambulance
services must be certified or licensed to operate.
Commercial services are licensed and nonprofit providers are certified.
There are currently 167 certified and 17 commercial providers.
About 107 of these ambulance services charge for their services.
Ø
Connecticut’s
regulation of EMS is comprehensive and involves territorial assignment of
providers (into primary service areas), rate setting, and determination of need.
Ø
Ambulance
services that charge must have approval from DPH to offer new or expanded
services. The purchase of an
existing ambulance provider in its entirety is exempt from the DPH determination
of need requirements.
Ø
Primary
services areas (PSAs) were first designated in 1974 as a result of legislative
action. For each town, DPH
designates PSA responders at three levels – first responder, basic life
support (BLS), and advanced life support (ALS).
Ø
There
are currently 181 designated first responders, and 183 BLS and 107 ALS
responders.
Ø
DPH
sets maximum allowable statewide rates that each provider may
charge for different levels of ambulance service.
Ø
Government
and private third party payers establish rates for what they will
pay for ambulance transport service.
Ø
Medicare
recipients comprise the largest portion -- 55 percent -- of both emergency and
non-emergency ambulance call volume; Medicaid
makes up 12 percent.
Ø
The
top six commercial providers handle between 75 and 80 percent of all ambulance
calls in Connecticut. The filed
rates by these commercial providers have all exceeded the provider statewide
average rate since 1994.
Ø
Committee
recommendations maintain the current system, but suggest policy enhancements to
improve the ability of both local and state government to perform oversight
functions.
Ø
Reasons
for the scope of recommendations include:
· need for enhanced accountability;
· unclear need for wholesale change;
· recent significant changes just implemented or proposed; and
·
complexity
of the current system.
Ø
Recommendation
areas include:
·
local
EMS plans need to be established;
·
mechanism
to resolve EMS provider and municipal differences over performance agreement is
required;
·
model
guidelines for local EMS plans and agreements need to be developed;
·
municipalities’
ability to remove EMS providers for poor performance needs to be improved;
·
annual
report on local EMS plans is necessary to track performance;
·
response
time measurement is imprecise, and requires common definition;
·
sales
of existing ambulance companies holding PSAs should include adoption of existing
performance agreements; and
·
outcome
measures need to be developed to assess EMS system.
Ø
Further
refinements to the system will be explored in Phase II of the EMS study.
Ø
The
committee took no action on alternative approaches that would alter the
fundamental regulatory structure.
The chart that follows summarizes the proposed changes to the EMS system. It provides an overview comparing the current regulatory structure to the proposed changes for each of the main participants in the system.
Proposed
Changes Regarding Accountability in the EMS System
|
|
|
Current
Regulation |
Proposed Change |
Department of Public Health |
|
|
Planning for EMS is disconnected with municipalities |
Municipalities become a planning partner with the state |
|
May inspect response time records |
Required to receive and publish uniform information on response times |
|
Has minimal performance standards in regulation |
Will provide guidance documents on performance agreements and oversee system of locally determined performance standards |
|
In most cases, the only entity providing oversight of providers that could lead to corrective action or negative consequences |
Municipalities have greater role in providing oversight and in developing corrective action plans |
|
May remove a provider if it determines that it is in the best interest of patient care to do so |
This standard is maintained |
|
Extent of subcontracting by PSA holders is unknown |
Subcontracting and mutual aid agreements must be disclosed in EMS plan and agreements |
Municipalities
|
|
|
Participate in initial sign-off for indefinite PSA assignment – no reconsideration of PSA |
PSA assignment can be reconsidered every three years if previously agreed to performance standards are not met |
|
Have attenuated role in EMS planning |
Have a direct and active role in determining the level and quality of service provided in own community |
|
May contract for services |
Must have an enforceable agreement with providers |
|
May develop performance standards. Municipalities that have developed standards, in most cases, only have standards for basic ambulance service |
Must develop performance standards based on local conditions and resources for the continuum of EMS providers from dispatch to advanced life support |
|
May monitor performance standards |
Must monitor the performance of providers |
|
Residents may receive information on the performance of their municipality’s EMS provider |
Must report publicly on the performance of providers on at least an annual basis and will be publicized by DPH |
|
May petition DPH for removal if an emergency exists and if the actions of the PSA holder jeopardize the safety, health, and welfare of the citizens |
May petition DPH for removal of a PSA responder based on poor performance as defined by the municipality as well as existing standard |
|
No assurances about provider performance, if the current provider changes ownership |
New owner must abide by existing performance contracts |
Providers
|
|
|
May enter into an agreement with municipality |
Required to enter into an agreement with municipality |
|
May be subject to performance standards |
Required to adhere to locally determined performance standards |