City of Dallas creative improvement on EMS and revenue development.

• Author: Seals, Norman
• Position: Best Practices - Emergency medical service

City of Dallas Fire-Rescue developed a five-year strategic plan, in conjunction with internal and external stakeholders, that will increase the efficiency of the existing system and reshape the future direction of service delivery.

In the City of Dallas, Texas, the demand for pre-hospital care delivery has grown by a substantial 18 percent over the last five years. At the same time, Dallas, like most other U.S. cities, has faced fiscal challenges brought on by the recent economic downturn. As a result, the leadership of the City of Dallas Fire-Rescue Department (DFRD) found it necessary to evaluate the future of emergency medical service (EMS) delivery to the city They developed a five-year strategic plan, in conjunction with a number of internal and external stakeholders, that will increase the efficiency of the existing system and reshape the future direction of service delivery.

BACKGROUND

In addition to the economic difficulties that have plagued municipal government over the past several years, another change has developed in the area of health-care reform. For many decades, the health-care industry has been structured around a fee-for-service model. But the recent healthcare reform efforts such as the Affordable Care Act are predicated on converting to a value-based model that considers metrics such as customer satisfaction ratings, patient outcomes and the avoidance of readmission once a patient has been discharged from an in-hospital admission. Organizations are examining the costs of health care delivery and ways to lower those costs, improve patient outcomes, and increase patient satisfaction.

The shift to value-based health care will have dramatic impacts on all EMS agencies, including municipal-based agencies. Historically, the primary source of revenue for these agencies has been transporting patients to an emergency department. Some agencies also bill patients directly for treatments delivered in the home when the patient subsequently refuses treatment. But many people utilize EMS services for situations that would not be considered an emergency by most people. This, combined with the need to avoid lawsuits, means that EMS agencies are forced, for lack of better options, to transport patients who do not need anything more than transportation to an emergency department to receive minor care. This system is less than efficient, requiring a great deal of subsidy from municipal government, and it will create increasing challenges for agencies that have not changed their service delivery models.

These issues do not just affect EMS agencies, of course. Hospitals have experienced more impact from the changing societal factors and healthcare reform than EMS providers. Hospital overcrowding, readmission penalties, reimbursement reductions, customer satisfaction ratings, and many other factors are creating a difficult situation for these organizations.

One particular patient category that is causing...