An EY category #3 example from emergency medical services (EMS) in the USA
>How things are currently, and why that’s bad. When someone tells a public safety access point (PSAP) that there might be a problem, the dispatcher generally sends an ambulance at a minimum. Then, the city or ambulance provider takes the nearest obvious patient(s) to the emergency room. The resulting EMS bill is often extremely high as well as the ER bill. Sometimes, the providers are not in-network and the patient must pay in full even if there was not a true emergency.
>How they could be instead, and why that’s better. The PSAP could pre-commit to only sending certain types of units when a set of criteria are met. And, if none of the criteria are met for a public safety response, then the patient could be given self-care instructions ranging from watchful waiting to calling the patient’s doctor. If a crew is sent to the scene, then the crew could send the patient to the most appropriate place (ranging from “stay home for a week” to “Uh oh, you really do need an emergency room.”). This would result in greatly reduced spending by the PSAP, public safety agencies, ambulance providers, hospital, patient, and other healthcare-related entities. The patient would also have better outcomes due to decreased financial stress, decreased risk of iatrogenic infections, etc.
>What’s blocking the transition from 1 to 2. A public safety agency/ambulance provider is only paid when they transport a patient to the emergency room because that’s what all the insurance companies have agreed to do.
If a hospital dares to tell an ambulance provider that they can send patients to another type of location, the hospital will lose money.
If an ambulance crew does not transport a patient to an emergency room, the crew takes on liability for practicing unconventional medicine.
Dispatchers are generally not permitted to send anything less than an ambulance and a fire engine. Sometimes, ambulances are only provided at the most costly level (ALS). The crew may even be required to go lights and sirens as a matter of policy despite the increased risk of death and injury. But if a city does not do a “full response”, then it is on the hook if anyone complains about reduced responses (aka political fallout) and there may be legal liability for the reduced response. Dispatchers are also often not RN or MDs. So they may not be permitted to definitively diagnosis or recommend treatment outside of a very narrow set of pre-defined situations.
April 25, 2021 Update: Today, there is a New York Times article talking about the closure of ambulance services in rural America. As the article says, the situation was entirely foreseeable (article reasonably claims that the direct proximate cause was lowered patient transport volumes from Coronavirus disease 2019).
An EY category #3 example from emergency medical services (EMS) in the USA
>How things are currently, and why that’s bad.
When someone tells a public safety access point (PSAP) that there might be a problem, the dispatcher generally sends an ambulance at a minimum. Then, the city or ambulance provider takes the nearest obvious patient(s) to the emergency room. The resulting EMS bill is often extremely high as well as the ER bill. Sometimes, the providers are not in-network and the patient must pay in full even if there was not a true emergency.
>How they could be instead, and why that’s better.
The PSAP could pre-commit to only sending certain types of units when a set of criteria are met. And, if none of the criteria are met for a public safety response, then the patient could be given self-care instructions ranging from watchful waiting to calling the patient’s doctor. If a crew is sent to the scene, then the crew could send the patient to the most appropriate place (ranging from “stay home for a week” to “Uh oh, you really do need an emergency room.”). This would result in greatly reduced spending by the PSAP, public safety agencies, ambulance providers, hospital, patient, and other healthcare-related entities. The patient would also have better outcomes due to decreased financial stress, decreased risk of iatrogenic infections, etc.
>What’s blocking the transition from 1 to 2.
A public safety agency/ambulance provider is only paid when they transport a patient to the emergency room because that’s what all the insurance companies have agreed to do.
If a hospital dares to tell an ambulance provider that they can send patients to another type of location, the hospital will lose money.
If an ambulance crew does not transport a patient to an emergency room, the crew takes on liability for practicing unconventional medicine.
Dispatchers are generally not permitted to send anything less than an ambulance and a fire engine. Sometimes, ambulances are only provided at the most costly level (ALS). The crew may even be required to go lights and sirens as a matter of policy despite the increased risk of death and injury. But if a city does not do a “full response”, then it is on the hook if anyone complains about reduced responses (aka political fallout) and there may be legal liability for the reduced response. Dispatchers are also often not RN or MDs. So they may not be permitted to definitively diagnosis or recommend treatment outside of a very narrow set of pre-defined situations.
For what it’s worth, Coronavirus disease 2019 has forced many cities to change their practices because there are not enough units. CMS has also had on-again-off-again efforts to send patients to alternate destinations (e.g. https://www.cms.gov/newsroom/fact-sheets/emergency-triage-treat-and-transport-et3-model) but many such programs eventually end and the local city must find alternative grant funding in the long-term. As usual, the necessary know-how has existed for decades (e.g. https://en.wikipedia.org/wiki/Medical_Priority_Dispatch_System#Response_Determinant).
April 25, 2021 Update: Today, there is a New York Times article talking about the closure of ambulance services in rural America. As the article says, the situation was entirely foreseeable (article reasonably claims that the direct proximate cause was lowered patient transport volumes from Coronavirus disease 2019).