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All four of West Virginia’s federally elected officials called on the national Centers for Medicare & Medicaid services this week to implement a new treatment model they believe will help support hospitals and first responders struggling with ongoing staff shortages.
The treat-in-place model the legislators are proposing would allow emergency medical services to receive insurance payments for certain calls where a patient is brought somewhere other than a hospital for treatment.
“There are certain low acuity situations that EMS, in their current scope of practice, could ‘treat in place’ or divert to another system instead of taking that patient to an emergency room,” said Jim Kaufman, president and CEO of the West Virginia Hospital Association. “The kind of calls we’re talking about happen pretty often here.”
The request letter sent Monday by Sens. Shelley Moore Capito, R-W.Va. and Joe Manchin, D-W.Va. and Reps. Carol Miller, R-W.Va. and Alex Mooney, R-W.Va. was put together with help from the Hospital Association. The model they’re proposing is “built” on one in western Pennsylvania, and would only apply to 911 calls for three conditions: a hypoglycemia evaluation for diabetics, an asthma or COPD evaluation and a seizure evaluation for people with a preexisting condition.
According to data gathered by the Hospital Association, about 15,000 people sought care for these conditions in emergency departments across the state in 2022 but were not admitted to the hospitals.
“Patients don’t always have to go to the emergency room and there are certain patients that may need assistance of some kind, but that don’t need to be admitted, or don’t need to be waiting for hours just to not be admitted,” Kaufman said.
Kaufman’s mother-in-law has diabetes, and he said he thinks of patients like her when it comes to the option to treat-in-place.
“Every once in a while, her blood sugar gets a little off and the facility she lives at would call EMS. Well they’d come, give her some orange juice and take her to the emergency room because EMS would not get paid for that visit unless they did so,” Kaufman said. “But basically all she needed was some orange juice, a candy bar, a little bit of observation and she would be fine. She didn’t need to be in the hospital.”
The treat-in-place model would be triggered by a 911 call only if a patient meets certain criteria for the three conditions it applies to. All patients, Kaufman said, would still have the option to go to the hospital for treatment.
“A lot of the time, our EMS are already doing this — they’re just not getting paid for it, and that’s a problem,” Kaufman said.
Chris Hall, executive director of the West Virginia EMS Coalition, said emergency responders in the state — much like hospitals — are understaffed and consistently underfunded, making their resources limited.
“EMS is commonly dispatched by 911 to respond to requests for medical assistance that may not require care in an emergency room setting,” Hall said. “However, current payment rules and liability concerns prevent EMS from providing treatment in place or transporting to more appropriate treatment locations.”
First responders sometimes have to transport patients hours or dozens of miles away to get to the nearest hospital. These kinds of trips, Kaufman said, divert EMS from responding to other, potentially more emergent, situations. They also occupy hospital staff who the patient may not need to see for care.
Three of the state’s largest insurance providers — Highmark, Public Employee Insurance Agency and Medicaid — have given initial support for the model centered around the three specific conditions.
Given that support, the state Office of Emergency Medical Services has already started drafting protocols that would be followed statewide for the treat-in-place model.
“If Medicare would participate in this demonstration, West Virginia would be able to advance a statewide demonstration that all EMS providers could participate in while having the payers for approximately 75 percent of the patients that EMS treats included in the demonstration,” the letter from the federal elected officials reads.
The Hospital Association estimates that such a model could save the state “approximately” $3 million annually in unnecessary emergency room visits.
Hall said the federal support for the treat-in-place model is a “welcomed step” toward addressing ongoing challenges for EMS in West Virginia. Since 2022, at least 15 organizations licensed to respond to 911 calls have ended operations in West Virginia, affecting more than 14 counties.
“Other EMS agencies remain open but have reduced services, resulting in increased response times and lower quality of care,” Hall said. “Without additional support to help EMS providers, the West Virginia EMS Coalition believes that many communities may face the loss of emergency ambulance service or a significant reduction in service in the near future.”
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