President-Elect Donald Trump is nominating Robert F. Kennedy, Jr., to be the secretary of the Department of Health and Human Services, and Dr. Oz Mehmet to be the director of the Centers for Medicare and Medicaid Services. In these positions, Trump, Kennedy and Dr. Oz are promising to “Make America Healthy Again,” which is an advocacy movement and book by the same title.
Their goals, as I understand them, include familiar ambitions like reducing suffering from chronic disease and reducing consumption of highly processed foods. Other goals might include making childhood vaccinations optional or unavailable, reducing the influence of drug makers on health policy and making alternative treatments more easily available.
As EMS at the federal level is a part of the National Highway Transportation Safety Administration within the Department of Transportation, EMS leaders and providers lack a formal path to influence HHS and CMS. That being said, here are three prescriptions for Kennedy and Dr. Oz to consider as they work to “Make America Healthy Again.”
Rx 1: Full reimbursement for Medicare and Medicaid patient transports
Most EMS agencies lose money on every Medicare and Medicaid patient transport, which compromises agency staffing, availability, equipment and training. Full reimbursement for every patient transport, regardless of payor, will improve the healthcare EMS can deliver each day to all the patients they encounter.
Rx 2: Reimbursement for alternative transport destinations and treatment in place
Many patients don’t need transport to a hospital, let alone an emergency room visit. For example, falls are a common patient response in many service areas. If the patient is covered by Medicare and declines transport, there is no reimbursement for the response and lift assist. There is also no financial incentive for the EMS providers to determine the underlying cause of the fall, connect the patient to healthcare or social services, or request durable medical equipment to help keep the patient upright.
Many conditions, like hypoglycemia and opioid overdose, are treated in place and, after treatment, the patient is awake and alert enough to decline transport. Again, many of these responses are not reimbursed by federal payors.
There are also many conditions, like acute alcohol intoxication, that don’t require emergency department care, but the patient is too obtunded to be left alone to sleep it off. Transporting the patient to a sobering center, an alternative destination, should be eligible for reimbursement.
Kennedy and Dr. Oz could have an immediate impact on the quality and viability of the prehospital care system, while also reducing emergency department overcrowding, by allowing CMS to reimburse alternative transport destinations and treatment in place.
Rx 3: Eat less, move more
More than 70% of Americans are overweight or obese, a statistic that EMS providers know all too well, because they are responsible for lifting and moving many of those Americans every day. EMS rarely is dispatched to a patient just because they are overweight. Instead, EMS responds to patients with health conditions, like diabetes, hypertension, stroke and heart attack, that are caused by or worsened by obesity.
There will be EMS providers cheering in the streets if Kennedy and Dr. Oz can reduce American’s consumption of highly processed foods, sugar-laden hot and cold drinks, and oversized meal portions. In addition to eating better and less, HHS and CMS can encourage and incentivize all Americans, not just those on Medicare and Medicaid, to move more. Regular exercise, of any type, is better than no exercise.
Your Rx to MAHA
What are your prescriptions to “Make America Healthy Again”? How can the changing HHS and CMS leadership and their priorities best serve the needs of EMS providers and make prehospital medicine sustainable? Send us an email, editor@ems1.com.
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