Advisory Council Recommends Changes to EMS Funding, Education

The National EMS Advisory Council approves several advisories, including recommendations to require post-secondary education for paramedics and reclassify EMS as a medical provider with CMS

Vince Robbins’ first meeting as chair of the National Emergency Medical Services Advisory Council (NEMSAC) certainly was exciting, as the council finalized seven advisories and recommended several more as drafts, on topics ranging from reimbursement to data collection.

“This meeting was pretty remarkable because so many advisories came to completion after a year and a half of these members’ hard work,” said Robbins. “These council members began their work in May of 2015, and 19 out of 25 of those seats were new appointees.”

The council addressed the “fragmented, conflicted and underfunded methods” of EMS reimbursement and payment models. Its members recommended that NHTSA and FICEMS not only conduct a comprehensive study of current EMS reimbursement systems, but also work with the Centers for Medicare and Medicaid Services (CMS) to classify EMS as a “provider” instead of “supplier.” The council echoed this suggestion in a second advisory recognizing the essential role of EMS as healthcare decision-makers.

Addressing the importance of health information exchanges (HIE), the council approved the Data Integration and Technology Committee’s call for FICEMS to support a “universal health record with bidirectional flow to all who care for patients.”

“There is value to EMS obtaining follow-up on patients,” said Steven Diaz, MD, who co-chairs the Data Integration and Technology Committee and is senior vice president and chief medical officer for Maine General Medical Center. “This does not currently exist in most places in the U.S.”

The Provider and Community Education Committee addressed the need for a strategic plan for the various tiers of paramedic education including at the associate, baccalaureate and graduate level degrees. The committee recommended that NHTSA convene a group to “craft the essentials of a core curriculum for the supplemental content in the formal paramedicine degree,” hoping to strengthen the industry perception of EMS providers as health care workers, bring parity with other allied health professionals and improve wages. Among other health professions, EMS providers are sometimes not recognized as medical practitioners due to the lack of a formalized post-secondary education requirement. To further address this problem, the committee recommended revising and aligning seminal industry documents such as the EMS Education Agenda for the Future and the National EMS Scope of Practice Model.

Robbins, who is president and CEO of MONOC, one of New Jersey’s largest EMS and mobile healthcare providers, also moderated a spirited debate among council members and members of the public regarding the proposal to streamline the numerous confusing terms used for EMS providers.

While the Innovative Practices of the EMS Workforce Committee initially suggested that the standardized terminology be determined by FICEMS and NHTSA, some members believed it was NEMSAC members’ duty to suggest a specific term. At issue was the suggested term “paramedic,” thought by some to be a way to universalize all EMS providers for the sake of consistency and to reduce confusion among laypeople about job titles. Council members disagreed about adopting this term for the interim advisory statement.

“There hasn’t been enough discussion to definitively say that the term should be ‘paramedic,’” said Val Gale, Battalion Chief of Health and Medical Services of Chandler (Arizona) Fire, Health and Medical Department. As committee co-chair, Gale expressed concern that using the word “paramedic” to describe the entire profession might produce “unintended consequences.”

Members of the public also commented on the nomenclature proposal. Gary Wingrove, former NEMSAC member and government relations specialist for Mayo Clinic Medical Transport, stated that he believes the U.S. is the only English-speaking country in the world not to use the term “paramedic” to describe all EMS providers.

“This is a time to be bold and make history,” Wingrove told the council.

Donnie Woodyard, director of EMS Compact and Information Systems for the National Registry of EMTs, expressed his agency’s hesitancy for adopting a singular title for the name.

“The different levels of EMT are well-defined and changes to these terms have a significant legislative impact,” he said.

Ultimately, the council voted 10-5 in favor of not suggesting a specific term, and the interim advisory reads: “FICEMS and the DOT should officially recognize an all-inclusive standard generic term nationally to describe all health care providers performing within the field of paramedicine, regardless of certification or licensure.” A final vote on the advisory will take place in 2017.

Robbins emphasized the common theme among the finalized advisories: that the EMS system codified in the 1970s has evolved into something very different than it was.

“We need to recognize this evolution and give it a name,” Robbins said. “It is not really just EMS anymore.”

Finally, the council and federal officials recognized outgoing Chair John Sinclair and Vice-Chair Anne Montera for their dedication and contributions to the council. Sinclair and Montera, who served one-year terms, will continue to serve on NEMSAC until the council members’ two-year terms expire in the spring. Robbins said that the transition to a new administration in the White House would likely delay the appointment process for new and existing council members.

The NEMSAC’s final and interim advisories will be available on the NEMSAC website.