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Rural Hospital Flexibility Program Tracking Project
Appendix D5
Emergency Medical Services
Information
Collected During State and Hospital Site Visits
This protocol is designed for use with the
hospital-based person judged to be the most knowledgeable about the hospital's ER situation and the local EMS
system. It is likely that this person will be the CEO or the head of the ED, but it might also be the medical director or the director of nursing. Thus, even if you have already administered a separate protocol to this person, please ask the full set of EMS questions as well. If you have time to pose these questions to more than one knowledgeable respondent at the hospital, please do so.
INTRODUCTION (not to be read verbatim): The Rural Hospital Flexibility Program provides funding explicitly for initiatives designed to strengthen rural EMS systems. There are also a number of reasons that conversion to CAH status might affect the way your facility and the local EMS system interact. For example:
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your hospital must be linked with at least one referral hospital and have formal patient transfer agreements,
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you must make emergency care available around the clock, but staffing requirements for the ED have been relaxed,
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the 96-hour limit on average length of stay may affect the number or type of patients transferred between your hospital and other facilities,
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changes in the scope of services provided by your hospital may affect care for patients in your ER.
Today, we would like to explore some of these issues with you.
I. Pre-Conversion Hospital And Area Characteristics
Basic information on the local EMS system and the hospital's ED should be available from the pre-visit questionnaire. Please send a copy of that document to Project HOPE.
(7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133)
1.
Before discussing any changes that may have come about as a result of CAH conversion, I'd like to get your impressions of the
local EMS system that existed before conversion.
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In general, do you think this system was
adequate to meet the pre-hospital needs of the community?
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Were there any major shortcomings of this system? (If needed, might prompt on some of the following components: vehicles, equipment, personnel, medical direction, response times, skill levels, communications, coordination between providers.)
2.
How about your hospital's emergency department? Were there sufficient resources and infrastructure to provide for the emergency needs of patients who presented in the ER?
II.
The Conversion Decision And Character Of The Process
No questions in this section.
III.
The Post Conversion Experience
1. Has CAH conversion had any impact on the local EMS system? For example:
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Increase/decrease in
number of CAH patients transferred to other facilities
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Increase/decrease in need to
send CAH nurses on inter-facility transports
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Change in the way
medical direction is provided
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Change in amount of
collaboration/integration between local ambulance providers and the CAH (e.g., shared supplies/staff, joint purchasing/training, shared data systems, CAH now billing for ambulance providers, CAH now owns or operates local ambulance service)
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Change in amount of
collaboration between local ambulance providers (e.g., pooling of capital, sharing of equipment, mutual aid agreements, joint purchasing)
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Other activities funded explicitly with RHFP funds (e.g., collection of trauma data, EMS/ED training programs, equipment upgrades, enhanced communications systems)
2.
Has CAH conversion had any impact on your hospital's ED? For example:
-
Hours of operation
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ED staffing (e.g., now using PAs instead of MDs; if so, impact on costs, quality?)
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Number/type of
patients coming to ER (e.g., hospital is bypassed less because it is now part of formal system, or bypassed more because it no longer provides some types of care)
3.
Do you expect any (further) changes along these lines in the future?
IV. Emerging Issues
Background for
Interviewers:
The new Medicare fee schedule for ambulance services was scheduled to take effect on January 1, 2001, but has been delayed to an unknown date. The proposed fee schedule will disadvantage hospitals that had been operating their own ambulance service and receiving cost-based reimbursement, as well as ambulance services that were under contract to a hospital that billed Medicare (on a cost basis) on their behalf. Thus, the fee schedule could provide an incentive for a CAH to divest itself of its ambulance service.
The Medicare Benefit Improvement and Protection Act (BIPA) of 2000 now allows CAHs that own or operate an ambulance service to receive reasonable costs for these services, as long as there is no other provider of ambulance services within 35 miles of the CAH. For CAHs that qualify, this provision helps to mitigate the proposed fee schedule's disincentive to providing ambulance services, and may even encourage CAHs without ambulance services to begin providing these services.
1. IF THE HOSPITAL OWNS/OPERATES AN AMBULANCE SERVICE:
Is there
any other ambulance service located within 35 miles of your own service?
If yes:
(CAH will be subject to the new Medicare ambulance fee schedule and cannot receive Medicare cost-based reimbursement for its ambulance services.)
Do you think that the
proposed Medicare fee schedule for ambulance services will have any impact on your hospital's continued operation of its ambulance service?
If no: (As a result of the Medicare Benefits Improvement and Protection Act of 2000, the CAH will receive Medicare cost-based reimbursement for its ambulance services instead of the new Medicare ambulance fee schedule.)
Do you think your hospital will continue to operate this ambulance service in the future?
If yes: How important is the new Medicare provision permitting you to receive cost-based reimbursement for these services to your decision to continue providing ambulance services?
If no: What are your main reasons for discontinuing this service? Are you aware that CAHs may now receive cost-based reimbursement for their ambulance services instead of the new Medicare ambulance fee schedule (as long as there is no other ambulance provider within 35 miles)?
2. IF THE HOSPITAL DOES NOT OWN/OPERATE AN AMBULANCE SERVICE:
Has this hospital ever seriously considered operating its own ambulance service?
If yes: Has the proposed Medicare fee schedule for ambulance services been a deterrent to your taking this step?
Recent legislation (the Medicare benefits Improvement and Protection Act of 2000) now allows CAHs to receive
cost-based reimbursement for ambulance services that they provide, as long as there is no other provider of ambulance services within 35 miles. Is there any possibility that you will
begin operating your own ambulance service in the future in order to take advantage of this provision?
3. Are there any (other) issues standing in the way of a closer integration of EMS services into the CAH's rural health network?
V. Closing
1. Are there any problems remaining with either the local EMS system or your hospital's ED that you think could be helped by (additional) RHFP funds? What (else) would you like to see happen as a way of improving the provision of EMS locally?
2.
Do you have any advice for EMS stakeholders in other areas with a hospital considering CAH conversion?
3. Could I please get your job title and a phone number in case other members of our team wish to contact you later for additional information?
Job title: ______________________________________
Phone: ________________________________________
4. Is there anyone else in the hospital or in the community that you think we should speak with to gather additional information? If so, get name, title, and phone number, plus try to indicate why this person is being suggested.
Name: ______________________________________________________________
Job title: ____________________________________________________________
Phone: ______________________________________________________________
Reason to contact: ____________________________________________________
Name: ______________________________________________________________
Job title: ____________________________________________________________
Phone: ______________________________________________________________
Reason to contact: ____________________________________________________
Name: ______________________________________________________________
Job title: ____________________________________________________________
Phone: ______________________________________________________________
Reason to contact: ____________________________________________________
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