EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review• The temptation to classify ALS personnel into lower paying positions with little roomfor promotion or professional development.• ALS not being a priority, therefore being neglected.• Believing that ALS remunerations will solve municipalities’ financial woes.• Not realizing the training commitment required for ALS.• Municipal public safety leaders sharing their power with medical directors and otherstate regulators.• Cultural changes in organization, as ALS service tends to increase participation bywomen and minorities. The organization must be able to make this advantageous fortheir service.Adding ALS to public or private organizations is not easy. There are many sacrifices andmany changes organizations will have to incur. Above all, if an organization cannot commit tofulfilling the high standards needed, IT SHOULD NOT TAKE ON ALS. The NJOEMS needs toprepare for organizations wishing to provide ALS by:• Refining the application process.• In conjunction with the MICU Advisory Committee and selected organizationalconstituencies, create a clear set of standards that must be met by applyingorganizations. Balance must be maintained to assure strict guidelines without makingit impossible to qualify.• Consider establishing pilot projects for the two years of expansion, with the first yearconcentrating on training, quality management development, establishing appropriatemedical direction and assuring plans for financial survivability. The second yearshould concentrate on implementation and evaluation of services.• ALS projects ready to proceed should not have to wait out an entire year to beoperational.• Financial projections and due diligence should be done before an ALS project isapproved.ALS Financing – It is difficult to predict what needs to be done as the future forreimbursement remains unclear. The Institute of Medicine Report pointed out that there is a $600million shortfall nationwide in EMS reimbursements. A great paradox continues to exists wherean EMS systems cost is based on a readiness capacity, but reimbursement is based onTriData, a Division of 118September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Reviewtransportation. The results of this paradox significantly effect low-volume systems, mainly inrural areas, and non-transport response systems (common for New Jersey ALS). 68While the EMS industry is unclear on the future of financing, many predict that little willchange in regards to CMS federal reimbursement. As most ALS projects have become dependenton federal reimbursement, they will continue to experience frustration and look for ways tomaximize returns. In Chapter 3 we recommended a county-wide approach to billing that mayoffer a better outcome for ALS services. ALS non-transport units serving areas of limitedtransport services should consider the benefits of providing transport.Summary of FindingsAfter reviewing the issues involving the future of ALS in New Jersey, we offer thefollowing summary of findings.• The current ALS model allows for excellent ALS care, proper medical direction andgood quality management.• The hospital-based ALS system is in jeopardy as profitability for hospitals, usingALS as a means of patient catchment and inability to afford paramedic salary andbenefits may make service prohibitive.• A graying workforce may lead to a large turnover of paramedics, especially if atransport role is added.• ALS provision should be permitted by non-hospital agencies. A strict set of standardsshould be in place prior to new services beginning.• Municipalities should consider alternate delivery models such as fire serviceparamedic first response, hospital/municipal agreements and countywide EMSsystems. These may maximize patient care while assuring economies of scale. Oneidea is to allow the municipality to provide ALS service and hospitals to providequality management and medical direction.• At this time, EMT-Intermediate is not likely to benefit New Jersey.• One paramedic and one EMT should be the minimum crew for ALS transport units.Non-transport ALS units could respond with one paramedic. Local medical directorsmay continue to require two paramedics on each ALS unit.68 Ibid., p. 36.TriData, a Division of 119September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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