MedStar Mobile Healthcare

The Texas EMS Alliance recently conducted a Q&A with Doug Hooten and Matt Zavadsky of MedStar Mobile Healthcare in Fort Worth to listen to their thoughts on the future of EMS in Texas.

Doug Hooten serves as the CEO and Matt Zavadsky serves as the Chief Strategic Integration Officer. Under their leadership, MedStar has developed and implemented numerous programs with payors and other health care stakeholders that have transformed MedStar into a fully integrated partner in health care delivery. MedStar has received numerous state and national awards for their innovative approaches to high performance and high-value service delivery.

Matt Zavadsky is pictured speaking at EMS EVOLUTION 2018.

TEMSA: The U.S. Department of Health and Human Services (HHS) is required to provide Congress with an ambulance cost data collection program outline for the Medicare program by December 31, 2019.  What should ambulance agencies be doing now to prepare for Medicare’s cost data collection program?

Doug Hooten/MattZavadsky: One of the best strategies for ambulance agencies is to maintain as much situational awareness as much as possible.  National associations such as the National Association of EMTs, the International Association of Fire Chiefs and the American Ambulance Association have been doing a very good job keeping their members aware of the likely discussions and potential models that may be used.  And, of course, the Texas EMS Alliance is offering educational opportunities for their members everyone should make plans to attend. Additionally, ambulance agencies should begin to assess their ability to account for their costs of service delivery. It’s often not as easy as it sounds. Multi-role agencies will need to be able to track and report costs and revenue related ONLY to ambulance service delivery.

An article series in EMS World helps agencies learn about cost accounting for agencies providing ambulance services, including recommendations for dual-role agencies.  And, the National Association of EMTs has public use files that can be used to do service cost analysis.

TEMSA: You have been working with RAND and CMS on the cost data collection process.  Any insights?

Doug Hooten/MattZavadsky: CMS has contracted with RAND to conduct the due diligence and make recommendations regarding how the cost and revenue data collection should be implemented.  The RAND team has been excellent to work with.  They have done work on EMS issues in the past for CMS, specifically, as study published in Health Affairs indicating significant Medicare expenditure savings if CMS gave EMS flexibility in the transport destination for Medicare beneficiaries.  RAND’s team has been very proactive and has conducted several national conference calls seeking stakeholder input.  At their request, we also helped facilitate four specific focus groups exploring the nuances of cost data collection.  These focus groups consisted of EMS agency leaders, field EMS providers, ambulance providers fromTexas that have been doing cost reporting as part of the Ambulance SupplementalPayment Program and a final group consisting of rural and super-rural providers. 

What we’ve come to learn through this process is that RANDis leaving no stone unturned.  They have been requesting and receiving excellent insights from very diverse provider representatives.  Recently, during a briefing they gave to the NAEMT EMS 3.0 committee, RAND discussed in great detail the processes they will be using to evaluate revenue collected by ambulance agencies.  We were a little surprised by that because up to that point, the majority of the discussions had been about the cost of service provision.

The RAND team also explained about the decision process, and that MedPAC will have a significant role in approving the final process, specifically with determining what costs will be allowed, or not allowed, to be included in determining the cost of ambulance service.  For example, a fire station that houses fire apparatus in addition to an ambulance. Some states that pay supplemental payments based on cost allow the entire fire station (and even some of the personnel assigned to the engine that respond to EMS calls) to be allocated to the ambulance service cost.  It’s been made relatively clear that Medicare will only allow costs directly attributable to ambulance service provision to be included.

Doug Hooten is pictured speaking at EMS EVOLUTION 2018.

TEMSA: You have a unique new payment model with a commercial payer. Can you explain that to TEMSA?

Doug Hooten/MattZavadsky: It’s a population-based model that pays MedStar a fixed payment for ambulance and mobile integrated healthcare (MIH) services on a capitated, per member, per month (PM/PM) basis.  Each month, the payer counts the number of members in MedStar’s service area covered under the plan and issues us a negotiated payment for each of those members.  We no longer bill the payer for ambulance transports, or for MIH services.  We do a monthly encounter report for each member encounter, the disposition, and several quality measures for member safety, experience and utilization.  The payer also sends us monthly utilization reports for all the members in our service area, with the cost related to the utilization.  We identify high risk patients and enroll them in our MIH program to help them managed their health care more effectively.

There is no more claims processing and no balance billing debates.  The alignment of financial incentives allows us and the payer to better collaborate on making patient centric versus economic decisions regarding the transport dispositions of members calling 9-1-1.  The transport rate to the ED rate for the capitated population is currently running 63 percent.  This compares to 76.5 percent for our general population with no identified adverse patient outcomes.  We’ve also enrolled 30 high utilizer members in or MIH programs. 

We believe that for some EMS agencies and payers, this is a much more logical economic model, one that we hope becomes more common in the future.

TEMSA: How do you prepare for a successor in your EMS agency? Any best practices?

Doug Hooten/MattZavadsky: It’s no secret that bench strength in EMS is challenging and we need to do a much better job developing future managers and leaders.  It takes a significant commitment from leaders to develop their potential successors, or even have formal mentor programs.  There may be several reasons why leaders don’t actively engage in succession planning:

  1. We don’t like to admit we won’t be in our current position forever, but we too often focus on the negative reasons for departure.  When we worked for a large national EMS provider, they had a rule that if you had not implemented a written succession plan for your replacement, you would be passed over for promotion.  That was a strong incentive to have one in place!
  2. It takes time and slows us down.  Teaching someone to do what we do is slower than just doing it ourselves and often we don’t see the incredible value in teaching others how to do what we do.
  3. We don’t want someone to tell us a better way todo what we do.  When you teach others, they often ask scary questions like “why do you do it that way when you can doit this way?” But, we’ve found that we often learn as much, if not more, from the people in our succession plan when they provide new perspectives.

At MedStar, we’re piloting a very formal succession process that involves a written succession plan between the successor and the mentor.  It outlines a specific plan for mastering key skills necessary to the successor to have to prepare them to take on the mentor’s role in the organization. There is a timeline and identified milestones to track the development process.  Everyone reading this article should ask themselves right now, “If I win the lottery tomorrow, who can step in to take my place here when I call in ‘rich.’”  If no one comes to mind immediately, get to work!

TEMSA: Why is it important to be engaged at the state and federal level and with organizations like TEMSA?

Doug Hooten/MattZavadsky: In order to be truly part of a profession, you must engage with an association that advocates for the profession.  There is tremendous strength in collaborative groups. Imagine a twig from a tree. Alone, the twig is fairly weak and easily breaks.  But, if you bind a twig together with 50 or100 other twigs, now you have a strong pillar. Combined voices are much stronger than solo voices.  There is also incredible learning opportunities through associations like TEMSA, not only at the formal conferences, but through networking.  We witness the email and personal exchanges between members asking about experiences they’ve had with a number of ‘thorny’ issues.

And, there’s the whole information thing!  EMS leaders are exceptionally busy and are too often looking through a microscope, not a telescope.  Professional associations like TEMSA synthesize data and the landscape to deliver valuable and actionable information to its members.  This includes providing information on the economic, regulatory and political issues that might blindside you, unless an organization like TEMSA is watching out for the opportunities and icebergs that could impact you.