• Arthur L Kellermann, Kristy Gonzalez Morganti, Abby Alpert, Gregg Margolis, and Jeffrey Wasserman.
• From the RAND Corporation, RAND Health, Pittsburgh, Pennsylvania, USA (KGM); the RAND Corporation , RAND Health, Santa Monica , California , USA (AA, JW); the Office of the Assistant Secretary for Preparedness and Response, Division of Health Systems and Health Care Policy, U.S. Department of Health and Human Services , Washington DC , USA (GM); and the RAND Corporation, RAND Health , Arlington, Virginia , USA (ALK).
• Prehosp Emerg Care. 2014 Jan 1;18(1):76-85.

BackgroundThe primary objective of this study was to determine how EMS organizations that are piloting patient-centered treatment and transport protocols are approaching the challenges of implementation, reimbursement, and quality assurance. We were particularly interested in determining if these pilot efforts have raised any patient safety concerns.MethodsWe conducted a set of discussions with a small group of key EMS stakeholders regarding the status of pioneering efforts to develop and evaluate innovative approaches to EMS in the United States.ResultsWe had discussions with 9 EMS agencies to better understand their innovative programs, including: the history of their service policy and procedure for transports that do not require emergency department care; the impact of their innovative program on service costs and/or cost savings; any reimbursement issues or changes; patient safety; patient satisfaction; and overall impression as well as recommendations for other EMS systems considering adoption of this policy.ConclusionsIn general, EMS systems are not reimbursed for service unless the patient is transported to an ED. Spokespersons for all nine sites covered by this project said that this policy creates a powerful disincentive to implementing pilot programs to safely reduce EMS use by directing patients to more appropriate sites of care or proactively treating them in their homes. Even though private and public hospitals and payers typically benefit from these programs, they have been generally reluctant to offer support. This raises serious questions about the long-term viability of these programs.

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