Item 4 - Report on Mobile Healthcare Services Option

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This is compounded by people seeking routine primary care who arrive by private vehicle at the ED. In the last decade, the frequency of ED visits has coincided with a decreasing number of EDs and inpatient beds. EDs nationwide are under increasing pressure to provide care for more patients, resulting in crowding, hallway boarding of admitted patients, and ambulance diversions. ED crowding has had multiple other negative effects, including decreased physician productivity and increased waiting times for minor illnesses. Delays in the ED are now also occurring for the treatment of serious problems, 2 as well. One study estimates $4.4 billion could be saved by redirecting unnecessary ED visits to less expensive clinics 3 and urgent care centers. In addition, EMS systems across the country receive federal funds through reimbursements from the Medicare program. Because the elderly are heavy users of EMS, Medicare represents 50-70% of billings and collections in a typical EMS agency. Those aged 65 and older are 4.4 times more likely to use EMS than younger individuals, and they represent a growing segment of the population. The new Medicare fee schedule significantly reduces Medicare payments to EMS providers, leading to a $600 million 4 annual shortfall for services provided to Medicare beneficiaries. Finally, current financial incentives for delivery of emergency and trauma care services are suspected of adding unnecessary costs to the health care system and burdening already overburdened hospital-based providers. Under the current system a patient with a sprained ankle may be transported by ambulance and treated at the ED incurring substantial costs when a simple splint by an EMT and a car or taxi ride to a primary care provider would achieve essentially 5 the same outcome at a much lower cost. In short, unnecessary and/or costly trips to EDs - which are often insufficiently reimbursed - are creating a crisis in both the quality and delivery of health care for jurisdictions 3