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In previous columns, I have mentioned the political and operational challenges and opportunities facing fire service-based EMS systems as the Affordable Care Act (ACA) moves through its implementation – which has already started. There is urgency to the decision points presented in this upcoming major shift in EMS, but where, when and how are leaders across the full spectrum of the fire service addressing them?
There will be implementation differences from state to state, urban to rural, etc., regarding specific ACA elements, but there are also consistencies nationally that have clearly emerged. Strengthened and different types of partnerships with hospitals and the medical community at large, enhanced fire service-based EMS service delivery options and becoming part of new healthcare and revenue models that will be created are just some of these opportunities. There are more.
Impact on pre-hospital care
The extent to which fire department leaders are able to influence the implementation of ACA and its impact in their communities will set the stage for the future effectiveness of their fire service-based EMS systems – and that is not an overstatement. As political leaders and many in the fire service have communicated in no uncertain terms, the ACA is the law of the land. When fully implemented, it will significantly impact pre-hospital (9-1-1) emergency medical care. This will affect up to 80% of the emergency activity that occurs within many large and small fire department service delivery systems.
The ACA’s impact will be felt in career, combination and volunteer fire departments that provide some level of EMS. If fire chiefs, union officials and other fire department leaders choose to sit back and take a “wait-and-see” approach, they are actually taking the risk that critical opportunities may be lost to their organizations in the process.
Sometimes, it can be helpful to revisit a few of the timeless guidelines that drive influencing significant change and how to gain the support of people who control the resources, make the final decisions, and develop policy. The bad news is that there isn’t a secret formula for successfully accomplishing this every time. But the good news is that there are steps that can be taken that will improve the odds of being successful. I’m going to share just a few hints in this column. They may seem simple and basic, but they are often overlooked or skipped altogether in the change process. It’s very difficult to force people to do what they simply don’t want to do. However, these hints may assist your organization in influencing the decisions of others by helping them understand that what is being proposed is in the best interest of your community – and them as well in their roles as leaders:
• Become as educated as possible about the subject you are addressing. Then, develop what you want to accomplish into strategic and operational goals and integrate them as important elements of the organization’s strategic plan. These should be outcome based and measurable, with realistic timeframes for implementation.
• Identify (and make contact with) key partners and opinion leaders (internally and externally) to encourage their input and support, and be willing to make revisions based on the input and suggestions that are received. These may include regional-, state- or even national-level partners. They often include fire service and non-fire service partners as well.
• Identify the resource requirements to implement the goals and objectives that are being set, including how these resources may be provided – and by who. This is not only critical from an operational standpoint, but can be very helpful to political leaders and other policy-level decision-makers.
• Work in cooperation with your partners to encourage political leaders and other decision-makers to support what is being proposed. If there is known opposition to what you are proposing, be sure to share that information with them as well.
• When implemented, ensure an ongoing evaluation, revision and training process is in place to maximize the effectiveness of the system as a whole. This includes communicating effectively internally and externally with all parties involved in an ongoing way.
• For major and/or more controversial issues, this entire process can be most effective when it is done in concert as a labor-management initiative.
The opportunities and transitions coming forth in our fire service-based EMS systems due to the ACA are extremely timely and important. This also provides even more incentive for you, your fire departments, as well as regional and state organizations to join the Fire Service-Based EMS Advocates Coalition. Joining may seem like a minor thing, but it’s not. Your membership as an advocate can be very important as the coalition’s steering committee continues their advocacy on behalf of fire service-based EMS at the national level. Go to www.fireserviceems.com to sign up – and do it today. There is no charge and it’s easy to do.
Critical decisions ahead
The implementation of the ACA is going to cause critical decisions to be made in the next one to three years that will impact EMS tremendously for many more years to come. Some of these decisions may end up being as important to fire departments as the decisions their leaders made years ago to get into the fire service-based EMS business in the first place.
As we in the fire service all know, in most fire departments, our EMS service-delivery model is so closely joined and aligned with our fire suppression deployment model that a reduction in EMS resources will also affect fire suppression resources. People in labor and management are going to be sharing much more detail about these issues as they continue to unfold with the phasing-in of the ACA. In the end, the final decisions will be impacted and/or made by elected officials, other policy level decision-makers, community leaders, the health care industry, fire department leaders, private-sector EMS representatives and other stakeholders.
The success of the fire service in influencing those decisions in ways that will be in the best interest of public safety and the effectiveness of our fire departments is critical. Being able to do that effectively as an equal partner with others is not only a reality operationally – it must be a political priority.
Dennis Compton presents “Instilling Accountability in Fire Officers” at Firehouse Expo 2013, July 23-27 in Baltimore, MD.