Managed Care: Is There A Fit For The Fire Service?

Managed care, gatekeeping, pathway management, capitation - do any of these terms have anything to do with the fire service? The answer is unquestionably yes! Whether you agree or disagree with the care provided under the managed care environment, it is...


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What is wrong with this system? First, citizens must decide whether to call 911 or the managed-care organization. Second, the person who decides to call the managed-care organization first may be denied needed rapid medical intervention from the local fire department. Compounding this have been repeated failures to pass legislation in Congress defining an "emergency." Several bills at state and federal levels have defined an emergency as how a "prudent layperson" would define it. Those bills also contained language indicating managed-care organizations would have to pay for medical services provided the cases were emergencies. As of this writing, many of these bills have not been passed into law due to the strong insurance lobby.

Many fire agencies have been slow to embrace working with managed care organizations. Major private-ambulance companies have eagerly stepped up to work with managed-care organizations to control finances through alternative-delivery care models and "gatekeeper" communication centers.

Bottom line - a fire agency must identify the needs of the managed-care organizations in its area, then begin a working/business relationship with them. The EMS industry is estimated to be worth $10 billion a year and is a subset of the entire medical industry, valued at $1 trillion a year. With these types of dollars on the table, it's easy to see why the fire service must participate in this ongoing transition of our medical industry.


Gary Ludwig is the chief paramedic for the St. Louis Fire Department and is currently serving his fourth term as an elected member of the EMS executive board for the International Association of Fire Chiefs. He was awarded Missouri's EMS Administrator of the Year for 1998.