National EMS Education Standards and QAAP Affect Fire Service

by mobrian on December 29, 2008

A Guest Post By Chief Bill Forbush, Garden City Fire Department

Recently, many EMS providers have attended regional meeting with state health officials to discuss a number of pressing issues, including the National EMS Education Standards. The standards were developed by a committee of the National Association of EMS Educators (NAEMSE) under contract to the National Highway Traffic Safety Administration (NHTSA) and Health Resources and Services Administration (HRSA). The standards replace the current National Standard Curricula (NSC) and add to the existing core content and scope of practice documents. The final draft was delivered by the group to NHTSA in September and states now are faced with the option of adopting it, adopting it with addenda or rejecting it. National standardization of EMS has many potential benefits, but there are some aspects of the NEMSES document that could adversely affect the fire service and are causing concern among many Fire Chiefs.

One such consideration is the mandate that paramedic education programs be offered exclusively by institutions of higher learning who are accredited by the Committee on Accreditation of Educational Programs for the EMS Professions (CoAEMSP). This non-governmental body has accredited about 250 paramedic programs nationwide and only two in Michigan; Lansing Community College and Huron Valley Ambulance. The National Registry of EMTs, a non-governmental non-profit testing service has indicated that beginning Dec. 31, 2012, it will no longer accept candidates for testing unless they have graduated from such a program. While we wholeheartedly support quality in education, we are opposed to instituting artificial constraints, set by independent entities who have no accountability to Michigan citizens.

Further, we are concerned that many quality education programs, including some operated by fire service based or affiliated agencies, would be ineligible for such accreditation. Especially in these lean economic times, the fire service cannot afford to lose the flexibility provided by on-site and in-house training programs. Our communities can also ill afford the tuition increases and increased travel (backfill/overtime) inherent in a more monopolistic education system.

Interestingly, while the new NEMSES standards increase the depth of didactic knowledge for paramedics, they would not increase the skillsets available in the field. In fact, adoption of the standards without modification would “dumb down” the First Responder (known in the standard as “EMR”), and EMT levels, thereby taking away street skills that can now be performed. The SMAFC Chiefs are opposed to anything that reduces the level of care available for our citizens.

The Medical Services Administration (Medicaid) of the Michigan Department of Community Health is working with the Michigan Association of Ambulance Services (MAAS) to develop a Quality Assurance Assessment Program (QAAP) for the ambulance industry. A QAAP is a vehicle to increase Medicaid reimbursement for ambulance providers with high Medicaid populations. It is funded by taxing all ambulance providers at rate of about 3.9% of that services non-Medicare revenue. It appears to generally favor larger services. In Southeastern Michigan, much of the 911-generated emergency medical services responses are handled by fire-based EMS agencies. Many such agencies, particularly those providing advanced life support transport capability in the metropolitan area, bill for those services but are too small to benefit from a QAAP program.

Although governmental in nature, these communities would nevertheless be required to pay tax dollars into the QAAP fund to benefit larger services elsewhere. The QAAP concept is used in long-term care and other healthcare settings where there is less diversity in provider types. The position of the Southeastern Michigan Association of Fire Chiefs is that an ambulance QAAP would place an undue financial burden on our communities while providing no benefit for our citizens. We will therefore oppose QAAP and its proposed enabling legislation.

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