The Centers for Medicare Services plans to start a new pilot program known as ET3 that allows certain ambulance companies to take traditional Medicare patients who call 911 to less acuity health care facilities than the usual hospital emergency room.
Under the ET3 Model, Medicare will pay participating ambulance suppliers and providers to:
Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or
Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth.
Upon arriving on the scene of a 911 call, participating ambulance suppliers and providers may triage Medicare beneficiaries to one of these Model’s interventions.
The ET3 program will begin later this year for a two year period.
One of OPM’s heaviest weighted HEDIS measures turns on whether a pregnant woman visits her obstetrician in the first trimester of her pregnancy. Interestingly, Health Affairs Blog explains that
Prenatal care has been largely left out of the growing national conversation about the rise in maternal morbidity and mortality and the stark racial disparities in maternal health outcomes. This notable absence may be a consequence of how little is understood about the content and quality of prenatal care services and their relationship to maternal and infant health. Increased understanding of what happens during labor, delivery, and the postpartum period is essential to improving outcomes: the Centers for Disease Control and Prevention (CDC) estimates that roughly two-thirds of maternal deaths occur during childbirth and the first year thereafter. The remaining third of deaths occur during pregnancy. Prenatal care—spanning most of a year and consuming substantial time and resources from patients and providers alike—may represent an important opportunity to prevent these deaths, as well as to identify and mitigate risks of subsequent mortality or morbidity.
There are three primary impediments to rigorous research in this area:
Reliance on blunt quality metrics that do not reflect important dimensions of care;
Limited access to data on what occurs during prenatal care; and
Empirical challenges to evaluating the impact of prenatal care on maternal and infant outcomes.
In other words, it’s complicated.
Fierce Healthcare reports on a survey about the extent to which patients lie to their physician and offers tips to doctors on how to encourage their patients to be truthful. If patients lie to their doctors, then members may well lie to their health plan too so the tips in the article should be generally helpful.