Reference Documents
- Ambulance Providers: Costs and Expected Medicare Margins Vary Greatly; U.S. Government Accounting Office (GAO) Report (May 2007) - Download PDF 1MB) - "In 2002, Medicare implemented a national fee schedule designed to standardize payments for ambulance services. The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) required GAO to study ambulance service costs. GAO examined providers’ costs of ground ambulance transports in 2004 and factors that contributed to cost differences; average Medicare ambulance payments expected under the national fee schedule in 2010 and how those payments will relate to providers’ costs per transport; and changes that occurred in Medicare beneficiaries’ use of ambulance transports from 2001 to 2004. GAO estimated costs of ambulance transports based on a nationally representative survey of 215 ambulance providers that did not share costs with non ambulance services. Providers that shared costs with other institutions or services and could not report their costs for ambulance services separately, such as fire departments, were excluded because their reported costs appeared unreliable. GAO used its survey, Medicare claims, and other data for its analyses. What GAO Recommends GAO recommends that the Administrator of CMS monitor utilization of ambulance transports to ensure that Medicare payments are adequate to provide for beneficiary access to ambulance services, particularly in super-rural areas. CMS agreed with GAO’s recommendation."
- Leadership Guide To Quality Improvement of EMS Systems; U.S. National Highway Traffic Safety Administration (1997) - (Download PDF 1 MB) - "The Leadership Guide to Quality Improvement for Emergency Medical Services (EMS) Systems was developed to serve as a template for EMS managers who want to establish and maintain a program for continuously monitoring and improving the quality of patient care and support services in all parts of the EMS system. It encourages EMS leaders to integrate continuous quality improvement practices as essential parts of normal EMS routines."
- Best Practices in Performance Measurement; U.S. National Performance Review (1997) - (Download PDF 197 Kb) - "All high-performance organizations whether public or private are, and must be, interested in developing and deploying effective performance measurement and performance management systems, since it is only through such systems that they can remain high-performance organizations. Federal agencies were required to develop strategic plans for how they would deliver high-quality products and services to the American people. In 1993, President Clinton and Vice President Gore initiated the National Performance Review (NPR) to reinvent government. One of NPR's reinvention initiatives has been to foster collaborative, systematic benchmarking of best-in-class organizations, both public and private, to identify best practices in a wide range of subjects vital to the success of federal agencies in providing high-quality products and services to our principal customer the American people. This report documents the Performance Measurement Study Team's findings, and will be a useful tool for public and private leaders and managers in identifying and applying best-in-class performance measurement and performance management practices. When used in conjunction with the Customer- Driven Strategic Planning Study, federal agencies will have a framework for success in meeting the Administration's expectations for not only "doing the right things" but for "doing them right," as well."
- The Future of EMS in Canada; EMS Chiefs of Canada (2006) - (Download PDF 3.9MB) - "This plan presents the strategic policy framework to provide Canadians with excellence in-patient care today and into the future. The overarching pressure on the health care system will continue to increase with no end in sight. Long transfer of care delays in the emergency room are unfortunately now the norm, not the exception. This is a symptom of much greater challenges to our health care system. Given this reality, the current or traditional model of providing pre-hospital emergency care in Canada will need to be renewed and redefined. Over the short, medium and long term, we will need to consider and apply new alternatives. This will include new systems, leveraging new technology, and growing new competencies for clinical providers and leaders. The status quo is clearly no longer a viable option. This foundational paper is not a detailed road map. It is intended as a strategic framework and a basis for thought-provoking discussion and ultimately action by Canadian EMS leaders and policy makers."
- Snowbird Conference on Dispatch Call Processing Time Standards; National Academy of Emergency Dispatch (B. Sinclair; 1999) - (Download PDF 586 Kb) - At the 1998 Navigator conference held at the Snowbird resort in Utah, it was recognized that there was a need to agree on definitions for the various time sub-intervals found in call processing. This led to the development of what is now referred to as the 'Snowbird Time Standards'.
- EMS Agenda for the Future; National Highway Traffic Safety Administration (1996) - (Download PDF 817Kb) - "During the past 30 years, emergency medical services (EMS) in the United States have experienced explosive development and growth. Yet initiatives to create a system to provide emergency medical care for the nation’s population began with limited knowledge about what constituted the most efficient processes for delivering ideal resources to the spectrum of situations encountered by contemporary EMS. The EMS Agenda for the Future provides an opportunity to examine what has been learned during the past three decades and create a vision for the future. This opportunity comes at an important time, when those agencies, organizations, and individuals that affect EMS are evaluating its role in the context of a rapidly evolving health care system."
- EMS at the Crossroads; Institute for Medicine (2005) - (Download PDF 2 MB) - "The Committee on the Future of Emergency Care in the United States Health System, ably chaired by Gail Warden, set out to: examine the emergency care system in the United States; explore its strengths, limitations, and future challenges; describe a desired vision of the emergency care system; and recommend strategies required to achieve that vision. Their efforts build on past contributions, including the landmark National Research Council report, Accidental Death and Disability: The Neglected Disease of Modern Society in 1966, Injury in America in 1985, and Emergency Medical Services for Children in 1993. The committee’s task was to examine the full scope of emergency care, from 9-1-1 and medical dispatch, to hospital-based emergency and trauma care. The three reports in the series—Hospital-Based Emergency Care: At the Breaking Point, Emergency Medical Services At the Crossroads, and Emergency Care for Children: Growing Pains—provide three different perspectives on the emergency care system. The series as a whole unites the often-fragmented prehospital and hospital-based systems under a common vision for the future of emergency care."
- Quick and Dirty Guide to Performance Measurement & Pay 4 Performance; North American Spine Society; (2005) - (Download PDF 56 Kb) - A very useful and concise 3 page guide to the concepts and definitions used at the Agency for Health Research & Quality (AHRQ) for healthcare performance measurement and pay for performance programs.
- Pay-for-Performance Programs: Guiding Principles and Design Strategies; National Quality Forum; (2005) - (Download PDF 661 Kb) - Today’s prevailing methods of paying for healthcare in the United States do not incentivize or reward the provision of high-quality care. To address this issue, a variety of innovative new programs are proliferating rapidly across health plans and other organizations nationwide. Some 100 initiatives—commonly known as pay-for-performance (or value purchasing) programs—that are now under way presage a fundamental change in the market forces that drive healthcare delivery in the United States. Although the development of these programs has been based on experiential evidence and expert opinion, and to some degree on the scientific research, negative, unintended consequences are likely to occur if the programs are not properly designed. In response to the proliferation of these breakthrough and potentially powerful initiatives, a number of national healthcare organizations have espoused, or are in the process of promulgating, guidelines for pay-for-performance programs. However, these guidelines are not all well aligned or consistent, which tends to undermine their collective value. A standardized set of guiding principles and design strategies for pay-for-performance programs would facilitate the effective and prudent implementation of this promising new payment methodology. Such a set of principles and strategies would ensure that performance measures and other standards that are used in these programs are appropriate for that purpose. On March 1-2, 2005, the National Quality Forum (NQF) convened a conference in Lansdowne, Virginia, to build a foundation for the development of consensus standards in pay for performance. The conference marked the beginning of NQF’s efforts to promote quality healthcare through pay for performance and brought together national healthcare leaders from a variety of stakeholder perspectives for a focused discussion to evaluate the current state of pay for performance; to share lessons learned and promising models; and to identify research and knowledge gaps for which additional work is needed.
- Guide for Preparing Medical Directors; U.S. National Highway Traffic Safety Administration (2001) - (Download PDF 703 Kb) - The purpose of this guide is to aid the State EMS offices and experienced medical directors with their preparation of a one-day course for potential medical directors. This guide outlines the major responsibilities of a medical director and instructors may need to prepare audiovisuals, handouts and other support materials to make the class more successful.
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