Anthem Begins EMS Reimbursements, Even without Transport

When it comes to EMS reimbursements—even without transferring the patient—Anthem BlueCross BlueShield is leading the way. In an era when community paramedicine, mobile healthcare concepts, and telemedicine programs have sometimes struggled to garner financial support, Anthem quietly began paying for on-site treatment by EMS in situations where the consult does not result in a ride to the emergency department.

Although pilot projects have tried similar approaches, Anthem is the first major insurer to apply a global approach to compensating care that does not require a visit to the ED. The implications are enormous; EMS is no longer merely a supplier of transportation, but instead a provider of healthcare.

The program grew out of a disturbing trend: Low-acuity patients were clogging EDs because payers would only compensate for EMS calls and treatment if the patient was transported to the ED. Thus, in order to get paid, EMS felt forced to bring patients to hospitals.

The compensation equals 70 percent of the average reimbursement for a transport in the region. Although this figure is less than the payment for an ambulance run, in all probability, resources at the ED have now been freed by the absence of the low-acuity patient, and EMS now only transports patients who truly need to visit the hospital.

Of course, in order for this program to work, EMS must be properly equipped to assess, diagnose, and treat patients. This is where telemedicine comes in: A strong mHealth system will allow EMS providers to link the patient to the appropriate specialist through a real-time, high definition audio and video connection, plus send along images and data that are gathered on-site. Then, the specialist can evaluate the patient and advise a suitable course of action.

A superior mHealth platform will also maintain a high quality connection in any environment—even low-bandwidth or challenging network areas, such as rural regions, cell tower handoffs, or congested urban networks. The swyMed software platform is designed for precisely these circumstances and can be used on a tablet, smartphone, or laptop computer, as well as our DOT Telemedicine Backpack and swyMed Ambulance. swyMed has video enabled ambulances to serve as Basic Life Support, Advanced Life Support, Mobile Stroke Units, Critical Care Transport Units, and Mobile Intensive Care Units in the US and Europe.

Anthem’s policy is expected to effect more efficient and effective EMS, less crowded and more streamlined EDs, and less hassled patients and families. Considering the new financial incentive for EMS to treat patients on-site, we at swyMed expect to see increased demand for robust mobile telemedicine platforms. In the future, progressive providers may also cover services such as medication checks and non-9-1-1 home visits, but for now, community paramedicine is a great start.

To learn more about Anthem BlueCross BlueShield’s program, visit EMS World here.

To learn more about the swyMed telemedicine software platform, click here.