December 18th, 2014 by Will Humble
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Every year the CDC evaluates each of the states on their public health preparedness performance. Arizona continued to score high marks on this year’s preparedness report card. We got a perfect score this year for biological laboratory testing, and we’ve kept our excellent performance measures for incident management, medical countermeasures, and public information. Our response times for activating our emergency operation center have been well above the national target for the last three years, and our chemical laboratory detection capabilities have been fully “demonstrated” and “passed” for two years running.
Our state’s Strategic National Stockpile program received a special mention on page 18 of the report. ADHS, along with Maricopa and Pinal Counties, conducted a full-scale exercise to distribute life-saving medications to the public. This national recognition demonstrates the hard work of our preparedness staff and our local health department partners. Thanks to all of you for your hard work through the years to get us to this stage of readiness.
You can view this year’s National Snapshot report to see how Arizona compares to the rest of the nation. You can take steps to make sure your family is prepared too – check out my blog from last Spring – the Family is the First Responder.
December 17th, 2014 by Will Humble
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Arizona uses a Certificate of Necessity (CON) system to regulate ground ambulance service in Arizona – and to make sure that every place in the State has adequate emergency medical services, including the frontier parts of Arizona. The CON actually describes the geographic service area, level of service (advanced life support or basic life support), hours of operation, response times, effective date, expiration date and any limiting or special provisions for emergency medical services in the specific geographic area.
A ground ambulance service that is awarded one of our CONs must stick with the criteria on their certificate and operate in accordance to the statutes and rules by which it is governed. Check out these links for statutes and ground ambulance rules for the details of how it works.
A few years ago we posted guidance for folks who are interested in applying for new CONs for emergency medical services. The new guidance basically summarizes our statutes and rules for applying for a new CONs, which includes a requirement that the applicant shows that there’s a “public necessity” for the new service. Our guidance makes it clear that we’ll evaluate public necessity by analyzing the needs of the community, the adequacy of the current services provided, maximizing the use of contemporary Emergency Medical Services (EMS) protocols that have been demonstrated to save lives and quality of life, and ensuring cost controls.
Specifically, our guidance clarifies the kind of information we’ll use to make our decision whether to approve new CONs, including whether the applicant demonstrates:
- A plan for a robust, on-going benchmarking and performance improvement process that encompasses all components of the EMS system from emergency medical dispatch through emergency department arrival;
- A plan to collect and submit electronic patient care reports consistent with our EMS Bureau’s guidelines;
- A plan to adopt clinical guidelines and operating procedures for time sensitive illness consistent with American Heart Association best practice guidelines;
- A plan to initiate guideline-based pre-arrival instructions for all callers accessing 9-1-1 for assistance;
- Evidence of regular attendance and participation in meetings of the regional and State EMS Councils;
- A plan to ensure that ambulance service will be maintained and improved for rural communities; and
- Assurance that the service model will be cost effective and not result in higher ambulance rates.
Our overall goal is to basically improve the quality of emergency medical services by championing effective life-saving practices while making sure that costs are contained. The good news is that many of the recent developments in EMS care are operational and inexpensive (like using the new CCR method for resuscitation).
December 16th, 2014 by Will Humble
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American Medical Response’s (AMR) isn’t the only application in the pipeline. A number of fire departments along with private groups are applying for CONs right now. Some are farther along in the application process than others.
Why all the interest in running an ambulance company? Rural Metro’s bankruptcy has probably played a role along with the Affordable Care Act. Also, hospitals are now beginning to contract with Emergency Medical Services (EMS) agencies to help reduce the number of patients being re-admitted to the hospital for chronic disease management – a new revenue source for EMS agencies.
December 15th, 2014 by Will Humble
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We expect to see flu cases, hospitalizations, and even some deaths every year, but recent data from the CDC shows that this season may be a little different than the past few flu seasons. First, the flu strain causing the most cases so far this year is Influenza A (H3N2). Flu seasons in which H3 subtypes are more common tend to lead to more hospitalizations and death. In the past, most vulnerable groups have been the very young, the very old, and the chronically sick.
Second, the circulating H3N2 strain has changed or “drifted” from the H3N2 strain that is included in this year’s flu vaccine. Early analyses show that about half of the circulating H3N2 in the United States have slight genetic changes (a normal effect of viral replication) that may reduce the flu vaccine’s ability to fully protect against it. Now, what makes flu seasons so interesting is that both of these concerns could still change (or drift!).
We could have a year like 2010 when other flu strains surfaced as the season continued. We might have a repeat of 1976 where there was great vaccine protection in the face of drifted H3N2 viruses (likely because the vaccine offered cross-protection). Or…we could just have a severe flu season with a 30% protective vaccine.
In the face of the unknown, the overwhelming recommendation is to get the flu shot. It is better to have some protection (than no protection) against a potentially deadly flu season. It takes two weeks to get immunity, so get vaccinated now to start 2015 with the best protection available.
December 12th, 2014 by Will Humble
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Childhood immunizations are widely credited as one of the top ten public health achievements of the 20th century. For the 13 diseases included on the current U.S. childhood immunization schedule, 20 million cases of disease are prevented per year, 42,000 lives are saved, and the healthcare system realizes $13.6 million in direct medical costs (see the study here).
Unfortunately, due to challenges with vaccines costs, reimbursements and financing systems, there has been a decrease in the number of healthcare providers that offer vaccines. This has led to more children presenting for vaccinations at the county health departments and more children with incomplete vaccinations.
For several years now, immunization partners locally and nationally have worked to identify problems with vaccine financing and availability and define solutions. This summer, the Legislature passed House Bill 2491, which facilitated the creation of a Vaccine Financing and Availability Advisory Committee to analyze the situation in Arizona. The Committee’s report was released this week, and makes recommendations about cost, purchasing, payment and availability of vaccines. Bottom line? It’s going to take work to resolve the challenges of vaccine financing and accessibility, but coordinated action among stakeholders may get us closer to a solution.
December 11th, 2014 by Will Humble
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Good oral health is critical to a person’s overall health. Tooth decay and gum disease are linked with heart disease, stroke and diabetes, and premature births. Many people in our community can’t afford dental care, so they suffer from poor oral health that affects their ability to speak, smile, smell, taste, touch and eat. That’s why the Central Arizona Dental Mission of Mercy is such an important event for Arizona.
The event provides free dental services to people in need. Last year about 2,000 people were able to get services. This year’s Mission of Mercy takes place Friday, December 12, and Saturday, December 13, at the Arizona Fairgrounds. There’ll be about 100 portable dental units and 1,500 volunteers that will provide more than $1 million in free care to children and adults.
We’re supporting the event through Title V funds and several of our staff volunteered to provide health information about our programs and services to the patients. Maricopa County Public Health will be providing flu vaccinations to participants. A huge thanks to Kevin Earle, the Executive Director of the Arizona Dental Association, for his leadership in setting up this year’s Mission of Mercy.
December 9th, 2014 by Will Humble
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Late Monday, an Administrative Law Judge issued an Order recommending that I approve American Medical Response of Maricopa’s (AMR) application to operate ambulances (certificate of necessity or CON) in all of Maricopa County.
We regulate ambulance services differently than most states. In order to operate an ambulance here the applicant needs to meet a number of requirements including demonstrating that: 1) there’s “public necessity” for the services they want to provide; 2) they have the finances and operational skills necessary to operate the service; and that 3) they can provide high quality clinical care and evaluate their service with a performance improvement plan.
An application for a CON triggers a process that starts in our Bureau of EMS and Trauma System where we evaluate the application to see if it’s complete. Once that’s done, we notify folks in the area about the proposed CON. If the application is uncontested, then it comes directly to me for a decision. If the application is contested (as this one was), it goes to a hearing before a judge at the Office of Administrative Hearings.
The Administrative Law judge evaluates the application and the evidence presented during the hearing and issues a recommendation. The Judge sends the recommendation (called an Order) to me, and I have 30 days to make a decision. I can: 1) deny the application; 2) accept it as-is; 3) accept the application with amendments; or 4) allow the recommendation to take effect without acting.
The Judge reviewed several criterion in AMR’s application (public necessity, billing rate, fiscal and operational experience, clinical excellence, negative financial impact on the current provider). The Order concludes that: “In view of the foregoing, it is recommended that the Director approve the proposed Application, directing BEMSTS to issue a CON to American Medical Response of Maricopa, LLC (“AMR”) upon AMR’s confirmation that it is ready to immediately assume all rights and responsibilities under that CON.”
Before I make a decision, I’ll review the hearing record, the application and the judge’s decision and Order. I’ll be paying particular attention to how the Judge came to her conclusion. Stay tuned.
December 9th, 2014 by Will Humble
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Community Integrated Paramedicine programs are coming together in two primary business models in Arizona. The first one has EMS (emergency medical services) agencies partnering with hospitals to reduce the frequency that patients are re-admitted to hospitals. In the second, EMS agencies are cultivating social service referrals to reduce the frequency that folks use emergency departments for non-emergency events.
Community Integrated Paramedicine programs are on the rise because federal law provides hospitals a financial incentive to reduce the number of readmissions among patients discharged within 30 days. There’s also been a national focus on conducting community health needs assessments, which have exposed gaps in the availability of preventative health care services needed to improve the health and well-being of residents. Community paramedicine is increasingly being recognized as a cost-effective way to fill those gaps.
A new piece of the community paramedicine puzzle became available a couple of weeks ago with the publication of a document called Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis. The document examines the legal perspective and provides guidance on several topics including scope of practice, emergency calls, payment, liability and medical direction for community integrated paramedicine programs.
Community Integrated Paramedicine touches our Bureau of EMS and Trauma System, the Bureau of Tobacco and Chronic Disease and the Health Care Institution Licensing Branch. Our job over the coming months is to help Community Integrated Paramedicine Programs to navigate regulatory waters and manage the risks associated with a new business model for EMS providers – our Team is finalizing work on a guidance document right now.
December 8th, 2014 by Will Humble
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The University of Arizona Health Network joined the Maricopa Integrated Health System last week by committing to become an Infectious Disease Treatment Center of Excellence. By recognizing MIHS and UAHN as Infectious Disease Treatment Centers of Excellence, Arizona will be better able to: 1) develop a seamless infectious disease response plan as new infectious diseases emerge; 2) ensure smooth patient transport (if appropriate) avoiding unnecessary healthcare worker and community exposures; and 3) allow other hospitals to focus on screening and diagnosing patients.
We’ll be working with the Pima and Maricopa County health departments to help both hospital systems to develop plans and train their healthcare workers on all aspects of infectious disease response (including Ebola) as well as prioritizing personal protective equipment during shortages and back-orders. Recognition will be complete once the CDC conducts an on-site Hospital Readiness Assessment and our medical licensing team certifies the facilities in mid-December.