The focus areas of responsibility NAEMSP_Medical_Oversig… · [email protected]. Title: Microsoft...
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12/30/2011 1 EMS Medical Direction Practical Issues The nuts and bolts (and screws) Edward M. Racht, MD Chief Medical Officer American Medical Response AMR Medicine EMS Medical Direction Practical Issues EMS Medical Direction Practical Issues The nuts and bolts (and screws) The nuts and bolts (and screws)
Transcript of The focus areas of responsibility NAEMSP_Medical_Oversig… · [email protected]. Title: Microsoft...
12/30/2011
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EMS Medical DirectionPractical Issues
The nuts and bolts(and screws)
Edward M. Racht, MDChief Medical Officer
American Medical ResponseAMR Medicine
EMS Medical DirectionPractical Issues
EMS Medical DirectionPractical Issues
The nuts and bolts(and screws)
The nuts and bolts(and screws)
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How do we do the what?______________
National EMS Medical Director’s Course and Practicum
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The business of Medical OversightThe business of Medical Oversight
The focus areas of responsibilityThe focus areas of responsibility
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Establishment, implementation and maintenance of a
clinical standard of care
Establishment, implementation and maintenance of a
clinical standard of care
Oversight and delivery of educationOversight and delivery of education
Performance / quality managementPerformance / quality management
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Regulatory functionsRegulatory functions
Public educationPublic education
ResearchResearch
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Provider and profession advocacyProvider and profession advocacy
Manage your PracticeManage your Practice
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EMS is a practice of medicine …EMS is a practice of medicine …
Dissecting the business of EMS Medical Oversight (or any business, for that matter)
Dissecting the business of EMS Medical Oversight (or any business, for that matter)
• What am I expected to do?
• What do I have the authority to do?
• Who am I doing it for / with?
• How am I supported?
• How am I protected?
• What am I expected to do?
• What do I have the authority to do?
• Who am I doing it for / with?
• How am I supported?
• How am I protected?
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…more specifically……more specifically…
Scope, authority & responsibility Reporting structure Compensation Support structure
– Human resources– Physical resources
Liability coverage Political climate
Scope, authority & responsibility Reporting structure Compensation Support structure
– Human resources– Physical resources
Liability coverage Political climate
Scope, authority and responsibilityScope, authority and responsibility
Scope, authority & responsibilityScope, authority & responsibility
• Job description
• Your role
• What the system, community, chief, etc expect from you
• The breadth and depth of your involvement
• Job description
• Your role
• What the system, community, chief, etc expect from you
• The breadth and depth of your involvement
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Defining your job descriptionDefining your job description
Be specific in potentially controversial areas
Define reporting structure and expectations
Review at least every year
Be specific in potentially controversial areas
Define reporting structure and expectations
Review at least every year
Areas of focus(this will look familiar)Areas of focus(this will look familiar)
• Clinical practice• Education and
professional development• Performance and quality
management• Regulatory• Research• Public education • Advocacy• MD Operations
• Clinical practice• Education and
professional development• Performance and quality
management• Regulatory• Research• Public education • Advocacy• MD Operations
Reporting structureReporting structure
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Reporting structureReporting structure
• Critical
• Political
• Defines authority in a practical way
• Defines allegiances
• The nature of the relationship is critical
• Critical
• Political
• Defines authority in a practical way
• Defines allegiances
• The nature of the relationship is critical
Define the medical reporting & coordinating structure
Define the medical reporting & coordinating structure
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Compensation[scary music]
Compensation[scary music]
EMS is a practice of medicine …EMS is a practice of medicine …
It is appropriate to be fairly compensated for Medical Oversight services
It is appropriate to be fairly compensated for Medical Oversight services
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Compensation
Difficult to talk about
No “fair market value”
“Low bid” issues No resources Potential loss of
liability protection
Difficult to talk about
No “fair market value”
“Low bid” issues No resources Potential loss of
liability protection
Compensation models
Dollar amount per every patient transport (can be billed)
Dollar amount per 911 activation (for example -$5.00)
Dollar amount per medic hour worked (tax on medic hours for medical oversight)
Fixed stipend Purchase hours at going ED hourly rate – define
EMS hours Buy time from current practice
Dollar amount per every patient transport (can be billed)
Dollar amount per 911 activation (for example -$5.00)
Dollar amount per medic hour worked (tax on medic hours for medical oversight)
Fixed stipend Purchase hours at going ED hourly rate – define
EMS hours Buy time from current practice
Compensation models*Cautions*
Check impact on liability protection Clearly evaluate any conflicts of interest Beware of performance based contracts
linked to number of transports Be careful of compensation that can be
increased BY YOU for protocol changes Never take cash from unconscious
patients…
Check impact on liability protection Clearly evaluate any conflicts of interest Beware of performance based contracts
linked to number of transports Be careful of compensation that can be
increased BY YOU for protocol changes Never take cash from unconscious
patients…
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Barter
Support resourcesSupport resources
Think about what you need to get the job done…
Think about what you need to get the job done…
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… and specifically what you need to respond and care for patients in the field… and specifically what you need to respond and care for patients in the field
Medical Director essentials(use what Medics have as a reference)
Personal protective equipment
Identification / Access – Branding
Radio Pager / cell Response vehicle
options Medical equipment
Personal protective equipment
Identification / Access – Branding
Radio Pager / cell Response vehicle
options Medical equipment
Medical Director support
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A critical message about resources…
Walk the walk and play by the rules Walk the walk and play by the rules
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Liability CoverageLiability Coverage
Medical Director Liability in EMSMedical Director Liability in EMS
• Medical malpractice– Personal care delivered– Care delivered under your
guidelines / protocols by others
• Inappropriate oversight– Protocols / guidelines / credentialing– Quality improvement issues
• Employment issues– Wrongful termination– Demotion– Restraint of trade– Harassment
• “Every day” liability with a physician twist
• Medical malpractice– Personal care delivered– Care delivered under your
guidelines / protocols by others
• Inappropriate oversight– Protocols / guidelines / credentialing– Quality improvement issues
• Employment issues– Wrongful termination– Demotion– Restraint of trade– Harassment
• “Every day” liability with a physician twist
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Managing liabilityManaging liability
• Get appropriate coverage* and have it professionally reviewed
• Medical Directors should rarely be involved in the day to day employment issues of Providers (including hiring and firing)
• Communicate clearly, fairly and in writing on difficult issues
• Clearly define expectations of credentialing up front
• Get appropriate coverage* and have it professionally reviewed
• Medical Directors should rarely be involved in the day to day employment issues of Providers (including hiring and firing)
• Communicate clearly, fairly and in writing on difficult issues
• Clearly define expectations of credentialing up front
The five deadly sins in Austin(Everyone knows up front and knows the consequences)The five deadly sins in Austin
(Everyone knows up front and knows the consequences)
• Intentionally harming a patient
• Intentionally witholding needed care from a patient
• Falsifying a medical record
• Providing care while impaired
• Failure to remediate
• Intentionally harming a patient
• Intentionally witholding needed care from a patient
• Falsifying a medical record
• Providing care while impaired
• Failure to remediate
Medical Director Insurance PoliciesMedical Director Insurance Policies
• DirectorShield (NAEMSP)
www.EDMedmal.com
800-560-4353
• EMS Medical Director’s Insurance (ACEP) www.emsmdinsurance.com
866-577-7833
• DirectorShield (NAEMSP)
www.EDMedmal.com
800-560-4353
• EMS Medical Director’s Insurance (ACEP) www.emsmdinsurance.com
866-577-7833
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Political realitiesPolitical realities
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Never, ever, ever, ever forget the importance of integrity and
transparency.
You are both a public official and a physician.
Never, ever, ever, ever forget the importance of integrity and
transparency.
You are both a public official and a physician.
A 2011 To Do list……
Review any state law regarding Medical Direction of EMS in your State
Develop a contract or agreement for what you do
Set up a meeting with THE person you report to and ask them to define their expectations of you and medical oversight
A 2011 To Do list…
Determine your resource needs and make a list
Review your policy / procedure protocols for: Decredentialing Incident review
Work with the local news media on one public education project (feed them)
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Asinanypracticeofmedicine,goodbusinesshelpsdelivergoodmedicine
Asinanypracticeofmedicine,goodbusinesshelpsdelivergoodmedicine
EMS is no different…EMS is no different…
Thanks.Thanks.
Thanks…Thanks…
[email protected]@emsc.net
