The Missouri Legislature begins again in just a few short weeks.  There are plenty of very important EMS issues on the table this year.  These issues directly affect all of us and our families, not to mention those we serve.

Peer Review Protection

Just as we have each year for the past 3 years, we will try once again in 2008 to pass “Peer Review” protection legislation.  Presently, hospitals, doctors, nurses, psychologists and others are protected from plaintiff attorneys’ use of Quality Improvement records.  Not EMS professionals. 

Representatives from MEMSA, Missouri Ambulance Association, American College of Emergency Physicians, Missouri Chapter and numerous other EMS groups, we continue to try to protect those records during lawsuits but the trial attorneys keep over powering us.  This year Governor Matt Blunt has approved the recommendation of the Missouri Department of Health & Senior Services and made the issue one of the legislative priorities of the state health department, as well as the Time Critical Diagnosis (the designation of stroke and chest pain centers).  

Many thanks to directors of DHSS, Drs. Jermyn and Jane Drummond, for moving these serious EMS patient care issues to the top of a very large pile of 2008 legislative issues.  While the peer review issue has been around for several years, the Time Critical issue is relatively new and exciting because if the positive effect it could have on some EMS patients.  Dr Jermyn has been the leader behind getting this issue the exposure it needs.

Cell Phone 9-1-1.

There are fifteen counties in Missouri without the 911 system.

Every state in the union except Missouri has figured out a way to tax cell phones as a means to pay for their 9-1-1 systems.  The result of this is that fifteen counties in Missouri have no 9-1-1 system and only a few counties have a complete 9-1-1 system that actually tracks where the cell phone caller is located (and those systems are underfunded). 

The Missouri General Assembly had an Interim Legislative Committee working on the issue but placing a tax on cell phones during the 2008 election year will likely be a tough sell.  The goal should be to get all 114 Missouri Counties to have access to a 9-1-1 system that takes care of normal phone lines as well as cell phone calls.

Medicaid Funding for Ambulance Services

Presently ground ambulance services are badly underfunded by the Missouri Medicaid program (recently re-named to Missouri Health Net Program). 

The current Medicaid program pays only 40% of what Medicare pays for the same call – and the Medicare rate is 20% below the cost of the service provided to begin with.
According to the Missouri Department of Social Services, ground and air ambulance transport providers combined are losing $21.5 million a year because of the lack of compensation from Medicaid. This lack of payment for services leaves local tax payers or other institutions to pick-up the slack. 

This year ground and air ambulance services will be working together to seek an increase in the Missouri Medicaid program’s level of payment to that of the federal Medicare rate.  More on this soon.

Death Benefit for EMS, Fire, Law Enforcement. 

Last year legislation was proposed for a state-provided death benefit for public safety workers who die in the line of duty.  This legislation was still alive until the last week of the legislative session.  This year, the Missouri State Council of Firefighters is leading this effort in 2008 and has a good plan in place to move this legislation forward this year.
Time Critical Diagnosis

The Missouri Department of Health & Senior Services is proposing the state have a system to handle stroke and STEMI patients in the same way we have a trauma system.  This would seem to require that certain hospitals be designated (as we now have trauma centers) and that we assure that stroke and STEMI patients get routed to these “Centers”. Governor Matt Blunt has approved the recommendation of the Missouri Department of Health & Senior Services and made the issue one of the legislative priorities of the state health department.  This is an idea that could save lives just as the trauma system saves lives. 

 
AED legislation reform

The AHA is seeking to up-date the present Automatic External Defibrillator (AED) law so that “untrained” personnel can use the devices and have the same protections from lawsuits.  This is common in other states as the AED’s have become very simple to use minimizing the need for actual training.