Incentive–Compatible Prehospital Triage in Emergency Medical Services

Eric M. Webb and Alex F. Mills

Production and Operations Management, 2019, vol. 28, issue 9, 2221-2241

Abstract: The emergency medical services (EMS) system is designed to handle life‐threatening emergencies, but a large and growing number of non‐emergency patients are accessing hospital‐based health care through EMS. A national survey estimated that 17% of ambulance trips to hospital emergency departments (EDs) were medically unnecessary, and these unnecessary trips make up an increasing proportion of all EMS trips. These non‐emergency patients are a controllable arrival stream that can be redirected to an appropriate care provider, reducing congestion in EDs, reducing costs to patients and health care payers, and improving patient health, but prehospital triage to identify these patients is almost never implemented by EMS providers in the United States. Using a decision model, we show that prehospital triage is unlikely to occur under the current structure of fee‐for‐service reimbursements, regardless of how effective the triage process might be, unless low‐acuity patients are unprofitable and a hospital is willing to coordinate with EMS. We demonstrate several mechanisms a payer, such as Medicare, could use to promote prehospital triage: reforming fee‐for‐service reimbursements or offering a value‐based payment, such as bundled payments or shared savings contracts. Using data from a national survey and levels of triage effectiveness demonstrated in the literature, we conservatively estimate that Medicare alone could save between $3 and $70 million per year (depending on triage effectiveness) by providing incentives for prehospital triage. Between 26,500 and 628,000 non‐emergency patients could be diverted to more appropriate care options, making prehospital triage a practical step to address hospital emergency department crowding.

Date: 2019
References: Add references at CitEc
Citations: View citations in EconPapers (3)

Downloads: (external link)
https://doi.org/10.1111/poms.13036

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:bla:popmgt:v:28:y:2019:i:9:p:2221-2241

Ordering information: This journal article can be ordered from
http://onlinelibrary ... 1111/(ISSN)1937-5956

Access Statistics for this article

Production and Operations Management is currently edited by Kalyan Singhal

More articles in Production and Operations Management from Production and Operations Management Society
Bibliographic data for series maintained by Wiley Content Delivery ().