EMS and Managed Care: The Los Angeles Experience

Abstract

Background. Patients belonging to a managed care organization (MCO) who call 9-1-1 are typically transported to their MCO facility only if it is also the closest emergency department (ED). As past medical records and close follow-up are unavailable at the non-MCO facility, unnecessary workups and/or admissions may result. Objective. To examine the safety and feasibility of preferentially transporting MCO patients to the closest MCO ED rather than the closest ED. Methods. This was a retrospective review over a 52-month period comparing all patients transported by ambulance to an MCO ED when that destination was not the closest ED (targeted group) with all other transported patients. If the MCO facility was not the closest ED, then the emergency medical services (EMS) provider would be reimbursed an additional fee beyond the routine ambulance charges. The primary outcome measure was the additional ambulance transport time. The secondary outcome measure was mortality within the first 24 hours. Results. There were 15,938 patients transported under this program from July 2000 through December 2004 for whom outcome data were available. Of these, 10,532 (66%%) were transported by advanced life support (ALS) ambulance. The mean (± standard deviation) transport time to the hospital for all targeted patients transported during the study interval was 10.4 minutes (±3.2 minutes) compared with 8.6 minutes (±2.1 minutes) for all transported patients (p < 0.001). No patient required ventilatory support in the field. Twelve (0.1%%) patients died during the subsequent hospital admission and, after a blinded chart review, none of the deaths were deemed to be preventable or likely to have resulted from additional transport time. Conclusion. Our study suggests that paramedic transport of MCO patients to the nearest MCO hospital in lieu of the nearest ED is safe and feasible. Given the potential benefits to patient care, this program should be evaluated in other EMS systems.