Incentive-Compatible Prehospital Triage in Emergency Medical Services

Production and Operations Management 28(9), September 2019, pp. 2221-2241. doi:10.1111/poms.13036

Kelley School of Business Research Paper No. 16-65

Baruch College Zicklin School of Business Research Paper No. 2019-04-05

38 Pages Posted: 20 Sep 2016 Last revised: 15 Sep 2020

See all articles by Eric Webb

Eric Webb

University of Cincinnati, Lindner College of Business

Alex Mills

Baruch College Zicklin School of Business

Date Written: April 19, 2019

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 healthcare through EMS. A national survey estimated that 17% of ambulance trips to hospital Emergency Departments (EDs) were medically unnecessary, and that these unnecessary trips make up an increasing proportion of all EMS trips. These non-emergency patients are a controllable arrival stream that can be re-directed to an appropriate care provider, reducing congestion in EDs, reducing costs to patients and healthcare 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.

Keywords: health care management, incentives and contracting, public policy, service operations

Suggested Citation

Webb, Eric and Mills, Alex, Incentive-Compatible Prehospital Triage in Emergency Medical Services (April 19, 2019). Production and Operations Management 28(9), September 2019, pp. 2221-2241. doi:10.1111/poms.13036, Kelley School of Business Research Paper No. 16-65, Baruch College Zicklin School of Business Research Paper No. 2019-04-05, Available at SSRN: https://ssrn.com/abstract=2839785 or http://dx.doi.org/10.2139/ssrn.2839785

Eric Webb (Contact Author)

University of Cincinnati, Lindner College of Business ( email )

2925 Campus Green Drive
PO Box 210130
Cincinnati, OH 45221
United States
5135567131 (Phone)

Alex Mills

Baruch College Zicklin School of Business ( email )

55 Lexington Ave
New York, NY 10010
United States

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