Each year, thousands of people in Memphis utilize the City’s emergency medical service (EMS) as their gateway to healthcare. Many of those who call 911 are not experiencing life-threatening emergencies but are still in need of assistance. In 2015, in response to this reality, Memphis Fire Department developed and deployed its Healthcare Navigator model to aid those who need care but did not require a lights-and-sirens trip to a hospital emergency department. The firefighter/paramedics, physicians, nurse practitioners, physician assistants, and social workers who make up this specialized team are committed to safely and effectively navigating these persons to the most appropriate resource for their needs while preserving emergency response equipment for higher-level events in our community.
Despite avoiding thousands of unnecessary emergency department visits, Memphis Fire Department was unable to be paid for its Healthcare Navigator services. This is due to an unfortunate and long-standing feature of the traditional insurance reimbursement mechanism. For decades, insurance companies would only reimburse EMS agencies when a person was transported by ambulance to a hospital emergency department. This was the case even when some other treatment was more appropriate and less costly.
Thankfully, this has recently begun to change as Medicare began to pay some EMS providers for treating non-emergency patients on scene or transporting them to alternate destinations such as behavioral health facilities. This represented a fundamental shift but was limited to a small number of beneficiaries. To expand this type of work, Memphis Fire Department turned to the Tennessee General Assembly to pass legislation which would direct TennCare to reimburse EMS agencies in much the same way when dealing with non-emergency Medicaid patients. It was estimated that this legislation, introduced by Senator Paul Rose in the state Senate and Leader Karen Camper in the House of Representatives, would result in approximately $8 million in savings for the state and federal governments. Legislators in both chambers voted unanimously in favor of the bill, which was signed into law by Governor Bill Lee on April 27, 2022. Memphis Fire Department has begun conversations with TennCare to implement this payment mechanism and looks forward to successfully caring for the Memphis public within a sustainable system of reimbursement.