Financing King Country EMS

EMS Financing Strategies Financing an EMS system is an important component and can represent a critical success factor. Systems that do not have adequate resources will be unable to perform at optimal levels. However, systems that are wasteful in regards to resources will represent an inefficient system that will drain public resources. Such a system will likely be the subject of budget cuts or reorganization. Therefore it is important to form a balance in EMS funding between being underfunded and draining public resources.

Each EMS system must continually struggle with this funding balance and no two systems are alike. Most systems incorporate a wide range of different funding sources that include everything from relying on volunteer services, to providing fee-for-services, and to using local funding. Having a high level strategy to ensure an EMS system maintains an optimal amount of resources at all times can help simplify this process.

Most healthcare organizations have abandoned the idea that healthcare systems can be improved through increased spending and are now focusing on efficiency as a driver of patient outcomes (Fitch & Knight, 2015). Another consideration is that changes to the financing system tend to be relatively slow. For instance, in Kansas City, the city used a design that had been in place for more than twenty-years and when reforming the system they expect that the system will be in operation for twenty years or longer (Associates, 2004).

Kansas City, and many other cities, have long operated on a system concept known as the Public Utility Model that focuses on the separation between authorities and responsibilities (Stout, 1980). This system has been shown to contain high levels of accountability and stability overall (Associates, 2004).

However, many contemporary organizations have moved to a system that is based on what is referred to as the "Triple Aim" which has also been integrated into the Affordable Care Act or 2010; this concept focuses on creating the right foundation for population management, managing services at scale for the population, and establishing a learning system to drive and sustain the work over time (Whittington, Nolan, Lewis, & Torres, 2015). The factors that this concept is grounded upon are not independent and are designed to be balanced in an organization.

Furthermore, this concept is well suited to work in a dynamic and evolving system as can be found in both EMS and healthcare in general in the United States. The EMS system being researched is King County and this system uses a hybrid approach to financing that includes many best practices from other models. The primary source of funding in this system comes from an EMS levy that is based upon property taxes in the county (Seatlle and King County EMS, 2014).

This system allows for reserves to be created that can be directed at making the system more efficient and seek out the balancing point as outlined in the concept of the Triple Aim. The goal is to lower expenditures without sacrificing service quality or health outcomes.

The aims of the most recent levy charged in the county include: • Realigning resources to promote efficiencies and provide value to EMS partners; • Continuing to manage use of resources -- particularly ALS and BLS call volumes; • Developing reserves and designations to cover ALS costs as recommended by King County Auditor's Office; • Using reserves prudently; • Reviewing operational and business practices for efficiencies with a.