309373
Utilization of Emergency Medical Services by Department of Defense Beneficiaries
In light of sequestration, the Military Health System is actively deploying various efforts to increase system efficiencies and control health care costs. While many of these initiatives are targeted towards overall population health and optimization of current health care resources, a comprehensive look at out-of-hospital care has yet to be explored. This study seeks to understand basic characteristics, costs, and utilization trends of emergency medical services (EMS) by Department of Defense (DOD) beneficiaries.
Methods:
A retrospective analysis of TRICARE claims for fiscal years 2010 – 2012 was utilized. Claims data were extracted from the Military Health System’s Management Analysis and Reporting Tool (M2).
Results/Outcomes:
Between fiscal years 2010 – 2012, 2.1 million line items were billed to TRICARE at a cost of $394 million. Characteristics of EMS high utilizers were DOD beneficiaries in TRICARE Standard (fee-for-service plan), retirees and their dependents, or active duty dependents. Emergent transports (911 emergency services) represented 50% of total EMS claims with chest pain and respiratory distress being the top diagnoses.
Conclusion:
DOD beneficiaries utilize a wide variety of EMS resources (ground, fixed-wing, rotary) for both emergent and non-emergent episodes, however there are opportunities to reduce unnecessary utilization and control costs for out-of-hospital care.
Learning Areas:
Administration, management, leadershipConduct evaluation related to programs, research, and other areas of practice
Program planning
Learning Objectives:
Identify characteristics of Department of Defense health care beneficiaries.
Define the basics of the TRICARE program.
Describe trends in emergency medical services utilization by Department of Defense beneficiaries.
Keyword(s): Emergency Medical Services, Health Care Costs
Qualified on the content I am responsible for because: I am a senior policy analyst for the U.S. Navy Bureau of Medicine and Surgery and advise the Surgeon General of the Navy on issues and recommendations relating to current operations (TRICARE benefit, patients administration, DOD/VA affairs, business decisions) of Navy Medicine. Additionally, I am a clinical instructor with the Emergency Health Services program at the George Washington University's School of Medicine and Health Sciences.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.