CMS Administrator Seema Verma Talks Expansion of Telehealth, Development of COVID-19 Vaccine and Answers Recent Allegations

CMS Administrator Seema Verma

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Marianne O’Hare : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcar e of the future.

This week Mark and Margaret speak with Seema Verma,
Administrator for the Centers for Medicare and Medicaid Services for
the Trump administration. She shares her observations about how
swiftly they transition ed their agency's regulations covering health
care for more than 1 30 million vulnerable Americans and seniors .
Talking about the hundreds of waivers that were put in place to allow
hospitals to continue operations in the pandemic and for telehealth to
become more widely adopted to keep people connected to their
position and what that will look like going forward .

Lori Robertson also checks in, the Managing Editor of F act C heck.org
looks at misstatements spoken about health policy in the public
domain, separating the fake from the facts . We end with a bright idea
that's improving health and well being in everyday lives.

If you have comments, please e - mail us at [email protected] or find
us on Facebook , Twitter , or wherever you listen to podcast. You can
also hear us by asking Alexa to play the program . Now stay tuned for
our interview with CMS Administrator Seema Verma here on
Conversations on Health Care.

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Mark Masselli: We are speaking today with Seema Verma, administrator for the
Centers for Medicare and Medicaid Services for the Trump
administration. She oversees a $1 trillion budget administering health
programs for more than 130 million Americans and is a key member
of the W hite House COVID - 19 Task Force.

Margaret Flinter: Prior to j oi ning the Trump Administration, Administrator Verma
advised a number of states on alternative approaches to the Medicaid
expansion created by the Affordable Care Act. She was the architect
of the healthy Indiana plan later reworked as HIP 2.0 under then
Ind iana Governor Mike Pence . She was also the founder and the CEO
of S V C, Inc, a health policy consulting firm . Administrator Verma, we
welcome you to Conversations on Health Care today.

Seema Verma: Good morning, thank you f or having me.

Mark Masselli: Well, a dministrator, as everyone knows , we're in the midst of this
global pandemic, which science is responding as rapidly as it can and
yet the virus has exacted a really crushing toll. Almost 200,000
Americans have died and it's been especially rough on the e lderly, the

CMS Administrator Seema Verma

vulnerable populations served by Medicare and Medicaid, the poor
underserved and communities of color . HHS and CMS acted swiftly in
March to relax some of the restrictions that were governing these 130
million Americans through both programs . I wonder if you could tell
our listeners about some of the most significant waivers and changes
that were put in place to ensure the health needs of our most
vulnerable populations .

Seema Verma: Well, thank you for that question and just to kind of give you a sense
of our overall theme, when the pandemic hit, we wanted to do
everything we could to support those providers on the front lines .
Understanding that many of them were operating in crisis situations,
they may be overloaded with a number of people com ing in to their
emergency rooms and their ICU s and so that was kind of the
mentality that we started with. Fortunately, for CMS, we had been on
a three - year journey to be working more hand in hand and to increase
the dialogue between providers with our Pat ients over Paperwork
initiative. Hats off to the CMS team that worked day and night, I can
tell you our team met literally every day for the first two months and
trying to get rid of a lot of regulations and they centered around a few
areas.

The first one is one that we call hospital without walls, which was sort
of understanding that hospitals may be able or may need to be able to
provide services outside of their physical capacity or their physical
four walls. Allowing them not only to maybe use their di fferent wards
like a maternity ward, maybe that got turned over to be able to
provide services or maybe they wanted to set up a testing site in the
parking lot or maybe they wanted to see patients in another facility .
Really giving them a lot of flexibilit y to prov ide services out of their
walls, that was called hospital without walls. The second area that we
were very focused on was regulatory burden. We know that, on a
good day most of our providers find a lot of the CMS regulations
restrictive . Obviously , they're for a reason, program integrity, quality
and safety , but I think we had to think of this in terms of this is crisis
level care. And so gave them a lot of flexibility, whether it was simple
things like waivers of the S tark L aw so that they could p rovide meals
to their medical professionals.

The other thing that we focused on was giving them flexibility around
paraprofessionals and augmenting the workforce. There's some
restrictions within our policies that say certain kinds of providers can
only p erform certain types of tasks. We knew in this situation, it had
to be all hands on deck, so we relaxed a lot of the requirements for
example for nurse in SSS , and that was really important so we can
make sure that we were keeping those ICUs o pen and that they had
the appropriate staffing . Telehealth , which I hope we can spend some
more time on, that was a big one for us really getting rid of a lot of

CMS Administrator Seema Verma

regulatory barriers. The other thing we did was provide resources.
Not only were the provider relief funds there $ 175 billion, but even
before that early before Congress was able to authorize those funds,
we did the accelerated payments program and put out basically giving
loans to providers, hospitals and doctor ’ s offices, over $106 billion.

A lot of as you c an see a lot of changes, we've put out probably
around what we call three interim final rules. Not only we made these
changes, we actually can't just make that we have to go through
formal rulemaking and so that was an effort. Then the other big piece
of i t was just a lot of waivers over hundreds of waivers that we put
out for the healthcare community. We did that across the nation. We
didn't want providers to have to file and ask for per mission for every
single waiver. Once somebody asked for it and we fel t like it was
reasonable , we just did blanket waivers. It applied to everybody
across the country. I think t hat's been really helpful as we’ve seen the
virus move to different communities. That way the health system is
ready to go, they have the flexibilit ies that they need.

Margaret Flinter: Well, Administrator Verma, I can tell you that we imagined you were
working 24 x7 with your team, when we saw the speed at which some
of these changes were happening. We do want to talk about
telehealth, which we though t was one of the very impactful ones. I
think generally been lauded by everybody across the country, in the
healthcare industry and good response by consumers as well. I want
you to share with our listeners a little more about this rapid expansion
of teleh ealth . What do you think about these changes remaining in
place based on the fact that patients are telling us that this really
works for them and certainly healthcare leaders are asking for it to
remain in place and I also want to quickly just comment on the issue
of ensuring pay parity for providers who deliver care via telehealth to
t heir patients as we go forward.

Seema Verma: When it comes to telehealth, again, this was something that
f ortunately the agency had already been working on before the
pandem ic had . We had made some adjus tments to allow for brief
check - ins and recognize that telehealth was in an area . One of our
strategic initiatives as fostering innovation and one of the things that
we've tried to do is to make sure whether it's in the Medica re
program that we're doing everything we can to foster innovation
across our country. Telehealth was a great example of this. When the
pandemic hit, we tried to do everything we could to expand
telehealth. It wasn't just identifying services, we actually increased
the number of services, there's now 135 services that can be
provided. We also got rid of barriers to make sure that different types
of providers could use telehea lth and could provide services.

There are also barriers in the program that restri ct the number of

CMS Administrator Seema Verma

visits , so for example, in nursing homes, you could only do one
telehealth visit a month. We recognize d that obviously it wasn't going
to work. We've also made sure that it can be provided in different
settings , so again just trying to get rid of all of that red tape around
telehealth. As I travel across the country and talk to providers and
patients I'm hearing across the board, how valuable people feel
telehealth has been . From providers, they're saying, look, this isn't
goi ng to replace in patient care, but it's certainly something that can
augment it. Many of them have said, we found some things in
telehealth that we didn't quite see or that we wouldn't necessarily
been able to accomplish in a face - to - fac e visit.

One of the examples that I always hear about are medications . People
can go retrieve their medicines, they have it all in front of them, and
they can actually show the doctor, this is what I'm taking. I heard from
a provider in Ohio, who said, she was treating a disabled child an d it's
very difficult for that family to come in but she was able to see the
child in their environment. She was also able to meet some of the
other caregivers that participate in the patient's care that don't
necessarily come in for a visit. I think we're all recognizin g that there's
a lot of benefit, certainly convenience. In the case of the pandemic,
it's actually protected our patients and protected our healthcare
workforce. Going forward I think there's a lot of benefit.

The President is very committe d . He's put out an executive order. It's
his intent to try to make this a permanent benefit . We will obviously
need some help from Congress to make sure we can provide it
outside of rural areas. A few areas where I think it's particularly
helpful and that' s in mental health. As we're seeing more in - person
visits return, we're seeing that in the data. You're obviously seeing
telehealth go back down but one area where we continue to see
many visits is in mental health and a lot of people just feel more
comfor table doing that via telehealth. It reduces the stigma and so
given some of the pressing mental health issues that we have in this
country, we think that it's v ery important for that service.

The other area, I think, is important, and this is for rural ar eas but
even there's other parts of the countries that just may suffer from not
having a workforce there or havi ng access to certain specialists or sub
specialists. Telehealth can kind of bridge that gap and make sure
across the country that people have ac cess to the type of speci alty
care that they might need.

In terms of reimbursement, that's a great question and I can tell you
that the agency is grappling with that as well. We have to make sure
that the reimbursement is adequate and that there's still an incentive
to provide the services. If the reimbursement is too low then the
providers are n’t going to do it, they're not going to offer this. At the

CMS Administrator Seema Verma

same time we also need to recognize that there are some things that
ca n only be accomplished in an in - pers on visit.

There is still a lot of work that goes on behind the scenes with the
telehealth visit, getting patient to set up, there's still billing , so we’re
still trying to study what the difference is. That's something that we're
going to continue looking at and I want to make sure that it is
adequate enough to ensure that our providers kee p offering it.

Mark Masselli: Administrator Verma, you've been a strong proponent of alternative
approaches to the administration of Medicaid in your efforts to
promote flexibility for individual states, including waivers for such
things as work requirements, health savings accounts for Medicaid
recipients. We've seen states take many varied approaches to the
program, but under the Family First Coronavirus Response Act, s tates
saw their F ederal medical assistance percentage go up by 6.2%. That
really was an important boost to so many governors and S tate
Medicaid directors who are struggling to meet the needs of the
vulnerable population . I think on their mind right now is how long will
that last, is this going to be the new floor for Medicaid , and it seems
like it's a quick way to get financial support to states. Can you talk a
little bit about what your internal thinking is now and how long this
addi tional 6.2% will stay i n place?

Seema Verma: Well, that's a great question , and when i t comes to the Medicaid
program, I've been a strong proponent of state innovation . I've
worked with a lot of states before coming to CMS. At the end of the
day, from having worked with states a nd having worked in the F ederal
G overnment now almost four years, one of the longest serving
administrators, I can tell you that innovation doesn't happen in
Washington . It happens on the front lines and providers that are
treating patients are really in t he best position to think about what's
going to work best and the same thing for states. They know their
communities better. Every state is different in terms of their delivery
system. I think from our standpoint, we need to provide more
flexibility for st ates so that they can design programs that are going to
work best for the populations that they serve.

We're trying to move away from a Mother - May - I approach where
states are having to come to the F ederal G overnment to ask
permission for just routine cha nges. That being said I think states
need to be held accountable around integrity and around
accountability for the outcomes they achieve with their programs.
This is a very vulnerable population. These individuals have no place
to turn and we have to make sure that we fulfill society's commitment
to them to make sure that they have high quality care. One of the
things that we've done in Medicaid is start a new scorecard so we can
actually evaluate state ’ s performance and how is the quality of care ,

CMS Administrator Seema Verma

what ki nds of outcomes are they achieving for their Medicaid
recipients.

In terms of the F MAP and the increase that is ultimately up to
Congress. That being said, I think anytime we're giving money to
states, there should always be some accountability and some
transparency about how those dollars are used and what they're
doing to actually improve the quality of care and the outcomes for
these individuals.

Margaret Flinter: Well, Administrator Verma, I'd like to focus a little bit on our nation's
nursing homes a nd assisted living facilities , obviously, an area where
there was a devastating toll of the COVID pandemic. You have issued
new guidelines for Medicare and Medicaid certified nursing homes to
better protect the health of patients and their caregivers. Talk a little
bit about some of the new safeguards outlined in the CMS targeted
COVID - 19 training for frontline nursing home staff program. I think
you have some other similar programs aimed at making sure that
there's excellent training for healthcare profess ionals in these
settings , so what's changed and w hat can we look for ward to see?

Seema Verma: Sure , so obviously our focus has been on protecting the most
vulnerable . In nursing homes, we took very early action, even as early
as January and February, putti ng out guidance to nursing homes and
to all health care facilities and restricting visitation. That being said,
y ou're right, it's had a devastating impact on our most vulnerable
population. From my standpoint, there's been a lot of attention given
to hospi tals and workers on the front lines in hospitals. But I think it's
important to remember that we had a whole nursing home workforce
that was under incredible stress . They were not only performing their
day to day responsibilities, but they also had to serv e as kind of a
support system to the residents of nursing homes . It's been
par ticularly challenging for them.

What I would say about our approach just overall is it's been let's
push on every lever we can across not only CMS, but working with
some of our partners and it's really been unprecedented action.
We're shipping in supplies to nursing homes, we're putting point of
care tests in there. CMS has issued many different types of
regulations, probably more than we've done in the last three years, in
terms of the amount of regulations and guidance that we've given
nursing homes. I think we also recognize that some of those frontline
workers, they may not have time to read pages and pages of CMS
regulations and so what we put together was a training. This wa s
intended to help those frontline workers understand those best
practices. This was based on all of the investig ations and surveys that
we did.

One of the things that we did is require all of the states to conduct

CMS Administrator Seema Verma

surveys of nursing homes in terms of inf ection control. We've done
that over the past few months, almost 99% of nursing homes have
been inspected. We've also gone in when we've seen outbreaks and
we've worked with the CDC to do these investigations. The training
was built on some of the things a nd some of the lapses that we were
seeing around infection control. It's intended to be a resource for
nursing homes, assisted living, and really any facility that has
congregate care living . It's just routine things like addressing the
mental health issue s of the residents, hand washing, hygiene ,
cohorting, so a lot of different topics that we know that the nursing
homes were facing.

Mark Masselli: Well, that's such an important program. Congratulations. We're
speaking today with Seema Verma, Administrator for the Center for
Medicare and Medicaid Services for the Trump administration. She
oversees a $1 trillion budget administering health coverage programs
for more than 130 million Americans . Administrator, you were talking
earlier about you're focusing on rural communities, 57 million
Americans, one in five live in sparsely populated regions , and
obviously the pandemic has highlighted a lack of direct access of care
for so many. In particular, we note the limited broadband access,
which hampers the ability of clinicians to deliver telehealth to these
populations. I wonder if you could talk a little bit about what the
combined strategy of HHS and CMS is to help improve that care to
strengthen rural hospitals, rural community health centers and the
like n . Tell us a little more about your strategy there ?

Seema Verma: Sure , so I think one thing that we've all come to appreciate about the
pandemic is that it's exposed all of the issues in our health care
system, whether it's just the disparities that we have in te rms of our
minority communities, but also some of the challenges tha t rural
providers face on a day - to - day basis. Even before the pandemic, we
know that we've seen a number of hospital closures across the
country and that our rural communities have really been struggling to
provide accessible care to their residents. From our standpoint, I think
it's trying to really come up with a comprehensive solution. In the
past, I think a lot of the approaches are, let's just put more money
into it and at the end of t he day, that doesn't really solve the
underlying problems.

What we've done are a couple things, one we have addressed where
there have been very clear financial issues and that's our Medicare
reimbursement. The way that it's worked is it kind of pitted ur ban
areas against rural areas. We've seen that there's been growing
disparities between Medicare's reimbursement of services in urban
areas versus rural areas. We made some sweeping changes to
Medicare reimbursement to ensure that rural communities were
be ing appropriately reimburse d. The other area that that we focused

CMS Administrator Seema Verma

on and we just put out this model and it ’ s called our CHART model.
The idea is to actually give some seed money to rural communities, so
that they can think about how they can transform thei r system and it
requires them to work together. So i t ’ s working not only with
Medicaid insurance companies , the hospitals, the clinics, everybody
kind of coming together and thinking about what's going to work best
here.

In the past, rural communities, I mean, they're just struggling to keep
their doors open, they don't necessarily have the time or resources to
do this type of planning so t hat's what these resources are intended
to do. The other area that the CHART model allows is that it says that
maybe w e should be paying our rural providers in a different way .
We've all been trying to move away from a fee - for - service system but
I think that's more important in rural areas where it's a challenge for
them to provide care that's based on volume . They're not going to
have the volume. What we've also seen, a lot of times, even when
they're providing services, people in their communities will bypass the
availability of those services and go to another area or another
community to obtain those services. We want to make sure that we
are providing some new opportunities to reimbursing rural providers,
maybe it's better to pay them on a capitated basis, a bundled
payment, predictable income for those rural providers, so that they
can actually focus on improving outc o mes and keeping people
healthy.

There are some opportunities there to change the way we reimburse
for services. Then the last area is just giving them more flexibilities.
Some of the regulations that we have just don't make sense in a rural
community and they need more flexibility, whether it's around
telehealth or some bed limits for critical access hospitals or having
more flexibility when it comes to what paraprofessionals can do in
their community. We're very hopeful that the CHART model will
actually lead to some exciting new models that can be replicated
across the country.

Margaret Flinter: Well, that's great. I want to give you a chance to talk about something
that we saw some good news on in recent days . You've been very
focused at CMS on the prom otion of value based care models over
really several years now , but I understand in one program, the
Pathways to Success Program , which is an approach in the Medicare
Shared Savings Plan, you've got only 5% of the ACO s in the plan, but
realized $2 billion in savings in 2019. I think this is particularly
important because there's always the concern that we held back on
services in order to save the money, but in this program designed
specifically to get greater value without curtailing access to any
services . We want to give you a chance to maybe talk about that, and
can we expect to see an expansion of that program or that model of

CMS Administrator Seema Verma

care?

Seema Verma: Sure, I think that it's been an important development in the whole
concept of value based care. When I came t o the agency, the ACO
program in some cases was losing money. There were some providers
that were doing well, but there were a lot that were taking all of the
CMS waivers and they weren't necessarily producing any results. We
took, I would say, kind of a b old initiative, a little bit of a risk to say,
look, if you want to stay in this program and you want these
flexibilities, then we expect you to take risk. The way Pathways was
set up was that it puts providers that are participating in the ACO
program on a track to take more and more risk. If they're not willing
to do that, then they then they wouldn't be in the program anymore.

I think people were concerned that providers wouldn't want to take
risk number one or that they wouldn't be successful and that we
actually may deter providers from participating. But we've actually
seen the exact opposite been really encouraged with the number of
participation with the amount of savings and that we've actually seen,
also the quality being maintained and also great results from our
physician led practices . They have had tremendous results, we gave
them a little bit more flexibility in terms of taking on risk , but I think
this really speaks to the fact that in value based care there has to be
upside and downside risk for providers . Some skin in the game to
produce the types of res ults that we're all looking for.

Mark Masselli: Administrator, we know we're running out of time but quickly ,
Operation Warp Speed to accelerate the vaccine deployment is
something that's on everyone's mind. There's a really bigger challenge
o f how we're how are we going to, o ne, do that safely and make sure
the vaccine is developed, but more importantly, how are we going to
distribute vaccines at the same time we're doing flu ? How are you
int ernally helpi ng provide support to states, local health departments,
community health centers, all of those key players out there in terms
of making sure that we can really reach every American with both the
flu shot and h opefully a vaccine that's safe?

Se ema Verma: Well, first of all, I would say there are no shortcuts when it comes to
safety and efficacy. There are many levels of review. It's not, even
before it goes to the FDA, there's a patient safety board that takes a
look at the data that comes from the manufacturers before they even
submit it to the FDA. The FDA has a number of advisory committees ,
external advisory committees, so there's not going to be any
compromises when it comes to safety and efficacy. At the same time
that these vaccines are be ing developed, we have a large operation
a round the distribution of these, that's being handled by the
Department of Defense. We are working on sort of building off of
what we already do with the flu system in terms of distributing the

CMS Administrator Seema Verma

vaccine, but also un derstanding that we're going to need to go
beyond that , really working with our retail pharmacies, our traditional
clinics .

From the CMS standpoint, we just want to make sure all the
reimbursement is in line and that providers in different types of
settin gs can get the appropriate reimbursement. So like I said this is
something that with O peration Warp Speed, people are working
around the clock . We've already asked states to come up with their
plans about how they're going to distribute the vaccine to make sure
people in their states can get access to the vaccine.

Margaret Flinter: Great , and administrator Verma, CMS is one of those F ederal entities
considered an able steward of the public resources and really a
beacon of fiscal responsibility with public f unds. We have a recent
congressional report alleging that you utilize d several million dollars
in personal expenditures during your tenure as the administrator . Can
you comment on this so the public can have a better understanding?

Seema Verma: Number one, I will say that there was an independent Office of the
Inspector General report that found that there weren't these types of
issues . They review these contracts and they did not find this finding.
The report that you're referencing came out from four demo cratic
committees that alleged this. There’s absolutely no evidence of that.
The Inspector General didn't find that. Everything that we have done
at CMS is to promote the CMS programs. When I came on board,
what I wanted to do is sort of change the way CMS was operating. We
wanted to make sure that people understood the changes that we
were making. We wanted to go beyon d just the healthcare
community. When we're making changes on interoperability or
Medicare Advantage , those are things that require or that we'd want
the general public to understand. So w e're trying to go beyond the
routine, but I would say healthcare industry, to make sure that there
was a broader understanding. We've reached out to those journals
that reach women, for example . We know that women make a lot of
health care decisions, which is why we were trying to reach out to the
women's media. The Inspector General didn't find any of this and I
think this has just been unfortunately a political attack on public
servants, which we would expec t previous to an election.

Mark Masselli: We've been speaking today with Seema Verma, A dministrator for the
Center for Medicare and Medicaid Services for the Trump
administration, overseeing health coverage for more than 130 million
Americans. You can lear n more about their important work by going
to www.cms.gov or follow her on Twitter at @SeemaCMS.
Administrator Verma, thank you for your commitment to advancing
health policy for working to leverage the power of technolo gy as a
force multiplier in the care delivery system, and for joining us today

CMS Administrator Seema Verma

on Conversations on Health Care .

Seema Verma: Thank you.

Margaret Flinter: Thank you so much.

[ Music ]

Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of decep tion in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: In a Labor Day press conference and a rally in North Carolina the
following day, President Donald Trump made several unsupported or
inaccurate statements about a COVID - 19 vacc ine. The President
claimed “if thi s were the Obama administration, you wouldn't have
that vaccine for three years and you probably wouldn't have it at all. ”
He has previously made similar claims. It's his opinion that he alone
could pull off a vaccine in r ecord time , but it's premature to declare
victory and the idea that no other leader could do the same lacks
support. The key idea behind Operation Warp Speed is to
manufacture a vaccine before it's known to work so that it can more
quickly be distributed i f it ends up being approved , but that's not new.
It was done in 2009 for the H1N1 influenza vaccine. Although the
effort this time is much larger given the greater concern of the
Coronavirus pandemic, there's no reason to think a different
President would not have come up with a similar strategy as other
countries and organizatio ns are using the same approach now.

Trump also inaccurately said “ we have 30,000 people in just one
vaccine right now under test in very, very highly infected areas ”, and
he said “ the numbers are looking unbelievably strong. ” As of
September 7, the day Trump made his remarks, no trial had met its
enrollment target of 30,000 people and no one knows yet how the
vaccine s are performing. As of September 7 th , Pfizer BioNTech was
close to that mark. It had enrolled 25,189 volunteers in 39 States.
Since the studies are double blind, neither the President nor anyone
within the company is working on vaccines or the FDA knows how
well the vaccines are performing in the phase three trials so fa r . The
only people privy to that information are those on the dat a and safety
monitoring boards.

Finally, while insisting that he has never said there will definitely be a
vaccine in October or November, Trump repeated the idea that it was
possible and pre viously said that such timing was likely. Health
officials have said a vaccine is unlikely to be available that soon.

CMS Administrator Seema Verma

That's my fact check for this week. I'm Lori Robertson, Managing
Editor of FactCheck.org.

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcr adio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[ Music ]

Margaret Flinter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday liv es. Baltimore,
Maryland has one of the highest emergency medical call volumes in
the country and it results in a significant number of patients being
taken to the ER for conditions that could have been treated outside of
the ER . The University of Maryland Medical Center and the Baltimore
City Fire Department teamed up in the hopes of reducing unnecessary
ambulance trips and hospitalizations. They created a new pilot
program which pairs doctors and nurses at the hospital level with
paramedics in the field, b ringing medicine right into the patient's
homes.

Dr. David Marcozzi: 911 low acuity calls, we augment the Baltimore City EM S system, so
that we co - dispatch a paramedic and either nurse practitioner or
doctor to the scene of low acuity calls and we then enr oll them into
our program. We then treat them at the scene, discharge them with
prescriptions as needed, and then we follo w up with them within 24
hours.

Margaret Flinter: Dr. David Marcozzi of the University of Ma ryland Medical Center says
that, this comm unity paramedicine program has a two prong goal .
One, reducing unnecessary trips to the ER by del ivering right care at
the scene, two bringing a coordinated paramedicine team including
doctors and nurses into the homes of patients being released from
the h ospital to ensure that their recovery is supported for better
outcomes, thus greatly reducing the risk of re - hospitalization.

Dr. David Marcozzi: It's eye opening to once you understand the challen ges when we
discharge a patient . People stay just at home t o navigate the
insurance industry, the multiple providers they're supposed to follow
up with, then they follow up back to their primary care. We're
exploring, could we do this for longer for THS. Our data demonstrates
that the patients who are followed in our program are admitted to
the hospital significantly less that translate into lower costs to the
system.

Margaret Flinter: But most importantly he says the patient outcomes are markedly

CMS Administrator Seema Verma

improved. The Mobile Integrated Healthcare Community
Paramedicine Pr ogram reducing unnecessary emergency room trips ,
now that's a bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

Mariann e O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community
Health Center .

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