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Publisher’s Note: This is the first of a multi-part series on how innovative employees and organizations that encourage out-of-the-box thinking can reduce costs, improve care and add long-term value to the current dysfunctional healthcare model.  If you have ideas for future blogs, contact John at

A Fort Worth Emergency Medical Services (EMS) agency is pioneering new programs to reduce costs for hospitals, other providers and payers, improve care, and add value to a healthcare service that historically derived success by frequency of service—taking patients to hospitals or making patient transfers.

MedStart LogoMedStar earned its stripes by creating an innovative EMS public utility model that eliminated the need for tax subsidies and for setting high standards for service accountability—responding within nine minutes of receiving 911 calls 90 percent of the time.  From a public policy perspective, improving response times and eliminating tax subsidies was a big win.  But changes in healthcare reimbursement created opportunities for MedStar to redefine their value to the community.  Now the agency is expanding its emergency response and transfer model to include pre-hospital care, and in the process they believe, based on encouraging early results, that they can make a major contribution to hospitals and payers by saving them money.

It all began in the mid-2009 when Matt Zavadsky, then the MedStar Director of Operations, an innovative thinker and a master’s prepared healthcare services executive with a specialization in EMS, launched a trial program in community health.  In the mid-2000s, Mr. Zavadsky detected those long-term trends that suggested that existing healthcare reimbursement models with misaligned incentives that rewarded more care, more service, would change.  Mr. Zavadsky realized the new approaches to paying for health services like EMS would be game-changing. 

Along with his colleagues at MedStar they conceived a trial plan to determine whether primary care home visits, carried out by paramedics, could reduce the number of 911 EMS calls from their “frequent flyer” patients, or as Matt prefers to call them, the “executive platinum members of our Fort Worth EMS loyalty program. 

“When you have people calling 15 times within 90 days you know you have a problem.”  Most were indigent or on Medicaid, a notoriously poor EMS reimbursement source in Texas, and given the average cost of a MedStar bill—more than $1,000—this was a drain on the organization and clogged up the public hospital’s emergency department.

So, Zavadsky and his team created a test program with the top 21 frequent flyers.  A paramedic who was on light duty because of an injury was used to recruit these patients into the program.  “These are people we know, very well,” Mr. Zavadsky explained.  “We have been to their residences so often that we usually know other members of their families well.”  With the patients on board to try the program, Zavadsky and his team set out to measure what impact pro-active visits by paramedics would have on their hospitalization.  “The results were significant—transports dropped dramatically. 

“By decompressing the emergency department at JPS, Fort Worth’s public hospital and trauma center, we also saw a potential side benefit: improvements in patient satisfaction, both for EMS and the hospital,” Zavadsky explained.  “When a patient has been sitting in a hospital ED for six hours waiting to be seen, they are probably not going to award the hospital a good score on a Press Ganey survey.”  Given that a portion of a hospital’s reimbursement is tied to patient satisfaction and patient readmission rates, this is an opportunity for EMS to deliver value.

Next: How MedStar helped a Fort Worth hospital save big money by reducing readmission rates.

© 2012 John Gregory Self