This Weekend’s Homework Assignment

For many years, fire departments (many, but not all), have had their capabilities rated by the Insurance Services Office. These ratings, formally referred to as Public Protection Classifications,  graded fire departments on a set of standardized benchmarks on such things as response times, coverage area size, water pressure, number of hydrants, etc., as well as proficiency in the technical aspects of fire suppression. The better a department measured up, the higher their rating. A CLass I rating is considered a badge of honor for fire departments.

Now, the benefit to the citizenry came in the form of lower homeowner's insurance premiums. The higher your local fire department's PPC, the lower your premium. Thus, fire departments had incentive to provided the best services possible, and fire chiefs could point to tangible benefits to the homeowners they served when it came time to pass, increase or renew taxes to support department operations.

Now imagine, if you will, a similar mechanism for EMS systems. If your system boasts stellar cardiac arrest survival rates, or great response times, or pioneered a new sepsis alert protocol that lowered mortality in your area for sepsis patients, or just purchased CPAP devices that dramatically reduced the number of CHF patients getting costly ventilator care in your local ICU's, why shouldn't there be some break in health insurance premiums for the citizens you serve? For that matter, why not pay for performance? Should systems that perform exceeedingly well get better reimbursement than low-performing systems?

That way, your local EMS system would have incentive to provide top-notch care, and citizens would have tangible reasons to support your operations with tax dollars.

So, your homework assignment is as follows:

1. What would be necessary to implement such a system?
2. Who should administer it?
3. What benchmarks should we require? And no vague answers like "response times." Response times are arbitrary and meaningless for the vast majority of EMS calls. If that's a benchmark, specify a a target response time for a particular type of call.
4. What are the obstacles to implementation, and how might we overcome them?

Feel free to give me your ideas in the comments, or if you prefer, use this as fodder on your own blog, and post a link back here.

I'm interested in hearing your thoughts…