Instructions:
I need the following word doc (CRM 717 Overview NEW2) that is attached in the file, to be recrafted, rewritten, in the most highest form because the plagiarism count is incredibly high. I need the page count to be around the same, 5-6 single spaced pages, the plagiarism count when I submit can’t be any higher than 3%, I currently ran this paper through Turnitin, and it is over 80% so I definitely need your help in this dire assignment. This is a massive part of my grade, and the plagiarism count has to be 3% or under. The word doc (CRM 717 Overview NEW2) just needs to be near plagiarism free.
Throughout 2020 and 2021, the use of telemedicine has expanded across the healthcare spectrum in the United States, largely by necessity in response to the COVID-19 pandemic. Telemedicine has emerged across different communities throughout the Nation as an important vehicle for delivering healthcare services without the need for in-person interactions. Adoption and incorporation of telemedicine practices and information into emergency medical services (EMS) and 911 organizations operations can benefit patients, the EMS and 911 communities, and the healthcare delivery systems in which they operate. Telemedicine has been increasingly included in healthcare systems for many years yet has only recently begun to be adopted in EMS and 911 delivery of healthcare services. The pressures and complexities of providing out-of-hospital care during the COVID-19 pandemic have led to an increase in the use of telemedicine in healthcare. This has established a new level of service for EMS and 911 systems with which to provide care to patients. Aim 1 – Establishing a Telemedicine Program – Relationship with the Emergency Triage, Treat, and Transport Model Medicare regulations have historically only allowed payment for emergency ground ambulance services when individuals are transported to hospitals or critical access hospitals, with non-emergency payments for transportation to skilled nursing facilities, dialysis centers, and home when deemed medically appropriate. Most beneficiaries who call 911 with a medical emergency are therefore transported only to a hospital emergency department, even when a lower-acuity destination or no need for transportation may more appropriately meet an individual’s clinical care needs. Emergency Triage, Treat, and Transport (ET3) is a CMS Center for Medicare and Medicaid Innovation (CMMI) voluntary, five-year payment model implemented on January 1, 2021 that intends to provide greater flexibility to ambulance care teams and 911 centers to address the emergency health care needs of Medicare fee-for service beneficiaries during and following a 911 call. CMS will continue to pay to transport a Medicare fee-for service beneficiary to a hospital emergency department or other covered destination. In addition, under the model, CMS will pay participants to 1) transport to an alternative destination partner, such as a primary care office, urgent care clinic, or a community mental health center (CMHC), or 2) initiate and facilitate treatment in place with a qualified health care partner, either at the scene of the 911 emergency or via telemedicine. CMS issued a Notice of Funding Opportunity (NOFO) in March 2021 to seek applications for the medical triage line intervention of the ET3 Model. Through a competitive process, up to 40 two-year cooperative agreements may be awarded to eligible entities (e.g., local governments, their designees, or other entities) that operate or have authority over one or more 911 call centers in geographic locations where ambulance suppliers and providers have been selected to participate in the ET3 Model. The ET3 model will allow beneficiaries to access the most appropriate emergency services at the right time and place. The model will also encourage local governments, their designees, or other entities that operate or have authority over one or more 911 centers to promote successful model implementation by establishing a medical triage line (or establishing a partnership with a medical triage provider) for low-acuity 911 calls. As a result, the ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports. Value Proposition As telemedicine practices are increasingly adopted across the Nation in EMS and 911 services, the benefits of this emerging approach to healthcare delivery have become more apparent. In summary, telemedicine for EMS and 911 organizations may improve patient outcomes, enhance the patient experience, and reduce the per capita cost of health care. For EMS and 911 organizations interested in establishing a telemedicine program, capturing these benefits in a value proposition will help bring administrators and partners on board. Examples of the value telemedicine can provide for different healthcare stakeholders include: • Patients: rapid access to care, enhanced understanding of care options and delivery, real-time interaction with known or specialized healthcare providers, reduced healthcare bills • Community: improved overall health of populations, reduction in burden of healthcare costs • EMS system: increased efficiency, real-time consultation with remote physicians, improved patient experience and outcomes, enhanced integration with healthcare system, improved relationships with hospitals, diversified revenue streams, increased patient and practitioner safety, enhanced decision making, reduced vehicle crashes and wear • 911 system: increased efficiency, enhanced integration into the overall healthcare system, improved situational awareness, enhanced decision making, better understanding of patient outcomes • Overall healthcare system: increased efficiency, integrated systems of care, lower overall costs Alignment within the community Building on the foundation laid by the 1996 EMS Agenda for the Future, EMS Agenda 2050 was developed through a multi-year initiative that established a vision of people-centered EMS and 911 systems. The document articulates a bold plan for innovative, people-centered possibilities to advance EMS systems. A key component was to foster models for systems that account for changes in social needs, including new reimbursement models. Establishing and implementing telemedicine programs for EMS and 911 systems follows that purpose. The six guiding principles of EMS Agenda 2050 are shown in Figure 2. Inherently safe and effective Providing high quality care without in-person interactions Benefit: reduction of response crashes, reduction of emergency motor vehicle crashes and risks, elimination of lights and sirens use Integrated and seamless Incorporating various data sources, increasing connectivity with providers, and coordinating care across jurisdictions Benefit: easily adapt to the out-of-hospital workflows and environments Reliable and prepared Routine, effective telemedicine interactions and effectively adapting to challenges Benefit: new technologies such as FirstNet and satellite broadband enable capabilities regardless of location Socially equitable Providing telemedicine care appropriate for urban and rural areas, cognizant of the needs of different patient populations Benefit: patient access to care regardless of the ability to pay or transportation resources Sustainable and efficient Establishing new reimbursement models and maintaining effectiveness without hospital transport Benefit: lower cost per visit, elimination of inappropriate utilization, lower emissions, lower wear and tear on equipment Adaptable and innovative Developing new methods for delivering healthcare services Benefit: rapidly overcome care delivery challenges to unforeseen events (e.g., telemedicine has been used for this purpose during the COVID-19 pandemic) Aim 2 – Telemedicine Program Initiation Establishing an EMS or 911 telemedicine program includes gaining understanding of key concepts and important considerations, conducting a variety of assessments for the EMS or 911 organization’s capabilities and operating environment (as well as those for the community), identifying gaps in those capabilities, and developing a business plan to implement telemedicine practices that ultimately builds a sustainable program based on its value proposition. Assessments Many different pieces are needed to fit together to decide on whether to pursue and develop a telemedicine program for EMS and/or 911. Important assessments include: 1. Financial – opportunity for reimbursement for ongoing operations costs, as well as billing and payment requirements of Medicare, Medicaid and commercial insurers 2. Community needs – health needs of the community overall, needs of unique patient populations, and the availability of practitioner partners in the local community 3. Current capabilities – telemedicine-relevant abilities of the EMS and/or 911 organization 4. Resources – clinical, operational, and technical support for telemedicine, including management, clinical personnel, and technology 5. Funding – financial support for establishing a telemedicine program Throughout these individual assessments, the organization can identify gaps and combined with the individual results, can conduct an overall gap analysis to identify where focus is needed to move forward. The combined gap analysis and results can then be used to develop a business plan for program implementation. Figure 3 shows this general process of conducting assessments and a gap analysis to develop a business plan, as well as measure progress. Figure 3 in telemed brochuere Financial Assessment The financial assessment is a critical early step to developing a telemedicine program. Understanding the financial landscape, including costs and revenues, will ultimately determine if a telemedicine program is feasible and sustainable. A financial assessment of the program’s operating costs will require identification of both start-up costs, capital funding requirements, and operating costs for ongoing clinical services. A financial assessment of the program’s operating revenues will require identification of reliable sources of revenue to fund ongoing clinical services to patients and to achieve program sustainability. Current Capabilities Assessment The current capabilities assessment can identify specific methods by which the EMS and/or 911 organization could optimally meet the healthcare needs of the community to receive the right care at the right time. The current capabilities assessment can also identify those capabilities the EMS or 911 organization can leverage for telemedicine, especially for: • Connectivity and bandwidth of network systems • Hardware and software, including adaptability of current infrastructure • Systems and data integration, including meeting technical and administrative requirements • Medical oversight • Practitioner availability / connection • Cybersecurity requirements, especially those related to interconnection Resources Assessment The resources assessment can identify the various support systems, assets, and personnel that will be required for a telemedicine program. These resources can be categorized as operational or technical. Operational Resources • Availability of telemedicine-specific resources • Availability of EMS and 911 resources and bandwidth for any increase in responsibilities • Availability of personnel to maintain and oversee telemedicine functions • Medical oversight • Process for changing standard operating procedures and clinical protocols • Training that will be required • QA/QI processes that may be included • Public information campaigns to garner acceptance of telemedicine by consumers through increasing their understanding of the new services being offered and how the new system will improve their care Technical Resources • Status of current technology utilized by EMS/911 in the community Network and infrastructure − Options for rural/frontier connectivity − Access − Hardware and software − Remote patient monitoring (RPM) • Network/Infrastructure capabilities of potential partners • Availability/feasibility of testing/deploying infrastructure (i.e., network, hardware, software) required • Availability of ongoing technical support during operation Gap Analysis An overall gap analysis can be created for telemedicine program initiation by combining the individual assessment gap analyses. This can help highlight the target areas on which an EMS or 911 organization may want to focus to move forward with program initiation. See Appendix B for a visual representation of how to get started with the gap analysis. Aim 3 – Design and implementation of the telemedicine program Integration as an Extension of EMS and 911 Incorporating telemedicine practices into EMS and 911 operations represents a significant shift in culture in their operating environments. It will be important to continually maintain contact and buy-in with the stakeholders identified in the previous chapter to keep the necessary stakeholders as aligned as possible and help smooth the transition of the EMS and 911 organization to establishing telemedicine operations. How EMS and 911 telemedicine systems integrate into other components of the healthcare delivery system, (e.g., hospitals and other