BILL ANALYSIS Ó
AB 2406
Page 1
Date of Hearing: April 1, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 2406 (Rodriguez) - As Introduced: February 21, 2014
SUBJECT : Emergency Medical Services Authority: abuse of
emergency medical services.
SUMMARY : Requires the Emergency Medical Services Authority
(EMSA) to prepare and submit a report to the Legislature, no
later than December 1, 2015, identifying programs that have been
implemented in the state by local emergency medical services
agencies (LEMSAs) that address the misuse and abuse of the
emergency medical services (EMS) system in California.
Specifically, this bill :
1)Requires the report EMSA must submit to include:
a) A summary of the different programs implemented by
LEMSAs and specific information on the various approaches
applied to serve those who frequent EMS system transports,
such as:
i) Identification and prioritization;
ii) Medical assessments;
iii) Care management or comprehensive care;
iv) Support to the patient and family by directing the
patient and his or her family to available resources such
as health insurance coverage, access to primary care and
mental health services, transportation, and other
relevant social services;
v) The financial impact of servicing frequent EMS user
transports, including funding sources and the costs of
providing these services;
vi) Best practices; and,
vii) Cost-saving measures to offset frequent EMS user
transport expenses.
AB 2406
Page 2
b) Recommendations for the implementation of a statewide
program to address the misuse and abuse of emergency
medical services.
2)Requires EMSA to submit the report to the Legislature no later
than December 1, 2015.
3)Requires EMSA to include in the report and summary an Internet
Website where the report can be downloaded and a telephone
number to call to order a hard copy of the report and to post
the report and summary on EMSA's Internet Website.
EXISTING LAW :
1)Establishes EMSA, which is responsible for the coordination
and integration of all state activities concerning EMS,
including the establishment of minimum standards, policies,
and procedures.
2)Authorizes counties to develop an EMS program and designate a
LEMSA responsible for planning and implementing an EMS system.
Requires a LEMSA that elects to implement a trauma care
system to develop and submit a plan to EMSA prior to the
implementation.
3)Defines "emergency" as a condition or situation in which an
individual has a need for immediate medical attention, or
where the potential for such need is perceived by emergency
medical personnel or a public safety agency.
4)Specifies that any individual who reports, or causes any
report to be made, to any city, county, city and county, or
state department, district, agency, division, commission, or
board, that an emergency exists, knowing that the report is
false, is guilty of a misdemeanor. Provides that it is a
misdemeanor to knowingly report a false emergency, but that
this conduct is a felony if the offense results in great
bodily injury or death.
5)Imposes liability for all reasonable costs incurred by any
unnecessary emergency response when a person is convicted of
use of the 911 emergency line with intent to harass and
imposes liability for a person convicted of filing a false
emergency report liable for the costs of the emergency
response.
AB 2406
Page 3
6)Requires the Legislative Counsel to annually prepare, publish,
and maintain an electronic list of all reports that state and
local agencies are required or requested by law to prepare and
file with the Governor or the Legislature.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, several
counties and agencies in California have adopted programs that
have greatly reduced nonessential use of EMS transportation
and emergency department (ED) visits. These educational and
instructional efforts have resulted in tremendous savings to
Medi-Cal, hospitals, and other state and local agencies. The
author would like to make available to all LEMSAs the programs
that some agencies are undertaking to curb over utilization of
EMS transportation and EDs. The author furthers that these
programs not only save scarce health care resources, but also
provide humanitarian outreach to a largely vulnerable
population of patients by directing them to appropriate
services at proper levels of care. Requiring EMSA to identify
programs that have been implemented throughout the state to
address EMS frequent users and to prepare and submit a report
to the Legislature will provide program information and a
format to other counties and agencies to assist them in
implementing their own programs to rein in unnecessary medical
costs. The author argues that ambulance transport to a
hospital's ED has become the first and only access point to
the healthcare system for many Americans. However, the misuse
and abuse of ambulance transportation and EMS services in
California by those commonly referred to as frequent flyers
cost taxpayers millions of dollars annually and stress already
overloaded hospital EDs by unnecessarily transporting
non-acutely ill or injured patients there when more
appropriate and less costly transport and care settings may be
available.
2)BACKGROUND . According to recent studies published in the
Annals of Emergency Medicine, in 2007, an estimated 45.2
million adults had one or more ED visits. A small number are
responsible for a disproportionate share of ED visits. Only
8% of users were responsible for 28% of all adult ED visits.
Most frequent users had health insurance (84%) and a usual
AB 2406
Page 4
source of care (81%). Characteristics associated with
frequent use included poor physical health, poor mental
health, and family income below the poverty threshold. In
2010, this pattern continued as frequent users comprised
between 4.5% and 8% of all ED patients but accounted for 21%
to 28% of all visits. Most frequent ED users are white and
insured, disproportionately through public insurance programs.
On average, these patients have higher acuity complaints and
are at greater risk for hospitalization than occasional ED
users. Frequent users are also heavy users of other parts of
the health care system.
3)FREQUENT USERS . According to the American College of
Emergency Physicians (ACEP), the definition of a frequent ED
user varies and studies show a misconception of frequent users
abusing their access to emergency care. Instead they are
coming in for real emergencies including urgent mental health,
drug, and alcohol-related issues as opposed to primary
care-treatable problems. ACEP stresses the importance of
developing models that integrate medical care of the patient
with social services he or she needs. The City of San Diego
defines frequent users as people who have used EMS more than
three times in a six month period and represent .08% of the
city's population yet account for more than 17% of paramedic
and ambulance calls. In 2012, San Diego had 1,136 frequent
users totaling more than $20 million in ambulance and
paramedic costs alone. One of the ways the city is addressing
these frequent users is through the San Diego EMS Resource
Access Program, a paramedic-based system that intercepts high
EMS users to reduce their dependence on EMS by linking them
with appropriate resources for their underlying medical,
mental health, and social needs. During the first two years
of using this case management approach, the program
demonstrated significant improvements for 51 clients and
reduced the number of ambulance transports from 736 to 459.
The City and County of San Francisco and Alameda County have
both used their fire departments to identify frequent users
and address the reasons for their high use of EMS. In San
Francisco, a homeless outreach program was established which
reduced emergency call volume by 75% in 18 months and has
saved the City $12 million. Alameda County is proposing a
local pilot program called the Fire Station Health Care Portal
that would offer non-emergency preventive and primary care, ED
follow-up, and 911/211 phone advice and response. The Portals
will be staffed by a nurse practitioner, emergency medical
AB 2406
Page 5
technician, a registered nurse care coordinator, and a patient
care technician.
4)California's EMS system . California operates on a two-tiered
EMS system. EMSA is the lead agency and centralized resource
to oversee emergency and disaster medical services. EMSA is
charged with providing leadership in developing and
implementing LEMSAs throughout California, and in setting
standards for the training and scope of practice of various
levels of EMS personnel. California has 32 LEMSAs that
provide EMS for California's 58 counties. (Seven regional EMS
systems comprised of 33 counties and 25 single-county agencies
provide the services.) Regional systems are usually comprised
of small, rural, less-populated counties, and single-county
systems generally exist in the larger and more urban counties.
LEMSAs are responsible for planning, implementing, and
managing local trauma care systems, including assessing needs,
developing the system design, designating trauma care centers,
collecting trauma care data, and providing quality assurance.
5)PROPOSED AMENDMENT . The author wishes to make an amendment to
the intent language of this bill.
6)RELATED LEGISLATION .
a) AB 1621 (Lowenthal and Rodriguez) requires EMSA to
develop the State Emergency Medical Services Data and
Information System (SEMSDIS), and, after approval by the
Commission on Emergency Medical Services, adopt minimum
standards to implement and maintain SEMSDIS by July 1,
2016. AB 1621 is pending in the Assembly Health Committee.
b) ACR 84 (Rodriguez) proclaims May 18, 2014, through May
24, 2014, as Emergency Medical Services Week. ACR 84
passed the Assembly Rules Committee on March 20, 2014 with
a vote of 9-0.
7)PREVIOUS LEGISLATION .
a) AB 678 (Pan), Chapter 397, Statutes of 2011, establishes
a supplemental payment program for governmental entity
providers of Medi-Cal emergency medical transportation
services using certified public expenditures to match
federal funds.
b) AB 1059 (Huffman), Chapter 403, Statutes of 2011, adds
AB 2406
Page 6
new data elements to the annual report to the Legislature
required of each county establishing a Maddy EMS Fund
regarding moneys collected and disbursed.
c) AB 1988 (Diaz), Chapter 333, Statutes of 2002, requires
EMSA to convene a task force to study the delivery and
provision of EMS. Requires the task force, among other
things, to develop a plan to ensure that all Californians
are served by appropriate coverage areas for emergency and
trauma services and that sufficient numbers of EDs and
trauma centers exist to serve each area's population.
REGISTERED SUPPORT / OPPOSITION :
Support
None on file.
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097