Alex Mills and I submitted “Incentive-Compatible Prehospital Triage in Emergency Medical Services” to MSOM today! That project started in January 2014 and has evolved significantly since its start. I think the final paper turned out really well. I’ve updated my Current Projects page to be more relevant.
Abstract for submitted work: The Emergency Medical Services (EMS) system is designed to handle life-threatening emergencies, but a large and growing number of non-emergency patients are accessing hospital-based healthcare through EMS. A recent national survey estimated that 17% of ambulance trips to hospital Emergency Departments (EDs) were medically unnecessary, and that medically unnecessary trips make up an increasing proportion of all EMS trips. These non-emergency patients are a controllable arrival stream that can be re-directed to an appropriate care provider, reducing congestion in EDs, reducing costs to patients and healthcare payers, and improving patient health, but prehospital triage to identify these patients is almost never implemented by EMS providers in the United States. Using a queueing model with economic costs and rewards, we find that prehospital triage is unlikely to occur with traditional fee-for-service reimbursements, regardless of how effective or accurate the triage process may be. However, offering bundled payments to EMS providers would provide them with an incentive to conduct prehospital triage, and, moreover, with incentive to improve their triage effectiveness.