The Emergency Medical Services (EMS) industry has evolved significantly since 2020. From how EMS operates to the regulatory landscape, change seems to be happening in every corner. Preparing for what’s coming seems to be ever-more challenging. Thankfully, 12 industry leaders shared their insights on EMS hot topics and trends to help us navigate through times of uncertainty. Read the original article here: https://traumasoft.com/ems-challenges/2023-ems-trends/

1. 2023 EMS Trends from 12 Industry Leaders
2023
EMS TRENDS
from 12
Industry
Leaders
1

2. 2023 EMS Trends from 12 Industry Leaders 2
Introduction
The Emergency Medical
Services (EMS)
industry has evolved significantly since 2020.
From how EMS operates to the regulatory
landscape, change seems to be happening in
every corner. Preparing for what’s coming
seems to be ever-more challenging.
Thankfully, 12 industry leaders shared their
insights on hot EMS topics and trends to help
us navigate through times of uncertainty.

3. 2023 EMS Trends from 12 Industry Leaders
Expect Greater
Legislative
Activity at the
State Level
The one trend that immediately comes to mind
is greater legislative activity at the state level. I
think we are going to see a greater push at the state
level to expand the consumer protections against
surprise medical billing. As you probably know, the
federal No Surprises Act exempted ground
ambulance services from these restrictions. As a
result, we are currently the only health care industry
that is still balance billing patients.
One of the predictable consequences of that
exclusion is a significant uptick in complaints being
filed with state agencies. In many cases, this has
led to unfavorable media coverage, which
frequently characterizes our exclusion as a
“loophole.” There are several bills in state
legislatures that would ban balance billing
outright. I think some of these are likely to pass in
2023, as states look to close that loophole.
Brian Werfel
Partner,
Werfel & Werfel
3

4. 2023 EMS Trends from 12 Industry Leaders
Supply Chain
Issues Start
to Ease Up
I am hopeful that in 2023 we see
the supply chain issues start to ease
up. Over the last couple of years, the
supply chain issues have impacted our
ability to make capital purchases, thus
impacting other areas of our
operations. As these supply chain issues
begin to subside, we should also be seeing
a decrease in the cost to operate as
supply chain issues has been directly
attributed to the rising costs ambulance
companies are facing.
SamuelScheller,
MBA, NRP
CEO, Guardian Elite Medical Service
(NV)
4

5. 2023 EMS Trends from 12 Industry Leaders
Look to
Maximize
Productivity by
Automation
With labor costs surging on a year-on-year
basis, smart EMS providers should be
looking to maximize productivity of existing
teams by implementing greater efficiencies
and automating processes rather than
increasing headcount.
Utilizing a software like Traumasoft for only
one part of your process but utilizing other
systems to handle the other processes slows
down operations and increases room for
error. For the greatest workforce
optimization, operators should invest the
time to learn all the capabilities, functions
and integrations that technologies like
Traumasoft offer and put them into
operation. It may be a learning curve at first
but the ROI will be significant and long term.
Kevin E. Frisch
CEO,
Banquest Payment Systems
5

6. 2023 EMS Trends from 12 Industry Leaders
Increasing Use
of Non-
Ambulance
Transportation
Resources
The first topic that popped into my head is
the increasing use of non-ambulance
transportation resources within the EMS
system along with alternative facility
destinations other than the ED. There has
been a monumental shift in practices among
some EMS systems that are struggling with
recruitment and retention of EMS personnel.
Earlier this year, I was able to take a deep
dive and write an article, Can NEMT
Companies Save the EMS System?
The trend of right sizing the EMS system has
accelerated post-covid and will be
something to watch in 2023.
Michael Shabkie
Founder,
Non Emergency Medical
Transportation Accreditation
Commission (NEMTAC)
6

7. 2023 EMS Trends from 12 Industry Leaders
EMS is in
Survival Mode,
but will Spawn
Innovation
The best description I’ve heard for the current situation in EMS is “labor pains.”
These words have a double-meaning as we obviously have a severe staffing issue,
but it is that created-shortage of labor that is also likely to give birth to new
structures in prehospital care out of fiscal necessity. The pandemic has accelerated
trends that continue to stress many agencies, both rural and urban, occasionally to
the very brink of financial collapse. Those who can, have been forced to seek
additional operating funds from the local governments they serve. That abrupt
change in the bottom-line with dramatically increased expenses is also opening
opportunities for fire departments not currently providing transport to compete
for those same limited tax dollars by offering to collapse EMS into fire services.
A shortage of paramedics is also forcing services to reconfigure their basic
structure. Once proudly “all-ALS” agencies must now consider tiered responses
allowing them to convert a portion of their fleet to BLS-level
skills. Teleconferencing and nurse triage lines are also being used in some areas to
sort or eliminate transports. Aside from slowing the escalation of operating costs,
these structural changes should also allow more entry-level medical providers to
work at the top of their scope of practice and possibly encourage advancement (if
not abandonment) of their careers in EMS.
The pendulum of power has definitely swung from the employer toward the
provider. This means that broader operational initiatives that once sought to
improve safety by reducing hours of work or miles of responses are now less
affordable priorities as funds shift toward wages to simply keep shrinking fleets
available. While innovative solutions are being sought, the competing interests of
reality limit the extent of creativity in those new ideas. For the next several years, I
suspect EMS to be in survival mode, but that doesn’t necessarily mean
administrative retreat as the fight for life spawns innovation. Additionally,
potential legal changes, such as meaningful “essential service” status, could
further alter the current environment. At the very least, watch for more
consolidation announcements.
Dale Loberger
MARVLIS Consultant,
BCS; FTO, Union EMS;
Captain, GRVFD
7

8. 2023 EMS Trends from 12 Industry Leaders
2023 is Going
to be a Year of
Growth for
EMS
Greg Friese,
MS, NRP
Editorial Director,
EMS1
8
2023 is going to be a year of growth for EMS.
The profession will build off the encouraging
successes in 2022 to invest in retaining their
top employees by paying a thriving wage,
improving benefits and reducing hospital
drop-off times. I also think EMS employers
are going to continue their successes in
recruiting new personnel through earn-
while-you-learn programs and seeking out
people who want to make a difference in the
lives of others. For people who want to serve
their community, this is a great time to join
and be a part of EMS.

9. 2023 EMS Trends from 12 Industry Leaders
EMS will Continue
to Focus on
Workforce
Engagement and
Employee
Retention
Scott Moore
Senior Consultant
& Show Host,
Moore EMS Consulting
9
I believe that EMS organizations and the
leadership teams that guide them will continue to
dig into the foundational elements of what drives
workforce engagement and overall employee
retention. For EMS employers to be successful,
they will need to focus on the employee
journey. This will include what an employee
experiences from when they consider pursuing an
EMS certification to when they apply for, and
accept, a job in EMS. Additionally, it will be critical
for EMS leaders to consider what the EMS
employee is seeking during their time in EMS,
whether it is for a life-long EMS journey, or a
career in another field. The focus will need to shift
to the whole employee rather than just the work
they perform for the EMS agency. Employers who
can shift their mindset to the employee
experience and role that employees want work to
play in their lives, will enjoy higher retention
rates and better organizational results.

10. 2023 EMS Trends from 12 Industry Leaders
Moving Towards
a Model that
Delivers the
Right Care to
Every Patient
Chris Kelly
Attorney, Page,
Wolfberg & Wirth
10
I think the way we provide EMS will continue to evolve in
2023, moving away from the model that delivers every
patient to a hospital, toward a model that delivers the
right care to every patient. Whether it’s a protocol or
process that allows dispatch to send a service other than
an ambulance to a patient, or if it’s driven by EMS crew
determinations in the field that patients can be treated-
in-place, offered telehealth services, or taken to
destinations other than a hospital, or if it’s accomplished
by proactive measures that focus on meeting the needs
of a person so that they do not make that 9-1-1 call to
begin with- the way we provide care is changing. And it
must. Patient needs, community expectations, staffing
shortages, hospital delays, and payer policies are just
some of the factors that are driving this change. Any of
these individually could nudge us toward an evolution of
EMS, but taken together they demand it. The good news
is we are making the necessary adjustments already, and
we see the path forward. This path will continue to open
up and become even more clear in 2023.

11. 2023 EMS Trends from 12 Industry Leaders
Continued
Mergers and
Acquisitions and
a Dynamic
Crossroad
Maggie Adams
President,
EMS Financial Services
11
The new year will see the continuation of mergers and acquisitions among both providers and billing
companies. For some ambulance services, joining forces makes good sense as they can better leverage
resources and ensure service continues – particularly in under-served and rural areas.
Billing company mergers mean that providers who outsource their billing may need to get used to new
processes. However, a new billing company can be an opportunity for both the provider and the vendor –
relationships can be revisited and enhanced, better reporting may become available, and provider education
can grow. For providers who land with a new billing company, it’s a good idea to check their billing
performance and compliance by having an audit done in six months to a year.
For emergency services, 2023 will be a good time to take a look at their emergency dispatch protocols. Work
with your Medical Director, operations management and your call-center to ensure that your protocols reflect
the true BLS and ALS issues that occur in your community. Further, make sure your emergency dispatch
protocols are in compliance with Medicare’s guidance. Consideration of emergency dispatch is critical when
billing for ALS services. Government audits continue for emergency providers. For non-emergency providers
who receive emergency calls directly from local facilities, it is critical that your internal dispatch protocols are
strong and in compliance. Emergency services continue to be as sensitive to compliance & audit concerns as
non-emergency services.
A dynamic crossroad has emerged and with it an opportunity for EMS software companies and providers
alike. Community paramedicine/mobile integrated healthcare is growing nationwide. At the same time,
commercial payers have become more tuned to the social determinants of health (SDOH). Therein lies the
crossroad – MIH is growing, and commercial payers are very interested in SDOH. Payers like Aetna-CVS, United
Healthcare, UPMC Health Plan, and Kaiser Permanente have committed massive resources to respond to
SDOH topics like homelessness, food inequities, access to transportation, etc. Concurrent to these
developments, the American Medical Association joined forces with payers to expand the list of available
SDOH codes so that data on SDOH can be better captured. SDOH problems like homelessness, social exclusion,
alcohol and drug use, problems related to living alone are the types of issues EMS sees every day. With payer
focus on SDOH and our industry’s movement to more mobile integrated healthcare, we have a huge
opportunity to capture more data on these topics and ultimately receive reimbursement for MIH responses.
There is a billing code (A0998) for treatment without transport. More commercial payers recognize this code.
If EMS employs this code on billing and adds an SDOH code to their claims to describe the patient condition,
we will be providing more data to payers that supports our efforts to expand MIH. Our trips reports are rich
with information on the problems EMS sees in the field. Capturing more information from our reporting will
also point to MIH opportunities and alliances that can be had with other healthcare providers (home health,
hospice, chronic disease management, drug and alcohol treatments). My hope is that software vendors and
providers will work together to better capture that data so that the people with the pocketbooks learn more
about our participation and support for these challenging problems.

12. 2023 EMS Trends from 12 Industry Leaders
MIH/CP is
Becoming
More of a
Foothold
Chris Cebollero, NRP
President & CEO,
Cebollero & Associates
12
Over the past years MIH/CP is becoming more and
more of a foothold. Now the insurance companies
are getting involved. I’m part of the largest pilot with
a large payer that includes 8 states, and 20 EMS
systems. In 2023 we are adding 10 more states and
20-30 more EMS systems. Universal reimbursement
for community paramedic home visits are just
around the corner.

13. 2023 EMS Trends from 12 Industry Leaders
Paramedic
Responsibilities
will Include
Other Health
Care Settings
Joshua D. Hartman,
MBA, NRP
Senior Vice President, Cardiovascular
& Public Safety Divisions, HMP
13
EMS continues to be in an evolutionary pathway. COVID
exposed several positive factors related to EMS
professionals. In addition to showing how EMS
professionals could diagnose and treat COVID patients
in several different settings, COVID also demonstrated
versatility of our capabilities. For example, of all the
professionals staffing a vaccination center, often it was
the paramedic who was able to perform at every role
such as intake/assessment, drawing up the vaccination,
administering the vaccination, monitoring for post
vaccination side effects, and treating the rare, but
significant complication. In the not distant future, this
will make its way into legislation in areas where
paramedics are currently restricted to the traditional
EMS environs to now include responsibilities in other
health care settings. Other trends and advances as part
of this evolution is delivery of whole blood into the field,
advances in the treatment of OHCA, and alternate
transportation pathways for patients who may be best
treated in a setting other than the traditional emergency
department.

14. 2023 EMS Trends from 12 Industry Leaders
A Perfect
Storm Brewing
to Challenge
EMS
Omar Masri
CEO,
Mamori.io
14
A major trend I see is that there is a perfect storm
brewing to challenge EMS organizations both
economically and organizationally. First, you have Health
insurance providers and government regulations
squeezing transport provider revenue. Second, you
have rising inflation increasing operational cost and staff
stress levels, and finally you have the unrelenting growth
of cyberattacks aimed at extorting money from EMS
organizations and disrupting business continuity.
At Mamori.io we recognize that running an EMS
organization is becoming increasingly challenging and
stressful, and that is why we are focused on helping EMS
organizations protect themselves from modern
cyberattacks with a comprehensive, easy to deploy,
and cost-effective cybersecurity solution. Our mission is
to remove the stress of cybersecurity from EMS business
owners. Traumasoft is using Mamori.io to secure its
valuable data, and we are happy to help all their partners
and customers do the same.

15. 2023 EMS Trends from 12 Industry Leaders 15
About
Traumasoft
Traumasoft is one truly integrated product for
Emergency Medical Services (EMS) that drives timely
efficiencies. We are an all-in-one system capable of
managing every aspect of your EMS operations. One
system comprised of interconnected solutions handles
staff, integrates processes, manages assets, and grows
revenue. Schedule a demo today to see how we can
help you increase operation efficiency and profitability.

16. 2023 EMS Trends from 12 Industry Leaders 16
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