Prehospital Medical Planning for the 2015 Philadelphia Papal Visit.

In September 2015 Philadelphia hosted the World Meeting of Families, which culminated with a two day visit by Pope Francis. Emergency medical services (EMS) planning for the event was a complex process that involved the cooperation of municipal, state, and federal agencies, as well as many private organizations. Because the visit was designated as a National Security Special Event, Philadelphia had to balance the priorities of the United States Secret Service and other law enforcement agencies to keep the Pope and visitors safe with the medical needs of visitors and the ongoing needs of the city. Planning had to consider the impact of security on EMS operations, the anticipated crowd size and demographics, and how many patient encounters were likely. Other considerations were the weather, the number of additional medical providers and ambulances that would be needed for the event, where they would come from, and how these resources would be best deployed. The event had a regional impact, as the Pope visited several areas of the city and adjacent suburbs over his two day visit. Vehicular traffic and public transportation were heavily affected. Area hospitals increased their staffing in anticipation of higher patient censuses. This made it difficult to find sufficient volunteers in the immediate Philadelphia area to work at medical tents at the event venues. The city's extensive planning efforts, combined with some good luck, overcame these many challenges. The World Meeting of Families and Papal visit were viewed as a success for the attendees and the city. Philadelphia's experience may be beneficial for other cities hosting such events in the future.

Rapid Assessment Medical Support (RAMS) for active shooter incidents.

This country has witnessed a steady increase in the number of active shooter incidents in recent years. The traditional emergency medical services (EMS) response to such incidents has been to stage at a safe distance until the scene has been secured by law enforcement. Such an approach may lead to unnecessary delays in medical care and potentially needless loss of life. To address this issue locally, the Philadelphia Fire Department (PFD) and the Philadelphia Police Department (PPD) collaborated to develop the Rapid Assessment Medical Support (RAMS) program. All PFD paramedics have been equipped and trained to move with PPD officers into a scene that has been cleared by police but not yet secured in order to initiate emergency care, with an emphasis on hemorrhage control. Patients are then extracted to awaiting EMS resources in the cold zone. The history behind the program and the challenges and obstacles that had to be addressed in its development are described. These included initial and ongoing training and funding sources; buy-in from risk management, labor, and the individual providers; whether only paramedics should be included in the RAMS program or if the PFD's firefighter-EMTs should be included as well; the potential for mission creep as police recognized the value of this asset and its potential application to other scenarios; and how to involve the many nonmunicipal ambulance services that are not involved in the routine operation of Philadelphia's 9-1-1 system. To date, RAMS teams have been activated on multiple occasions, but fortunately the incidents were resolved without injury or loss of life. However, the program provides another valuable tool with which the City of Philadelphia can respond should another active shooter incident occur.

Estimated cost savings associated with the transfer of office-administered specialty pharmaceuticals to a specialty pharmacy provider in a Medical Injectable Drug program.

BACKGROUND: A large managed care organization (MCO) in western Pennsylvania initiated a Medical Injectable Drug (MID) program in 2002 that transferred a specific subset of specialty drugs from physician reimbursement under the traditional "buy-and-bill" model in the medical benefit to MCO purchase from a specialty pharmacy provider (SPP) that supplied physician offices with the MIDs. The MID program was initiated with 4 drugs in 2002 (palivizumab and 3 hyaluronate products/derivatives) growing to more than 50 drugs by 2007-2008. OBJECTIVE: To (a) describe the MID program as a method to manage the cost and delivery of this subset of specialty drugs, and (b) estimate the MID program cost savings in 2007 and 2008 in an MCO with approximately 4.6 million members. METHODS: Cost savings generated by the MID program were calculated by comparing the total actual expenditure (plan cost plus member cost) on medications included in the MID program for calendar years 2007 and 2008 with the total estimated expenditure that would have been paid to physicians during the same time period for the same medication if reimbursement had been made using HCPCS (J code) billing under the physician "buy-and-bill" reimbursement rates. RESULTS: For the approximately 50 drugs in the MID program in 2007 and 2008, the drug cost savings in 2007 were estimated to be $15.5 million (18.2%) or $290 per claim ($0.28 per member per month [PMPM]) and about $13 million (12.7%) or $201 per claim ($0.23 PMPM) in 2008. Although 28% of MID claims continued to be billed by physicians using J codes in 2007 and 22% in 2008, all claims for MIDs were limited to the SPP reimbursement rates. CONCLUSION: This MID program was associated with health plan cost savings of approximately $28.5 million over 2 years, achieved by the transfer of about 50 physician-administered injectable pharmaceuticals from reimbursement to physicians to reimbursement to a single SPP and payment of physician claims for MIDs at the SPP reimbursement rates.