How the CARE Act is a Roadmap for MIH:
The CARE Act represents a long-overdue shift in how different out-of-hospital systems are funded and utilized. As we’ll see throughout this article, the primary goal of this legislation is to transition MIH from a transport-heavy model to an objective-based, definitive care system.
Of course, the “heroic” aspect of emergency response will always have its place, but all too often, agencies have been held back (or never really got going with MIH) because the reimbursement model didn’t feel financially viable. On the other hand, it is a tragedy when a provider wants to do the right thing for a patient but is pressured into transport them just to keep their program alive.
Here’s how we’ll break down the new landscape for Mobile Integrated Healthcare (MIH):
- Breaking the “Taxi” Cycle
- The Economic Argument: Saving the System Thousands
- MIH Funding
- Improving Provider Longevity and Burnout
Breaking the “Taxi” Cycle
The core of the CARE Act addresses a fundamental flaw in the current 911 system: the lack of reimbursement for “Treat and Place.” For decades, the American Emergency Medical Services (EMS) system has been shackled to a “transport-to-pay” model. In the eyes of payers, an ambulance is little more than a cab; if the wheels aren’t turning toward a hospital, the agency isn’t getting reimbursed, nothing towards manpower, fuel, or supplies used. This creates a perverse incentive to transport every patient to the Emergency Room, regardless of whether they need to be there.
By establishing official reimbursement codes for treatment without transport, the CARE Act allows EMS, treat and place, as well as MIH-CP to function as true healthcare navigators. Instead of the hospital being the only destination, paramedics can finally focus on getting the patient to the “right place at the right time.”
The Economic Argument: Saving the System Thousands
The fiscal implications of the CARE Act are staggering, representing a fundamental change in how we value emergency medicine. When a patient is unnecessarily transported to an Emergency Department, the financial ripple effect extends far beyond a simple ambulance bill; it often triggers a cascade of expensive diagnostic tests and a multi-thousand-dollar hospital admission. For example, treating an acute exacerbation of a chronic condition on-scene can save upwards of $5,000 per encounter by avoiding an unnecessary inpatient stay.
By resolving these situations on-site, MIH providers eliminate the high-intensity resource consumption inherent to ER visits, providing immediate relief to both taxpayers and insurers. Furthermore, with hospitals frequently reaching occupancy limits, diverting low-acuity patient isn’t solely a financial benefit but a productivity one as well that’s essential for hospital survival. Reducing this “system drag” ensures that critical beds remain open for life-threatening emergencies rather than being occupied by patients who could heal more effectively at home.
MIH Funding
While “Treat and Place” handles the emergent 911 side, the CARE Act provides a long-term source of financial stability for MIH programs.
Without official reimbursement, many MIH programs are currently self-funded. The CARE Act seeks to codify the funding that allows paramedics to perform longitudinal care. Having the cadence with a patient allows the dynamic to be truly collaborative, perhaps for the first time. The tools, even the process may be the same but the environment is according to the patient and is usually one that is non-emergent.
Treating the right patients at the right time in the right place prevents the “revolving door” of 911 usage. In JEMS’ chat, Blevens shared a powerful anecdote of a 94-year-old couple who called 911 18 times in just two weeks. By using MIH principles, connecting them with Meals on Wheels and a PCP, they never had to call 911 again. That transition from 18 emergency calls to zero is the ultimate proof of concept for the CARE Act’s goals.
For more tips on funding MIH-CP programs, click here.
Improving Provider Longevity and Burnout
Beyond the immediate financial savings, the CARE Act creates a ripple effect that could solve the industry’s most pressing internal crisis: workforce burnout. Currently, the profession is often a “one and done” silo where paramedics are limited to 24-hour shifts and back-breaking labor. By formalizing MIH, the industry introduces a much-needed hierarchy and workforce variety.
In the same way a store manager is empowered to authorize returns or handle complex discrepancies, paramedics are finally gaining a similar level of clinical autonomy. This shift is vital in sensitive scenarios, such as managing hospice patients when their primary palliative facilities are unavailable. Instead of a high-stress, unnecessary transport to an emergency room, Mobile Integrated Healthcare empowers paramedics to treat these patients with the dignity and specialized care they require in the comfort of their own homes.
Even the most seasoned paramedic’s mind start to dim when they’ve spent years in intense, high-stress environments. The work EMS first responders do, while heroic, is exhausting both physically and mentally. Rotations like 24/48s often drive talented providers out of the profession. However, the growth of MIH agencies can offer an alternate path, pulling a seasoned provider off the truck to handle longitudinal community care or leadership roles. Much like the fire service, this hierarchy allows for professional growth, ensuring that the highest level of care remains available to the community while keeping a veteran presence in the field.
These second and third-order effects ultimately result in a stronger, more resilient healthcare workforce. When providers have a clear path for advancement and the ability to pivot into non-emergent roles, the entire system benefits from their collective experience.
Navigating the Liability Landscape
Critics of MIH and Treat and Place often point out risks. If a paramedic leaves a patient at home and that patient later deteriorates, who is responsible? However, Blevens argues that the current system of “transport everyone” doesn’t actually shield providers from liability; it just changes the nature of the lawsuit.
For instance, in time-sensitive emergencies like cardiac arrest, an agency can be sued for bypassing a local facility to reach a specialized center, or conversely, for stopping at a community hospital that lacks definitive care capabilities. Professional liability, often defined by the “duty to act” and the “standard of care”, is present in every clinical decision, whether it involves transport or on-scene management
The CARE Act shifts EMS focus toward evidence-based triage and oversight to reduce liability. By utilizing clinical data and physician-led medical direction, agencies can prioritize the home as the “best place to heal.” Backed by clear protocols, this approach allows patients to recover in stable, familiar environments while simultaneously decompressing over-taxed emergency departments.
The Path Forward: A Call to Action
Unlike previous restrictive iterations, like ET3, this legislation is designed to be more accessible to the over 19,000 EMS agencies across the United States. The CARE Act represents an evolution, it is the moment EMS finally steps out of the shadow of the transportation industry and takes its rightful seat at the healthcare table
