Questions About EMS on a sleepy morning – Care to answer?

I Love it! but it's 0630 here and I'm too sleepy to answer at the moment. I'll get back to ya

These are some fine questions… and luckily I have had my coffee…

1) The industry would come under fire after a few patients had unfavorable outcomes after they were left at home/on the street for ailments the EMTs/Paramedics decided were not transport worthy on the initial call

2) Considering that the service is already losing money on every Medicaid call, I would venture to say no.

3) Something we are very prone to forget is that ultimately our patients are our customers. This fact gets lost on EMTs and Paramedics way too often. I would improve customer service all around.

4) If it was the Medical Director I would probably use bigger and more complicated words. If it were my mother, I would continue on my path of simplicity for the sake of better understanding by the patient.

1. Does anyone really think the hospital and other medical lobbies would want this, or even allow this to happen? As it is, ambulance providers get paid for what? Yep, that’s right, bringing people into the hospital, for a small pittance. Why would the hospital and other medical lobbies ever allow that to happen? Have you seen what Medicare pays out to the hospitals in comparison to what they pay out to EMS? And of course, as someone else put it, think about who you would be allowing to treat and release. Enough said.

2. This is assuming that everyone is dependent on fee reimbursement. There are many fire-based, government third-service, and volunteer agencies that do not even bill. My own medical director has said that our system will just fund itself with tax dollars. Not being a business major, and admittedly having only a narrow view of the world, I do not see how a provider can provide what some consider to be 'truly cutting edge care' solely on the current reimbursements, let alone a lower one, especially from Medicaid. Even most of the private services that I am familiar with receive some sort of subsidy for operations.

3. What would I change personally? Nothing, sarcasm and all. It is what it is. None of my patients have ever complained about my care or attitude towards them over the 34 years I have been out there. A couple of state troopers complained because I shut down their interstate highway, in both directions on a holiday weekend, and a few nursing home nurses have complained over the years because they lost arguments with me, but that’s about it. As to my mother, she used to be an EMT and she has watched me over my shoulder. If I cut out the sarcasm she would think I was sick and try to feed me chicken noodle soup or something. And my medical director has shown up on my calls and seen me at my best and worse, and I am still here.

4. First, my service does only 9-1-1 response, so we are ‘losing’ a large part of the money-making transports. I would have to look seriously to adding that component. In our own community, the elderly segment of the population is expanding rapidly, and I have seen a definite need for a community based solution to that need. Another thing I would do that would garner community support would be to add a home visit/ prevention program, using existing crews, to my service. Another would be to curb wasteful spending (sounds like a Republican, doesn’t it?) but then that is not a problem within my specific agency. My service is part of a larger system, and while we watch our expenditures pretty closely, and my chief can get more mileage out of a dollar than most people I know, the same cannot be said for other agencies within the system, or even the ‘system’ as a whole. Taken on our own, outside of some of the other agencies, it would be hard for another agency to come in and take market share. Sure, someone like AMR might be able to, but I don’t think it would be easy for them to come in and take over ‘market share’ and sustain it.

Good morning!

1) I don't think the publc/patients would be interested in being told to go to a doctor's office instead of the emergency room. They want their opiates NOW, damnit!

2) I'd expect our service to accept the lower fee for every transport, as about 1/3 of our transports currently generate NO revenue.

3) We have a big national competitor (aka “The Evil Empire”) in town, and they're NOT interested in taking our calls. But, as we're the designated (by ordinance) the EMS Authority, WE wouldn't have to change a thing, BNC ambulance would have to follow OUR rules.

4) We already have a strong medical control system, with on-scene supervison and PCR reviews by division supervisors, shift commanders, Training & Quality Improvement staff and medical control physicians. We point to that amount of oversight as a positive aspect of our quality of care.

5) Not for nothing (and I don't mean to be a jerk, it just comes naturally), the longer that EMS is referred to as an “industry”, the longer it will take us to be recognized as a PROFESSION.