Questions About EMS on a sleepy morning – Care to answer?
January 26, 2010 | Administration & Leadership, change, Command & Leadership, Economics, Emergency Medical Services, EMS, ems 2.0, EMS Management, EMS Topics, Funding & Staffing, Patient Management | Ckemtp | 8 Comments

It is a very sleepy morning for me today. Yesterday was a hard-fought day on the ambulance by our standards. For the first part of the day I couldn’t run a call without somebody getting angry at me. It really didn’t bother me all that much, but you know how it goes. I actually got about 6 hours of sleep during the night though, so I got that going for me. Perhaps it’s the morning fog mixed with the lack of coffee available in the station this morning that’s causing my AM neural firings to generate random questions… perhaps I’m just nuts. However, if y’all would like to think about some things (and perhaps answer in the comments section, please) I invite you to join in on my personal morning groggies.

Here goes:

  • If Medicare would assign a payment that you could access for treating and releasing patients, thereby diverting them from the Emergent healthcare system and redirecting them to the more cost effective healthcare system, how would that change the industry?

 

  • If your service could choose to accept a lower payment from Medicare and Medicaid for every transport without regard to the nuances of medical necessity and never have to be denied reimbursement in exchange for a lower payment for every call, would your service take it? How would that change the industry?

 

  • How would you improve your service if all of a sudden a big, national competitor moved into your service area and started taking your share of the market… you’re losing calls to them and it’s affecting your bottom line… What do you do to improve your service to keep yourself in business?

 

  • How would you change your care if your medical director was watching over your shoulder on every call? What would change if it were your mother watching you?

I think that these questions aren’t the biggest questions facing the industry today, but I’ll bet ya’ that if they were considered by peons like us and also by the powers that our landscape would change quite a bit, wouldn’t it?

See you in the comment’s section.

  • http://jeramedic.wordpress.com/ Jeramedic

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

  • http://jeramedic.wordpress.com/ Jeramedic

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

  • http://thehappymedic.com the Happy Medic

    Should we have to rely on reimbursments for refusals or should companies be reimbursed by ambulance level of care and hours of operation, then more depending on the specifics of transport?
    Should a rig in Baton Rouge get the same check from Grandma Medicare every month that the one in Boca Roton does?
    Could a new way of funding EMS change the industry? Or will we always be locked into requiring ambulance companies to make a profit on the backs of the patients and their staffs?

    Good questions CK.

    As far as my medical director looking over my shoulder, or my mother, I recently had the Chronicles cameras over my shoulder, as you know, and all it changed was my sarcastic tone. Everything else was the same, especially protocol wise.
    Some of us forget that hidden in all the ruels and “BS” protocols are all the tools you need to do what is right, so just do what is right.
    It really is that simple and I challenge anyone who disagrees to keep a smile on their face after 24 hours and 30 clients similar to the ones you'll meet on the Chronicles of EMS:San Francisco.

  • http://davidkonig.com Dave Konig

    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.

  • http://profiles.yahoo.com/u/PABYPQLCXR5V7D7ZPT7NLI4Q3M Stuart

    1. It would help high abuse systems if there was a system that allowed some payment for assessment BUT the lowest common denominator always comes to into play…everyone has a few and everyone knows them. They will cause big trouble by leaving pts that need to go.

    2. There is no money in EMS. If you take a lower payment then someone else will figure how to screw you out of money, and the uninsured will continue to be hard pressed to pay. So, it will make no difference.

    3. Professional, efficient, and CLEAN. The rest has to take care of itself.

    4. We have doctors ride with us regularly. I agree with DAVE, I would probably use bigger words with the Med Director. I would probably lose the sarcasm with my Mom riding.

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  • 9_ECHO_1

    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.

  • TheBadLT

    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.

  • TheBadLT

    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.

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Chris Kaiser aka "Ckemtp"

I am a paramedic trying to advance the idea that the Emergency Medical Services can be made into the profession that we all want it, need it, and know it deserves to be.

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