Replies to This Discussion

Permalink Reply by Fireyladd - Retired Chief Sharp on February 5, 2009 at 11:07pm

Yes, and your point is?.............................
Your officer carries the responsibility to make the decision. I can fully understand your frustration however.
Sounds like you need to take your Officer to coffee and discuss your concerns with her.

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Permalink Reply by lutan1 on February 5, 2009 at 11:08pm

I hope if I need transporting one day, that the paramedics transport me with my health interests first and foremost, as opposed to the $.

Where would they stand if the patient went pear shaped and dies and it went to an inquest?




FYI, we have a different system here- our ambulance service is State based and fully funded by the government. The public can take out membership, $60 for singles and $120 for families, per year http://www.ambulance.vic.gov.au/Main-home/Membership.html and they won't be charged for the trip. Without membership, you'll be charged a small house mortgage!

From the website:
Members and their dependants are entitled to free ambulance transport, paramedic care and treatment, including air ambulance throughout Victoria and Australia.
For non-members ambulance fees start at more than $825 for emergency treatment and transport by road ambulance in metropolitan areas and more than $2800 for the air ambulance helicopter

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Permalink Reply by Kimberly A Bownas on February 5, 2009 at 11:09pm

Rob we are Volunteer and we don't or actually can't bill. This officer has no clue what she is talking about and as far as I am concerned that is not what I am here to worry about. The patient and the condition of the patient is my concern. There was a lot of issues that were going on that we needed ALS and I wanted to load the patient and do a meet and assist with the medic. As I stated in my post. Thanks for the comment though and I do read and take what everyone is saying and think about it. I am still learning more and more every day. You can never learn enough or stop learning in this business...

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Permalink Reply by lutan1 on February 7, 2009 at 3:42am

In my area we have limited ALS Ambulances and we are running about 6,000 calls for service each year... that would be a heavy burden on my county's small ALS fleet.
But in this case, we're talking about one incident, not 6000. (Agree that 6000 is too much of a burden in your case)

It's one incident where a non clinical decision was made, that could have had ended badly for the patient by delaying urgent treatment at a medical facility.

Clinical decision must prevail....

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Permalink Reply by Kimberly A Bownas on February 7, 2009 at 9:02am

strtcopr,
We have in the past couple years had to contract with a paid service for the day times. This is because we can't guarantee that we can get the ambulance out during the day. So we did the responsible thing and have coverage for the daytime hours of 5 am to 5 pm. In this case the ALS unit that is stationed in my firehouse was already on a call, this happened while they were on that call. The second ALS unit was coming from their main station about 20 to 30 minutes away. We responded cause it was a second call in our district and the second ALS unit was dispatched at the same time. If the call ends up being a BLS call then we cancel the second ALS unit so that they can go back in service and be available for another call in the county. My concern is that what you were talking about happening will happen here and we will not have a Volunteer Squad anymore if we don't start doing what we need to do and transport during the day when we have a crew that can when the other unit is on a call.

thanks....

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Permalink Reply by Marc Hansen on February 7, 2009 at 9:36am

If you dont bill for EMS provided why are you paying for all the equipment, training and a truck from your budget? In these days strained budgets that seems like a waste of money. What we do in my little old neck of woods is if the transporting unit does the billing to the insurance company and the second service bills the first an agreed upon amount. This works with the several vollie BLS units in the area and the other paid ALS service. That way all get paid and only one bill is submitted. For services that only provide QRS the are to restock their supplies used from the transporting unit or can call and give a list of durable equipment needed to restock.
On the flip side you both showed great professionalism during the call-nothing in your post said you questioned your captain on scene and after the call your captain took the time to explain the reasoning behind the decision

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Permalink Reply by Kyann Miner on February 7, 2009 at 9:37am

We too have a paid EMS service that helps us out on calls as our department is volunteer and although we have serveral medics they can not always respond to possible ALS calls. Our SOP's are set up so that we package and load the pt into our squad and meet the medic's enroute then they medic hops on the squad with us. Check with your chief on insurance issues, not your officer, they are not always correctly informed on billing procedures, as we have a company that does our billing and they send out a bill to the pt's for our services and also for the medic's services. We've never had an insurance company deny a payment for the medic's to be performing their duties on our squads unless the medic wasn't truely needed. It could be that because it was only the two of you that were able to go on the squad until you met up with the medic that she was concerned that something would happen that is beyond her scope of practice and instead of letting you know that she was worried about that she put the blame on the insurance company.

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Permalink Reply by John on February 7, 2009 at 9:45am

We don't have that problem here, but I can definitly see a problem with that, With a possible stroke patient time is of the essence to get the patient to a hospital for treatment. Waiting for another ALS unit to arrive is crazy, load and go and intercept enroute.

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Permalink Reply by Joe Stoltz on February 7, 2009 at 10:37am

I agree completely Kim, and I think I would have insisted that we begin packaging and loading the patient; but then an assistant Chief outranks the EMS Captain. :o) I think your instinct was the proper one, but of course chain of command has to be followed too.

Five minutes is five minutes, and on every serious, life threatening call there is a point at which five minutes will make a difference. There's no one on earth who can tell where that point is, except in hindsight. We have to keep the patient's best medical interests in mind at all times, and the financial interests can wait until later.

Going to the "What if" soapbox, what would have happened if the ALS rig crashed 3 minutes out of town? Would you have been notified by dispatch immediately, or be left waiting for the rig that never shows up? The reason I ask is this: we occasionally work with a paid ALS transport service. They have their own dispatcher on a totally different radio system, and we (an assistant Chief and myself) once waited 45 (forty-five) minutes for them to show up. We had no driver for our rig that morning.

The young crew actually got lost, then stuck in a snow drift for a time until they could get themselves out and finish responding to the scene. We were never notified of the problems, and the crew never admitted anything was wrong; we found all this out later. Had they put the patient's best interests up front they (or their dispatcher) would have immediately called out of service and our dispatcher would have called out another agency.

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Permalink Reply by Joey "BigShow" De Piano on February 7, 2009 at 12:27pm

Bro I can understand that frustration though i am not ems we are seeing things in fire side as well though none involve risking a patient thats insane your officer should be brought up on charges and between all of us I would make a call to local papers and your t.v. news..let the public know that they might be at risk cause of this little insurance scam cause thats all it is....you may also think about making copies of the oath your officer swore to no matter what life comes firt...send a note to mayor and council as well if your mayor gives a damn at all they will look into you have nothing to lose cause if that were me and it wen tno where its time to leave the organization and find one who cares still to tell insurance compaines drop dead

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Permalink Reply by FETC on February 7, 2009 at 12:35pm

Kimberly,

First off I am on the other side of the coin after reading other FFN responses... and hear me out completely before you criticize me supporting the actions of your Captain.

The ALS service was 5 minutes out. The patient was not packaged at this point. You are basically working alone. Even if the Captain assisted in getting the patient fully packaged, you would more than likely had the ambulance on arrival before you left the scene. Now just because the aide took a BS which may or may not be accurate, it read 368 right? Is this a diabetic issue? Did you do a BS with your equipment? This # without confirmation could mask the trauma related injury from the fall. Has the patient reinjured the underlying aneurism, or do they have a new neck or back injury from the fall as well? Did you do all the vitals or was this the aides? Was the patient packaged with full c-spine precautions? Therefore, completing your own BS, full vitals, and packaging, I do not see any delay in the patient's transport, if this were to be done while waiting for the ALS.

Now addressing your concerns about PAID SERVICES and VOLUNTEER. Your Captain clearly understands the ambulance companies challenge to recouperate money in this tough economic time. The Captain also stated they didn't want to see the patient get a bill in the mail for an additional ALS services either. That is pretty forward thinking on part of the customer isn't it? He or she knows the ALS can't bill the patient's insurance company. The patient may see a $1000-1500. ALS bill in the mail as compared to turning the patient over to the billable service. You weren't looking at a 15 minute or 30 minute wait....yes load and go if the wait is too long, intercept along the way. But come on it was 5. In those 5 minutes, at my call we would have needed additional equipment from our ambulance to package, load onto the gurney or carry the patient out of the apartment with just two personnel. All of which is tough to maintain care and treatment without having patient abandonement issues.

Background:

This is not an isolated incident. It costs money, even if you are a volunteer squad to provide EMS to the citizens of your community. I must assume the fact that your BLS service doesn't bill your patient's either. With that said you are in a dilema as is so many others in the United States.

The federal laws state that the only party that may bill the insurance company for ANY services rendered in an ambulance (911 EMS) is the transporting service. To put it in perspective (that would be the owner of the ambulance)

Here is the confusing part. We all know ALS intercepts are common in the EMS field. Many have been doing them for years. The problem is the laws have changed in reference to cost recovery to NOT allow the ALS Intercept Service to submit a seperate ALS bill to the individual patient's insurance. Doesn't matter if they are a private insurance, medicare or medicaid patient, this is a federal law.

In my region, I work for a fire based EMS service. We provide ALS services to our community. We also provide ALS intercepts to any surrounding town in our catchment area. Many of whom are volunteer BLS ambulances. Many have been established for years and are hard core, "We won't ever bill a patient becasue we are a volunteer service."

Now, when we are dispatched to that town, we are essentially providing ALS services for free. But is it really? The answer is no it is not. We are burdening the taxpayers of my community with providing ALS to your community for services you expect for free.

It only takes a few calls in this economy before a bean counter figures out that this cannot keep happening before my money runs out. My budget is taking the hit for your decision to remain a non-billing service. Besides while we are providing that ALS for free, my own town who has paid a ton of money for ALS services could be left unprotected.

Two things need to happen to fix this problem. Which we have just insituted in my region. First, you as a service can just plain stop calling us or dispatching ALS and provide ONLY the lower level of BLS care to your citizens or community. OK, we all know this is not acceptable ethically right? So most likely you are going to continue calling for the medics anyway.

So if you are going to continue calling, in my area you have two options. 1. For towns who want ALS intercepts with their BLS squad. We have established an agreement that when we intercept with your squad we will transfer the patient into our ambulance and your services are discontinued from that point forward. We take the patient, we bill the patient and this is OK per the law. But this basically sucks, because we are doing it on the side of the road. Not a pretty sight when the family who are following the ambulance to the hospital wants to know why are swapping ambulances? PR nightmare but some choose this because they refuse to start billing for EMS transports.

2nd option: We arrive on scene, and put our paramedic in the back of your ambulance or squad and you continue to the hospital with ALS onboard. We as the ALS provider can't legally bill the patient but we will bill your town $500.00 per call for ALS services rendered to your service. This is done in the form of a negotiated contract between the services.

It is really up to your service to decide if you want to start billing for transports and then recoup the ALS charges when you bill your patient for ALS. If not, then you are providing EMS transport for free, manpower for free, and ultimately paying our ALS charges from your town budget, hence patient gets ALS care for free.

But guess who really loves this set-up, guess who really loves the volunteer EMS squads and their ambulances? The insurance companies do because you are making their profit margins that much BIGGER.

Medical services in the field are a professional service that needs to be financially backed, I don't care if it is a volunteer squad, paid squad, private squad, but someone has to pay for the money previously invested into the ALS training, equipment, ambulances, medicines, refreshers, future ambulance or equipment purchases and the personnel salaries that are involved in maintaining an ALS service.

Times have changed... Many of our volunteer squads and ambulances now bill for EMS transports so the other townspeople do not have to pay for Mrs Smith's ALS bill... the end user does!

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Permalink Reply by Joe Stoltz on February 7, 2009 at 12:57pm

FETC, here is the rub: In New York State, ambulances staffed by volunteer fire departments are probited from charging for services, under state law. Section 209(b)(4) reads:

4. Fees and charges prohibited. Emergency and general ambulance service authorized pursuant to this section shall be furnished without cost to the person served. The acceptance by any fireman of any personal remuneration or gratuity, directly or indirectly, from a person served shall be a ground for his expulsion or suspension as a member of the fire department or fire company.

Also - there is no statute under NYS law that mandates our town to provide ambulance coverage, as there is for fire protection. I like the idea of an ALS agency billing the town for ALS intercepts, but I don't think that would go very far here. Last year we used ALS intercepts a total of 48 times, out of about 115 calls. Let's see, that would be $24,000 billed to the town, or about 15 per cent of our fire contract amount.

Very interesting times we live in. Our primary ALS provider (fly car only) may call it quits shortly, and with good reason - it is economically infeasible to continue to operate at a loss. We were told that ALS ambulances are the thing now, and that fly cars are a thing of the past.

It won't be much longer until the volunteer ambulance service is a thing of the past too. We have to anticipate the transition and make it as seamless as possible.

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