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Active Shooter/Violence Resources for EMS

Written by AAA Staff on December 8, 2015. Posted in Human Resources, Operations.

Updated December 22, 2015

In the sad wake of many recent mass shooting incidents, the AAA wants to ensure you and your team have all of the best information possible about handling these scenarios.

Are there other resources you use with your team to prepare for active shooters? Please share with us in the comments and we will augment this list. Thank you, and stay safe!

Preventing and Surviving Violence

DHS’s First Responder Guidance for Improving Survivability in Improvised Explosive Device and/or Active Shooter Incidents
FEMA’s Fire/EMS Department Operational Considerations and Guide for Active Shooter and Mass Casualty Incidents
AAA’s Preventing Workplace Violence article by Scott Moore, JD (member-only)
Interagency Board’s Improving Active Shooter/Hostile Event Response: Best Practices and Recommendations for Integrating Law Enforcement, Fire, and EMS
Implement a workplace violence policy, similar to AAA’s sample (member-only)
Understand the 5 Phases of Active Shooter Incidents (Police 1)
Consider sending staff to EMS Active Shooter training
Learn more about other DHS Active Shooter Preparedness Resources

Recovering from Active Shooter Incidents

Critical Incident Stress Management (CISM) onsite counseling for staff (free to AAA member organizations)
Employee Assistance Program in-person counseling (free to employees of AAA member organizations)
Find a PTSD counselor

Articles

Special thanks to Scott Moore of EMS Resource Advisors, Steve Delahousey of AMR, Aarron Reinert of Lakes Region EMS, John Peterson of Sunstar Paramedics, and Christopher Eisenhardt of Pinellas County Sheriff’s Office SWAT Team for their assistance.

CMS Releases Ambulance Cost Data Collection Report

Written by Tristan North on December 4, 2015. Posted in Cost Survey, Government Affairs, Medicare, Member Advisories, Member-Only, News, Reimbursement.

The Centers for Medicare and Medicaid Services (CMS) has released its report on the feasibility of collecting cost data from ambulance service providers. Under the American Taxpayer Relief Act of 2012, Congress directed CMS to conduct the report entitled “Evaluation of Hospitals’ Ambulance Data on Medicare Cost Reports and Feasibility of Obtaining Cost Data from All Ambulance Providers and Suppliers”. The report can be accessed here.

The report states that due to the diverse nature of our industry with a majority of providers being small entities, traditional mandatory ambulance cost reporting is not feasible. While it does not make a recommendation on a data collection system, the report highlights the work of the AAA with The Moran Company and will be helpful in our push for a survey approach to collecting ambulance cost data. Here is AAA’ summary of the report, AAA Summary of CMS Acumen Cost Analysis.

The survey approach to collecting ambulance cost data is a major component of the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377, H.R. 745) which would make the current Medicare ambulance increases permanent. The data collected through the survey would help the AAA make data-driven recommendations to the Congress and CMS on future changes to the Medicare ambulance fee schedule.

The contractor, Acumen, who developed the report, was also asked to look to see if cost data submitted by hospital-based ambulance service providers would be helpful. Acumen determined that the data submitted varied significantly and thus was not useful.

For questions about the AAA efforts on cost data collection, please contact AAA Senior Vice President of Government Affairs Tristan North at tnorth@ambulance.org.

Spotlight: John Peterson

Written by AAA Staff on November 30, 2015. Posted in Spotlight.

John Peterson
Chief Administrative Officer
Sunstar/Paramedics Plus
Largo, FL

Can you please tell us a little about yourself?

I am originally from Apple Valley, Minnesota, a suburb of Minneapolis. I attended college in Chicago where I met my wife, Sarah. She is also a native Minnesotan. In 2003 we made the move to Florida for warmer weather. We enjoy Florida living, including kayaking and spending time at the beach. We are avid NFL football fans and are season ticket holders to the Tampa Bay Buccaneers. Of course, our Minnesota Vikings purple pride still remains. One thing that some people don’t know about me is that besides being a paramedic, I am also a board certified Occupational Therapist.

How did you come to work in the industry? How long have you been involved?

My first experience in EMS came when I injured my back playing football in high school. This became my first ambulance ride and was an experience I’ll never forget. After graduating from college I had a friend who was working for a private ambulance service. He told me that the company he worked for was paying for people to go to EMT school and then providing them with full time employment. I jumped at this opportunity and never looked back. I fell in love with EMS and became a paramedic as soon as I could after EMT school. I worked as a paid on-call firefighter/EMT and as a paramedic/firefighter in Illinois before moving to Florida. I have gradually worked my way up through the ranks at Paramedics Plus and now have the opportunity to be the CAO for Sunstar.

What do you enjoy most about your job?

What I enjoy most about my job is the chance to make a positive change that improves the work life for our employees and provides the highest possible quality of service to our community.

What is your biggest professional challenge?

I think my biggest professional challenge currently is recruitment and retention of paramedics. The EMS industry appears to be seeing a reduction in interest from younger people in the workforce. This is at least in part due to wages and work schedules that struggle to compete with other healthcare industries.

What is your typical day like?

My typical day starts with 30 minutes on the elliptical machine. Once at the office, I try to get through as many emails as I can before the meetings of the day start. I spend a lot of time leading and attending meetings as we work to improve efficiency and provide the highest quality of service possible. The email and phone communications last all day. It’s hard to ignore those smart phones.

How has participation in AAA membership and advocacy helped your organization?

One of the things I appreciate most about the AAA is the opportunity for EMS organizations from around the country to work together on projects that have positive industry-wide impact. It think is important that the AAA promotes a one team, one mission approach that puts aside agency competition for the betterment of the industry as a whole. The annual conference provides excellent educational and networking benefits and the daily digest emails help keep me informed of what is happening in the industry. I am looking forward to furthering my involvement with the AAA.

2016 AIF: A Step Backward

Written by Brian Werfel on November 25, 2015. Posted in Medicaid, Medicare, Reimbursement, Talking Medicare.

By Brian S. Werfel, AAA Medicare Consultant | Updated November 25, 2015

Each year, the Centers for Medicare and Medicaid Services (CMS) determine the following year’s Ambulance Inflation Factor (AIF), a figure that has deep revenue implications for ambulance services of all sizes. CMS recently announced that the 2016 AIF will be a disappointing – 0.4%.

In this inaugural edition of the Talking Medicare blog, I explore the ins and outs of the AIF, including the impact of the Multi-Factor Productivity Index on our industry’s Medicare payments.

Background

First, some background. The Affordable Care Act revised the formula by which CMS calculates the annual adjustment to Medicare’s reimbursement rates for ambulance services. Prior to 2011, Medicare’s payment for ambulance services increased each year by an amount equal to the percentage increase in the consumer price index for all urban consumers (CPI-U) for the 12-month period ending in June of the previous year (i.e., for 2016, the 12-month period ending on June 30, 2015). Starting in 2011, the CPI-U increase is reduced by the so-called Multi-Factor Productivity Index (MFP).

What to Expect Next Year

For 2016, the change in the CPI-U was equal to 0.1%. In a transmittal issued November 17, 2015, CMS indicated that it estimates the MFP will be 0.5% next year. As a result, CMS calculated the Ambulance Inflation Factor (AIF) to be – 0.4% next year.

Yes, you read that correctly. Your Medicare reimbursement rates will decrease next year!

MFP’s Impact Over Time

The MFP represents a permanent reduction in the amounts paid by the Medicare Program for ambulance services. And, unlike other recent reimbursement hits our industry has faced, this reduction compounds itself over time.

What do I mean by that? Quite simply, I mean that the lower rates become part of the baseline against which the next year’s AIF is calculated. As a result, the gap between our industry’s costs of providing ambulance services and Medicare’s reimbursement for those services grows larger every year.

To give you a sense of the impact of MFP over time, this chart shows the payment of an ALS emergency transport in New York City over the past several years. In 2010, the Medicare allowable rate for this transport was $491.06. In 2016, the Medicare allowable rate for that same transport will be $517.02, an increase of 5.3%. However, without the MFP, the Medicare allowable would have been $544.22, or 10.8%. In other words, our Medicare increase would have been more than twice as much in the absence of the MFP.

Keep in mind that the AIF was created to ensure that Medicare reimbursement keeps pace with the increased costs of providing ambulance services to your community. By that yardstick, the current process for calculating the Ambulance Inflation Factor is clearly inadequate.

One of the key issues facing our industry is our ongoing fight for permanent Medicare ambulance relief. The recent AIF simply highlights the need for a better method of ensuring that Medicare’s payments keep pace with our costs.

Have an issue you would like to see discussed in a future blog post? Please write to bwerfel@aol.com.

Need Some Help?

AAA members are invited to send Medicare claim questions to Brian and David Werfel.

Not yet a member? Join today to gain access to AAA’s reimbursement, human resources, and healthcare law expertise.

Palmetto Announces Prior Authorization Workshops

Written by AAA Staff on November 20, 2015. Posted in Medicare, Regional Workshops, Reimbursement.

Palmetto GBA asked AAA to share the following announcement with our members.

Repetitive Scheduled Non-Emergent Ambulance Transportation Documentation Requirements—North Carolina

Palmetto GBA will hold Repetitive Scheduled Non-Emergent Ambulance Transportation Prior Authorization Demonstration face-to-face workshops in North Carolina for ambulance providers providing repetitive scheduled non-emergent transports to familiarize them with The Centers for Medicare & Medicaid Services (CMS) demonstration currently going on in South Carolina.

These workshops are designed to familiarize providers, whose ambulances are garaged in potential demonstration expansion states, with demonstration requirements including the process of submitting a prior authorization request, billing for repetitive scheduled non-emergent ambulance transports under the repetitive scheduled non-emergent transportation demonstration, as well as common errors identified during the demonstration in South Carolina. Each event will include a question and answer period at the end of the formal presentation.

Background Information

The purpose of the current prior authorization demonstration is to ensure that beneficiaries continue to receive medically necessary care while reducing expenditures and minimizing the risk of improper payments to protect the Medicare Trust Fund by granting provisional affirmation for a service prior to submission of the claim. Prior authorization allows providers and suppliers to address issues with claims prior to rendering services and to avoid the appeal process.

Prior authorization will not create new clinical documentation requirements. Instead, it will require the same information necessary to support Medicare payment, just earlier in the process.

Workshop Topics:

Repetitive Scheduled Non-Emergent Ambulance Transportation Demonstration Expansion Regulations
Documentation Requirements
Proper Claim Submission
Q & A

Note:

These workshops will provide insight for new, intermediate or advanced staff; however, we suggest that providers who are new to Medicare or have new staff attend online learning courses for beginners on the Palmetto GBA website. Basic billing and other online educational resources can be found in the Self-Paced Learning section under the Learning and Education link on the left navigation.
CMS requires that Medicare contractors track all educational activities, which consists of capturing the provider’s six-digit Provider Transaction Access Number (PTAN) and National Provider Identifier (NPI). Please bring this information when attending the workshop.

North Carolina
Ambulance Prior Authorization Workshop: Repetitive Scheduled Non-Emergent Ambulance Transports
Audience: Part B Ambulance providers of repetitive scheduled non-emergent ambulance transports
Event Type: In Person Seminar

How to Register

The schedule of workshops and registration information is listed below. To reserve your seat or find out more about the workshops in your area, please make sure you:

Create a profile at the new Event Registration Portal to create an account. Your existing Workshops database profile is not linked to the new portal as the profile creation process is different.
Log in your Event Registration Portal account and you will be able to register yourself or other people for any workshops hosted in the portal before registration closes. Each workshop will have a separate registration link. For the workshops that Palmetto GBA sponsors, Palmetto GBA’s registration page will be displayed. If the state Association is sponsoring the workshop, the link will take you directly to the Association’s registration page.

**As a reminder, providers are encouraged to telephone the Provider Contact Center (PCC) at 855-696-0705 with any claim specific questions they may have as these will not be able to be addressed at the workshop.

MedStar PR Guru’s 5 Best Practices for Media Appearances

Written by AAA Staff on November 20, 2015. Posted in Community, Press.

If you attended AAA’s 2015 Annual Conference & Tradeshow, there is a good chance you participated in our Becoming Irreplaceable Community and Media Relations Boot Camp. This session, presented by MedStar Mobile Healthcare’s Matt Zavadsky, covered proven strategies to become a partner in your community. Today, Matt put pen to paper over at EMS1 and shared 5 best practices for media appearances by EMS chiefs and field personnel.

Reporters will LOVE you if you incorporate their question into your answer. This allows them to take the sound bite they are looking for without having to dub in their question to make it understandable for the viewer or listener.

Read the full article at EMS1!

CMS Announces 2016 Inflation Factor

Written by David Werfel on November 18, 2015. Posted in Government Affairs, Member Advisories, Member-Only, Regulatory.

The Centers for Medicare and Medicare Services (CMS) has officially announced that the inflation factor for payments under the Medicare ambulance fee schedule for 2016 will be negative .4% (-0.4%). As part of the Affordable Care Act, a productivity adjustment has been part of the calculation for the last several years which for 2016 has resulted in a negative update.

The calculation for determining the Medicare ambulance inflation factor is as follows: Consumer Price Index – Urban (which is the change in the CPI-U from June to June) minus the non-farm business multi-factor productivity adjustment (MFP) as projected by the Secretary of HHS (10-year average). The CPI-Urban for 2016 is 0.1% with a MFP of 0.5% which equals negative .4%.

The AAA had projected an inflation factor of negative .5%.

2016 EMS Leadership Academy, Including a NEW Executive Level Retreat!

Written by AAA Staff on November 16, 2015. Posted in Events, Leadership Academy.

SafeTech Solutions’ Leadership and Supervisor Academies are featuring several courses in 2016 designed to encourage and develop leadership and management among the EMS community. Please join your peers at the following stimulating programs:

EMS Leadership Academy [quote_right]”I had the opportunity to participate in Level I and Level II thus far, and without a doubt this was the best leadership training and education I have ever received in my over 25 years of participating in professional development seminars. I cannot wait to participate in Level III and IV in 2016.” — Maria Bianchi Executive Vice President, AAA [/quote_right]

A dynamic four-level, 60-hour educational program designed for current & future leaders, focusing on developing leadership skills, creating vision, getting people to follow you & managing organizational & cultural change.

EMS Supervisor Academy

An intense, three-level, 60-hour immersive experiential education program to develop frontline EMS supervisors who are key facilitators of high employee engagement & operational success.

Executive-Level Retreat (New for 2016!)

The practice of leadership never stops. Great leaders continue to take time for their growth and development. This two-day retreat is an opportunity to meet with other Leadership Academy graduates from across the country & support your practice of leadership.

View the course schedule and to register!

We look forward to seeing you there!