COVID-19 employee Travel FAQ

Over the last week, we have received several questions from AAA members about various COVID-19 impacts on EMS organizations.  As the infection numbers around the country are on the rise, many new issues have arisen that are posing issues with many EMS employers.

  1. Travel Orders

What can I do when our employee voluntarily chooses to travel out of state and, due to state level travel orders which require mandatory quarantine for 14 days upon their return, the employee cannot work and is seeking to be paid emergency leave under the Families First Coronavirus Act (FFCRA) or take additional unpaid leave during the quarantine period?

As an employer, you have several options.  One of the most important things to know is that your employee does have to abide by any federal, state, or local quarantine order.  However, this does not mean that the employer is helpless in addressing this the issue of employee voluntary travel.  The last few months have been incredibly trying on all of us, particularly those who are on the front lines battling the COVID-19 pandemic, it is understandable that employees are looking to take vacations out of state.  While this is understandable, the employee is still making a decision that can impact their health and their employment, as well as, the health of their coworkers and patients.

Employer Option 1

As an EMS employer, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Despite this, many EMS employers have decided to provide their employees with emergency paid leave under the FFCRA.  The employer can choose to pay the employee emergency leave under the FFCRA during the mandatory travel quarantine.

Employer Option 2

As stated in Option 1, the FFCRA specifically permitted EMS agencies the right to exclude emergency responders from the group of employees who are eligible to take emergency leave under the FFCRA. Most of those employers who have decided to provide emergency leave under the FFCRA, their intent was to provide the emergency leave to employees who, through no fault of their own, were exposed to COVID-19 and required to quarantine.  However, an employer has the right to exclude some employees, such as those who decide to voluntarily travel outside state, and as a result, required to quarantine upon return.  The key is to ensure that you have an established policy, it is applied consistently, and has been meaningfully communicated to your employees.  This is the best practice for mitigating any discrimination or disparate treatment claims.

Employer Option 3

The employer can choose to discipline the employee for choosing to leave the state, despite the travel order.  If an employee knowingly travels out of state, despite the existence of a mandatory travel quarantine order, the employer can discipline that employee for any quarantine related attendance issues.  The employer cannot let that employee return to work unless they have abided by any travel orders.  Several of the states who have issued orders, include an option to avoid a 14-day quarantine order if they have a negative COVID-19 test within three days of returning to their home state.  Alternatively, they can end the 14-day quarantine period if they receive a negative test after returning to their home state.

Employer Best Practice

The best bet for employers is to contemplate the possible issues that could arise with your employees as a result of the local travel orders.  Employers should draft a policy that delineates the work-related implications of employee travel.  This policy should be communicated through multiple channels, and ideally, be acknowledged in writing by your employees.  This will provide your employees with a clear understanding of the implications of deciding to travel out of state during the pandemic.

  1. COVID-19 Parties

Several member organizations have asked what actions they can or should take when they learn that an employee has attended a COVID-19 party.  These events, which defy logic, particularly for those of us who consider EMS, healthcare and EMS personnel, healthcare workers, are parties where uninfected people go to a party with known infected people to mingle and see who becomes infected.

Option 1

Under the General Duty clause of the Occupational Health and Safety Act (OSHA), an employer has an obligation to provide a workplace which is “free from recognized hazards that are causing or are likely to cause death or serious physical harm to his employees”.  This includes if an employer is aware that there are employees who are engaging in behavior that may create a workplace hazard, like attending events such as a COVID-19 party.

If an employer discovers that an employee has attended an event like a COVID-19 party or a large scale event where protective measures were not taken, such as mandatory mask wearing and social/physical distancing, the employer has a duty to investigate and take action.  This would include requiring that the employee remain out of work for the recommended quarantine time or upon a negative COVID-19 test.  The employer could pay for this test but is not required to.  If the employee voluntarily took part in this event and the exposure was not work-related, they would not be obligated to pay for the COVID-19 test.

Option 2

For the many reasons stated above, the employer has an obligation to the rest of its workforce to ensure that this potentially infected employee does not expose the rest of the workforce.  The employer would be justified in addressing this issue through their disciplinary process.  As is always recommended, I recommend that employers communicate with their employees to let them know that the choices they make outside of the workplace have implications inside the workplace.  While this should be obvious to our employees, not all operate by the same playbook.

Employers should be aware that there are state laws that limit the level at which an employer can dictate an employee’s “off duty” time.  For example, an employer in New York cannot take work action against an employee for their personnel time political activities.  However, an employer may address the employee if that off duty conduct involves their employee’s failure to be safe by wearing a mask and maintaining social/physical distancing while attending a political event or political-based protest.  As previously mentioned, employers have obligation to provide a workplace that is free from “recognized hazards”.

Employer Best Practice

I recommend that employers consult with their local attorneys if they faced with taking work-related action for an employee’s off duty conduct if they are in a state with off duty conduct laws.  The best way to ensure you protect your workforce is to ensure that the organization has a comprehensive policy and procedure manual that is updated every year.  Additionally, all employees, including supervisory personnel, should sign an acknowledgement annually. Lastly, it is recommended that the organization highlight a few policies throughout the year.  Specifically, I recommend that organizations log all incidents, complaints, and discipline to permit trending of workplace activity which suggest which policies and procedures need to be highlighted.

CDC Announces Live Stakeholder Call Schedule

CDC Announces Live Stakeholder Call Schedule

Helping communities plan for, respond to, and recover from the COVID-19 pandemic
Childcare Programs, Youth Programs and Camps, Schools, Workplaces, Mass Transit
Please join us for the stakeholder calls below:

CDC’s Live Stakeholder Call Schedule (Click the links to register for each call.)
Youth Programs and Camps Tuesday, May 19 from 4-5 pm ET
Schools and Childcare Programs Wednesday, May 20 from 4-5 pm ET
Workplaces and Mass Transit Thursday, May 21 from 4-5 pm ET
Youth Sports Friday, May 22 from 4-5 pm ET

Leaders may use the tools below as they make decisions during the COVID-19 pandemic.


Thank you for all you are doing to promote the public’s health during this time.

Compliant Hazard Pay Practices

MEMBER ADVISORY

Recently there have been several states where legislative efforts have been filed or legislation passed related to the provision of Hazard Pay for front line healthcare and public safety workers.  In addition, there are suggestions that the next federal stimulus package may include provisions for hazard pay for those responding to this pandemic. While this financial relief would be incredibly helpful to those working on front lines, there are important considerations for employers to understand as they implement these pay measures.

Hazard Pay or premium pay is broadly defined as compensation paid to an employee for performing hazardous duty or work involving physical hardship. This can include work duty that causes extreme physical discomfort and distress which is not adequately alleviated by protective devices.  The Fair Labor Standards Act (FLSA) does not directly address Hazard Pay.  However, it is important for employers to know that the payment of Hazard Pay will impact the calculation of an employee’s regular rate of pay and the corresponding overtime compensation.  As many EMS employers are already aware, the payments of differentials, incentive pay, or other premium compensation require a special “weighted” average overtime calculation.  The United States Department of Labor provides a Fact Sheet which details how an employer must calculate an employee’s overtime when certain additional compensation, including Hazard Pay, is included.

We recognize that many EMS agencies are already aware of the impact different premium pays, such as shift differentials or bonuses have on an employee’s wage calculation.  It is important that EMS employers know that amounts paid as Hazard Pay must be handled similarly.  If your organization utilizes a payroll service, often they can provide assistance to ensure the calculation is accurate.  I suggest strongly that you perform a random audit to ensure that the payroll software platform is calculating the wages correctly.

Please be sure to contact the American Ambulance Association if you have questions or need further clarification regarding compliant Hazard Pay practices.

COVID-19 Continuity of Operations Checklist

Download as PDF

As you begin the process of returning employees to their usual on-campus workspace, be sure to consider all angles and implications of a returning workforce. It can be helpful to create a Re-Entry Task Force as part of this process. Including representatives from all areas of your business ensures needs, concerns, and challenges are identified and considered as decisions are made and re-entry processes begin. A suggested list of departments/partners to include:

  •  Operations
  • Communications
  • Patient Billing Services
  • Education & Training
  • Fleet & Facilities Maintenance
  • Human Resources
  • Information Technology (IT/IS)
  • Safety & Risk (OSHA, compliance, HIPAA)
  •  Legal
  • Human Resources/Workforce

Position Analysis

As you work with your task force to determine who, when, and how to return employees to their usual on-campus workspace, it may be helpful to work through an analyze of each position. We suggest using the SWOT analysis tool as you determine which positions should return, when or how the position might change to better meet the needs of your organization. Below is a sample table with some example considerations.

Sample considerations:

  • Productivity:
    • Has productivity for any position/employee increased or decreased while working off-site?
    • Is it possible to maintain on-site productivity with a staggered re-entry plan?
    • Is it possible to maintain on-site productivity and return employees to on campus workspaces with staggered shifts?
  • Cost:
    • Has the cost of any position/employee increased or decreased while working off-site? (IT support, supplies, lost productivity, time off, etc.)
    • Will the cost of maintaining a sanitary workspace for returning employees be cost prohibitive for our organization?
    • Are necessary cleaning products and equipment available?
  • Technology:
    • Do we have the necessary technology for employees to reasonably work off-site while
      maintaining information security, communication, etc.?
    • Do we have the IT support available to troubleshoot any issues?
  • Physical Space:
    • Have we reviewed the CDC’s Guidance on Reopening Guidance for Cleaning and Disinfecting Public Spaces, Workplaces, Businesses, Schools, and Homes
    • Is our office/building set up in a way that we can return people to work while practicing
      recommended social distancing measures?
    • Will we need to install any physical barriers, hands-free door systems, or other otherwise
      reconfigure our office layout as employees return to campus?
    • Do we need to install handwashing, physical distancing signs throughout our facility?
    • Have all physical spaces been disinfected, and is there a schedule to maintain a clean and
      sanitary environment?
  • Equipment:
    • Do we have enough equipment so that we can limit shared equipment use between staff, or
      are we able to limit equipment use to certain staff only? (i.e. copiers, fax machines, phones, etc.)
    • If implementing a staggered shift arrangement or office/work from home plan, is there sufficient equipment to ensure functionality and productivity?
    • Do we have possession of or access to all necessary PPE for employees returning to an on-campus workspace? (i.e. face coverings/masks)
    • Fleet & Facility Maintenance
    • Do we have the necessary supplies to keep our non-clinical fleet vehicles clean and disinfected?
    • Do we need to change air filters, etc. to reduce exposure and cross contamination in the building?
    • If we added new chemical disinfectants, are the MSDS sheets in present, up to date, and
      accessible for all employees?
    • Have all employees responsible for using chemical disinfectants been trained proper use to
      avoid injury?
  • Mental Health & Wellness
    • What is the cost of continuing a remote workforce? Are there mental health resources available to them through health insurance, employee assistance programs, or other wellness programs?
    • Is it feasible to have regular check-ins with employees to ensure they are coping with
      increased stress, lack of childcare, and change of workplace structure?
    • As employees return to on-campus workspaces, do we need to implement temperature screenings upon arrival?
    • Continue to work off-site requests
    • Some employees may request to continue working off-site. Is there a process in place to screen and evaluate those requests?

Resources

Guidance on Preparing Workplaces for COVID-19
CDC Guidance on Cleaning and Disinfecting Your Facility
World Health Organization Getting your workplace ready for COVID-19

Webinar | Living Room Leadership

Living Room Leadership – Addressing Telework, IT, Compliance and Security Issues in a Remote Office Environment

Wednesday, April 17, 2020 | 1:00 pm Eastern Time
Presented by:  Katie Arens, Scott Moore, Esq., and Frank Gresh

During the ongoing COVID-19 pandemic, EMS providers have been forced to adopt new strategies for working while social distancing, though this has raised new challenges. Join Director of Customer Accounts & Mobile Health Solutions at LIFE EMS Katie Arens, EMS workforce consultant Scott Moore, and Chief Technology Officer at EMSA Frank Gresh as they discuss the challenges and solutions to the new normal of working from home. Learn best practices for IT support and maintenance, compliance, cybersecurity, and other challenges facing the at-home workforce.

8 Ways You Can Support Millennials in Your Workplace

Millennials… am I right?

That seems to be the most popular punch line when I am sitting around a table with colleagues discussing organizational change or current challenges in EMS, particularly staffing and development. I recently attended a conference focused on leadership in EMS and if there was a session without mention of the dreaded millennial and how awful they are, I missed it. To be honest, it’s getting old and my ability to filter my exasperation is wearing thin, especially as we are now seeing offers of multi-day trainings for how to work with millennials. The entire concept seems quite strange to me… were there classes offered to the Boomers on how to get along with the Generation Xers?

The words I usually hear associated with the generation at hand are entitled, needy, whiney, lazy, untalented and impatient. I don’t believe anyone I know well or have worked with over the years would describe me with any of these terms (ok… maybe impatient from time to time), although I am in the generational age range for millennials. In fact, I am willing to bet many of you work with people who are within the age range for millennials, yet you would not immediately lump them into the group you find so difficult. According to the PEW Research Center, millennials were initially described as those being born after 1981 are now defined as those born between 1977 and 1992.

While I am not attempting to climb up and be a representative for the entire millennial generation, I do believe this simple list addresses many of the issues I have heard, from both sides of the generational gap, over the past few years.

  1. Stop complaining about millennials.
    Generally, please stop using the word millennials to begrudgingly sum up every challenging situation or conversation you’ve had involving someone younger than you. Specifically, please stop complaining about millennials to me… a millennial. I realize you think my entire generation is made up of needy children who cannot be bothered to show up for work, but is that how you would describe me? I will admit the above description does fit some of my generational cohorts, if you can admit there is a certain irony in constantly complaining (whining) about a generation of whiners.
  2. Get to know me.
    Time is precious, and you don’t have enough of it. Staffing shortages, schedule changes, contract demands, and personnel issues take up so much of your time it can be easy to overlook the simple things that really make a difference in an organization. Something as small as a conversation can drastically change how I feel about, and in, an organization; it helps me learn about the culture of the organization, how I should approach leadership with any issues that come up in the future and how long I’ll stick around. Leadership taking the time to have a conversation, even 15 minutes, will set the foundation for the relationship I will have with the individual(s) as well as the organization.Seriously, take time out of your day to get to know me as a person instead of an employee number. This can start in the interview or orientation process, and continue while I’m on shift. Most EMS organizations have shift supervisors that are also working on the truck and, in many cases, orienting new employees during their first 60 days; take the time to have a conversation about expectations (from both sides), communication preferences and styles, and personal and professional goals. Onboarding someone to your organization is about more than protocol compliance and radio reports.
  3. Stop talking to me about money.
    Yes – money is important, and I expect a reasonable level of compensation for the work I am doing. I want to be able to support myself, my family and my lifestyle but I’m about more than that. By and large, I am value driven; I want to know that what we are doing is making a difference somehow, and that my values are mirrored in the organization I work for. To clarify, money is NOT the primary motivator and when you lecture me about finances (the way my father would), I shut down and know that you do not understand me.PS: Organizations that take the extra time to lay out and explain complete compensation including benefits, insurance costs, etc. and offer resources for budget planning are absolutely adding value to all employees, not just millennials.
  4. Share your vision, so I know the path and the timeline
    I might seem impatient…but my whole life I’ve been told to set goals and reach them. Go to college and get a respectable job. DO better. BE better. Nobody ever told me to be PATIENT. Share the vision of the organization. Share your vision for me (specifically) within the organization, and ask what my vision is. Work with me so I can understand my potential career path and a realistic timeline, so I can be an active participant in my development and, together, we can manage my expectations.
  5. Realize that when I ask you “why” I’m not challenging you.
    I legitimately want to understand why I’m doing what I’m doing. The things we do during downtime, on scene and in the back of the ambulance are all part of a process, not the entire process. Understanding where my “place” in the process is and what happens next helps clarify the importance of specific tasks, particularly those that need to be completed in a certain order or timeframe. It is important for leadership to go beyond the “because I said so” reasoning. I remember being told once, long ago, that I should never tell anyone something I can’t show them. That message stuck with me and I have come to expect the same from others, particularly those handing out orders. Help me see the why and I will gladly complete the task… maybe I’ll even find a way to do it more efficiently.
  6. Stop telling me “Good Job”. It’s a cop out – you know it and I know it. Just stop.
    Recognizing effort is always better than recognizing completion. EMS is a high-stress, mentally demanding industry that can feel somewhat all-consuming. When I take on a project that means extra time away from my family or squeezing more work into my already busy shifts, learning and exercising new skill sets or successfully coordinating the work of others, an “Atta Boy!” just doesn’t cut it. Also, I know I’m not perfect, so when performing my annual review, a blanket “you’re doing a great job…” tells me you’re really not putting the effort into giving me an honest review and you’re not invested in my continued improvement.
  7. Don’t be my punchline.
    This is a simple one… I expect you to practice what you preach. For example, if you implement (and enforce) an organizational policy that says employees cannot call in late or sick via text message, do not cancel a meeting or let me know you will be late via text message. Require a minimum of a 4-hour notice for a sick call? No problem, until you cancel our meeting at the last minute, or even worse, after it has already started, you’re not there and I have to call you. Please do not talk to me about the importance of dedication and doing the right thing even when no one is watching and let me see you leave early when your boss is out of town or hear you complain about meetings that go past 5pm. Coaching me on the importance of follow up? Please, please make sure you set the example of what good follow up looks like, because if you’re enforcing rules that you clearly believe you are exempt from and failing to provide the example, you lose a lot of credibility.
  8. Get Social
    It’s a social world, and we’re proud of what we do and where we work. For many being an EMT or paramedic isn’t just a job, it’s their identity; take the opportunity to post your new hire photos and bios on your social media accounts and tag the employees in the celebrations so their friends and family can share in their pride and success.

 

Cataldo Ambulance Service Wellness Couch to 5K

In October 2016, Kelli Megill, a Human Resources Generalist at AAA member company, Cataldo Ambulance Service based in Somerville, MA, attended the safety symposium hosted by their worker’s compensation carrier. Much of the symposium focused on why employees get hurt and what employers can do to help stop the trend. A reoccurring thread in all of the most effective injury prevention programs was promoting the fitness and wellness of an organization’s employees.

Kelli decided to launch what has been the most embraced wellness initiative in the 40 year history of the company. The Cataldo Couch to 5K Program began about 8 weeks ago and culminating with the 5K road race/walk on June 5th. Kelli pitched the program to the other members of the Human Resources team and Ron Quaranto, the Chief Operating Officer (AAA Region 1 Director). The program now has over 100 employees participating in the program which is more than just the run/walk on June 4th.

Cataldo has tackled wellness events in the past, including the company hockey team, Spartan races, and other chartable road races. The company, which provides emergency services to several of the communities along the Boston Marathon route, sponsored several employees to run the 26.2 mile trek from Hopkinton to Boston. However, they have always struggled with engaging more than a small group of its workforce.

The team assembled a small committee comprised of the COO and other department heads whom had expressed great excitement for the project. They decided that that they would choose a local charitable 5k and encourage teams to raise funds while improving their own health. Most Couch to 5k programs require between 8 and 9 weeks of training. The committee searched for race dates that were approximately 12 weeks out giving them enough time to promote the program and garner excitement and participation. Cataldo committed to paying for every participant’s registration fee and would give every participant a running shirt. Cataldo reached out to their company sponsored health insurance carrier to see if any portion of the registration fee could be covered by their “Wellness” fund. The carrier not only agreed that the registration fees eligible for reimbursement but also the run shirts.

Cataldo sent out a company-wide email promoting the event and encouraging employees to sign up. The initial email, give a sign up deadline of 8 days. It explained that the training would mostly be individual but encourage some to be “Team Captains”. Team captains would stay in contact with their team members to motivate and answer questions or give tips. The initial goal was to get 30 people to sign up which was surpassed in a couple of days. By the 8 day deadline, they had nearly doubled their initial goal of 30 and set a new goal for 100 participants. After the first few registrants, it became a bit of a competition with team captains recruiting members. The response has been fantastic with not only employees but their family members joining as well. The insurance broker, inspired by what the company was doing, registered a team as well.

As with most multi-week projects, enthusiasm can wane. At week 5, so the committee posed Week 5 challenge to all of our participants. If the participant sent a picture of them doing some sort of physical activity 5 times that week, they were entered into a drawing to win a $50 gift card for a sporting goods store. The committee has been getting great pictures and videos from many of the participants over the following weeks. In addition, they created a closed Facebook group that several participants have joined and post weekly “motivational” pictures and emails that are distributed to all participating in the program. The committee has several employees who have express interest in extending a Running Club after the 5k on June 4th.

Human Resources leaders in EMS have struggled to get employees to embrace wellness initiatives. Despite our employees witnessing the health related risks of poor nutritional choices and lack of physical activity every day, many wellness initiatives still fail to gain traction with our employees. Many wellness programs offer premium differentials to encourage participation but often this is not enough to motivate participation. Research is very clear that employees who focus on good diet, exercise, and regular sleep experience less illness, absenteeism, injuries, stress, and long term health related problems.

Like Cataldo, ambulance services need to persist in their efforts to find the wellness program that works for their employees and company. Remember, this is not a “one size fits all” mentality. Premium differentials, health screenings, healthy food options in vending machines, fitness club discounts, employee assistance programs, exercise clubs, are just a few options. EMS organizations need to commit to these programs once you find the ones that resonate with your employees.

Cataldo is not exactly sure why this program, versus many of the others it has tried, has caught on with so many of their employees and beyond. When asked what she thought “moved the needle” this time around, Kelli Megill said that they really made it fun by creating a community of individuals all pulling towards the same goal while raising funds for a great cause.

Overtime for PTO Bill Passes the House

Yesterday a bill that would possible amend the overtime provisions of the Fair Labor Standards Act passed the House. H.R. 1180, titled the Working Families Flexibility Act of 2017 was introduced by Alabama Representative Martha Roby this past February.

The proposed change would permit private employers who currently pay employees overtime for hours worked over 40 during a given week to substitute that overtime pay for compensatory paid time off in the amount of 1.5 hours for each hour of overtime worked. In order to do so, the employee would have to agree in writing with the substitution of PTO for overtime pay prior to working the overtime hours. The agreement must provide that the employee knowingly and voluntarily agrees to the substitution of PTO for overtime pay. In the case of unionized companies, the substitution can only be made if provided under the collective bargaining agreement.
To be eligible to substitute PTO for overtime pay, the employee must have worked for the employer for at least 1000 hours during the preceding uninterrupted 12 month period before the agreement is made or the receipt of the compensatory PTO. The Bill provides for limitations to the number of hours that can be accrued and the length of time it can be carried.

An employee may accrue not more than 160 hours of compensatory time. Any unused compensatory time accrued under this provision by the end of a calendar year would have to be paid to the employee no later than January 31st of the following year. An employer may designate and communicate to the employees a 12-month period other than the calendar year. However, any unused compensatory time must be paid not later than 31 days after the end of such 12-month period.

When employers are paying the unused compensatory PTO, the pay shall be paid at a rate of not less than the regular rate earned by such employee when the compensatory time was accrued or the regular rate earned by such employee at the time such employee received payment of such compensation, whichever is higher. This could mean that the employee is receiving pay at a rate higher than it would have been had the employer simply paid the overtime at the time it was incurred.

The Bill provides for some flexibility with when it pays the compensatory PTO. An employer may pay monetary compensation to the employee for accrued hours in excess of 80 hours provided it gives the employee 30 day notice. In this case, the wages would need to be paid consistent with the manner described above. However, if an employee voluntarily or involuntarily terminates employment, the employer must pay all accrued compensatory PTO to the employee.

Under the Bill, an employer who has adopted the policy of paying compensatory time instead of paying overtime wages may discontinue the practice upon 30 days written notice to the employees. Conversely, an employee may rescind their agreement to be paid compensatory PTO at any time. In such instances, the employer must pay all unused PTO accrued under the agreement within 30 days.

The Bill language contains significant provisions to protect the employee from employer threats or coercion to agree or not agree to the adoptions of compensatory PTO or to the use or failure to use such compensatory time. The Bill requires that the employee enter the agreement voluntarily and that they can essentially use the compensatory PTO or the corresponding pay in any manner that they choose. If passed, the Department of Labor will have to issue regulations that more specifically guide this practice.

While this Bill still may not get the votes it needs in the Senate (S. 801), employers should consider how adopting such a policy may impact their organizations. From a cash flow perspective, this could provide some flexibility during the year. However, the monies must be paid to the employee at the end of the 12 month period. Often employers who already have a practice of paying out unused PTO or vacation time at the end of a year struggle with the significant expense coming due. This is particularly difficult if it occurs at the end or beginning of the calendar year as there are usually additional expenses during the holidays and reductions in cash receipts during January and February for many ambulance providers.

For employees, this Bill could be a mechanism for accruing time in excess of any existing vacation, sick, or paid time of benefits that could be used for unexpected absences or for significant illnesses. Often, our employee are not financially prepared for the wages lost when they are sick or injured and do not have enough sick time to cover the absences. However, many have come to rely on the weekly payment of regularly worked overtime to cover their life expenses. Either way, it may give our employees something that they always love, the ability to choose.
We will continue to monitor the progress of this bill over the next few months and will keep members up to date. If our members have questions about this or any other Human Resource or Operational practices or issues, utilize the resources available to you as part of your AAA membership.

The Cost of a Bad Hire

Our industry has been struggling with a staffing crisis for several years. We are all looking for ways to attract and hire qualified individuals to staff our ambulances and work in our dispatch and billing offices. This shortage has often resulted in ambulance providers hiring many people who meet the basic qualifications for the position even if they might not be the best fit for the company. There is a strong focus on reducing overtime hours to keep cost in line with shrinking reimbursement dollars. However, when a new person is introduced to the company community and culture, there are impacts that are not always recognized. Our industry has also struggled with the concept of collecting and reporting cost data because there are many dynamics that drive cost for ambulance providers throughout the country. Difficulties with identifying and isolating recruitment and retention costs are no exception to this struggle. An article published by the HR Daily Advisor discusses a recently published survey that studied the financial impacts a bad hire has on an organization. Not only does the organization lose the money associated with onboarding the wrong candidate (interview time, screening costs, orientation costs, uniforms, third ride time, etc.) but also the costs associated with the delay in finding the right person and the lost productivity and morale of the coworkers due to the bad hire.

Maintaining Compliance Within an EMS Service

Maintaining compliance within an EMS service can be a daunting task, especially given the number of regulations that we must follow.

One way to look at EMS is if a trucking company married a hospital.

There are rules and regulations to abide by for an entire fleet of vehicles, from safe operation guidelines all the way down to the use and color of lights. Then there are requirements for a group of healthcare providers, which include necessary certifications such as CPR and knowledge of pertinent life-saving skills.

Not only does maintaining compliance keep vehicles and equipment running smoothly, but it can offer employees valuable peace of mind and keep everyone focused on the same goals of providing the best care possible.

I like to consider compliance an investment in common sense.

Employees know what is expected of them at all times, and they know what type of support their employer will provide to keep their skills sharp. In turn, an EMS service gains from being in good standing with regulators and from an engaged, confident workforce.

The benefits of a strong culture of compliance are immense. An organization that lives and breathes compliance can help ensure a smooth-running operation that features top-notch communication and quality providers who offer excellent care.

Journey to Compliance

These six key ways ensure compliance will serve as a roadmap to a strong culture in your organization:

  1. Start from the top: Backing from leadership ensures a strong culture of compliance. For certification and education compliance to stick, it starts with the attitudes of upper management, such as the board of directors, chiefs, officers, and day-to-day operations staff. Leaders must actively support all compliance efforts, including regular compliance-related reports, approving policies and having a general knowledge of the rules that govern EMS providers. Without the right tone from the top, an EMS service’s compliance efforts are usually undermined and ultimately fail. This results in issues with governing bodies, payers, scheduling and staffing.
  2. Commit to resources: Having the right personnel and systems in place are both vital to creating a strong compliance culture. The organization’s compliance staff should have experience in directing compliance efforts and supporting the evaluation of compliance-related risks. When it comes to certifications and education, compliance is always black and white. Knowing how to evaluate and respond to operational issues is important to maintaining compliance and successfully operating an EMS service. Systems that provide information to assist the service in complying with its obligations are a necessity.
  3. Have the write stuff: Developing written policies and procedures for compliance programs and internal controls is essential to adequately address regulatory requirements and an EMS service’s specific risks. Having these policies and procedures in writing sets the expectation of what is required of both managers and employees. Assessing risks before drafting these programs will help identify key areas where controls are needed. A compliance program should include how a service’s policies can be implemented from an operational perspective. This will include internal controls and standard operating procedures.
  4. Provide education: Providing the training for your EMS employees gives them peace of mind that they will be in compliance and acknowledges that the service values them.
  5. Test the system: Subjecting procedures to an independent review and audit ensures the compliance system is working correctly. This review provides an evaluation of where the EMS service’s compliance efforts stand. It also offers an opportunity to correct deficiencies before an outside regulatory audit is performed.
  6. Communicate more: Communication is vital to all organizations, but it can be the most difficult piece of the puzzle to achieve. With compliance-related responsibilities, sharing information is very helpful and, in some cases, required. Communicating expectations within EMS training programs is imperative. Reporting compliance efforts and noting any deficiencies should be a part of a communication strategy, especially if your state has an active medical director and/or board of EMS.

New I-9 Form Required

New Form I9 Effective January 22, 2017

All employers are required to begin using the new Form I9 starting on January 22, 2017. The new form can be found on the US Citizenship and Immigration Services (USCIS) website. To ensure that you are utilizing the correct form, an expiration date of August 31, 2019 is in the top right hand corner of the form.

Last year we were aware of several ambulance providers who were the subject of Form I9 audits by the USCIS which resulted in technical violations for failing to complete the form correctly. The Form I9 is the document all U.S. employers are required to have completed when hiring a new employee to assure that they are legally eligible to work in the United States. While there has been a reduction in Form I9 Audits from USCIS in 2015, employers should be prepared as the five year trend is on the rise and I am aware of several ambulance providers currently dealing with audits.

The Law

The Immigration Reform and Control Act (IRCA) of 1986 requires employers to examine documentation from each newly hired employee to prove his or her identity and eligibility to work in the United States. The IRCA led to the Form I-9 Employment Eligibility Verification, which requires employees to attest to their work eligibility, and employers to certify that the individual presented documents to the employer that appeared to for the individual and genuine. The form has very specific rules regarding when the certain section of the form must be completed, which documents the employee can proffer as proof of eligibility, and how information must be present in the different sections of the Form I9.

While most employers understand that they must obtain certain information from every newly hired employee, they are often not aware of the specific dates upon which the different sections of this form must be completed. This is where the greatest number of compliance issues arise.

The Form’s Timing

Section 1 of Form I9 is the Employee Information and Attestation section and must be completed by the employee by the close of business on the employee’s first day of employment. This section consists several mandatory fields of the personal information of the new employee and two optional fields. It includes the employee’s full name, date of birth, address, and social security number, email address (optional), telephone number (optional).  In addition, the employee must attest that they are a citizen of United States, a Non-Citizen National, a Lawful Permanent Resident, or an Alien Authorized to Work in the US. The employee must provide an Alien Registration Number or USCIS Number if they check that they are a lawful permanent resident. If they are an Alien Authorized to Work, they must provide the date their authorization expires and their Alien Registration Number. The employee must sign the document and date it. If there is a translator or preparer, they must complete the certification at the end of Section 1.

Section 2 is the Employer or Authorized Representative Review and Verification section and must be completed by the close of business on the third day of employment. This section is where many make a very simple error. First, there is a place at the top of this section where the employer must list the employee’s full name. This frequently gets left blank. Next, the employer must identify the document(s) that the employee is presenting as proof of identity and employment authorization. In Column A, there is a list of acceptable documents, typically a Passport, Permanent Resident Card, or Employment Authorization Document. One or more of these documents can be sufficient. Alternatively, the employee can present one document from each List B and C. These are typically a driver’s license and a birth certificate. These documents don’t have to be copied, but if they are, they must be kept with the Form I9.

It is critical that the employer complete the Certification section of Section 2. This is another area where employers frequently make mistakes. In the Certification, there is a section to mark the date of the employee’s first day of employment. I often find this section blank or find that the employer mistakenly enters the date that they viewed the employee’s documents. The employer needs to complete the Certification section and date it, entering the employer’s business name and address. Failure to complete any of these sections can lead to a Substantive or Technical Violation and fines.

Section 3 of the Form I9 is completed by the employer when re-verifying that an employee is authorized to work or when rehiring an employee within three years of the date on the original Form I9. It is important that employer develop a mechanism for identifying and ensuring any expiring document(s) that requires re-verification. Of course, an employer can always complete a new Form I9 for a returning employee.

Penalties

Title 8 of the Code of Federal Regulations Section 27a.10 established a fine range from $110 to $1,100 per violation.  Fines can be for either a Technical violation, one where an employer fails to ensure that the employee provided all of the personal information, name, DOB, address, etc. or a Substantive violation, where the employer fails to review and verify the required documents or when someone is working without authorization.  These fines can be issued for each individual violation and can be substantial.

Other common errors that carry fines include not documenting the title of the document that the employee presented as proof (example, US Passport, State Driver’s License and Social Security Card).  Not initialing corrections made to the form when corrections are necessary.  Not re-verifying those work authorization documents that require re-verification.

Solution

All of the fines are avoidable by ensuring that you clean up the Form I9 process within your organization. First, services should ensure that only individuals trained and knowledgeable in completing the Form I9 are involved in this process. For training, the USCIS provides great Form I9 training for free on their website. In addition, USCIS has great instructions that accompany the Form I9 and provide for video instruction on their website.  Following these instructions carefully will be the best guarantee that you will complete the form correctly.

In addition, every ambulance service should conduct an audit of their Form I9 processes within their organization. I would have one individual, who is knowledgeable about the rules, conduct a review of all Form I9s for current employees and for any employees who were terminated within the last five years. Under the Regulations, employers can purge any Form I9 documents for employees who are terminated after one year from termination or three years after the date of hire, whichever date is later. However, employers should have Form I9 documents on all employees who are currently on your payroll.

For purposes of record keeping, it is best to keep all Form I9s in one location so that they can be easily provided in the event of an audit. Employers are not required to make copies of the documents an employee provides to the employer as proof of authorization. However, if the employer does copy the documents, they should be kept with the Form I9. I recommend employers make copies of those documents, store them with the Form I9, and be kept in a secure location. If those documents are stored electronically, it is critical that there are sufficient systems in place to ensure the integrity and security of the documents including an electronic audit trail.

Many employers utilize e-Verify, the online system hosted by the USCIS in partnership with Social Security Administration (SSA) that allows employers to search the linked federal databases to ensure that employees are eligible to work in the US and verifies the employee’s Social Security Number. e-Verify is free to employers and is voluntary throughout the country. However, you should check you state law as many states have passed legislation requiring the use of e-Verify. It is easy to enroll and is a necessary part of any I9 compliance plan.

I can tell you that all of the providers that I have questioned about this issue assured me that they have adequate processes in place to ensure compliance. However, after we discussed the timing and information required for the different sections of the Form I9 that were identified in many of the audits I am aware of, it quickly became apparent that most did not really have safeguards in place.

Have an HR Question?  Ask Scott!

Update on Section 1557 of ACA

This past June the AAA notified our members of the new Non-Discrimination Rules under Section 1557 of the ACA. Under the new rules, covered entities are required to provide auxiliary aides and services for individuals with Limited English Proficiency (LEP) and communications related disabilities. For a full description of all of the Section 1557 requirements, see the AAA Member Advisories.

While there is usually a period of time before enforcement actions occur with new Regulations, the Office of Civil Rights published a press release announcing a Voluntary Resolution Agreement between the OCR, the U.S. Attorney’s Office of the District of Connecticut (DOJ), and a healthcare system who is subject to the Section 1557 Rules. The Agreement, which resolved a complaint and subsequent investigation involving a hearing impaired patient who requested auxiliary aides due to a hearing impairment upon arriving at the hospital for care. The patient never received any communication aides during the course of the stay. This should serve as a notice to all ambulance providers that they must comply with all of the requirements of the Section 1557 Rules. For assistance or guidance on the requirements of Section 1557 and how ambulance services can be comply, be sure to read the AAA Member Advisories or seek assistance through the members area or by calling the AAA.

Have an HR Question?  Ask Scott!

Video: Managing Former Peers—Tips for New Supervisors

A must-watch for your new managers and supervisors!

One of the trickiest transitions in am emergency medical services career is moving from peer to supervisor. The American Ambulance Association’s HR & Operations Consultant, Scott Moore, Esq. shares some tips on redefining relationships with the EMTs and Paramedics you now supervise.

Have a question for Scott? AAA members, submit your requests today via our HR & Operations Consultation form!