AAA Members on Capitol Hill

This week, AAA members were once again on Capitol Hill meeting with members of Congress. AAA Government Affairs Committee Chair, Jamie Pafford-Gresham of Pafford EMS, met with entire Congressional Arkansas delegation. While on the Hill, Jamie also met with members from Oklahoma and Mississippi. AAA Board Member, Kim Godden (Superior Air-Ground Ambulance), Payment Reform Committee Chair, Asbel Montes (Acadian Ambulance Service), and AMR VP Federal Reimbursement & Regulatory Affairs, Deb Gault were also on the Hill for meetings this week. Collectively the group met with over twenty Congressional offices this week. Thank you to all of our members for their hard work fighting for permanent Medicare relief. We appreciate you taking the time to visit Washington and meet with your representatives.

Pafford EMS CEO, Jamie Pafford-Gresham, and Sen. John Boozman of Arkansas

Pafford EMS CEO, Jamie Pafford-Gresham, and Sen. Tom Cotton of Arkansas

Have you met recently with a Member of Congress? Are you interested in getting involved with the AAA’s advocacy efforts? If so, email Aidan Camas at!

Fighting for the Future of Ambulance Organizations

AAA Executive Vice President, Maria Bianchi, recently penned an Op-Ed for JEMS entitled: Join AAA in Fighting for the Future of Ambulance Organizations. Learn about the AAA’s work towards Payment Reform and join us in our fight for our future. Help ambulance organizations be identified as healthcare providers by those who have influence on our regulations and reimbursement rates.

Learn more about 2017 AAA Member Benefits!

New Rural Provider Task Force

AAA President Mark Postma created the Rural Providers Task Force which is being chaired by Jim Finger of Regional Ambulance Service in Rutland, Vermont. The Task Force will bring the perspective of small providers to the AAA Payment Reform Committee as it develops recommendations on how best to reform Medicare reimbursement policies. We are specifically targeting as Task Force volunteers those AAA members who operate 10 or fewer ambulances and serve rural communities.

The Task Force will initially focus on three key policy areas which are:
1) Ensuring that a cost data collection system is not overly burdensome on rural providers;
2) Understanding the impact of changing from ambulance service suppliers to providers will have on rural operations; and,
3) Looking at potential different options for defining rural areas within large urban counties under the Goldsmith Modification.

Our industry is predominately small operations with rural areas often relying on ambulance services as the only form of emergency medical care. Approximately 73% of ambulance service providers bill less than 1,000 transports to Medicare each year. President Postma has adopted the tag line for the AAA of “Representing EMS in America” and it is important that rural providers are representing within the reform efforts.

If your organization is rural and operates 10 or fewer ambulances and you would like to provide input on how potential reimbursement policy changes could affect organizations such as yours, please consider volunteering for the Task Force. The Rural Providers Task Force will have a limited number of participants comprised of individuals representing a cross-section of provider types and geographical areas. If you are interested in being considered for a spot on the Task Force, please click on this INTEREST FORM and complete and submit it.

If you have any questions about the Task Force, please do not hesitate to contact Jim Finger at or Tristan North at

Join the Task Force!

Happy Holidays!

Happy holidays to you and your family from the American Ambulance Association. We so deeply appreciate your selfless service to your communities.

AAA will reopen to serve you at 9:00 a.m. ET on Tuesday, January 3.


In Memory of Joe Paolella, Sr

The American Ambulance Association was deeply saddened to learn of the recent passing of Joseph “Joe” Paolella, Sr.

Joe, along with his brother Phil Paolella, was the co-owner of New Haven Ambulance Service, one of the four companies that founded American Medical Response (AMR).

Joe was an innovator and pioneer in the field of pre-hospital care, and he will be deeply missed by the American Ambulance Association and it’s members throughout the United States. Joe devoted much of his career to advocating for legislation and regulations that paved the way in ensuring that the highest levels of patient care are delivered by ambulance providers in Connecticut and across our nation. Joe also selflessly mentored many ambulance leaders throughout their careers, giving many hours of his time to developing the talents of others.

Joe’s wife, Lorraine Paolella, and their entire family are in our thoughts.

Visiting Hours

Wednesday, December 21, 2016
4:00 PM – 7:00 PM
Iovanne Funeral Home, Inc.
11 Wooster Place
New Haven, CT US 06511


A Mass of Christian Burial will be celebrated Thursday morning at 11:30 in St. George Church, Guilford. Please go directly to Church Thursday morning. Burial will follow in All Saints Cemetery, North Haven.

St. George Church
33 Whitfield Street
Guilford, CT 06437

Donations in Lieu of Flowers

In lieu of flowers contributions in Joe’s memory may be made to The MSA Coalition 9935-D Rea Road, #212 Charlotte, NC 28277 or Masonicare Home Health & Hospice 22 Masonic Ave. Wallingford, CT 06492.

Obituary & Additional Details

Read Joe’s obituary at the Iovanne Funeral Home website►

AAA Releases 2017 Medicare Rate Calculator

AAA 2017 Medicare Rate Calculator Now Available!

The American Ambulance Association is pleased to announce the release of its 2017 Medicare Rate Calculator tool. The AAA believes this is a valuable tool that can assist members in budgeting for the coming year. This calculator has been updated to account for recent changes in Medicare policies, including the 2017 Ambulance Inflation Factor (0.7%) and continuation of the current temporary add-ons.

To access the Rate Calculator, please CLICK HERE.

To access the Fee Schedule, please CLICK HERE.

CMS has not yet published the Public Use File for 2017.  Once the file is released, the AAA will verify that the rates are correct and notify you of any discrepancies.

Download the 2017 Rate Calculator

2017 Fee Schedule

Rep. Tom Price Selected as HHS Secretary, Verma for CMS Admin

Rep. Tom Price, M.D., Named HHS Secretary


President-Elect Trump has nominated Dr. Tom Price for the position of Secretary of the Department of Health and Human Services. Rep. Tom Price has served as the Congressman for the Sixth District of Georgia since 2005. He is currently the Chairman of the House Budget Committee.

Chairman Price received his B.A. and M.D. from the University of Michigan. He was first elected to Congress in 2004 and has served as on the Ways & Means committee and as Budget Committee chairman. Chairman Price opposes expanding the Affordable Care Act, voted for MACRA, supports expanded use of Health Savings Accounts, and providing age-adjusted tax credits.

Akin Gump has put together a detailed summary of legislation introduced by Rep. Price’s to repeal and replace the Affordable Care Act (H.R. 2300, the Empowering Patients First Act).

5 Things To Know About Rep. Tom Price’s Health Care Ideas

Seema Verma, Named CMS Administrator


The President-Elect has also nominated Seema Verma for the position of CMS Administrator. Currently, she is the founder and CEO of a health policy consulting firm in Indiana. She is a close advisor to Vice President-Elect Pence and worked as a policy advisor for Governor Pence, focusing on Medicaid and public health.

Prior to consulting, Ms. Verma served as Vice President of Planning for the Health & Hospital Corporation of Marion County and as a Director with the Association of State and Territorial Health Officials (ASTHO) in Washington D.C. She received her Master’s degree in Public Health with concentration in health policy and management from Johns Hopkins University and her Bachelor’s degree in Life Sciences from the University of Maryland.

Trump Picks Seema Verma To Run Medicare And Medicaid

The AAA will keep you posted as we learn more about the plans and potential policies of Chairman Price and Ms. Verma.

2016 AMBY Innovation in EMS: Tri-State Ambulance, Patient Transport Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Tri-State Ambulance Awarded a 2016 AMBY for Innovation in EMS

amby-congrats-tri-state-ambulanceAmbulance services which provide 911 coverage frequently have patients who request service but ultimately fail to accept transportation to a hospital for further care. Depending on the service area, non-transports can be 30% or more of all requests for service. These ambulance responses can range from falls or diabetic issues, to motor vehicle crashes and anything in between. It is known that transporting a patient to an emergency department is not always the most appropriate choice for their medical care. Often, a visit or a conversation with their primary care or specialty provider may be a better option.

Due to HIPAA regulations and continuity of care rules, the patient response information, when they are not transported, does not proceed further than a typical quality assurance or billing department review. This ultimately leaves the patient’s primary care provider or other specialty care provider completely unaware that their patient was cared for by another medical professional in an urgent setting. Upon investigation we found that the general public was unaware that their information from the contact with an ambulance service was not being sent to their current providers. In an electronic world, the general assumption by most patients was that all medical situations would be collected in one comprehensive medical record and not separated by service providers. This situation was noticed by a new billing manager who was often the last person to look at a patient’s medical record. It was quickly realized that other health care professionals should be aware of patients who are cared for by an ambulance crew and not transported.

Although there have been tremendous strides made in the Community Paramedic (CP) or Mobile Integrated Health (MIH) programs, the industry is still far from global reimbursement and universal standards. The hope for this project was to establish essential communication that was missing between a patient’s medical provider and the documented ambulance visit. Through this communication, providers may proactively set an appointment with the patient which could help prevent an emergency room visit or ultimate admission and therefore reduce the potential patients that would be subject to a CP or MIH program. As with most aspects of healthcare, it is proven that early intervention has the best long term results and often at a significant cost savings to the system and patient. The best systems would utilize a multifaceted approach that uses early intervention and post care follow up.

The goal of the project was to make available the patient care report from an encounter with an ambulance crew, when not transported, to their permanent medical record of their primary and/or specialty care provider. Secondly, it was intended for a provider to deliver proper follow up care and ultimately improve patient outcomes or experiences. It was thought that patients who receive the proper follow up care are less likely to call for an ambulance again for the same issue, thus reducing repetitive patients. It was also considered that improved follow-up would reduce the potential for the patient to develop more serious medical situations in the future.

<h5>Planning and Implementation</h5>

  • All stakeholders were identified and made aware of the current plight
  • Legal and compliance departments were consulted on all legalities with release of a patient medical records to a third party
  • Analyzed current electronic patient care reporting (ePCR) system for viability
  • Ensured process required minimal resources and would be cost effective
  • Created electronic release of information to third party form that met all legal requirements
  • Educated and trained employees on proper utilization of form • Built paperless IT structure to support secure sharing of information
  • Created procedure for hospital follow-up of patients • Monitored and adjusted processes to ensure goals were being met

The project was first implemented in Q4 of 2013 with some major changes since inception. The basic practice of sending patient medical records to the medical provider of the patient’s choice was implemented and worked smoothly from the start. The process involves an ambulance crew obtaining two signatures from a patient when transport was refused. The first signature is the acknowledgement of the refusal of transport and the second is the voluntary request to disclose their medical record to the provider of their choice. The release of information disclosure is strictly voluntary and complies with HIPAA regulations. After implementation, it was noticed that the process didn’t seem to have a quantifiable way to track improvement in patient results or outcomes. On January 1st of 2015, the new process was executed with two local health systems that routes the patient record directly to a quality assurance nurse for review. Both of these local health systems incorporate large medical clinics which provide medical services to the vast majority of the local population. The nurse would then contact the patient to see how they are doing since the encounter with the ambulance crew and to schedule appointments with their providers if needed. The nurse was also able to see if the patient had come in to urgent care or the emergency department after they refused transport or to see if they have any pending appointments. Dependent on the nurse findings from the telephone call, they had the ability to contact a patient to change an appointment to an earlier date or to see if there are any other services that they can refer to the patient.

The initial impact has proven to be very successful. The first positive impact was with our paramedics and EMTs and their response to the new process. Sending the ePCR to the patient’s medical provider allowed the employees to know that the patient was going to get further care or follow up that they needed. This has enabled the field EMS provider to still feel a sense of completion and satisfaction because they are providing the catalyst for further care. Also, when these patients receive a follow up call or physician visit they are less likely to become a high utilizer, as shown by preliminary data. Reducing unnecessary calls for repetitive patients has also improved employee morale. Further research is being conducted to evaluate the percentage of improvement from the reduction of repetitive patients.

Another positive impact was discovered when patients would ultimately go by other means to an urgent care or emergency department and in turn notify the emergency provider that they were evaluated by EMS. At the request of the emergency department provider, we are then able to send them the patient response information from our interaction. This information provides assessments and other key factors that the attending provider may need to offer effective care. This can all happen in real time because the patient has already provided written authorization for the release of their medical record to the provider.

An unexpected result that has also created a positive impact is the utilization of the hospital’s immense resources. When a patient has authorized us to send their medical records to their healthcare provider it creates a bond that allows us to share information for the benefit of the patient. This makes it possible for us to reach out to social workers or other healthcare resources such as patient advocates to help patients with things that we are not equipped or staffed to handle. A person will utilize the 911 system for an unmet need, even if not medical in nature. We now have an expanded use of resources to meet the needs of patients in our community.

Improvements have been made to our quality assurance program for patients who requested service but refused transportation. With the addition of the follow-up calls by nurses, we were able to track and review patient outcomes when they refused transportation. Being able to ascertain a patient’s final diagnosis by another medical professional versus what was determined in the field has given us valuable information to use for training and education. Before the use of this new method the quality assurance process could only make a determination based on the narrative written by the crew. Now, we are able to have a full circle review of the care and outcome of the patient. As health care continues to evolve with trends towards CP and MIH and possible changes to Medicare reimbursement, reviews like this are becoming ever more important. Additional research is being proposed by a local hospital to do a retrospective analysis to determine the impact of the process on patient outcomes. The study is focused on patients who called 911 related to a fall and are over the age of 55. The purpose of the study is to determine if interventions performed by their provider reduced the likelihood of future falls or injuries related to falls. This is being done in conjunction with data from the hospital and any interactions a patient has had with the ambulance service.

Congratulations to Tri-State Ambulance for their selection as a 2016 AMBY Winner.


2016 AMBY Best Use of Technology: Trinity EMS & Firstwatch, Opioid Epidemic Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Trinity EMS & FirstWatch Opioid Epidemic Project Awarded a 2016 AMBY for Best Use of Technology

Trinity EMS & FirstWatch | Massachusetts

amby-congrats-trinity-ems-with-firstwatchMassachusetts has seen a massive increase in opiate overdoses and deaths. In 2013 there were 918 opiate related deaths in Massachusetts. Massachusetts had 1531 deaths in the first six months of 2016. Many of the communities Trinity EMS serves are on the front lines of this issue. Their EMT’s and paramedics are helping to revive patients every day from an opiate overdose. Understanding the scope of an issue is a critical first step to solving an issue. They started using their PCR data to help frame the issue for their communities. They began tracking the demographics such as age and gender of the patients, time of day and day of the week, and location within the communities. They also monitor the volume to identify spikes in volume in individual communities and system wide. Trinity reported data monthly, one month behind to the health department, public safety partners, methadone clinics, hospitals and city governments. This data was well received. Other services contacted them for help in developing their tracking and reporting. They added FirstWatch to their program to speed up the notifications. Monthly reporting is still valuable. Instant reporting is even better. FirstWatch allows their communities to be notified within an hour of an opiate overdose. Public health and public safety now have this intelligence right away.

The goal was to gather and present data in a cross discipline format for aid with better understanding on the situation. First responders, law enforcement, public health, EMS, and district attorneys, and the press have received and used their data. Trinity wanted to show:

  • The profile of the patients we are seeing
  • The frequency of the patients
  • The location and time of the overdoses
  • The severity of the patients. (Our volume of overdoses have leveled off, the acuity of the patents is still increasing)
  • Our monthly report is a key performance indicator as to the opiate issue at the street level in our communities
  • Our needle pick up data indicated where outdoor intravenous drug use is happening
  • Many of the overdose calls to the 911 centers are not communicated as being overdoses; “fall”, “respiratory”, “unconscious” are common chief complaints at dispatch. This data would not have been collected and reported using chief complaint as a filter

When it became clear the opiate issue was becoming a wide spread crisis Trinity started working the issue. They knew their best area to provide data from was PCRs. They came up with a set of data points they thought would help. They attended many meetings and public events. During those forums dozens of additional questions and theories came forward. Trinity took and implemented all that they had data for. (Example. There was question about social benefits and opiate use. They are able to show on an ongoing basis that there is no correlation between opiate overdoses and the 1st and 15th of the month.)

Before 2015, Trinity reported opiate overdoses usually annually only when requested. Starting in 2015 they reported monthly. They wanted to provide data even quicker. Trinity had seen FirstWatch a few years before. They felt the speed and automation FirstWatch could provide was a critical improvement. The intelligence gathered with knowing in live time of opiate overdoses can’t be overstated. The automation allows that intelligence to be gathered no matter the day or time.

Trinity started working with FirstWatch in December 2015. In May 2016, Trinity put FirstWatch directly into the hands of public health, public safety and public schools. Each discipline has a HIPAA compliant login with access to data specific to their mission. They worked very closely with FirstWatch so they could understand the capabilities within the system. They brought the idea and FirstWatch brought the execution and focus. The FirstWatch platform is amazingly powerful for Trinity, to provide live access is amazing. In June 2016, Trinity participated in a Middlesex County District Attorney opiate task force meeting. Trinity had earlier in the meeting done a 20 minute presentation on the opiate crisis in our city. This provided the 70 people in attendance a fresh look at the data. Towards the end of the meeting conference to alert families and friends of addicts to watch their loved ones, and scheduled “emergency” Narcan administration training for the community. During DA Ryan’s presentation, Trinity received a FirstWatch alert for a 39 year old female opiate overdose from 30 minutes before. Three minutes later they received another alert for a 41 year old female that suffered a fatal opiate overdose. They were able to share that with the group and drive home the DA’s message.

The City Governments, Public Health, Police and Fire Departments in Trinity’s communities were eager to learn about the data they were able to collect, and their data began to become focal points at press conferences and city council meetings. News agencies began contacting Trinity to help paint the picture of the epidemic in feature stories. In sharing the mapping aspect of Firstwatch they hope that these agencies can further understand the epidemic and develop plans to combat it. Trinity has become the de facto subject matter experts of the opiate crisis.

Congratulations to Trinity EMS and FirstWatch for their selection as 2016 AMBY Winners.


2016 AMBY Best Quality Improvement Program: Gold Cross Ambulance, Documentation Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Gold Cross Ambulance’s Documentation Project Project Awarded a 2016 AMBY for Best Quality Improvement Program

Gold Cross Ambulance | Utah

amby-congrats-gold-crossThe documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:

  1. Create a way to measure overall documentation quality.
  2. Establish a formal standard for documentation and educate crews about the documentation expectations.
  3. Improve the overall documentation of the ePCR.
  4. Improve the number of patients with properly collected and documented vital signs.
  5. Improve amount of reimbursement and decrease collection cycle time.

Gold Cross formed a work group to tackle these issues, which consisted of members of the Quality Department, Training Department, Billing Department, and Operations Department. The group meets every other week to evaluate progress and assess the need for adjustments to the system. Mid-year of 2014, the group worked to revise the program for documentation evaluation. A new standard was created based on the ePCR fields. A point system was established for documentation which gave each ePCR field a weighted number of points, equaling 100%. Incomplete or missing fields result in a loss of points for that field, which provided a way to measure documentation performance. The scoring data is tracked in our ePCR quality module, allowing us to analyze and report on the data easily. The feedback on any areas of missed points is sent to the crew via the ePCR messaging system, so it is easily accessible to the crews during regular daily tasks. Feedback is focused on improvement comments instead of punitive comments. Positive feedback is included in each evaluation. The group released an initial version of the General Instructions for the ePCR, which was an internal manual detailing expectations for every field in our ePCR. The focus was to provide clear expectations to all field crews regarding how to properly fill out the ePCR and what content should be included. The training department created an educational program on the online educational software program, detailing the documentation guidelines and testing the crews on the material. The General Instructions for the ePCR were also posted on the company training site, so crews would have easy access at any time. The Quality Department developed a class for the newly hired providers. The class emphasizes the need for quality documentation, outlines the program, and includes actual documentation examples for evaluation and discussion. Patient advocacy through documentation is instilled in the participants of this class. The Billing Department developed a class which is taught at six months after hire. In the class, documentation is reviewed from class participants. The billing department shows how the bill is processed from the documentation, and they discuss common challenges to the billing process. The program has been monitored with continuous PDSA cycles and has been adjusted as needed for continued improvement.

An initial company goal for documentation was set at 90%. From project start to current date, the company-wide documentation averages have increase from 74% at the beginning of the project to 96% currently. Field crews have expressed greater clarity in the company expectations for documentation. The overall average documentation scores by division are posted regularly for the company to view, and this has had the additional benefit of sparking a competitive streak between some of our divisions, further improving the scores. The improvement in collection of vital signs not only improved overall patient care, but resulted in a Performance Improvement Award from the Utah State Bureau of EMS in 2016. The bureau looked at pediatric vital signs and recognized two rural and two urban EMS agencies in the state for their improvements. Gold Cross Eastern Division won the award for a rural agency, and Gold Cross Salt Lake Division won for the urban agency. Their study found our agency improved the collection of pediatric vital signs by 53% in our urban area and 66% in our rural area.

The most important impact of this project is improvement in patient care, which is our primary mission. The goals for complete documentation have encouraged field crews to make sure they complete proper assessments, since they know those areas of the ePCR are evaluated and must be complete. Improvements in assessment result in better differential diagnoses and improved treatment plans and outcomes. The documentation project has positively impacted Gold Cross financially as expected. Reimbursement rates have increased and the time to complete the collection cycle has improved. Due to the documentation improvements, the billing staff spends less time researching information, following up on incomplete documentation, and fighting in appeals.

Congratulations to Gold Cross Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.


2016 AMBY Best Community Impact Program: Medic Ambulance, Reduced Readmissions Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Medic Ambulance Reduced Readmissions Project Awarded a 2016 AMBY for Best Community Impact Program

Medic Ambulance | California

amby-congrats-medic-ambulanceMedic Ambulance Service is the exclusive ALS service provider in Solano County, a HRSA-designated medically underserved area with a physician-provider to population ratio of 81.1 per 100,000. In 2014 Medic Ambulance became aware of an opportunity to participate in a Community Paramedicine Pilot initiated through California Ste EMSA. After collaborating with LEMSA and the community hospitals, Medic Ambulance unanimously concluded that the 23% average readmission rates for each CHF and COPD patients was taking a crippling toll on the hospitals’ reimbursement and increasing Emergency Department wait times. Starting in January of 2015, Medic Ambulance Service enrolled six paramedics into approximately 300 hours of additional training focused on the biopsychosocial needs of patients with CHF or COPD. The education has continued through monthly case reviews and peer-to-peer lessons-learned where the entire team brainstorms innovative solutions to the patients’ challenges. From the beginning, Medic Ambulance Service was poised on creating a sustainable model that would persevere past the period of being a pilot or grant funding. They made this goal of preservation well-known to all stakeholders, and after quickly proving the value through low readmission rates they had established a sustainable funding source, happy to pay for Community Paramedicine Services.

Project Goals

  1. Reduce the readmission rates of patients with CHF or COPD.
  2. To create a sustainably funded model to ensure the project remains available to our community and is replicable in other areas.
  3. Provide superior customer service.
  4. Teach patients how to improve their health by appealing to the patient’s values.
  5. To provide these services at a lower cost than was otherwise available.

Project Phases

  • Planning Phase: The project was planned based upon the results of the community needs assessment. The findings indicated that there is a substantial difficulty within the community to access restorative medical aid. Each Community Paramedic underwent over 300 hours of focused training on the management of CHF and COPD, cultural sensitivity, and rehabilitative services.
  • Implementation Phase: To ensure compliance with the strictest regard for patient outcomes and program oversight Medic’s Community Paramedicine Program is IRB approved, reports at least monthly to a Steering Committee with diverse medical and nonmedical expertise, 100% charting review by a Registered Nurse, and utilization of, EMS Survey Team, a third-party patient surveyor. These highly trained Community Paramedics began seeing patients in September of 2015 and the most common question we are asked by the local hospitals is when can we help them lower their readmission rates for patients that don’t have CHF or COPD. With a sustainable and reproducible model we intend to keep filling healthcare gaps and mold healthcare delivery to suit the needs of every community we serve!

Our goals with this project are built upon the IHI Triple AIM to improve the patient experience of care, improve the health of populations, and reduce the per capita cost of health care. We are absolutely meeting these foundational goals!

  • 85 patients have been referred to the program (59 enrolled)
  • 118 visits have been completed

Medic Ambulance measures and objectives reveal that the enrolled population has only a 8.5% unplanned readmission rate; as opposed to a 23% rate of those not enrolled. During home visits it was discovered that:

  • 50.8% of patients had medication errors
  • 48.7% of the patients that thought they were taking all their medications correctly weren’t
  • 72.9% of patients needed help understanding their discharge instructions.

These enrolled patients also self identify an average overall health rating improvement of 22.8% between their pre-enrollment and post -enrollment health. During this same interval the patients’ understanding of their hospital discharge instructions has risen by 16.8%, understanding of when to take medications improved 8.3%, and understanding of their medication side effects improved by 14.1%.

EMS Survey Team, a third party patient surveyor, attempts phone contact with all enrolled patients. These scores are recorded and measured against the 128 different EMS services they contract with. This program is the #1 rated provider with a total score of 96.48/100 and 100% of all responses have been positive.

Patient Feedback

“It’s been a very good experience. She (the Community Paramedic) explained everything so I could understand.” – Patient

“There’s a lot of people out there who need this, especially those without insurance.” – Patient

“My blood pressure started going up and it wouldn’t come down. I had medication but it wasn’t helping.” – Patient who was not taking her medication at the correct frequency.

“She (a patient) feels more comfortable.” – Patient’s daughter “This is a pilot program but everyone so far is very pleased with how it is working.” – Director of case management at a referring hospital. “If I get sick I know they’re gonna be there for me and that I’m not alone.” – Patient

As a third generational, family-owned EMS provider, nothing is more important to us than the community we serve as the exclusive ALS provider. The creation of this program wasn’t created as merely a proof of concept, we continue to grow and adapt this program to meet the needs of the populations through changing the landscape of health care. The impact of this program’s success has been marked with already saving the health care system $137,000 with a projected savings of $685,000 by the end of 2017, improved health literacy in vulnerable populations, reducing overuse on the 9-1-1 and Emergency Department systems, and catalyzing positive health changes through empowerment. It is projected that over 25% of the patients enrolled into this program have a functional health literacy defined as “below basic”, the lowest possible category per the National Assessment of Adult Literacy, compared to 14% of American adults that fall into this category. At this level of health literacy the dates of appointments and clearly defined times to take medications are often understood, but the understanding of how negative lifestyle choices, such as smoking, poor diet, and recreational drug use affect their management of diseases is not universally comprehended.

Congratulations to Medic Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.


2016 AMBY Best Community Impact Program: AMR, River Rescue Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

American Medical Response River Rescue Program Awarded a 2016 AMBY for Best Community Impact Program

amby-2016-congrats-amrAMR | Oregon

The Oregon River Safety Program (aka AMR River Rescue Program) is provided by American Medical Response (AMR) as a community service for two communities it serves in Oregon. The program is the only one of its kind exclusively operated by a private EMS provider, supported by strong community partnerships, and was developed after a series of thirteen drowning deaths over five years in the 1990s at two popular river parks. Ten years earlier, AMR developed its Reach and Treat (RAT) Wilderness Medicine Program to provide medical care for people ill or injured on Mount Hood and the surrounding national forest. Since Swift Water Rescue was part of the existing Reach and Treat Teams training and competency, AMR worked with the Troutdale City Council and a group of dedicated civic leaders to launch the River Rescue Program in July, 1999. For the remainder of the summer, AMR used its RAT Team members as Swift Water Rescue Specialists to staff the new River Rescue program.

The program was developed to meet the certification standards of the United States Lifesaving Association (USLA) for open water lifeguarding, and is staffed by Oregon licensed Emergency Medical Technicians and Paramedics. To meet USLA requirements, AMR developed an 80-hour training program with core USLA curriculum as well as additional site-specific training. River Rescue Technicians are not the same as pool lifeguards, but instead are highly trained and certified professionals with expertise in lifeguarding, swift water rescue, and medical care. The AMR River Rescue program received USLA Advanced Lifeguard Agency Certification in April 2012. The United States Lifesaving Association is America’s nonprofit professional association of lifeguards and open water rescuers. The USLA works to reduce the incidence of death and injury in the aquatic environment through public education, national lifeguard standards, training programs, promotion of high levels of lifeguard readiness, and other means.

This year marked the 18th season for the program. From 1999 through 2016, the AMR team performed 97 rescues, more than 1,400 assists of people in distress, and dedicated thousands of hours to prevention activity. Based on pre-program statistics, 66 drownings would have occurred over those years without the program. Each year, the team consists of approximately 20 River Rescue Technicians trained in Swift Water Rescue who provide life guard services seven days a week, ten hours a day at Glenn Otto Park in Troutdale, and at High Rocks Park in Gladstone, Oregon from Memorial Day weekend through Labor Day.

AMR’s Oregon River Safety Program has been highly successful in relegating some of the State’s highest drowning sites for recreational waterways to a footnote in history. The Program has increased swimmer safety through public awareness campaigns; prevention interventions, such as life jacket loaner programs; and community and media partnerships. It has also amassed a wealth of data to guide program enhancement which has documented a significant increase in the use of life jackets for all age groups. Lastly, the Program has prevented drowning through direct and often dramatic rescue interventions by AMR technicians.

From its inception, the goal of AMR’s River Rescue Program has been to prevent loss of life due to drowning and to make the locations AMR guards safer. Primary responsibilities of River Rescue Technicians are to provide public education on water safety, raise awareness of the potential hazards of rivers and open bodies of water, promote life jacket use, deter risky behaviors (such as drug/alcohol use and unsafe ways of floating downriver on makeshift “rafts”), and rapidly respond to swimmers in distress. AMR River Rescue has released a new mission statement for 2016: Drowning prevention through education, vigilance and rescue.

AMR River Rescue utilizes a public health model “Spectrum of Prevention” approach to support the goal of drowning prevention by focusing efforts on: individuals, groups, providers, networks, organizations, and public policy makers. Injury prevention efforts are targeted by utilizing the significant amount of data captured by the program each year to help identify trends. AMR River Rescue has also developed strong partnerships with traditional media to further educational goals, allowing them to reach large television/radio audiences with important water safety messages for visitors to Oregon’s rivers, as well as tips and advice to prevent drowning elsewhere, such as in pools and spas, and in and around the home. In addition to onsite, rivers-edge, education and prevention, River Rescue Team members participate in social media and community events to share information on water and pool safety for children and parents.

Planning and implementation of the program has developed over the course of the last eighteen years. In 1999, after 13 people drowned over a five-year period at Glenn Otto Park on the Sandy River in Troutdale, Oregon, AMR worked with local officials and civic leaders to pioneer an on-site river rescue program using EMS personnel trained as lifeguards specializing in swift water rescue. The program was modeled after ten years of success with the Reach and Treat Team developed by AMR in the late 1980s. AMR’s River Rescue program is distinctly different than the Sheriff’s office and fire departments’ water rescue programs. While they cover long stretches of waterways and can only respond after an incident is reported, AMR’s program focuses on the most dangerous river sections that have the highest drowning mortality sites. To protect these areas, public education and risk mitigation were made priorities and coupled with the River Rescue Technicians’ training in Swift Water Rescue to spot trouble and act immediately.

The window to intervene in a developing drowning and save a life is often less than 30 seconds. After several years of program development, the River Rescue Program received certification from the United States Lifesaving Association (USLA), which is recognized internationally as the “gold standard” for accreditation.* To meet USLA standards, AMR developed a unique 80 hour training program with a core USLA curriculum with additional swift water and medical training. The program is unique in the U.S. and is the only certified agency that provides lifeguards solely in a swift water environment (versus beaches or lakes).

Because prevention is an important component of the program, a life jacket loaner program was developed, offering free daily use of hundreds of personal flotation devices (sizes from infant to adult) to visitors of the parks. In the summer of 2002, after three people drowned in less than a month at High Rocks Park along the Clackamas River, AMR expanded the program to cover the popular river site. Responsibility for the Clackamas River is vested with the Clackamas County Sheriff’s Office, but the shore is governed by two cities, one on each side of the river. The lack of clear jurisdictional responsibility had caused a stalemate over how to improve safety at High Rocks Park for many years until AMR proposed expanding its River Rescue Program to that site and agreed to accept responsibility. (AMR knows the county well – as they have been the 9-1-1 ambulance provider in Clackamas County for decades). High Rocks Park presents much different challenges than Glenn Otto, with 20-25 foot rock cliffs and formations from which adventurers jump into the cold, fast moving water. Both the Sandy and Clackamas River share origin from Mount Hood glaciers and have swift current, cold water and underwater hazards.

The program also serves as a regional resource for water safety public education, water hazard mitigation, deployable rescue swimmers, as an in-water search resource for recovery of drowning fatalities in other areas of local rivers (upon request from law enforcement) and provide services and support to the Regional Clackamas County Water Safety Consortium.

Clackamas County Water Rescue Consortium members include:

  • AMR River Rescue Program
  • Canby Fire District
  • Clackamas County Sheriff’s Office Marine Patrol
  • Clackamas County Fire District 1
  • Estacada Fire District
  • Gladstone Fire Department
  • Lake Oswego Fire Department
  • Tualatin Valley Fire & Rescue
  • Sandy Fire District Recruitment and Training

To prepare for staffing the river parks by Memorial Day weekend, AMR begins each season by recruiting candidates in February. They must pass a rigorous swim test (covering 500 meters in less than 10 minutes without the assistance of any propulsion devices) in order to continue through the selection and training process. New candidates join returning members in a challenging, eighty-hour course led by veteran River Rescue Technicians and other experts. Training topics include:

  • Swift water Hydrology and Hazards
  • Swift water Rescue Tactics
  • Lifeguarding Tactics
  • Observation and scanning
  • Rescue Scene Management
  • Community Education
  • Rescue kayaks
  • Rescue paddleboards
  • Media Relations
  • Staffing River Parks

Teams of 2-3 River Rescue Technicians are on duty at each site, and are in constant radio communications with each other, AMR’s Communications Center, the 9-1-1 Center and local law enforcement officers. An alert is transmitted any time a River Rescue Specialist enters the water to conduct an assist or rescue, and if not canceled within five minutes, a full EMS response is dispatched. According to the USLA, the most challenging assignment for a lifeguard is safeguarding natural bodies of water, referred to as open water. Unlike pools and waterparks, crowd conditions, swift currents, cold water, underwater hazards, weather, and related conditions of open water can change quickly and pose unique obstacles to maintaining water safety. A primary responsibility is to provide constant outreach to warn visitors of the hazards, both new inherent, at each site. AMR technicians monitor water temperature, current speed, underwater hazards and public census at regular intervals every day, including in-water assessments. Even the most seasoned swimmer can be taken by surprise in swift moving water, but are generally less inclined to exercise risky behavior after an on-site expert has informed them of the hazards and possible consequences. Over the years, AMR’s River Rescue Team has become the region’s water safety subject-matter experts whom media outlets and others frequently turn to for water safety messages. Due to the focus on prevention and media interactions, the River Rescue Team receives annual training in prevention messaging and media interaction, including mock on-camera interviews and speaking points which undergo annual revisions based on previous years data.

Over the last 18 years the program has successfully reduced the drowning rate at Glenn Otto and High Rocks parks from approximately 1 in 15,000 to 1 in 256,500. The very first achievement however, was relieving community tension. At the first City Council meeting after the program began, then Councilor and now Mayor Doug Daoust, asked AMR leaders “how it feels to deliver a miracle?” Having received one of the highest compliments it could imagine, and with intense media attention, AMR set about re-instilling the philosophy of extensive selection and training, hypervigilance, and a primary focus on prevention. The official title, Oregon River Safety Program, was so named because water safety and prevention is the core focus of the program. Not only has community awareness and use of lifejackets increased, but families frequently state that they come to one of the parks for the add safety of lifeguards. The drowning rate at Glenn Otto and High Rocks parks has been reduced from approximately 1 in 15,000 to 1 in 256,500, and AMR hopes to continue to improve every year. In 2016 alone two people (a sixteen year old and a six year old) were pulled up from underwater, and an additional 147 adults and children were assisted before submerging. Over 18 years the program has directly intervened in 1,650 lives who were either beginning to or actively drowning, and have made direct prevention contacts to 23,330 people and families. The program:

  • Has saved lives, which has in return, propelled the continuance of the program.
  • Stopped the long history of fatal drownings in young people at the two parks.
  • Success created relief among the communities and community good will towards AMR’s River Rescue Team.
  • Has enhanced strong community partnerships.
  • Raised overall awareness in communities and the region about hazards of rivers in Oregon.
  • Has helped to normalized life jacket use.
  • Developed an avenue for EMTs to transition from River Rescue to AMR Ambulance Operations.
  • Has changed city parks from former “party” hangouts (with alcohol, drug use and risky behavior) to more family-friendly environments, decreasing law enforcement issues.
  • Has seen the number of visitors to the parks increase.
  • Has seen life jacket use improve across all age groups and the implemented life jacket loaner program has seen yearly increasing demand.

Today, AMR funds most of the $160,000 annual program as a community service, assisted by the City of Troutdale with a $10,000 grant most years. An additional $10,000 per year is needed for new/refreshed equipment and is a relatively small portion of the Multnomah and Clackamas County budgets. Seed funding to purchase equipment in the early years was provided by the Troutdale Booster Club and Providence Milwaukie Hospital. The program has also received grants from Safe Kids Portland Metro, Safe Kids Worldwide and the Consumer Product Safety Commission to purchase PFDs for the life jacket loaner program, develop water safety banners, support for water safety educational programs and awareness materials to distribute at events throughout the season.

Congratulations to AMR for the River Rescue Program’s selection as a 2016 AMBY Winner for Best Community Impact Program.


Ambulance services face huge losses under ACA

From the San Fernando Valley Business Journal

Two consequences of health care reform – lower reimbursement rates and more patients – have put some local ambulance companies on life support as they struggle to balance higher volumes of trips with less money in return. As a result, ambulance companies have left certain regions of the state amid consolidations and closures.

Read the Full Article (PDF Download)

MetroWest Takes Highest Honors at Oregon EMS Awards

Hearty congratulations to AAA member MetroWest, whose employees took top honors at the September 23 Oregon EMS Awards.

Oregon Emergency Medical Services has many outstanding providers, extraordinary acts and meritorious service that are recognized every year.  On Friday evening, September 23rd, at the Oregon EMS Awards Banquet in Bend, Metro West Ambulance Crewmembers, Larry Hornaday, Paramedic and Trish Smith, EMT, were be recognized as the Paramedic and EMT providers of the year for the State of Oregon.

Read the full story on the MetroWest site.





CMS Issues Transmittal on Changes to Ambulance Staffing Requirements

CMS Issues Transmittal on Changes to Ambulance Staffing Requirements; Clarifications to Service Level Definitions for Ground Ambulance Services

On September 12, 2016, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 226.  This Transmittal incorporates the recent changes to the vehicle staffing requirements into the Medicare Online Manual System.  The Transmittal is also intended to provide clarification on the definitions for certain levels of ground ambulance service.  The changes made by this Transmittal go into effect on December 12, 2016. 

 Vehicle Staffing Requirements

 In the CY 2016 Physician Fee Schedule final rule (November 16, 2015), CMS revised its regulations related to the staffing of ground ambulance services.  Previously, the Medicare regulations at 42 C.F.R. 410.41 required that all ground ambulances be staffed by a minimum of two crewmembers, at least one of whom must be certified as an EMT-Basic and who must be legally authorized to operate all of the lifesaving and life-sustaining equipment on board the vehicle.  For ALS vehicles, there was a further requirement that at least one of the two crewmembers must be certified as a paramedic or EMT and qualified to perform one or more ALS services.

In the 2016 final rule, CMS revised the regulation to further require that the ambulance supplier meet all applicable state and local laws related to the staffing of vehicles.  CMS indicated that these changes are intended to address jurisdictions that impose more stringent requirements on ambulance providers (e.g., a requirement that both staff members be certified as EMTs).  CMS further indicated that these changes were prompted, in part, by a report from the HHS Office of the Inspector General, which expressed concern over the fact that the current regulations do not set forth licensure or certification requirements for the second crew member.

In this Transmittal, CMS is updating Section 10.1.2 of Chapter 10 of the Medicare Benefit Policy Manual to reflect the changes to the underlying regulations.  Specifically, the Manual Section now makes clear that BLS and ALS vehicles must meet the staffing requirements under state and local laws.  For BLS vehicles, the new definition also clarifies that at least one of the crewmembers must be certified at a minimum at the EMT-Basic level by the state or local authority where the services are being furnished.  For ALS vehicles, the new definition clarifies that at least one of the crewmembers must be certified as an EMT-Intermediate or EMT-Paramedic by the state or local authority where the services are being furnished.

Note: A number of AAA members have expressed concern with the reference to “EMT-Intermediate” in the paragraph defining the staffing requirements for ALS vehicles.  These members note that their state may be moving away from the “EMT-I” designation, in favor of the “Advanced EMT,” “EMT-Enhanced,” or other similar designation.  These members expressed concern that Medicare contractors may interpret this clarification literally, and therefore downgrade claims properly billed ALS based on the services provided by Advanced EMTs or other higher EMT certifications.

The AAA recognizes the concerns expressed by these members.  It should be noted that the Manual changes being made by this Transmittal accurately reflect the current wording of the regulation.  It should also be noted that these changes do not impact the definition of “Advanced Life Support (ALS) personnel” set forth in 42 C.F.R. §414.605.  While that definition also makes reference to the EMT-Intermediate licensure, the definition makes clear that any individual trained to a higher level than the EMT-Basic licensure qualifies as an ALS crewmember.

Ground Ambulance Service Definitions

 The Transmittal also makes a number of clarifications to the ground ambulance services definitions set forth in Section 30.1.1 of Chapter 10 of the Medicare Benefit Policy Manual.  These changes are summarized below:

  • Basic Life Support (BLS) – CMS is revising the definition to align with the new minimum staffing requirements discussed above.
  • Basic Life Support (BLS) – Emergency – The current definition of the BLS emergency level of service reads as follows:

When medically necessary, the provision of BLS services, as specified above, in the context of an emergency response.  An emergency response is one that, at the time the ambulance provider or supplier is called, it responds immediately.  An immediate response is one in which the ambulance provider/supplier begins as quickly as possible to take the steps necessary to respond to the call.”

 CMS is removing the second and third sentences of the current definition.  In their place, CMS is inserting a parenthetical referencing the definition of an “emergency response” later in this same section of the manual.

  • Advanced Life Support, Level 1 (ALS1) – CMS is revising the definition to align with the new minimum staffing requirements discussed above. It is also clarifying that the ALS assessment must be provided by ALS personnel.
  • Advanced Life Support Assessment – The existing definition in the CMS Manual ends with the following sentence: “An ALS assessment does not necessarily result in a determination that the patient requires an ALS level of service.” In recent years, a number of Medicare contractors have interpreted this sentence to mean that the provision of a valid ALS assessment would not necessarily entitle the ambulance supplier to bill for the ALS emergency base rate, unless the documentation clearly established the provision of an ALS intervention.

CMS is adding a sentence to the end of the definition that clarifies that an ambulance supplier would be permitted to bill for the ALS emergency base, even if the ALS assessment results in a determination that the patient would not require one or more ALS interventions.  CMS further clarified that the ability to bill for an ALS emergency base rate is predicated on the ambulance transport otherwise meeting the medical necessity requirement.

  • Advanced Life Support, Level 1 (ALS1) – Emergency – Similar to the change to the definition of BLS emergency discussed above, CMS is removing the second and third sentences of the current definition, and replacing them with a parenthetical reference to the definition of an “emergency response.”
  • Advanced Life Support, Level 2 (ALS2) – CMS is rewording the definition, without making any substantive change. ALS-2 continues to be billable in situations involving a medically necessary transport of a patient, where the crew either: (1) provides one of the seven listed ALS-2 procedures (manual defibrillation/cardioversion, endotracheal intubation, etc.) or (2) the administration of three or more medications by IV push/bolus or continuous infusion.  The changes largely relate to how you count, for purposes of determining whether you can bill ALS-2, multiple administrations of the same IV medication.  Conceptually, CMS is indicating that a single “dose” requires a suitable quantity and amount of time between administrations, in accordance with standard medical protocols.  CMS is further indicating that a deliberate attempt to administer a standard dose in increments would not qualify as ALS-2.  In sum, to the extent a medication is administered in standard doses in accordance with pre-existing protocols, each separate administration would count separately towards the ALS-2 standard of three or more administrations; however, any attempt to cut the standard dose into multiple administrations would count as only a single administration for purposes of determining whether the ALS-2 standard was met.
  • Specialty Care Transport (SCT) – CMS is rewording the language in the “Application” section of this definition, without making any substantive change.
  • Paramedic Intercept (PI) – CMS is revising the definition to reflect the change in how a “rural area” is identified. The old definition included any area: (1) designed as rural by a state law or regulation or (2) any area outside a Metropolitan Statistical Area (MSA) or in New England, outside a New England County Metropolitan Area.  Under the new definition, an area is considered rural to the extent it is designated as such by state law or regulation or to the extent it is located in a rural census tract of an MSA using the most recent version of the Goldsmith Modification.
  • Services in a Rural Area – CMS is eliminating the reference to New England County Metropolitan Areas, as these areas are no longer relevant to a determination of rural. Under the new definition, an area will be considered rural to the extent: (1) it is located outside a Metropolitan Statistical Area (MSA) or (2) is identified as rural using the most recent version of the Goldsmith Modification, even though the area falls within an MSA.
  • Emergency Response – CMS is adding language clarifying that the nature of an ambulance provider’s response (i.e., emergent or non-emergent) does not independently establish medical necessity for the ambulance transport.
  • Interfacility Transport – CMS is adding a new definition for the purposes of billing SCT, which establishes that the interfacility transportation requirement is met whenever the origin and destination are both one of the following: (1) a hospital or skilled nursing facility that participates in the Medicare program or (2) a hospital-based facility that meets Medicare’s requirements for provider-based status.

AAA Endorses Increased Resources for AED Education (H.Res 877)

The AAA Board of Directors has voted to endorse H.Res 877. Sponsored by Rep. John Duncan (TN-02), H.Res 877 was introduced to encourage states to increase resources in schools for training and education on AEDs.

“Whereas the American Red Cross advocates that improved training and access to automated external defibrillators (AEDs) could save 50,000 lives each year;
Whereas the average response time to a 911 call is 8 to 12 minutes;
Whereas the likelihood of survival is reduced approximately 10 percent for each minute defibrillation is delayed; and
Whereas sudden cardiac arrest is most effectively treated by combining CPR and defibrillation: Now, therefore, be it
Resolved, That the House of Representatives–
(1) encourages public schools in possession of one or more
AEDs to schedule annual AED training for all school personnel,
for which staff meetings or in-service days allocated under
State law for training programs in emergency first aid and
cardiopulmonary resuscitation (CPR) may be used…”

Read the full text of H.Res 877.


CMS Medicare Ambulance Transports Booklet — Revised

CMS has released a revised Medicare Ambulance Transports Booklet. To order a hard copy, visit CMS’ Learning Management and Product Ordering System. Learn about:

  • Ground and air ambulance providers and suppliers, vehicles, and personnel requirements
  • Documentation requirements
  • Coverage, billing, and payments
  • Advance Beneficiary Notice of Noncoverage



Prior Authorization Expansion Delay

Prior Authorization – Repetitive Non-Emergencies – Expansion Delay

CMS has notified the American Ambulance Association that the expansion of Prior Authorization for repetitive non-emergencies, to the states not already on Prior Authorization, will not be implemented January 1, 2017.

The reason for the delay is that, pursuant to Section 515(b) of the Medicare Access and CHIP Reauthorization Act (MACRA), CMS must make determinations as to whether: (1) Prior Authorization for repetitive non-emergencies saves money, (2) it adversely affects quality of care and (3) it adversely impacts access to care.

These studies are being conducted and are expected to show the program saves money without adversely affecting quality or access to care.

For those of you in states currently not under Prior Authorization, it is highly recommended that you still prepare for it to be implemented, even though it will not be implemented January 1, 2017.  You should still ensure that these patients meet the requirements for medical necessity by reviewing your documents, obtaining documents from facilities, conducting assessments of repetitive patients, implementing internal procedures and processes, etc.

For those of you in states already under Prior Authorization for repetitive non-emergencies, there is no impact.  Your program continues.

2016 AAA Award Winners Announced

The AAA is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference and Tradeshow Awards Reception on Tuesday, November 8, 2016. Please join us in congratulating the winners.

J. Walter Schaefer Award

Randy Strozyk, American Medical Response

The J. Walter Schaefer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Randy has achieved this through his tireless dedication and service to the industry and his role in elevating the association and its members to national prominence.

Robert L. Forbuss Lifetime Achievement Award

Julie Rose, Community Care Ambulance

The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. Julie has held numerous leadership positions in the AAA including Membership Committee Chair, Region III Director and Alternate Director. Julie has worked tirelessly to get members of her Region to join the AAA, knowing that it is important to participate in the national organization to be part of the team finding solutions to today’s challenges in EMS.

President’s Award

Jon Howell, Huntsville Emergency Medical Services, Inc. (HEMSI)
Asbel Montes, Acadian Ambulance Service
David Tetrault, St. Francois County Ambulance District

These awards are given by the President to volunteer leaders who have shown commitment to the advancement of the AAA above and beyond the call of duty. This year the three outstanding volunteers represent tireless work on behalf of the AAA.

Jon Howell has served as the chair of the AAA’s nominating committee for 4 years and in that time has worked to grown the involvement of our members to participate in the AAA nominating and election process.  Asbel Montes has worked tirelessly as Co-Chair of the Payment Reform Committee, and David Tetrault has served as a Region IV Board or Director as well as an active participant on the Membership and Education Committee.  AAA President Hall was quoted as saying, “this award is given by the sole discretion of the President of the AAA and I cannot think of three more deserving individuals than Jon, Asbel and David.  No matter what I have asked them to do for the AAA, they have taken on the task with determination, commitment and a level of servant leadership rarely seen anymore.”

Distinguished Service Award

Brian Choate, Solutions Group
Kathy Lester, MPH, JD, Lester Health Law & AAA Healthcare Consultant
Scott Moore, Esq., EMS Resource Advisors LLC & AAA Human Resources Consultant
Brian Werfel, Esq., Werfel & Werfel, PLLC & AAA Medicare Consultant

The American Ambulance Association (AAA) is proud to award Brian Choate, Kathy Lester, Scott Moore, and Brian Werfel with 2016 Distinguished Service Awards.

The Regional Workshop team worked countless hours to create the content for the four compliance, billing and reimbursement policy workshops that were presented throughout the country. The workshops were designed to help all types of services structure their billing departments more maximum efficiency and integrity.

It is for this dedication of the team members to the AAA that we are proud to recognize Brian Choate, Kathy Lester, Scott Moore, and Brian Werfel with the 2016 Distinguished Service Award.

Partner of the Year Award

National Association of Emergency Medical Technicians (NAEMT)

The Partner of the Year Award is given to an EMS partner whose collaboration with the AAA enhances educational programs, legislative priorities and/or member benefits. This pas year the NAEMT has partnered with the AAA on numerous projects including Medicare Relief, EMS Compass and most recently issues a joint statement regarding Payment Reform Policies for EMS.

Affiliate of the Year Award


The American Ambulance Association (AAA) is proud to award Avesta with the 2016 Affiliate of the Year Award. The award is given to the vendor whose supports the programs of the association. Avesta is dedicated to solely to the practice of Human Capital Management and the development of solutions that meet the unique human resource challenges of their EMS clients. This year’s Affiliate winner has shown unconditional support of the AAA Stars of Life Program. The Stars of Life event, held annually in Washington, D.C., publically recognized and celebrates the achievements and exceptional work of EMS professionals.

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