Play Is A Gripping Reminder Of What First Responders Are Going Through

From WBUR Boston on July  13, 2020

Ed, a paramedic, hates the word “hero.” Played by veteran actor Jamey Sheridan in the Public Theater’s virtual play, “The Line,” Ed tells us that hero is a word “we use in the face of fear that separates us.” He’s been working in the field for 26 years and his cut-to-the-chase approach to life is indicative of what he’s endured. Ed and his colleagues typically “thrive in chaos,” but COVID-19, they soon learn, is no ordinary monster. The tumult it creates leaves an indelible mark on him and everyone else.

“The Line,” a documentary theater piece written by Jessica Blank and Erik Jensen, is an enthralling collection of seven stories gleaned from interviews, via Skype or FaceTime, with a diverse group of New York city health-care workers that details the fear, frenzy and loss they’ve gone through during the pandemic.

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Cleveland EMS crews win PTSD coverage, $3.7M in back pay

From Cleveland 19 News on July 13, 2020

CLEVELAND, Ohio (WOIO) – A fight for Post Traumatic Stress Disorder coverage years in the making has ended with a win for Cleveland paramedics, EMTs and dispatchers.

A union contract for Cleveland EMS just passed, under an agreement out of court that still needs to be ratified by city council.

The agreement includes about $3.7 million in back pay for employees and mental health language, addressing PTSD.

CARE has been negotiating their contract since March of 2016.

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CNBC | Why Ambulance Rides Are So Expensive In The United States

Thank you to American Ambulance Association Payment Reform Chair Asbel Montes for eloquently representing the EMS perspective on surprise coverage in this video from CNBC:

It’s an open secret in America that calling for an ambulance can be a financial gamble because of surprise bills. There’s no way for patients to know how much an ambulance will cost before they get inside the vehicle, and the final bill can be thousands of dollars. Here’s why ambulances are so expensive in the United States and what can be done to change it.

Covid-19 Is Bankrupting American Companies at a Relentless Pace

From Bloomberg on July 9, 2020.

Retailers, airlines, restaurants. But also sports leagues, a cannabis company and an archdiocese plagued by sex-abuse allegations. These are some of the more than 110 companies that declared bankruptcy in the U.S. this year and blamed Covid-19 in part for their demise.

Many were in deep financial trouble even before governors ordered non-essential businesses shut to help contain the spread of the virus. Most will reorganize and emerge from court smaller and less-indebted. The hardest hit, however, are selling off assets and closing for good.

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JEMS | Armstrong Ambulance Tackles COVID-19 Together

From the Journal of Emergency Medical Services on July 8, 2020.

To cope with the unprecedented challenge that remains before them, Armstrong’s first responders have been finding the support they need in numerous ways, whether it be from a member of the team, those working in a similar industry, or members of the many communities they serve delivering food and messages of encouragement to local bases.

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CNN | Contact Tracing Not Possible in the South

From CNN Health’s Contact tracing is no longer possible across the US South due to rapid coronavirus surges, health expert says on July 7, 2020

“The cases are rising so rapidly, that we cannot even do contact tracing anymore. I don’t see how it’s possible to even do that,” Dr. Peter Hotez, dean of tropical medicine at Baylor College of Medicine, told CNN’s Anderson Cooper Monday.
The rapid rise in cases is considered a surge, not a second wave, because the infection numbers never lowered to where officials hoped they would, director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci said in a Facebook and Twitter livestream Monday.

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NYT | The Fullest Look Yet at the Racial Inequity of Coronavirus

From the New York Times on July 5, 2020 by By Richard A. Oppel Jr., Robert Gebeloff, K.K. Rebecca Lai, Will Wright and Mitch Smith

Early numbers had shown that Black and Latino people were being harmed by the virus at higher rates. But the new federal data — made available after The New York Times sued the Centers for Disease Control and Prevention — reveals a clearer and more complete picture: Black and Latino people have been disproportionately affected by the coronavirus in a widespread manner that spans the country, throughout hundreds of counties in urban, suburban and rural areas, and across all age groups.

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WSJ | TX, AZ and FL have been some of the worst-hit states in recent days

From the Wall Street Journal on July 5

Some Hospitals in Southern, Western U.S. States Near Capacity Amid Coronavirus Outbreaks

Top officials in southern and western U.S. cities and states with growing coronavirus cases sounded the alarm Sunday, saying hospitals were near capacity and that stricter social-distancing enforcement was needed to stem the growing outbreaks.

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House Passes PPP Extension

On July 1, The U.S. House of Representatives unanimously passed a bill to extend the deadline to apply for forgivable small business loans through the Paycheck Protection Program. The legislation was previously passed by the Senate and President Trump is expected to sign the bill into law.

The bill extends the deadline to request Paycheck Protection Program loans to August 8 from June 30. The U.S. Small Business Administration (SBA), which oversees the program with the Treasury Department, stopped accepting loan applications at midnight Tuesday. The extension is intended to provide more time for small businesses to apply for the approximately $129 billion in PPP funding remaining.

The program provides forgivable loans that small businesses and other qualifying entities can use to cover payroll and other select costs.

The AAA will continue to press the Congress and federal agencies for help to ensure ambulance service organizations and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic have the necessary resources and financial assistance to serve their communities.

The AAA Public Relations Campaign Continues

AAA has once again teamed up with Mercury Public Affairs to run a public affairs campaign to ensure that Emergency First Responders are not forgotten by Congress.

For this campaign, our key message is as follows:

America’s front-line first responders, including paramedics, EMTs, and critical care nurses, are the very first medical professionals seen by all citizens that access healthcare using the 9-1-1 system.

 Surpisingly, Washington has forgotten all about them as the virus spreads, and our emergency response providers are being infected with COVID-19. Ambulance services are the public health and safety net for our country, but they have only gotten one tenth of the relief they are owed. Some are even being forced to shut down operations in communities across our country.

 Ambulance services have also been treating more and more patients at home for ailments like diabetes and asthma because emergency rooms are full. They have not been reimbursed for these critical services.

To take action and participate in this campaign, please visit the American Ambulance Association Action page.

Public Affairs Campaign

We have worked with our government relations team to identify the following Senators as the focus of our campaign:

  • Leader Mitch McConnell (R-KY)
  • Chuck Grassley (R-IA)
  • Todd Young (R-IN)
  • Rob Portman (R-OH)
  • Catherine Cortez Masto (D-NV)
  • Sherrod Brown (D-OH)
  • Steve Daines (R-MT)
  • John Cornyn (R-TX)

News Coverage

In addition to the Wall Street Journal and Washington Post, this effort has yielded even more news coverage:

Fear of Hospitals Driving Changes for Ambulance Pay in Medicare

May 29, 2020 in   Bloomberg Government

“Sen. Bill Cassidy (R-La.) has been discussing with Senate Finance Committee Chairman Charles Grassley (R-Iowa) how Medicare can reimburse ambulance services for “treat in place” services, a Cassidy spokesman confirmed in an emailed response to a question.”

Ambulance services getting crushed by being roped into virus response

May 25, 2020 in the Washington Examiner

“In an effort to combat hospital overcrowding during the coronavirus pandemic, states have required ambulances to treat patients at home if possible. Yet Medicare only reimburses ambulances when they transport a patient to a hospital, and most private insurers follow Medicare’s lead. This Catch-22 has cut deeply into ambulance companies’ revenues during the pandemic.”

Yonkers ambulance company seeks Medicare payment for treat-at-home calls

June 16, 2020
By: Jonathan Lamantia and Jennifer Henderson in Crain’s Health Pulse New York

During the height of the Covid-19 pandemic, New York’s ambulance companies increasingly found themselves treating lower-acuity patients at their homes rather than bringing them to overcrowded hospitals.

Empress EMS, a Yonkers-based ambulance company that covers parts of New York City and the Hudson Valley, provided about 1,200 treat-in-place visits during one 30-day period at the height of the crisis, including helping more than 300 individuals who were in cardiac arrest, said Hanan Cohen, Empress’s director of corporate development, mobile integrated health care and community paramedicine.

But none of the visits were reimbursable by Medicare, which Cohen estimates cost Empress more than $700,000 during that 30-day span.

Medicare shouldn’t make ground ambulance services take a financial hit for providing at-home care

June 29, 2020 By: Hanan Cohen STAT

Hanan Cohen is a paramedic and director of corporate development at Empress EMS, a partner of PatientCare EMS Solutions, which operates in New York in the Bronx and Westchester County.

 Balance of Power: Gen. McChrystal, Rep. Hill

July 1, 2020

By: David Westin on Bloomberg Radio (Interview begins around 54:12)

Hanan Cohen interviewed by David Westin, one of the network’s most prominent anchors and the former president of ABC News.

The program is syndicated across 300 stations in the US, including leading news radio stations in major cities from coast to coast. In addition, it is heard nationally on Sirius XM.


Government Affairs Update: What We’re Working On

With the U.S. Senate on track to consider a fourth economic stimulus package before their August recess, the AAA is working hard to promote legislative language that positively impact the EMS industry and ambulance services across the country. Here is a snapshot of those current efforts.

Ambulance Funding in Response to COVID-19

As the Senate develops its next economic stimulus legislation to address the impact of COVID-19, the AAA has met with leaders and staff on Capitol Hill to increase the percentage of the general allocation of funds under the Public Health and Social Services Emergency Fund (PHSSEF) for ground ambulance services providers and suppliers to equal a total of $2.89 billion in funds for our industry. The $2.89 billion reflects $48,000 per ambulance with an estimated 60,000 registered vehicles. We greatly appreciate the recent payments under the Fund which will help with our current situation. However, the ground ambulance services industry is only 0.90% of Medicare fee-for-service annual outlays which resulted in $270 million for our industry in round one of PHSSEF payments. This figure is disproportional to the large role of ground ambulance service providers and suppliers in responding to COVID-19 and our increased costs and reduced revenues during the public health emergency (PHE).

The AAA has highlighted the increased costs, uncompensated care and lost revenue related to COVID-19 and hope to see ambulance-specific funding in the Senate’s 4th stimulus package.

Expand Public Safety Officer Benefits (PSOB)

Since the beginning of the pandemic, the AAA has advocated to add COVID-19 as an infectious disease under the Public Safety Officers’ Benefit (PSOB) and extend coverage during the pandemic to paramedics and EMTs employed by a private ambulance service who die from COVID-19.

On April 9, the AAA and the National Association of Emergency Medical Technicians (NAEMT) sent a letter to U.S. Attorney General William Barr requesting the Department of Justice extend coverage under the Public Safety Officers’ Benefits (PSOB) program to all paramedics and EMTs during the COVID-19 national health emergency.

On May 22, the AAA received a written response from the DOJ denying any expansion of the PSOB program stating that paramedics and emergency medical technicians employed by private for-profit EMS agencies do not meet the definition of “public safety officers” for purposes of PSOB eligibility.

To push for a legislative fix, AAA Staff and consultants have continued to advocate that all paramedics and EMTs be covered by the program regardless of their employer.

Expansion of Treatment in Place

The AAA has sent several letters asking the Centers for Medicare and Medicaid Services (CMS) to reimburse ground ambulance service providers and suppliers for performing protocol-driven treatments in place during the PHE.

This coverage will help limit the spread of COVID-19 by keeping patients with mild cases of COVID-19 at home and out of overcrowded hospitals or other facilities where they could expose others to the virus. With mostly positive response on our proposed regulatory fixes, the AAA will continue to follow up and address any roadblocks to full coverage of Treatment in Place.

Allow Private For-Profit EMS Providers to Apply Directly for FEMA Grants

The AAA has long advocated to allow private for-profit EMS agencies to apply directly to the Federal Emergency Management Agency (FEMA) for Public Assistance program grants during the PHE and waive the matching requirement for emergency response providers. During the COVID-19 pandemic, it is more necessary than ever that EMS agencies receive the funding the deserve for their role in the COVID-19 response. This will allow all EMS agencies to apply for financial assistance and for state and local governments to focus their limited resources on directly combating the pandemic.

We have been met with positive response from key Senators serving on Committees and Subcommittees of jurisdiction.

Other Legislation

The AAA was pleased to see the introduction of the Pandemic Responder Service Award Act (S. 3763) by Sen. Casey (D-PA) which provides front-line healthcare workers with awards up to $10,000 based on days of eligible service during the PHE. In the case of any qualified health care worker who was hospitalized or died as a result of contracting COVID–19, the award would be the full $10,000. This bill specifically includes private for-profit ambulance service providers, in a well-needed recognition of the work they provide on the frontlines of COVID-19. The AA will continue to work with Sen. Casey’s office as well as push for the inclusion of private for-profit providers in the House companion bill.

The AAA is also pleased to announce the introduction of H.R. 7292 by Rep. Marcy Kaptur (OH-09) which would provide forgiveness of certain accelerated and advanced payments under Medicare parts A and B. While the funding provided by the CARES Act was critical at keeping ambulance service providers operating, the Medicare Accelerated and Advanced Payment Program has the potential to cripple health care providers in the near future as Medicare payments are withheld until those advanced payments are repaid. H.R. 7292 would forgive the repayments and help ensure financial stability for ambulance service providers across the country.

The AAA will continue to press the Congress and federal agencies for help to ensure ambulance service organizations and our paramedics and EMTs serving on the front lines of the COVID-19 pandemic have the necessary resources and financial assistance to serve their communities.


Study | Nationwide EMS Calls Have Dropped 26%, Attended Deaths Doubled

From the University at Buffalo News Center

Since early March and the start of the COVID-19 pandemic in the U.S., 911 calls for emergency medical services have dropped by 26.1 % compared to the past two years, a new study led by a University at Buffalo researcher has found.

But the study also found that EMS-attended deaths have doubled, indicating that when EMS calls were made, they often involved a far more serious emergency.

Study Details

Effect of the Coronavirus Disease 2019 (COVID‐19) Pandemic on the United States Emergency Medical Services System: A Preliminary Report
E. Brooke Lerner PhD
Craig D. Newgard MD, MPH
N. Clay Mann PhD, MS, MBA

Always In Our Hearts

Please join the American Ambulance Association in honoring those who have fallen serving their communities in the COVID-19 pandemic.

What does it mean to be a hero? Paramedics, EMTs, nurses, and firefighters risk their lives every day to serve on the…

Posted by American Ambulance Association on Tuesday, June 30, 2020

Stat | Treatment in Place

From Stat on June 29, 2020 by Hanan Cohen of Empress EMS and Patient Care EMS Solutions

Medicare shouldn’t make ground ambulance services take a financial hit for providing at-home care

Ever since the coronavirus pandemic began sweeping across the U.S., ambulance crews have been treating some patients at home rather than risking a hospital surge — and aren’t getting paid for it. At a time when ambulance services are on the frontlines of care, not just transport, Medicare is treating ambulances like expensive taxicabs.

Treating people in place — at the scene of a medical emergency, which can include the home, a long-term care facility, or other location — has become the expected standard of care, especially during the pandemic. Some states even mandate it. But the Centers for Medicare and Medicaid Services, which oversees Medicare payments, refuses to pay companies for the cost of providing medically necessary health care services if the patient is not transported to a hospital or other designated destination.

As a result, ground ambulance organizations that are fighting the Covid-19 pandemic on the frontlines by treating people with everything from low blood sugar to dehydration are taking a massive financial hit. And it’s coming at the worst time.

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CDC Chief Says COVID-19 Cases May be 10x Higher Than Reported

From the Washington Post on June 25

CDC chief says coronavirus cases may be 10 times higher than reported

The number of Americans who have been infected with the novel coronavirus is likely 10 times higher than the 2.3 million confirmed cases, according to the head of the Centers for Disease Control and Prevention.

In a call with reporters Thursday, CDC Director Robert Redfield said, “Our best estimate right now is that for every case that’s reported, there actually are 10 other infections.”

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CMS Launches the Office of Burden and Health Informatics

From Becker’s Health IT:
CMS launches new health informatics office to ease regulatory, administrative burdens: 5 details

CMS on June 23 unveiled the Office of Burden and Health Informatics, which will bridge tech and innovation initiatives with the agency’s efforts to reduce regulatory and administrative burdens for providers and beneficiaries.

“Specifically, the work of this new office will be targeted to help reduce unnecessary burden, increase efficiencies, continue administrative simplification, increase the use of health informatics, and improve the beneficiary experience,” CMS Administrator Seema Verma said in a news release.

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Bloomberg | Hospitals Are Counting Beds Again With Virus Cases

From Bloomberg Law on June 24, 2020

With all states reopened to some degree, cases and hospitalizations are rising. Arizona, California and Texas all set records for new cases on Tuesday. The question now is whether hospitals will be able to handle it, and what will happen if they can’t. “Many of them still have a lot of available capacity, but who knows how long that’s going to last,” said Eric Toner, a senior scholar with the Johns Hopkins Center for Health Security. “They should be getting themselves ready now.”

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