OSHA Injury Reporting

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers can begin electronically reporting their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA). 2017 Injury Data must be submitted to OSHA no later than July 1, 2018. For employers in states that are covered by OSHA approved state level work injury regulations, OSHA has announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members who need assistance ensuring they are compliant with this reporting requirement.

Recovering Loss of Revenue from “not at fault” Accidents

When your units get hit by a third party and the vehicle is out of service, are you getting Loss of Revenue for the downtime while the unit is being repaired? Whether you answered yes or no to that question, reading this article will be the one of the most lucrative uses of your time this year.

A call comes in and your dispatcher does a perfect job of answering and scheduling the run. The EMT’s jump into the clean, fueled, and well stocked ambulance responding to the call. Then from out of nowhere, a car turns directly into the ambulance’s path rolling through a stop sign. Now what? You have two paramedics stranded on the side of the road who will be spending the next few hours on paperwork and drug testing. In addition, all the drugs and small equipment need to be removed or secured. Hopefully you have another unit to dispatch or your competitor may have already been called.

What happens next is key to getting maximum recovery for your losses caused by the accident.

Key items that help maximize your recovery from accidents:

  1. Educate and equip fleet drivers with the tools necessary to collect key accident information at the scene and relay it. This includes a description of the accident, clear color pictures of the accident scene, the damaged vehicles, and third-party driver’s license and insurance information.
  2. Gather as many witnesses as possible and statements from both drivers.
  3. On board videos are great, but if not, having a smart phone video of the damage and intersection can be very helpful if the liability is in question.
  4. Get an accurate and thorough estimate. Be aware that, for the most part, insurance companies are motivated to pay out the least amount possible to get the claim settled. Their adjusters are typically not trained accurately determine the damage to specialty vehicles or the equipment they may contain. Using a TPA with strong experience with commercial fleets is critical.

We are surprised how many firms don’t realize or understand what they are entitled to recover because of an accident where their driver was not at fault. Essentially, the law supports that the owner is entitled to the use of their “chattel” and compensation pursuant to the same. Here is an interesting titbit. Chattel is originally a Latin and old French term referring to moveable personal property. A good term to throw out at the next risk managers meeting to impress everyone. With that said, what you are entitled to and what shows up in your mailbox are two drastically different things. Insurance companies are motivated to pay the least amount possible and delay that payment as long as possible.

Most people assume that insurance companies make money when they generate more in premiums than they pay out in losses and expenses, but for the most part that’s not true. Most insurers are happy to break even on their underwriting and make their money by investing the premiums and keeping the investment returns.

What am I entitled to from a “not at fault” accident? There are a lot of factors influencing this, but essentially you are entitled to your physical damage, diminution of value, and loss of use/revenue. How much you are entitled to are the subjective negotiations that firms like ours engage in hundreds of times each day. Driver liability, statute of limitations and minimum policy limits vary from state to state. Typically, the state where the accident happens will be the applicable laws and regulations.

If I have a spare unit to take the place of the damaged vehicle, am I still entitled to Loss of Revenue? The short answer is yes, but getting the carrier to ink the check is another matter. There are real costs of having a spare unit which is why the law supports the loss of the use as a recoverable item. Acquisition cost, maintenance, licensing, certification, insurance, and storage are all costs incurred by having a spare unit.

Pursuing Loss Recovery

The following are steps fleets can take to help maximize recovery:

  1. Pursue all possible recoveries. There is often potential recovery from the third-party drivers in the form of an umbrella policy, company policy, or personal assets. Driver liability, statute of limitations and minimum policy limits vary from state to state. The key is to know which accidents offer what potential in which states, and then to pursue recovery using the latest industry tools as quickly as possible.
  2. Follow insurance industry documentation standards. The required forms need to be properly completed and submitted to the third-party driver’s insurance carrier. Knowing insurance industry regulations, standards, and the law are key to move the carriers to action. Technically, a carrier can wait 30 days after receiving a demand before taking action on the claim.
  3. A key component to Loss of Revenue is accurate records showing the income the unit generated prior to the accident. This is the hardest to recover and gets the most pushback from the insurance companies. Putting the data in a format that meets the insurance company’s needs varies by company.
  4. Even after the carrier has agreed to pay, be prepared to make a lot of follow-up calls and emails to get your claim paid. A common tactic used by carriers is to drag out the claim hoping you will either give up or accept less. Essentially wearing you down.

The second key recovery component is Diminution of Value (DV), or Loss of Market Value the vehicle suffers even after it is repaired. Age of the vehicle, miles, condition, and other factors determine this amount. Without a strong recovery plan or Third Party Administrator (TPA), we see significant diminution of value left on the table. The key here is strong data which supports your valuation utilizing use multiple sources and have extensive experience and a successful track record for recovering DV.

Getting accurate value when a vehicle is a total loss. The term “Total Loss” is an insurance term lacking legal definition. Carriers have often used title branding laws to determine if a vehicle is a “Total Loss”. While each state has different criteria for “branding” titles, vehicles can, and have been, paid as total losses with damage percentages well below the title branding statutes. Carriers often tout statements such as “Federal Guidelines” or “State Statutes” when attempting to settle claims. More accurately, legal entitlements are based upon what is called the Restatement of Torts, and defined by case law in each state. Typically, property and casualty insurance adjusters don’t understand these laws and again are motived to pay out the minimum possible. Engaging a firm that specializes in commercial fleet claims can provide an arm’s length transaction necessary to be pro-active on the front side in setting the claim up properly, which usually results in a higher recovery.

So how do you win at the recovery game? Well unfortunately you are in a game where the opponent is highly motivated to not pay or pay the least possible, has their own set of rules on how much you should get, and make most of their profit on dragging out a payment when they finally do decide to pay.

There are essentially three routes you can pursue.

  1. Handle the claims yourself. Unless you have extensive knowledge in the law and insurance industry, plus have ample time to talk to the voicemails of insurance carriers, this option may not be ideal.
  2. Let your insurance company handle the claim. They will pay your Physical Damage, but rarely does the policy have coverage for Loss of Revenue and Diminution of Value.
  3. Hire a TPA (Third Party Administer) to handle the claims for you. Select a firm with a long track record, experience with specialty vehicles, adequate technology, a strong legal department, and specializes in Loss of Revenue recovery. Make sure their fees are performance based and they only win if you do. They can recover Loss of Revenue, Diminution of Value (inherent and repair related) and other costs typically not recovered.

Few fleets have the number of trained personnel in each of these areas to adopt these best practices. If the fleet’s resources are already stretched to capacity, consider outsourcing to a TPA. The chances are the partnership will yield state-of-the-art best practices and more than pay for itself.

I hope you found this article helpful, don’t hesitate to contact me with any questions or to learn more.

Brian J. Ludlow is Executive Vice President for Alternative Claims Management. He is an entrepreneur and consultant to the insurance, financial, and transportation industries. Brian specializes in disruptive technologies. His firm has transformed the accident claims recovery process.

bludlow@AltClaim.com | 231-330-0515

Family Liaisons Following EMS Line of Duty Deaths

I was just a kid when I started in EMS. 23 years old, hungry for adventure, and ready for everything the world of EMS was prepared to give me. Car accidents, gunshot wounds, stabbings, intoxicated shenanigans, elderly falls, fist fights, medical emergencies, strokes, and cardiac arrest were all on my list of expected possibilities. One of the scenarios I had not thought of, and nobody presented to me throughout school and orientation, was the possibility of clocking in for shift and not going home. I do not recall line of duty deaths being a discussion point in the paramedic curriculum, job interview, or orientation process. I had experienced the unexpected loss of a younger sibling due to a motor vehicle crash before I started my journey in EMS, but the fact that life is short and unpredictable did not connect with the fact that I was knowingly and willingly walking myself into unknown and potentially dangerous situations with each response. Even after the UW Med Flight crash happened early in my career, and in my service area, we simply did not talk about our own potential for death as a direct result of our profession.

Years later, after many more line of duty deaths and even more reports of violence against EMS and healthcare workers, this topic weighs heavy on my mind. In my time as Staff Development Manager for a service, I pushed for the DT4EMS courses to train our medics on how to recognize potential dangers, escape those situations, and defend themselves if they are unable to escape.  We all know the ‘scene safe/BSI’ tagline and list of what things might make a scene unsafe is not enough. As the Rescue Task Force (RTF) formed, I watched as some were excited for the opportunity to be involved and others started to question their willingness to respond to so many unknown situations as their young families were beginning to grow. I started asking myself if EMS agencies are doing enough in terms of preparing themselves and their employees for the possibility of a line of duty death.

The Line of Duty Death Handbook, published in part by the AAA, is a great tool to start building policies, protocols and personnel records. The handbook guides you through the importance of having employees fill out emergency contact and next of kin forms, and keeping them updated, as well as assigning family liaisons and how to manage coverage for funeral services. As I reviewed this, I started thinking about the assignment of a family liaison—a member of your agency who knew the individual well and will be the primary contact for everything the family needs once the notification has been made. What type of person should be assigned this role, and what kind of training should they have? I sat down with KC Schuler, MDiv and board member for the Fox Valley Critical Incident Stress Management group to discuss.

What are some considerations services should make when putting together their line of duty death policy/procedure?

I think the first significant consideration should be conducting pre-incident training. I mean, are you starting the conversation about critical incident stress exposure all the way up to, and including, the possibility that they may never go home to their family, at orientation? During onboarding? So many of the EMTs and Paramedics coming in are young, and this may be their first job. In my experience, they can be somewhat blind to the possibilities. Early education and creating a culture of support—including letting them know you have their back (and their family’s back) in every potential scenario is important. The second consideration, I think, is to determine what scope you define as a line of duty death. The on-shift motor vehicle crash or incident resulting in death while on the clock is apparent, but what about suicide? If someone is having significant job-related stress and commits suicide, will that be looked at as a line of duty death, or not? This is something all organizations need to consider before such an event happens.

S: What type of actions would you recommend take place, or are discussed, as part of the orientation process?

KC: This is a great time for employees to fill out the emergency contact and next of kin form—this also provides an opening to discuss the possibility of death and the importance of filling out the form accurately and keeping it up to date. They are the best ones to tell you who you should notify in such a situation; guessing in the event of a death is not ideal. A portion of orientation and annual training should also be spent on mental health, including awareness, recognition of post-traumatic stress symptoms in themselves and their peers, and available support resources. Trained peer support and EAP can be very valuable in the management of work and home related stressors. Again, being intentional to build and sustain an organizational culture of support prior to an unfortunate tragedy like a line of duty death will help all those involved.

S: The Line of Duty Death Handbook talks about assigning a family liaison—a person who becomes the 24/7 primary contact for the family once notification has been made. This person should be available, in person and via phone, and dedicated to the family whether it is household chores such as mowing the lawn and grocery shopping, to communicating with out of town family members and arranging hotels. Who should be considered for such an assignment, and what might the service do to prepare these individuals?

KC: This is a high-intensity assignment, and this role should not be assigned to shifts in the beginning either. Being a family liaison is a big responsibility, and it is not a responsibility that should shift from person to person; ideally, the family will have one liaison for the duration. Trust is a significant factor—the family must trust the individual they are assigned, so that individual must be able to build that trust or recognize early if it is not a good match. Services should consider the following in their selection of a family liaison:

  1. Someone who is specially trained in being a family liaison. The nature of this position is demanding and can significantly interfere with the liaison’s personal life and responsibilities of emotionally supporting another. They need to be able to have clear boundaries, open lines of communication to leadership, and have a stellar support system in place as well. The International Critical Incident Stress Foundation does offer a 2-day LODD course.
  2. Preferably, the family liaison would not have any other roles (such as being an honor guard member) as they will likely have other duties and responsibilities throughout the process and at the funeral itself. The liaison duties need to be 100% dedicated to the family.
  3. Gender sensitivity—If the deceased is a male, you may want to assign a female liaison to the spouse as there can be a lot of strong emotions during this time and unhealthy attachments can form. You should consider gender identity and sexual preference in assigning a liaison as well.

Training and preparation of individuals for family liaison assignment should happen before an event like this ever occurs.

S: If I am a service director looking to send a few people to train for this, what type of people should I look for?

KC: If I had to provide a list of characteristics for liaison selection, it would probably include someone who:

  1. Does not gossip and respects confidentiality.
  2. Can make things happen—someone who is comfortable making, and either has the authority to make decisions on behalf of the service, or has direct contact with someone who can.
  3. Has a great support system of their own.
  4. Understands and respects boundaries—can set limits where appropriate and necessary.
  5. Is comfortable speaking, but also understands and can recognize the importance of silence, or when not to respond.

S: When it comes to families, there are a lot of dynamics a liaison might have to contend with such as divided families or family members that do not get along. If more than one individual is involved in a LODD, such as two members killed in a car accident, there may also be dynamics between those two families that need to be considered. What are your recommendations for addressing those type situations, where either a single family or multiple families may be at odds?

KC: If there is more than one family involved (i.e., two employees) you will want to assign each family a liaison, and those liaisons will need to be in close communication with each other and the organization leadership. One thing agencies may wish to consider is holding family support or family networking events throughout the year, before an event like this happens. I mean, beyond the Christmas parties and summer picnics where all families are invited—events that allow family members of your employees to get together, build relationships, and form a support system between families who understand the dynamic of supporting someone in EMS. If families are meeting for the first time as the result of a fatal accident, the dynamic will likely be much different (and more difficult) than if they are afforded a place to get to know each other and form bonds before such an event would happen. It is a lot easier to blame a stranger than a friend; it is easier to share pain and experience with someone you share a bond.

If there is pre-incident conflict within a family, such as animosity between divorced parents or an ex-spouse, these situations become more difficult to manage. Training will help the liaison better navigate and handle these situations.

S: You mentioned before, the importance of knowing the resources in your area—what would you say to those services who might plan to reach out to their local CISM or hospital for a family liaison or other support in this situation?

KC: As I mentioned before, EAP is a valuable resource but likely not the best as a stand-alone support in the event of LODD, and it certainly would not be able to function as a family liaison. Many hospitals may have pastoral care staff, such as myself; however, many would not have the capacity to operate as a family liaison or the awareness, authority, and connections to make decisions on behalf of your service. So, neither of these options would not be the best plan in my opinion. CISM teams can help in debriefings, but again, that is different than functioning as a family liaison. Some of your staff members that are trained as CISM peer counselors, however, may be excellent candidates for continued training in LODD and more specifically, as family liaisons.

S: You also mentioned how the family liaison should be taken off shift responsibility and assignments while they are functioning as the family liaison. What time frame should a service expect, and could the director or administrative staff function as the liaison to reduce scheduling disruptions?

KC: The time frame will be variable and unique to each situation; this is part of the importance of a service’s selection and training of these individuals. They need to determine when the family needs the high-intensity liaison, when to move to periodic support, and when to transition out to periodic or then eventual annual check-ins. They need to do this without creating a co-dependence.

A director or administrative staff would not be the ideal candidate for the family liaison assignment. The director will be busy dealing with many other operational details and would not be able to devote the time or attention to the family during the high-intensity phase. Ideally, the liaison will be someone the fallen individual knew, worked alongside, and had a good relationship with; someone who can share some stories with the family. The liaison’s ability to do this goes back to the importance of fostering the family/spousal support network as well.

There are many ways in which services can prepare for a line of duty death. Option one is to bury your head in the sand and pretend it will never happen to you. This, we know, is a lie; a lie to ourselves, our employees and their families. Option two is to address the potential with eyes wide open and full support starting in orientation and stretching through the selection of qualified employees for advanced training. Even if I am lucky enough never to experience a LODD personally, I would rather work for an organization adopting option two every time.

“It is a curious thing, the death of a loved one. We all know that our time in this world is limited and that eventually all of us will end up underneath some sheet, never to wake up. And yet it is always a surprise when it happens to someone we know. It is like walking up the stairs to your bedroom in the dark, and thinking there is one more stair than there is. Your foot falls down, through the air, and there is a sickly moment of dark surprise as you try and readjust the way you thought of things.”

― Lemony Snicket, Horseradish

HIPAA and Mobile Devices: What Your Service Needs to Know

For ambulance services, HIPAA compliance is a particularly sensitive issue. Because of the sensitive nature of the health data that EMS and EMT professionals deal with on a daily basis, HIPAA Privacy and Security standards must be carefully adhered to.

This issue becomes even more sensitive when you consider that most of the data collected during pre-hospital care will likely be collected, tracked, and documented on a mobile device. Laptops, smartphones, and tablets are indispensable tools for ambulance care. Most of these devices will have access to electronic health records (EHR) platforms, which will in turn be connected to the rest of a hospital’s EHR data.

While mobile devices can provide convenience in life-or-death situations, they are also particularly vulnerable to the risk of a data breach. A data breach of unsecured health information can lead to serious HIPAA violations and put patient privacy at risk.

The kind of health information that these devices have access to is called protected health information, or PHI. PHI is any demographic information that can be used to identify a patient. Common examples of PHI include names, dates of birth, medical information, insurance ID numbers, addresses, full facial photos, and telephone numbers, to name a few.

The HIPAA Rules set specific standards for maintaining the privacy, security, and integrity of PHI. Though the regulation can seem complex, the standards are in place to safeguard PHI. As per HIPAA, ambulance services necessarily fall under the category of Covered Entities, meaning that they are responsible for maintaining compliance with both the HIPAA Privacy Rule and the HIPAA Security Rule.

These two rules set limits for how and when PHI must be stored and accessed. Below, we list a few of the major components of the HIPAA Rules that all ambulance services can implement in order to keep PHI safe and secure on the go.

  • All mobile devices that can access PHI must have full-disc encryption. Additionally, all devices should be routinely backed-up on encrypted servers. In the event that a device is lost or stolen, full-disc encryption will keep hackers or thieves from accessing sensitive health data.
  • Your organization should have HIPAA policies and procedures in place pertaining to mobile devices taken “off-site.” This would necessarily include all laptops, tablets, and smartphones with access to PHI that are used in pre-hospital care in an ambulance. By outlining when devices are permitted to be used, who is permitted to use them, and how they are to be handled in off-site settings, your organization will mitigate the risk to PHI stored on these devices.
  • Keep a full inventory of all devices within your organization that can access or handle PHI in any way. Routine check-ups on the condition and location of devices listed in your inventory will help ensure that devices are not misplaced. And in the event that a device is misplaced or stolen, organization officials will notice as soon as the inventory is reviewed so that action can be taken to remedy the breach.
  • Access to PHI on mobile devices and in pre-hospital settings should be limited only to essential members of the organization’s workforce. This is known as the Minimum Necessary Standard. It’s a part of the HIPAA Privacy Rule that states that access to PHI must be limited based on employees’ roles, and that when access is granted, it should be limited to the minimum access necessary for each employee to perform their role.

These are just a few of the ways that ambulance services can protect PHI and comply with HIPAA mobile device standards.

In addition to the actions listed above, a total compliance program that addresses the full extent of the law must be in place in order to prevent HIPAA violations and data breaches.

Addressing HIPAA compliance can help ambulance services confidently treat their patients without worrying about the risk of data breaches or government fines.

What I Wish I Had Known

Congratulations! You were selected for the Paramedic Supervisor position, if you accept, we’ll start the transition immediately.

I remember the excitement I had when I heard those words so many years ago. The excitement that carried strongly through 2 days of celebrating with my husband, anticipating the new world I was about to be part of; making a mental list of all the mountains I couldn’t wait to move! This excitement was quickly drowned by a sinking feeling deep in my gut. It felt like running out of gas on a country highway at one in the morning and your cell phone is dead; it’s dark, there is nobody around, and you cannot phone a friend.

Whether it comes right away, or later—because of the reaction of people we thought were friends or feeling overwhelmed in a new situation you were expected to handle with precision, we’ve all felt that feeling as a new leader. By sharing our stories with one another, the success and the failures, we all grow.

I remember getting so much advice from those who walked the road before me, some solicited some not. The stories were sometimes shocking, often comical and always gave me perspective and insight into my own blunders – most importantly the stories many shared with me taught me the importance of humility and the ability to laugh at myself, admit my mistakes, learn and move on. At some point, the tide started turning, and friends and colleagues began asking me for my stories and advice. Although I often felt like I wasn’t experienced (i.e. old enough) to be offering any advice I realized it’s not necessarily the age or years of experience behind the story that makes it meaningful. The power is in the ability to share an experience through storytelling—finding common ground amongst the hierarchy of titles and job descriptions.

I think it is easy to lose sight of how our words and actions can affect others as we are wrapped up in our day to day and moving down the checklist of tasks. The influence of a leader in an organization, even an informal leader, is long lasting and not to be taken for granted. Over the past year, I’ve been talking to many EMS leaders of the past and present. I’ve been asking them what they wish they would have known when they first started their leadership journey, and what advice they might give to others just starting out. Here are 10 of the most common answers I received.

Top 10 Things I Wish I Had Known

  1. I wish I would have known I could be myself. Being myself earned me the role, but suddenly it didn’t seem like enough. At first, I thought others were putting all this pressure on me to be an amazing supervisor immediately – in hindsight, I realize I was putting the pressure on myself and it was totally unnecessary. Being myself allowed me to be a more effective supervisor for my team and I wish it hadn’t taken me so long to figure it out.
  2. I wish I would have learned earlier how important listening is. Listening to understand your people, listening to learn and listening to understand the politics that are happening beyond the surface.
  3. I wish I would have known that I didn’t have to be right all the time; I wasn’t expected to be right all the time. I was only expected to be an honest and reliable resource for my team.
  4. Change is slow. PAINFULLY slow. In EMS there is constant instant gratification – you see a problem with a patient, you fix it, you drop them off. Transitioning to an administrative role and learning that change is slow and takes time (SO MUCH TIME!) is more difficult than I ever would have imagined. I had to really learn to see the long game.
  5. It’s not a “day job”. As a leader, you’re never off duty. Whether you’re on a regular rotation as a shift supervisor, or in the office as a manager or director, EMS is a 24/7 world which means you work nights, weekends and holidays right along with your team. You may not be on a truck or at a station—but you’re still available to them all the time.
  6. I wish I would have understood how important mission, vision, and values really are to a company, and how important it is to talk about them with staff.
  7. We’re all learning, and it is OK to ask for help.
  8. Just because a staff member is asking me a question, it does not mean they are challenging my authority. As a leader, it took me a long time to realize that I should embrace a staff member challenging a decision so long as they are doing it in a constructive manner.
  9. I wish I would have known how much of an impact I have on people. I don’t mean that in an arrogant way. I’ve had staff bring up conversations we had years ago, and I had forgotten all about it—but they were still carrying that encounter with them.
  10. That it wasn’t for me. I thought I wanted to be a supervisor – a leader. I was wrong. I was unhappy with the role and everyone knew it but me, and I was becoming destructive.
    When I came to the realization that I wasn’t the right person for the role, my boss allowed me a front row seat to the best example of leadership I have personally witnessed. He allowed me to step back from the role but didn’t forget about me; he continued to invest in me as an employee and as an individual despite the certain protest of others. To this day, he continues to provide guidance on my professional endeavors and is someone I truly look to for honest advice.

Congrats to CAAS Accreditations & Recerts

Congratulations to the AAA members who received Commission on the Accreditation of Ambulance Services (CAAS) accreditation or reaccreditation in November and December!

New certifications

  • Superior Air-Ground Ambulance (Elmhurst, IL)

Recertifications

  • Ambucare (Bremen, GA)
  • American Medical Response Central Mississippi (Jackson, MS)
  • American Medical Response, Los Angeles (Irwindale, CA)
  • American Medical Response, San Diego (San Diego, CA)
  • American Medical Response of West Michigan (Grand Rapids, MI)
  • American Medical Response South Mississippi (Gulfport, MS)
  • Lifeguard Ambulance Service (Milton, FL)
  • Metro West Ambulance (Hillsboro, OR)
  • Richmond Ambulance Authority (Richmond, VA)

AAA Members Serve in Disaster Relief

Expedited Application Processing to Join Federal Disaster Response

We are seeing unprecedented, catastrophic flooding in Texas and it looks as though disaster response efforts could potentially continue for the foreseeable future.

American Medical Response (AMR), has been a member of the AAA since 1992. The AMR Office of Emergency Management (OEM), within its national ambulance contract as the Federal EMS provider has responded to the state of Texas in its role as the FEMA prime contractor. The company has engaged a number of EMS companies who have responded to the Hurricane Harvey deployment. Many AAA member companies are disaster subcontractors for AMR and have proudly responded to federally-declared disasters since 2007.

Because of the potential protracted length of this storm and recovery efforts, AMR is now processing new applications to augment its existing operations. To help with those efforts, AAA wants to extend information about becoming a network provider for AMR. If your organization is interested in applying, please use this PDF application.

When officially deployed by AMR as a subcontractor, EMS providers are compensated portal-to-portal. During deployments, lodging, subsistence, and fuel may be provided. If not provided, EMS subcontractors will be reimbursed for approved expenses.

We recognize that many EMS providers are regulated by local or state agencies and may have restrictions when it comes to responding to out-of-area disasters. The EMS needs of local communities are primary and participation in the AMR Emergency Response Network is not intended to undermine those obligations. States may have Emergency Management Assistance Compact (EMAC) agreements with ambulance services; therefore, AMR will not utilize assets that are committed under EMAC.

We are all hoping the waters will recede and first responders will be able to return to their homes soon, but we could be looking at prolonged recovery, and we know our AAA members are always called to serve.

For additional information, you can contact:

Laura Vigus
Laura.Vigus@amr.net
214-793-4073

Thank You, Participating Members!

AAA is deeply proud to represent dozens of member organizations who deploy at a moment’s notice to serve in large-scale disasters like Hurricane Harvey as part of AMR’s federal emergency contract. Thank you for your service to our nation.

Acadian Ambulance(TX)
Alert Ambulance Service Inc (NJ)
Alliance Mobile Health (MI)
Amcare Ambulance (VT)
America Ambulance Service Inc.
American Trans Med(SC)
Anniston EMS (AL)
Arizona Ambulance(AZ)
ATS Ambulance
Baca/Crestone Ambulance Service (CO)
Bangs Ambulance(NY)
Bartlesville Ambulance(OK)
Beauport Ambulance Service Inc (MA)
Bell Ambulance Inc. (WI)
Bennington Rescue Squad(VT)
Calex Ambulance(VT)
Cape County Ambulance(MO)
Central Emergency Medical Service Inc. (GA)
Citywide Mobile Response Corp (NY)
Community (Mid Georgia) (GA)
Community Ambulance Genesis (OH)
Community Care Ambulance Network (OH)
Community EMS (MI)
Community EMS Dayton (OH)
Elgin Medi Transport(IL)
Elizabeth Township EMS (PA) (12167)
Empress Ambulance Service Inc (NY)
Erway Ambulance(NY)
F-M Ambulance Service Inc (ND)
Fraser Medical Services(IA)
Guardian Angel Ambulance Service Inc (PA)
Humboldt General Hospital (NV)
Huntsville Emergency Medical Services Inc(AL)
Huron Valley/Jackson Community Ambulance(MI)
Lakes Region EMS Inc (WI)
Life EMS (OK)
Life EMS(MI)
Lifecare ambulance(MI)
Lifecare of Virginia(VA)
Lifeguard Ambulance (TN)
Lifeguard Columbia County (FL)
Lifeguard Knoxville (TN)
Lifeguard Mobile (AL)
Lifeguard Morgan County (AL)
Lifeguard Nashville (TN)
Lifeguard Santa Rosa (FL)
Lifeline Ambulance (IL)
Livingston EMS(MI)
Lyndon Rescue(VT)
Medfleet Systems Inc (FL)
Medshore Ambulance Service (SC)
Medstar Ambulance (MI)
Memorial Hospital of Converse County (WY)
Metro Medical Services Inc (IL)
METS Ambulance(MO)
Mobile Medical Response Inc.(MI)
Mohawk Ambulance (NY) Parkland
Newport Ambulance Service Inc.(VT)
Newton County Ambulance(MO)
North Shore University Hospital (NY) Northwell Health
Pafford Medical Services (AR)
Port Jefferson Volunteer Ambulance Corp Inc.
Professional Ambulance and Oxygen(MA)
Professional Med Team Inc.(MI)
ProMed Ambulance(AR)
Puckett EMS(GA)
Regional Ambulance (VT)
Riverside Ambulance (AR)
Rockland Mobile Care(NY)
Rockland Paramedic Service(NY)
Rugby (ND)
Seniorcare EMS(NY)
Southstar Ambulance(GA)
Spirit Medical Transport (OH)
Star EMS/Miles Grubb Assoc.(MI)
Stat EMS (MI)
Summit County Ambulance(CO)
Superior Air-Ground Ambulance Service Inc (IL)
Taney County (MO)
TLC Emergency Medical Services Inc.(NY)
Trace Ambulance Service(IL)
Trans Am(NY)
Tri Hospital EMS(MI)
Tri-Township Ambulance Service(MI)
Valley Ambulance Authority (PA)

Alabama Governor Signs REPLICA Compact

Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact.

REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact,  recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states..

Learn more about how REPLICA participation can help your state at http://www.emsreplica.org.

Ransomware: A Ticking Time Bomb for Health Care

By Cindy Elbert
President, Cindy Elbert Insurance Services, Inc

If you’re doing business online, you need cyber-insurance. This fact was never made truer than on May 12, 2017 when 50,000 businesses in at least 74 countries were hit by a ransomware attack code named “WannaCry”. Hackers demanded companies to pay a $300 ransom fee or their files would be published on the Internet. The data thieves targeted mostly hospitals and other medical facilities because their data not only included names, home addresses, addiction histories, financial information and religious affiliations but also disclosed patients’ mental health and medical diagnoses, HIV statuses and sexual assault and domestic violence reports. A gold mine of personal information for those with dark purposes.

Two days earlier, a data breach at the Bronx Lebanon Hospital Center in New York compromised the medical records of at least 7,000 people. According to NBC News, “Leaks from the Rsync servers, which transfer and synchronize files across systems, are common. How many more nude photos of patients or ultrasound images will be exposed because of misconfigured Rsync backups?”

On May 4, 2017, a group calling themselves TheDarkOverload uploaded almost 180,000 stolen patient/medical records from three companies onto the Internet because they refused to pay a ransom. The databases stolen were in the .csv format and contained health information about cardiac diagnoses and psychiatric conditions such as depression, along with date of birth and social security numbers.

Most ransomware attacks are led by organized criminal groups utilizing a network of computers infected with malware that then poisons other computers once a spam message is opened. An example of a spam malware would be emails falsely marked as being from a co-worker or friend asking a recipient to open an attached file. Or, an email might come from a trusted institution, like a bank or merchant, asking you to perform a specific task. In other instances, hackers will use scare tactics such as claiming that a victim’s computer has been used for illegal activities to bully victims. When the malware is executed, it encrypts files and demands a ransom to unlock them.

Imagine the nightmare scenario of medical teams out on the field relying on electronic devices such as tablets, laptops, smartphones and PDAs to access patient care records suddenly discovering that their data has been locked, captured by malicious malware., held for ransom with lives in the balance.

Companies need the protection cyber liability insurance offers now more than ever.

Why Your Company Needs Cyber Liability Insurance

  • A single data breach could cost your company thousands of dollars, not to mention the hit to your reputation.
  • Hackers can be halfway across the world—or at the desk next to you.
  • An employee losing a company laptop or cell phone could result in a major security breach.
  • The more personal information your company collects opens your exposure to the likelihood of a data breach attack.
  • As of March 28, 2017, Internet providers can collect and sell your web browser history opening more opportunities for data to be stolen.
  • The average forensic investigation runs $25,000 per server.

Cyberthreats By the Numbers

  • Sixty percent of uninsured small businesses close their doors within six months following a cyber attack.
  • According to the 2016 NetDiligence Cyber Claims study, Healthcare data breaches made up 19% of all breach sectors.
  • The average cost for a breached healthcare company is $717,000.
  • According to the Identity Theft Resource Center’s 2017 Data Breach report, almost 2 million records have been stolen so far this year, making up 22 percent of all breaches – and this is before the “WannaCry” ransomware attack.
  • Forty-seven states mandate that your company take certain measures in the event of a security breach

Protect Your Company

Ransomware attacks and cyber theft will not be defeated any time soon. So now is the time to ask: How do you store sensitive information? How do you control access to sensitive information? Do you utilize a firewall and protection software? Do you allow employees and others remote access to your data bases? Do you have a written security policy? And, most importantly, do you have cyber liability insurance? Is it safe? If your company stores customer information, especially billing and medical data, then there is no question about it: You must protect yourself from the growing legion of cyber predators. You need cyber liability insurance.

About the Author

Cindy Elbert is President of Cindy Elbert Insurance Services, Inc. She is a licensed Property & Casualty Insurance broker/agent, and a proud member of the American Ambulance Association, California Ambulance Association, Arizona Ambulance Association, and The Independent Agents Association.

Cindy has been assisting ambulance providers with their insurance needs since 1982. She understands your questions and concerns and with her relationships with insurance underwriters she can provide you with coverage and service you deserve.
www.ambulanceinsurance.com
Visit the CEIS booth at the AAA Annual Conference & Trade Show!

CAAS-GVS Ambulance Remount Forum on June 7

CAAS GVS Remount Forum
June 7, 2017
NEW LOCATION: Harris Conference Center
Charlotte, NC
Register Now►

The Commission on Accreditation of Ambulance Services, Ground Vehicle Standard Division (CAAS-GVS) will be holding an open forum for organizations involved in the remounting of ambulances. The intent of this meeting is to identify and establish a dialogue with FSAMs and third party Remounters of ambulances in an effort to collect information that may be used in an identified project to create standards for the ambulance remount industry.

Any organization with interest in this topic is invited to attend, including ambulance builders, remounters, regulators, customers and component/material vendors.

This is an information gathering session only. Input from this meeting will be for the use of the GVS Committee once a remount standard project has been defined and scheduled. No decisions will be made or standards created at this meeting.

The meeting will be held on June 7, 2017, from 12:00 pm-5:00 pm EDT, at the Harris Conference Center in Charlotte, NC.

Pre-registration for the meeting will be required. Additional information and a registration link can be found on the www.groundvehiclestandard.org website.

Register Now

Get Big Savings by Using Savvik to Purchase ZOLL Products

Use the Savvik Buying Group Discount included with your AAA membership to purchase ZOLL products and save big! Simply ask your ZOLL sales representative to apply the Savvik contract rates to your next purchase.

Automated External Defibrillators, Related Equipment, Accessories & Product UpgradesZOLL_logo

  • 32% discount on AED Plus defibrillators
  • 32% discount on AED Pro defibrillators
  • 25% discount on all accessories and disposables
  • 25% discount on product upgrades
  • Multiple Unit Sales: Additional discounts available for 2 or more units in a single purchase order
  • Freight terms are prepay & add

ALS Monitors / Defibrillators and Automated CPR Devices Related Equipment, Accessories & Product Upgrades

  • 2% discount on AutoPulse
  • 18% discount on X Series defibrillators and related accessories
  • 18% discount on Propaq MD defibrillators and related accessories
  • 25% discount on M Series & E Series related accessories and disposables
  • Multiple Unit Sales: Additional discounts available for 2 or more units in a single purchase order
  • Freight terms are prepay & add

View The Full Price List

Ask your ZOLL rep to use the AAA’s Savvik Buying Group contract to receive these savings.
For more information or to contact your local sales manager or by visiting the ZOLL corporate website at http://www.zoll.com.

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.

Time to Automate

Founded in 1964, now nationally recognized, Mohawk Ambulance Service is the largest privately owned ambulance service in upstate New York. Our organization services six emergency centers, makes 56,000 trips annually and employs a team of more than 250 staff members. Eighty percent of our trips are for emergency transports where patients are unknown, in critical condition or have no identifying information. Finding fast, efficient ways to verify demographics and discover insurance coverage for these patients is imperative for our revenue cycle and our bottom line.

We’ve always worked closely with our local hospitals and nursing homes to obtain information. Many standard processes have been refined over the years with checks and balances to verify coverage, screen deductibles and reduce eligibility-related rejections before claims are submitted to a payor. But our billing team knew we could do more to eliminate duplicate data entry and processing lag time.

This article describes our journey to a more streamlined billing process. It includes lessons learned and best-practice recommendations for other EMS providers looking to improve staff efficiency and reduce receivables.

First Stop: Real-Time Insurance Discovery

The first area we tackled was insurance discovery where we had three employees stationed. We focused on our self-pay patients and transports lacking complete demographic or insurance information. The goal was to eliminate manual steps and workflow lags—which we quickly achieved.

The original process involved building a list, submitting it to Payor Logic, waiting three days for feedback, and then re-entering information into our billing system. By bringing our vendors together to meet with our team, a real-time technology solution was developed and implemented.

Now our insurance verification team has immediate access to Payor Logic’s search capabilities. Insurance discovery is an online, real-time process. Lists, batches, searching websites and waiting for results have all been eliminated. Also, the two vendors built a crosswalk that integrates insurance coverage results back into our billing system to eliminate duplicate data entry and rekeying.

The productivity our verification team is now able to achieve is amazing. They now do the work of three staff with only two employees—a 30 percent boost in staff efficiency for insurance verification.

Billing also Gets Tech Boost

At Mohawk, we use a combination of technology solutions to support our revenue cycle. But each company worked independently—creating separate silos. Billers would have to search across several different systems, payor websites and the digital pages to collate all the various demographic and insurance data required to submit a claim. We had technology, but the process remained cumbersome and labor intensive.

By working with our vendors, we built points of integration to increase the number of claims processed without adding billing staff. For example, once a biller pulls up a trip, dozens of data elements from the billing system are uploaded into a single view to eliminate searching and save time.

Everything the biller needs to complete a claim is displayed in a consolidated view, consistent across all Mohawk companies. Billers can easily see patient signature, facility signature, narrative, vital signs, advanced life support and more. This level of integration eliminates the need to look at every page of the system to build the claim—saving dozens of hours every week.

Lessons Learned

Like most EMS providers, our mission is to uphold the highest standard of services with consistent devotion to delivering superior emergency medical care. And through this automation project, we took service excellence one step further—delivering world-class service throughout our billing process. We find more insurance coverage, reduce eligibility-related rejections, convert self-pay accounts and collect more revenue from the right source. Results thus far include:

  1. 30% improvement in staff efficiency for insurance verification
  2. 67% less time needed per case to screen for Medicare deductibles
  3. 100% elimination of wait times to discover billable insurance for self-pay patients

EMS providers looking to streamline the billing process should revisit their existing technology applications and engage in serious discussions with current vendors. New capabilities are out there and should be explored. The automation efforts described above have resulted in an efficiency uptick for Mohawk, despite being short staffed. New workflows for verification are being maintained by our team and next steps for automation expansion are being discussed. By keeping open communications and an ongoing dialogue with all parties involved, this automation experience has been a win-win for our business, our staff and our patients.

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.

Bathroom Battle Continues

In an unprecedented move, the United States Supreme Court has cancelled a scheduled hearing for Gavin Grimm, a transgender student who is fighting for the right to use the restroom in his public school consistent with his gender identity.  The arguments were scheduled to be heard on March 28th but have been removed from the hearing calendar following the cancellation of an order signed by President Obama by the Trump Administration.  The Appellate Court had relied on the guidance in the Obama order in rendering its decision.  Many feel that the removal of this case from the U.S. Supreme Court calendar is an effort to delay hearing of this issue until the vacant seat is filled by nominee Judge Neil Gorsuch.  Learn more about Gavin Grimm, the cancellation, and what comes next on CNN.com.

While this is not a case that involves the rights of transgender individuals in the workplace, it was serving as the test case for the transgender issue.  In the meantime, many states have passed laws regarding the rights of individuals to use the restroom that is aligned with their gender identity.  Employers should know that the Equal Employment Opportunity Commission is likely to continue to interpret Title VII as including protections for transgender individuals from gender discrimination.  As always, we will continue to monitor the issue and provide guidance for ambulance providers.

Drug Supply Chain Security Act Guidance

The U.S. Department of Health and Human Services, Food and Drug Administration (FDA) recently issued guidance for the Requirements for Transactions with First Responders under Section 582 of the Food, Drug, and Cosmetic Act. For those of you who are not as familiar with this law, this is the section of the Act that is referred to as the Drug Supply Chain Security Act provisions. This Act enhanced the FDA’s ability to protect consumers from exposure to drugs that may be counterfeit, stolen, contaminated, or otherwise harmful from being dispensed and administered to patients by requiring certain product tracing information be provided and maintained by certain dispensers. The guidance is intended to describe the FDA’s current thinking on the topic and should only be viewed as recommendations, unless a specific regulatory or statutory requirement is cited.

Background

The Drug Supply Chain Security Act requires that dispensers (retail and hospital pharmacies), trading partners (manufacturers, re-packager, wholesale distributor), and third party logistics providers (entities that provides or coordinates warehousing but doesn’t take ownership) to provide and maintain tracing information to entities upon distribution or transfer of ownership and that both dispensers and those who receiving ownership of a product had to maintain the tracing information for a minimum of six (6) years.

The tracing information includes both a transaction report and transaction statement.  The information required in those reports are defined in Section 581 of the Act and include:

Transaction Report

  • Proprietary or established name or names of the product
  • Strength and dosage form of the product
  • National Drug Code number of the product
  • Container size
  • Number of containers
  • Lot number of the product
  • Date of the transaction
  • Date of the shipment, if more than 24 hours after
  • Date of the transaction
  • Business name and address of the person from whom ownership is being transferred

Transaction Statement

  • Is authorized as required under the Drug Supply Chain
  • Received the product from a person that is authorized as required under the Drug Supply Chain Security Act
  • Received transaction information and a transaction statement from the prior owner of the product, as required under section 582
  • Did not knowingly ship a suspect or illegitimate product;
  • Had systems and processes in place to comply with verification requirements under section 582
  • Did not knowingly provide false transaction information; and
  • Did not knowingly alter the transaction history.

The administrative requirements of these provisions have been a compliance challenge for many EMS agencies who often lack the resources to maintain this information in paper or electronic form for a minimum of six years.

Another requirement of the Act is that dispenser can only distribute medications to “authorized” entities who are licensed in the state to which they dispensing the product.  This is often a challenge because some EMS agencies do not meet the definition of “authorized” under the Act.

New Guidance

This new guidance was issued to minimize the possibility of disruptions to first responders due to the provisions of the Act. In issuing this guidance, the FDA states that it recognizes that dispensers, such as hospital pharmacies, often dispense small quantities of medications periodically and that many dispensers (pharmacies) lack the resources to provide product tracing information for these transactions.  Also, the FDA recognizes that many first responders do not meet the definition of “authorized” dispensers as delineated in section 581(2) of the Act but are authorized under applicable law to administer medications without a license by medical treatment protocols or standards.  The guidance states that the FDA does not intend to take action against with regard to the following provisions of the requirements for transactions with first responders.

Trading Partners

The FDA is not intending to take action against a dispenser who transfers ownership of product directly to a first responder when the dispenser does not provide the first responder with product tracing information provided that:

  • The dispenser captures and maintains the product tracing information for the transaction for not less than six (6) years after the transaction; and
  • The dispenser provides such product tracing information to the first responder or the FDA if requested not later than two (2) days after receiving the request.

The FDA also does not intend to take action against a trading partner (dispenser) who transfers product to a first responder who is not “authorized” as a dispenser within the meaning of the Act.

First Responders

The FDA is not intending to take action against first responders who:

  • Accept ownership of a product without first receiving the product tracing information and does not keep and maintain that information for six (6) years.; or
  • Does not have systems in place to enable the verification of suspect and illegitimate product as required by section 582(d)(4).

However, first responders who suspect that the product that they received is illegitimate, the FDA recommends that the first responder take steps to protect patients from receiving such product and should notify the authorities.

Bottom Line

This guidance should remove much of the administrative roadblocks for those who dispense medications to first responders.  It should also remove the administrative burdens for services who do not have the resources or infrastructure to comply.  That being said, if you are currently meeting these requirements, I would suggest that you continue to do so.  However, if these sections of the Section 582 provisions were preventing your services from getting medications from dispensers, this should provide some relief.  As always, if you have any questions or need further clarification, please contact the American Ambulance Association.

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.

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Patient Apologies in EMS

When something goes wrong during an ambulance transport, sometimes the most important thing to do is to apologize to your patient. Join Matthew Streger, Esq. of Keavney Streger for a brief overview of the Dos and Don’ts of saying, “I’m sorry.”