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.”
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.”
One of the trickiest transitions in an emergency medical services career is moving from peer to supervisor. The American Ambulance Association’s HR & Operations Consultant, Scott Moore, Esq. shares some tips on redefining relationships with EMTs and Paramedics during the move to management. A must watch for your newer leaders!
Last June the AAA notified its members that the Occupational Safety and Health Administration (OSHA) would be requiring employers to file workplace injury information electronically starting in January, 2017 for injury year 2016. This new requirement applies to all ambulance services with 20 or more employees because they fit into the “high risk” category of jobs. Employers with 20-249 will only be required to submit the summary data, those with 250 or more will be required to submit injury specific information. OSHA will allow for several mechanisms for submitting this information through a secured website which is scheduled to go live in February 2017. OSHA has provided additional information regarding the new reporting requirements on their website. As more information becomes available, we will share it with our members.
AAA members have free access to amazing bargains on everything from computers to PPE to ambulances through Savvik Buying Group. Check out the deal below, or contact Savvik’s friendly staff for assistance!
Not yet an AAA member? Join today to unlock access to Savvik deals, as well as all of membership’s other great HR, operations, and consulting benefits.
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This past July, the AAA advised our members about new Section 1557 Non-Discrimination provisions of the Affordable Care Act (ACA) impacting ambulance providers that became effective on July 18, 2016. On May 13, 2016, the Department of Health & Human Services (HHS) published the Final Rule aimed at improving access to care and eliminating discrimination and inequities in the provision of healthcare services. At that time we identified several provisions in the new rules that we felt ambulance providers might have difficulty complying with. The AAA requested some guidance from the Office of Civil Rights (OCR) regarding these challenges and had some dialogue with representatives from that office this past week.
Please be sure to review the July Advisory on the AAA Website for a detailed explanation of the rule requirements. As a brief review, the new ACA Section 1557 rules build off of existing Title VII and other discrimination laws that extend protections to previously underserved or under-represented groups of people with regard to healthcare. The new Regulations prohibit discrimination on the basis of race, color, national origin, sex, age, or disability in certain health programs or activities. In addition, the Regulations provide discrimination protections on the basis of pregnancy, gender identity, and sex stereotyping. The Final Rule also requires that “covered entities” make available assistance for individuals with Limited English Proficiency (LEP) and those with disabilities, including communications related disabilities.
The Rule requires that covered entities, including ambulance providers, with 15 or more employees to name a Compliance Coordinator and establish a Grievance Procedure. The Compliance Coordinator is to monitor and coordinate compliance efforts with regard to the provisions of Section 1557. The Grievance Procedure has to provide the appropriate due process standards that would allow for the prompt and equitable resolution of complaints concerning actions prohibited by Section 1557. HHS has included a sample Grievance Procedure in Appendix C to Part 92—Sample Section 1557 of the Affordable Care Act Grievance Procedure to assist covered entities in meeting this requirement.
In addition, the Rule requires that all covered entities make available (post) notices to patients and members of the public assuring them that the covered entity does not discriminate on the basis of race, color, national origin, sex, age, or disability. Required in the notice is that the covered entity has a Grievance Procedure and a Compliance Coordinator for those who feel that they may have been discriminated against. In addition, the notice must include the accessibility of auxiliary aides and services for individuals with LEP and those with communication related disabilities. HHS has included a sample notice that covered entities can utilize to meet these notice requirements. Also, providers are required to post tag-lines regarding non-discrimination and the availability of auxiliary aides in the top 15 languages spoken in the state that they provide services.
During our discussion with representatives from OCR, we explained that ambulance providers would have little difficulty complying with the Compliance Coordinator and Grievance Procedure requirements of the new rule but that the notice requirements would be a bit more challenging. We explained that, as mobile healthcare providers, patients do not generally come to our ambulance stations to access care but that we usually encounter patients on the scene of an accident or in a patient’s home. We expressed our concern that merely posting notices at our ambulance stations locations would not likely meet compliance with the new rules. OCR agreed with our concern and acknowledged that the Section 1557 provisions had been drafted with conventional “brick and mortar” healthcare providers in mind.
During the dialogue, we notified OCR that we have advised members to post the required notices at their physical locations, on their company websites, and in any other way that is feasible given our unique healthcare delivery model. We discussed the difficulties with placing the notice in the vehicle and the many reasons why this was not a viable option, which OCR acknowledged as presenting a unique challenge.
While OCR did not provide us with a reprieve from the notice requirements of the new rule, staff did state that our members needed to use “reasonable” efforts to provide a meaningful notice to our patients. While not the specific guidance we had hoped for, it is an acknowledgement that our healthcare delivery model presented practical challenges with these specific requirements. It is also possible that OCR issues more definitive written guidance in the future, but that is not likely to come until after the new Administration takes shape.
It goes without saying that member companies should already comply with Compliance Coordinator and the Grievance Procedure provisions of the rule. With regard to the notice provisions, member companies need to post the required notices at any station location and on their company websites in a conspicuous place. Also, that member companies post the required notices and taglines in a on any “significant publications or communications” that the company provides or distributes to patients or the public that they serve. The guidance did not define a “significant publication” but states that postcards and small pamphlets would not be considered “significant.”
More practically, given the nature of our industry, services should add language to any written correspondence that they have with the patient. For example, services can add the required notices and taglines to the patient signature process. Not that the patient has to sign off on the Sect 1557 notices but have the required notices and taglines precede the patient authorization signature language on your trip record. In addition, services should include the notice requirement to any correspondence or invoices sent to the patient.
Member companies may consider that the “reasonableness” of their efforts to provide notice may differ for emergency and non-emergency patients. Not all of the patients our members encounter are in emergency situations on a busy roadway. Typically, non-emergency patients have lower sense of urgency and the field providers may be able to more meaningfully provide notice to the patient of the non-discrimination provisions, grievance procedure, and the availability of auxiliary aides and services for patients with LEP and communication related disabilities. This can be done in a number of ways.
It is important that an ambulance provider be able to demonstrate that they made “reasonable efforts” to ensure the patient has access to care free from discrimination, understands that the company has a grievance procedure in the event that they feel like they have been discriminated against, and that the company will make available to them the auxiliary aides and services if they have LEP or communications related disabilities. OCR appears to be focusing their efforts on helping providers become compliant rather than any draconian enforcement approach.
OCR has generally adopted a position of assisting covered entities with compliance with the rules. Their office is a resource for our all covered entities whose intent is to comply with these new rules. However, providers who fail to make reasonable efforts or who continue to be non-compliant after identifying issues, should be aware that guidance available on the OCR website states that it will utilize enforcement mechanisms which include:
“The existing enforcement mechanisms under Title VI, Title IX, Section 504 and the Age Act apply for redress of violations of Section 1557. These mechanisms include: requiring covered entities to keep records and submit compliance reports to OCR, conducting compliance reviews and complaint investigations, and providing technical assistance and guidance.”
“Where noncompliance or threatened noncompliance cannot be corrected by informal means, available enforcement mechanisms include suspension of, termination of, or refusal to grant or continue Federal financial assistance; referral to the Department of Justice with a recommendation to bring proceedings to enforce any rights of the United States; and any other means authorized by law. The final rule also recognizes that an individual may bring a civil action to challenge a Section 1557 violation”
If you still have questions regarding what your organization’s obligations are under the ACA Section 1557 rules are, please do not hesitate to reach out to the AAA or to the Office of Civil Rights with the U.S. Department of Health & Human Services.
AAA members have access to deep discounts on products ranging from staplers to medical supplies to ambulances through the Savvik Buying Group. Featured vendors include ZOLL, Henry Schein, Grainger, 5.11 Tactical, Safetech Solutions, and many more.
This week, ZOLL and Savvik are giving away 10 AEDs. No purchase necessary, just complete their brief survey for a chance to win!
If you were asked to name the top 10 most popular websites in the United States today, I’m willing to bet that you could guess most of them: they are, in descending order of Alexa page view rankings, Google, YouTube, Facebook, Amazon, Yahoo, Wikipedia, Twitter, Reddit, Ebay, and LinkedIn.
“Wait,” you may be asking, “what is ‘Reddit,’ and how can it be in the top 10 most popular American websites if I’ve never even heard of it?”
As a self-appointed cultural ambassador for the millennial-heavy EMS workforce, I’d love to give you a basic introduction. Seasoned Redditors, feel free to skip this post. But those new to Reddit, or even social media in general, please hang in there—it is increasingly important for ambulance executives of all age groups and technology skill levels to “get” what is going on in influential online communities.
Reddit describes itself as “the front page of the internet.” What does that mean?
Reddit (usually styled lowercase as “reddit,” but I’m capping for clarity) is an online community platform allowing users to anonymously share, comment, and vote on links, images, personal stories and more in topic-specific “subreddits.” A user’s self-selected subreddits are merged into a personalized feed, which is often very different than the generic Reddit Front Page generated from the posts voted best across the whole site.
Wildly popular with millennials, Reddit is one of the most engaged and active digital communities in history. Reddit communities’ collective taste-making influence drives modern pop culture and politics in unprecedented ways, and the popularity and sway of the site is only growing.
I am sticking mostly to practicalities in this post, but highly recommend reading a little bit about the history of Reddit (2014 Mashable article, 2016 WSJ CEO interview), if you have a moment. The Wikipedia entry also gives a great overview.
Large swaths of your staff are routinely participating in Reddit communities, likely many times per week. For all that we hear about generational conflict in EMS organizations, wouldn’t it be great to gain some firsthand insight into the candid thoughts of EMTs and Paramedics across the country? Of course this only works if leaders approach Reddit (and the subs and threads of varying merit within) with an open mind—because of its inherently populist and anonymous nature, there is an ever-changing mix of valuable and abhorrent content that sometimes takes a little time to sort through.
Additionally, more and more people are electing to get their news, pop culture, and entertainment first through Reddit or other social media, instead of mainstream news sources. EMS leaders relying solely on information from TV newscasts or even the websites of traditional print journalism outlets are missing the backchannel dialogue and meta commentary that is shaping the way our industry is perceived.
Many ambulance execs are unfamiliar with the fact that top politicians as diverse as President Obama and Gary Johnson choose to interact directly with Redditors, personally fielding user questions in the r/IamA sub. Reddit’s political commentary subs are also famed for the sometimes prescient, sometimes wacky user analysis of current affairs and election hoopla. Start with r/politics, the largest sub, to get a feel for the Reddit politosphere, then find your niche in some of the more targeted subs below. Not seeing your interest? Search the site for hundreds of other options ranging from radical to reactionary—or start your own.
We all have that kooky relative who doesn’t “get” Facebook, and so posts inappropriate rants or the equivalent of text voice mails on our walls. Don’t be “that guy” (or gal) on Reddit—although most people are nice, not everyone is patient, and some users may report your post to moderators for removal. Also, it is just good manners to follow the norms of any community in which you participate, be it face-to-face or online. Here are some easy steps to ensure that you become a valued contributor to the Reddit community.
There are many EMS-focused subreddits, ranging from the (mostly) serious to the ridiculous. Here are just a few:
Hint: Sort by “TOP” then choose a timeframe to catch up on the best (or at least most popular) posts in a particular sub.
If someone posts something negative on Reddit (or Facebook, or Twitter, etc, etc) about the organization to which you’ve dedicated so much time and love, it can be very tempting to fire off your side of the story in response. However, it is almost always inadvisable to go in “guns blazing” on an anonymous message board, particularly if you aren’t very familiar with the norms for the specific sub in which you would respond.
If you really feel you must set the record straight, I suggest asking three other sensible Redditors and your attorney to review before posting, to make sure that you don’t accidentally open your organization up to a lawsuit or media nightmare. You may also want to create a separate “throwaway” username before replying, as anything you’ve previously commented or posted under your usual username is publicly visible. No matter how innocuous your past activity may be, it can and will be used against you in the court of public opinion (see: Ken Bone Reddit controversy).
In this case, it is a hard maybe. The tricky thing is that you want your organization to avoid being perceived as “Big Brother,” particularly in response to anything (good or bad) that might have been posted by one of your own employees. Given Reddit’s higher level focus on anonymity than, say, Facebook, even a “thanks so much, so glad to be your favorite employer!” reply can seem creepy or intrusive, depending on context. It may be best to just privately enjoy the knowledge that thousands are reading your unsolicited praises (and likely looking for job openings at your service).
If there are no HIPAA or human resources concerns involved, you can enlist the help of seasoned Redditors in crafting a response that is right in tone for your service.
Commercial self-promotion of any kind is very much frowned upon by the Reddit community. Viral marketing, or any post planting or vote manipulation that can be perceived as viral marketing, even more so. For a glimpse at the level of energy around this issue, please see r/HailCorporate, or consider the vitriol directed at users who create alternate “sockpuppet” accounts to upvote their own posts. Any kind of advertising outside of appropriate subs that specifically allow it (or actual Reddit ads) is risky at best, and may completely backfire.
Read the sidebar rules of the subreddit you’re considering posting in to see if commercial offers are permitted (for example, counter-intuitively, r/jobs forbids job postings). Your may wish to consider posting to one of the subs dedicated to job seekers, including r/jobopenings, r/youngjobs, and r/jobbit, or your closest local job sub.
Another thing to consider is buying an ad on the Reddit site, then running it in EMS-specific subs, particularly if you’re open to paying relocation for medics from other areas, or if you are willing to train individuals coming from other industries.
Note: recruitment is not yet a primary Reddit focus, so you may or may not have much luck at this point. However, as more people join Reddit and rely on it new and different ways, this is likely to change.
Have questions about Reddiquette or other social media platforms? Please don’t hesitate to reach out at firstname.lastname@example.org. Please feel free to share your own tips in the comments section below. We would love to hear about your ambulance service’s online successes and foibles.
As a current mobile integrated health provider, we recognize the values of an MIH program which most importantly provides quality patient care to those in need, often in the comfort of their own homes. This is often done under the direction of the patient’s primary care physician in conjunction with the patient’s healthcare team. This allows for the patient to maintain their quality of life while receiving the medical attention they need—and ultimately reducing the healthcare expenses of hospitalization.
COO, Cataldo Ambulance Service
Join Patrick “Sean” Tyler, executive vice president and chief operating officer of Fallon Ambulance Service, on September 28 for Alternative Pathways to Care: The Massachusetts Experience.
EMS systems around the US have historically been incentivized by Center for Medicare and Medicaid (CMS), private insurers and other payers to transport all patients encountered through accessing 911 emergency call systems, to an acute care facility emergency department (ED). The reimbursement model for ambulance services in place currently only provides payment for transport of any patient to a state licensed ED according to CMS. The changing healthcare system in the US, through the Affordable Care Act (ACA) 2010, looks to healthcare systems and contractors to provide healthcare at a lower cost. CMS is prescribed, as part of the ACA, to test innovative delivery models to reduce program expenditures…while preserving or enhancing quality of care furnished to individuals.”
This session will review the concepts and programs of implementing a modified system of care whereas trained EMS providers, under the supervision of a physician Medical Director, can transport patients experiencing a psychiatric emergency or require drug abuse services to a destination other than the acute care emergency department. This session also will review existing research papers, conclusions and data available for several existing programs for EMS utilization of permissive alternative destination for behavioral and mental health patients and patients requiring services for drug or alcohol use, in the absence of any acute medical condition.
You may have seen in the American Ambulance Association’s Digest newsletter that many ambulance services are facing a 400% price increase in the price of EpiPen epinephrine injections. AAA members are beating the surge through AAA’s partnership with the Savvik Buying Group (formerly the North Central EMS Cooperative). Members, save big on Epi-Pen and Epi-Pen Jr today!
This past May, the AAA published an Advisory to members to alert them of new OSHA injury reporting requirements for employers starting this August 10, 2016. The Department of Labor announced today that it will be delaying the implementation of these new requirements until November 1, 2016. In the press release, the DOL stated that it is “delaying enforcement of the anti-retaliation provisions of the new rule to allow time for additional outreach and education.”
The DOL states that the intent of the new rules are an effort to collect data for the purposes of improving safety to reduce injuries and illnesses in the workplace. The Occupational Safety Health Administration (OSHA) has issued its final rule regarding new Federal Reporting requirements for certain employers. The new rule will require those employers who are already required to record injuries to report those injuries to OSHA electronically. All ambulance providers with ten or more employees are required to keep a record of injuries that occur in the workplace.
To ensure that employees are encouraged to report work related injuries, the new rule has provisions that require employers to have reasonable procedures for reporting work related injuries and that they be able to do so free from fear of retaliation. OSHA notes in the new rule that it believes that many worker injuries go under-reported because of fear of negative job action. This is of particular concern with lower wage positions. The delay in enforcement announced today is to allow the DOL more time to perform outreach and education for employers regarding these specific provisions.
The AAA hosted a webinar in June to that outlined the new reporting requirements. This webinar was recorded and is available to those members who may have missed it. To access Don’t Let Work Related Injuries Cripple You, go to the Members Area on the AAA Website. As always, the AAA will monitor any guidance or outreach provided by OSHA to assist our members with regard to compliance. If you have any questions or need assistance, please contact any of our consultants on the website.
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Questions? Contact email@example.com to learn more, or for full pricing information.
Important new anti-discrimination regulations impacting the ambulance industry take effect on July 18, 2016. In this video, Scott Moore, Esq, AAA’s human resources and operations consultant, shares what your service needs to do to be prepared by the implementation deadline.
Download Scott Moore’s presentation, then customize it to share with your ambulance service!
The American Ambulance Association is pleased to announce that AAA members can now save significantly on Physio-Control products through the Savvik Buying Group.
Through Savvik’s partnership with Vizient (formally Novation), the largest acute care GPO in the United States, AAA members now have access to this discounted contract on AED’s, Monitors, and Lucas devices and accessories.
The Bankruptcy Trustee of Transcare Corporation, et al. is selling seven (7) Ambulance Service Certificates issued by the New York State Department of Health covering New York City, Hudson Valley and Long Island at public auction, free and clear of any and all claims.
This presents an unparalleled opportunity to serve both NYC EMS and many of the largest and most respected health care providers in the area covering nearly 14 million residents and millions of commuters and tourists.
The Service Certificates cover the following counties:
Bid on one or more of the service certificates!
Auction sale to be held on:
June 28, 2016 at 2:00 P.M.
United States Bankruptcy Court
One Bowling Green
New York, New York 10004
Offers to purchase must be made by twelve o’clock noon on June 27, 2016 and are required to comply with prescribed Sale Terms as outlined in the Sale Order filed in connection with the TransCare Corporation, et al. bankruptcy proceeding which is available upon request by contacting:
Salvatore LaMonica, as Chapter 7 Trustee
c/o LaMonica Herbst & Maniscalco, LLP
3305 Jerusalem Avenue
Wantagh, New York 11793
Telephone: (516) 826-6500
Jonathan N. Helfat, Esq.
c/o Otterbourg P.C.
230 Park Avenue
New York, New York 10169
Telephone: (212) 661-9100
Don’t miss the fantastic member-written editorial, Save lives, not seconds, in Wednesday’s Boston Globe. Submitted by Cataldo Ambulance’s Tom Kimball, it gets to the heart of many issues with using response times as the only performance metric. (Emphasis below is ours.)
Many cities and towns in Massachusetts still judge the performance of their ambulance services using metrics like response times, which can miss the point. An additional two minutes waiting for an ambulance will rarely make a difference for a trauma patient facing emergency surgery that may take hours.
Patient outcome is a more valuable measure of whether a medical service is doing right by people. In many areas of health care these days, it is the gold standard, a key factor in determining how much insurance companies pay service providers. Changing the terms of ambulance companies’ contracts to make good patient outcomes the goal could greatly improve the quality of medical care across the state — and save lives.
Attention AAA members! The American Ambulance Association is teaming up with Sterling Backcheck, the country’s largest and best-respected employee background screening company. AAA members receive deeply discounted pricing, as all background checks for AAA members are treated as one “client.”
Contact Peter.Mulherin@sterlingbackcheck.com for a fast free evaluation today!
When it comes down to the pricing structures offered by different credit card payment processors, how do you determine which is best for your ambulance service? The American Ambulance Association has teamed up with Payline Data to kick confusion to the curb.
Tiered pricing is a rate structure in which several hundred different processing rates are packaged into tiers that represent three different possible rates. Most providers package the rates into three groups with varying markups. Unfortunately, there is no regulation behind how merchant account providers must package their tiers, which prevents merchants from knowing exactly how much a given provider is making on each transaction. Despite the prevalence of tiered pricing in the credit card processing industry, a more competitive and transparent pricing model is available in the form of Interchange-plus pricing.
Interchange-Plus pricing is the most transparent pricing model and it’s what Payline offers to all AAA members. This model for pricing puts the power in your hands by giving you a straightforward and clear explanation of charges. Interchange describes the rates that come directly from the card networks. No merchant or processing company has any control over these rates. Every merchant pays interchange, which varies based on the type of card your customer is using. The plus is what Payline is charging you for our service. It is our profit and is shown in terms of a small percentage markup and a minimal transaction cost.
The best-fit pricing structure is one that is designed to help your business thrive. To hear more about our exclusive pricing option for AAA members, call our friendly Payline representative for a free, no-obligation quote today.
Director of Corporate Partnerships
Your membership is important to us–let us know what you think of your Payline experience!