HOT (red light and siren) responses put EMS providers and the public at significant risk. Studies have demonstrated that the time saved during this mode of vehicle operation and that reducing HOT responses enhances safety of personnel, with little to no impact on patient outcomes. Some agencies have ‘dabbled’ with responding COLD (without lights and sirens) to some calls, but perhaps none as dramatic as Niagara Region EMS in Ontario, Canada – who successfully flipped their HOT responses to a mere 10% of their 911 calls! Why did they do it? How did they do it? What has been the community response? What has been the response from their workforce? Has there been any difference in patient outcomes? Join Niagara Region EMS to learn the answers to these questions and more. Panelists from co-hosting associations will participate to share their perspectives on this important EMS safety issue!
Kevin Smith, BAppB:ES, CMM III, ACP, CEMC
Niagara Emergency Medical Services
Jon R. Krohmer, MD, FACEP, FAEMS
Team Lead, COVID-19 EMS/Prehospital Team
Director, Office of EMS
National Highway Traffic Safety Administration
Douglas F. Kupas, MD, EMT-P, FAEMS, FACEP
Medical Director, NAEMT
Medical Director, Geisinger EMS
Matt Zavadsky, MS-HSA, NREMT
Chief Strategic Integration Officer
MedStar Mobile Integrated Healthcare
Bryan R. Wilson, MD, NRP, FAAEM
Assistant Professor of Emergency Medicine
St. Luke’s University Health Network
Medical Director, City of Bethlehem EMS
Director of Fire & EMS Operations
Technical Assistance and Information Resources
International Association of Fire Fighters
Mike McEvoy, PhD, NRP, RN, CCRN
Chair – EMS Section Board – International Association of Fire Chiefs
EMS Coordinator – Saratoga County, New York
Chief Medical Officer – West Crescent Fire Department
Professional Development Coordinator – Clifton Park & Halfmoon EMS
Cardiovascular ICU Nurse Clinician – Albany Medical Center
Today, the Centers for Medicare and Medicaid Services (CMS) released “Putting Patients First: The Centers for Medicare & Medicaid Services’ Record of Accomplishment from 2017-2020,” a report highlighting the agency’s transformation in ensuring all Americans have access to quality and affordable healthcare.
The report examines CMS’ accomplishments over the last four years, highlighting agency actions that responded to the coronavirus disease 2019 (COVID-19) pandemic and furthered CMS’s Four Core Goals identified in 2017: empowering patients and doctors, ushering in a new era of state flexibility and local leadership, developing innovative approaches, and improving the CMS customer service experience.
Accomplishments covered in the report include the response to the COVID-19 pandemic and efforts through 16 strategic initiatives that resulted in major regulatory actions, changes in guidance, and streamlined processes and procedures – including the reorganization of CMS. It also allows agency staff and leadership to better understand the impacts of policy decisions, while providing a resource to inform future CMS decisions. The report also covers how progress with respect to the Four Core Goals significantly contributed to the agency’s ability to respond to the unprecedented COVID-19 public health event.
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.
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:
30% improvement in staff efficiency for insurance verification
67% less time needed per case to screen for Medicare deductibles
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.
Kathy Lester, MPH, JD
Healthcare Consultant to AAA
Tell us a little about yourself, please.
I am from Indianapolis, Indiana. I graduated from Warren Central High School, best known for being the high school of Jane Pauley and Jeff George. My undergraduate degree is from DePauw University. I had a double major in biology and English literature, with a minor in violin performance. I also loved philosophy and political science course and was the editor-in-chief of the college newspaper. I received my JD from Georgetown University Law Center and my Master of Public Health (MPH) from The Johns Hopkins School of Public Health and Hygiene, now known as the Bloomberg School of Public Health.
My husband and I met while both working for Senator Lugar. He retired from the Senate after 20+ years. We have two children and are trying to succeed in having tropical fish survive for more than a few months.
When and how did you get involved with AAA?
I began working with the AAA several years ago when we began developed recommendations for a quality program. I believe my first meeting with the group was in Las Vegas.
How do you help AAA?
Currently, I assist on the public policy issues. This includes working with the Congress to protect the add-ons, as well as develop payment reforms to create stability for Medicare rates. I help to draft materials for the Hill and legislative language. As part of this effort, I help with developing more comprehensive Medicare reform recommendations. I also assist with the regulatory agenda and engage with Centers for Medicare and Medicaid Services (CMS) and other federal agencies. In addition, I continue to work on quality structural and measurement issues.
What is your typical day like?
Unpredictable and fun! My days vary greatly. I can find myself on the Hill or driving to Baltimore to meet with CMS. I also spend a lot of time talking with AAA members and the staff team.
What are the biggest challenges you foresee for our industry?Any tips or last thoughts?
It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.
[/quote_left]All of healthcare is at a crossroads. While federal policymakers have successfully reduced spending in the Medicare program, the focus for the foreseeable future will be how to reduce the cost of providing services. It is more important than ever to understand the cost of services and to be able to articulate why these services are necessary.
For ambulance providers and suppliers in particular, there is great promise in the innovative payment models, because they would most likely recognize the high quality of health care services provided by ambulance providers and suppliers. However, there is also the potential that ambulance services could become subordinate to larger provider organizations. As this debate unfolds, it is critically important that data drive any reforms and that the industry look carefully at how programs such as value-based purchasing, the Medicare quality reporting programs (facility compare websites and the five star rating programs), and coordinated/integrated care models have worked for other Medicare providers. At the end of the day, ambulance providers and suppliers need to understand their care and cost models and articulate use these data points to develop meaningful and sustainable reform options.