New Benefit: Kindercare Discount & Priority Placement

AAA understands that EMS staff often experience significant challenges securing quality, reliable childcare, and that these challenges have been exacerbated by school and daycare closures caused by COVID-19. We are here to help!

The American Ambulance Association is proud to share that we have partnered with Kindercare to offer EMS providers priority childcare placement as well as a 10% discount on tuition. Please share this information with your staff! Visit www.kindercare.com/aaa for full details.

Kindercare Locations

AAA member employee families receive priority placement at all 1600 Kindercare centers, including the 400 Essential Care Centers that remain open during the pandemic.

Childcare Services & Age Range

AAA member employees save 10% on full-time, part-time, and drop-in tuition for children ages six weeks to 12 years at any KinderCare Learning Center or Champions before- and after-school sites nationwide.

Existing  Kindercare Families

This offer is available to new families as well as those already enrolled in a participating center.

Tuition Discount Guide

  1. Search for a center or site that is near you (Search Essential Centers Open During COVID-19 | Search All Centers, Including Those Currently Closed)
  2. Schedule a tour of the center or site online or by phone with the center information provided.
  3. When you enroll (or if you’re already enrolled), let your Center Director know you are a member of American Ambulance Association and that you are eligible for a 10% tuition benefit.
  4. Your Center Director will apply the discount on your next billing cycle.

 

Webinar Materials & FAQ: Claims Guidance for COVID-19

Webinar: How to Best Document and Track Claims Related to COVID-19

Recorded: Thursday, March 26th | 12:00pm Eastern
View On-Demand Recording
View PPT Slides

FAQ of unanswered webinar questions:

  1. Is the idea that the ET3 model will be pushed to all ambulance companies or only previously selected participants?

The request into CMS and leadership during the declared public health emergency is to allow all ambulance providers and suppliers to transport patients or treat in place based upon the concepts outlined in the Emergency Triage, Treatment and Transport model as defined by CMMI’s release last year.

  1. While we wait for finalization of the ET3 protocols, will billing be allowed retroactively?

If CMS follows other waiver provisions that they have been approving, then we would expect the waiver to be retroactive. However, that will be clearly identified when and if the final waiver is approved.

  1. Asbel spoke about Telehealth medical necessity, which we assume applies to the QHP.  Neither CMS nor the MAC has provided any guidance regarding MN guidance for the ambulance that is facilitating the telehealth.  CMS ET3 FAQ provides a non-answer. Can you advise?

You will need to understand the nuances around telehealth and what Medicare requires as a covered benefit for telehealth. Please see attached resources below

  1. Do we need to file an application for TIP?

That is unclear at this time. The AAA has been advocating for national policy that would not include an application process during this public health emergency. If CMS accepts our proposal, then we do not expect an application process.

  1. Will Medicare pay for signs and symptoms such as a cough that is not on our LCD list?

The Centers for Disease Control and Prevention (CDC) has established new codes related to COVID-19.  They are available in this link:  https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

  1. How can we bill for lift assists and basically public assist? For example, we are seeing increased med alarm pulls because in some of the senior assisted living or independent with aide service, the aide staff is not showing up or is late.  We are getting 911 calls for help getting dressed, move me from my chair to bed at night, etc. (We have one building with many PACE participants, so many Medicare primary)

Yes, you can bill for any response. I am assuming you are looking to understand who the payer source will be for those responses. Currently, Medicare does not pay for an ambulance response without a subsequent medically necessary transport to a covered destination.

The lift assist and public assist responses may be billed to whoever the caller source is if there is no state or local law that prohibits this practice.

Suggestion: You could work with your state legislature or local governing body to codify in statute or local ordinance the responsibility for these false alarms, or public assists are the responsibility of the requestor and invoke penalties if not paid. There are many local jurisdictions that codify this in law with prescribed penalties to try and deter this abuse.

  1. How does this impact the patients who typically are transported by sedan cars or gurney vans to dialysis, but now are confirmed COVID-19 or suspected and still need to be transported to Dialysis? Gurney Van or Sedan cars don’t have the isolation precautions to transfer those patients. Can those patients now be transported by BLS Non-Emergency ambulance?

Medicare has not changed its requirements for transporting beneficiaries to/from dialysis facilities.  We understand that some MACs recognize as a primary reason for ambulance transport patients who have a communicable disease or hazardous material exposure and must be isolated from the public or whose medical condition must be protected from public exposure.  Some MACs do not view this condition as a primary reason to transport a patient, however.  The AAA is seeking clarification from CMS to try to align MACs around the view that patients who require isolation because of a communicable disease or hazardous material exposure can be transported by ground ambulances.

  1. There is already an “I” origin/destination modifier for the site of transfer between modes of ambulances. Wouldn’t this new “I” confuse things?

Great question. Yes. We will wait and see final direction from CMS if they approved transport to a COVID-19 testing site.

  1. Does the use of the “I” modifier include a site such as a shelter that might be set up for COVID-19 patients? Specifically I am referring to a site that maybe the state or local authority has set up and is not directly tied to a hospital.

Yes, that is the waiver that we are seeking from CMS. They could recommend a different modifier. It should be noted that States do have the authority to request a waiver to allow for this, as well. You do not have to wait on the CMS.

  1. The ICD 10 codes related to COVID19 are not effective until April 1st. Once effective, can they be used on a run that occurred before that date?

On February 20, 2020, the Centers for Disease Control and Prevention issued guidance on the ICD-10 codes that should be used. You can find this guidance at the following site:

https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf

  1. Is there anything on the end user if ambulance personnel need to document differently for billing purposes?

Best practices would be to provide instruction or edits within your PCR that identifies the following: (1) COVID-19 suspected or positive patient; (2) PPE equipment used (not just a general statement); and (3) any other pertinent information related to the inability to sign any forms due to local or state mandates.

Due to circumstances surrounding this national emergency that we have not experienced before, things are constantly changing. Documentation will be the CRITICAL in helping to obtain additional federal, state and local waivers. Accurate and reliable documentation will be key in building the case retrospectively.

  1. Have there been any signature requirement changes due to COVID 19?

CMS has provided the following guidance:

“At this time, suppliers should do their best to obtain proof of delivery and should notate the file that the beneficiary declined to sign.  Where FedEx or similar delivery services have altered their delivery protocols (such as leaving packages at the home without signatures) due to the COVID-19 pandemic, CMS will consider the revised protocols if conducting review absent suspicion of deliberate gaming or attempted fraud.  Suppliers should continue providing the necessary supplies and document the proof of delivery to the best of their ability (such as a picture of the delivery and/or notation in the file). “

  1. Do any of the waivers apply to the patient signature requirement? Are there links or support for how to learn about 1135? How do we know what our state has done regarding 1135 waiver? How do we work with our state to expand services via 1135 waiver?

The link below is a great tutorial on how 1135 waivers work and tracking existing waivers.

https://www.kff.org/medicaid/issue-brief/medicaid-emergency-authority-tracker-approved-state-actions-to-address-covid-19/

The health agency in your state would be your POC to engage regarding ambulance requests for expanded services via the 1135 waiver.

  1. Is there a specific documentation on the HCFA form’s for using the 1135 waiver?

Each payer is issuing specific claims guidance on how to bill for waived services through the 1135. You will need to check with your state Department of Insurance or Medicaid Agency. They should have resources online to assist you with identifying what specific documentation is needed.

  1. Has there been any discussion in the delay of Data Collection?

No.  At this point the program remains underway.  The first set of services required to submit were notified at the end of 2019.  CMS continues to develop the tool it will use to collect the data, which we expect to see later this summer or early fall.  However, if the pandemic continues, we will engage with CMS to determine how they view data collection.

If you have an additional questions, please email the AAA at info@ambulance.org

Presenters:

Asbel Montes
Senior Vice President of Strategic Initiatives and Innovation, Acadian Ambulance Service

Asbel has been a member of the American Ambulance Association (AAA) for eight years and has served on its Board of Directors; he currently is Chair of the Payment Reform Steering Committee. Asbel also sits on the board of the Louisiana Ambulance Alliance. He is a respected thought leader on reimbursement initiatives within the industry and is a requested speaker at many conferences. He has also been asked to testify as an expert witness before federal and state health committees regarding ambulance reimbursement.

Asbel began his employment with Acadian in May 2009. He oversees Acadian’s revenue cycle management, contract management, business office process improvements, and government relations for state and federal reimbursement policy initiatives.

In 1999, Asbel began working for an ambulance billing and consulting firm. After three years, he decided to work for a private, non‐emergency ambulance service. Since then, he has provided leadership in revenue cycle management to four ambulance agencies located throughout the Southeast.

Asbel pursued his education the non‐traditional way by attending college online while maintaining a fulltime job. He received an associate’s degree in accounting in 2007 and graduated in November 2010 with a bachelor’s degree in business management.

Asbel is married to Stephenie Haney‐Montes. He has one daughter and resides in Carencro, LA.

Kathy Lester, Esq.
Principal, Lester Health Law

Kathleen Lester provides legal and strategic advice on legislative and regulatory matters involving Medicare and Medicaid coverage and reimbursement, quality measurement (including valuebased purchasing programs), federal health care funding, health information technology, and medical and Internet privacy — including the Health Insurance Portability and Accountability Act (HIPAA) regulations, other federal and state privacy laws.

Ms. Lester practices at the intersection of health care law and public policy. She focuses her practice on finding solutions to her clients’ problems by assisting them with compliance programs and by seeking legislative or regulatory modifications. She has worked with health care providers and suppliers to modernize their payment structures within the Medicare program. She also assists non-profit organizations navigate the complex maze of federal funding and the authorization process for public health programs. She has worked with manufacturers to ensure coverage and appropriate reimbursement. She helps clients identify and resolve issues that arise from creating, collecting, maintaining, using, and disclosing personal health information. She has been deeply involved in measure development, as well as the creation and implementation of value-based purchasing programs in the Medicare program.

Ms. Lester has served a wide variety of health care providers, including physicians, dialysis facilities, hospitals, long-term care providers, home respiratory suppliers, pharmaceutical manufacturers, device companies, and patient organizations. She also has assisted with the formation and growth of industry-wide coalitions. Ms. Lester has experience in all three branches of the federal government.

Ms. Lester served as a privacy consultant in the Office of General Counsel to the U.S. Department of Health and Human Services (HHS), where she finalized the HIPAA Privacy Rule. Ms. Lester also served as law clerk to the Honorable Michael S. Kanne, Circuit Judge, U.S. Court of Appeals for the 7th Circuit and worked for Senator Richard G. Lugar (R-IN). Prior to opening her own firm, Ms. Lester was a partner in the health care group at Patton Boggs LLP.

During her time at Johns Hopkins, Ms. Lester served on a number of research and review boards, including the Human Genome Project’s Ethical, Legal, and Social Issues Working Group. She has an undergraduate degree in biology with an emphasis on microbiology and genetic research.

Ms. Lester received her J.D. from Georgetown University (cum laude), her M.P.H. from The Johns Hopkins School of Hygiene and Public Health, and her B.A. from DePauw University (magna cum laude). She is a member of the District of Columbia, Indiana, and Maryland bars and is admitted to the U.S. Court of Appeals for the 7th Circuit.

Federal Coronavirus Stimulus Measures

Read a summary of President Trump’s proposed stimulus package developed by analysts from AAA lobbying firm Akin Gump.

As was the case following September 11, and during the Great Recession, President Trump and Congress have managed to bridge partisan divides and quickly develop several legislative packages to address the expanding impact of the coronavirus (COVID-19) on America’s public health system and the broader economy. Phase 1—the supplemental appropriations bill—has already become law. Phase 2—targeted relief for individuals, including paid family leave—has passed the House and is poised to pass the Senate this week. Phase 3—broader economic stimulus designed to deliver cash to individuals to help them weather the downturn, as well as industry-specific relief—is being crafted as we write, hopefully with a bipartisan agreement and quick enactment in a matter of days, not weeks. Continue reading►

2019 Avesta Private EMS Turnover Study

Once again, this year, the American Ambulance Association partnered with Avesta to conduct our annual survey of employee turnover in the private EMS industry. As a valued member of the association, it is our pleasure to share it with you today.

Download the Avesta 2019 EMS Employee Turnover Study

The survey was conducted and managed by the Center for Organizational Research at The University of Akron. The purpose of the study was to better quantify and understand the reasons for employee turnover at nearly every organizational level within EMS. At the very least, this study provides us with a continuing benchmark for defining job-specific voluntary and involuntary turnover percentages.

While no survey is perfect, our goal is to continue to analyze staff turnover and its impact on the private industry.  One thing is clear: when turnover is high, private EMS leaders are faced with increased costs associated with recruiting, selecting, and training replacements. Proactive minimization of turnover will reduce costs and have a positive effect on productivity, morale, and customer/patient satisfaction.

This report continues to serve as a crucial step in understanding and reducing employee turnover in the private EMS industry. We look forward to working with every member of the AAA to identify meaningful turnover reduction strategies.

Best regards,

Dennis Doverspike, Ph.D.,
Lead Industrial Organizational Psychology Consultant Avesta – Human Resource Support

Scott Moore
Principal, Moore EMS Consulting, LLC HR & Operations Consultant, AAA

President’s Perspective April 2019

Aarron Reinert
President,  AAA

Dear Fellow AAA Members,

Spring is in full bloom in Washington, D.C., and the American Ambulance Association is hard at work in our nation’s capital advocating for mobile healthcare providers. I am pleased to share with you several updates from your association.

Advocacy Progress

The AAA continues to forge ahead advocating for the legislative and regulatory priorities of our membership. Earlier this month, more than forty AAA volunteer leaders and members came to Washington, D.C., meeting with more than 100 congressional offices to advocate for Medicare policies and improved claims processing by the Department of Veterans Affairs for emergency ambulance services. (View photos on Facebook.)

The AAA has also taken an active role in responding to potentially harmful “surprise billing” legislation. The AAA has been urging Members of Congress to recognize the unique and essential nature of emergency ambulance services and ambulance interfacility mobile healthcare transports. Ambulance service suppliers and providers are already heavily regulated at the local level and struggle with receiving adequate reimbursement. The Congress should protect patient access to ground ambulance services and continue to allow us to balance bill.

The AAA is working closely with CMS and the RAND corporation on the development of the ambulance cost data collection system in order to ensure that the end survey and methodology is feasible for our industry. The AAA has established itself and our membership as an important stakeholder throughout the cost data collection development process, and we look forward to remaining involved this year.

On the legislative front, the AAA is eager to introduce a larger piece of Medicare legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, the lack of equitable polices, rural zip code classifications, and more. Buy Diamox 250 mg https://www.rpspharmacy.com/product/diamox/

Legislation to restructure the offset included in the Bipartisan Budget Act of 2018 to pay for the 5-year extension of Medicare add-on payments has been reintroduced in the Senate (S. 228) and should be re-introduced in the House soon. The AAA is also working on updating the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA) to adequately address issues regarding reimbursement from the VA.

With many important legislative priorities, we will continue to lean on our members for their support and encourage you all to continue to build relationships with your Members of Congress.

Ambulance Cost Education (ACE)

Time is running out to prepare for the new federal cost data collection requirements for ambulance services which go into effect January 1, 2020. To help ambulance services ready themselves, our expert faculty has developed comprehensive Ambulance Cost Education (ACE) webinars, regional workshops, and online resources. With AAA ACE, your service will have all the tools needed to comply with federally mandated cost collection. An ACE subscription is the turn-key solution to prepare for ambulance cost collection. Learn more about our affordable packages today.

Stars of Life

Every year, the American Ambulance Association’s Stars of Life program showcases the value of mobile healthcare to legislators and the general public. I look forward to seeing many of you this June in Washington D.C., for the 2019 celebration. Follow the 2019 AAA Stars of Life on Facebook and Twitter in the coming months! Levitra generic http://www.gastonpharmacy.com/levitra.php

Annual Conference & Trade Show

Preparations are in full swing for the 2019 AAA Annual Conference & Trade Show in exciting Nashville, Tennessee. AAA Annual is the can’t-miss educational experience for ambulance leaders interested in bringing excellence in reimbursement, operations, and human resources to their services! I hope that you will join me and hundreds of our colleagues for networking, learning, and fun November 4-6Early bird registration is open now!

Thank You, Members!

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2019!

Aarron Reinert
President
American Ambulance Association

RFP: Cost Collection SME/Project Director

Request for Proposals: Subject Matter Expert (SME)/ Project Director

Ambulance Cost Data Collection
Due April 20, 2019

Overview

The American Ambulance Association (AAA) invites proposals from qualified interested parties (individual and teams) for the purpose of directing the Ambulance Cost Data Project as a Subject Matter Expert (SME).

Introduction

As part of the extension of the Ambulance Medicare Add on payments, legislation passed on February 9, 2018, the Congress mandated that ambulance services provide cost data. General requirements of the legislation include the following:

  • Requires notice-and-comment rulemaking
  • May use a cost survey
  • Collect (1) cost; (2) revenue; (3) utilization; and (4) other information determined appropriate by the Secretary
  • Include information: (1) needed to evaluate the extent to which costs are related to payment rates; (2) on the utilization of capital equipment and ambulance capacity; and (3) on different types of ground ambulance services furnished in different geographic locations and low population density areas
  • May revise the system over time
  • Select a representative sample of providers and suppliers from whom to collect data
  • Determined based on the type of providers and suppliers and the geographic locations
  • May not be request same provider or supplier to submit data in two consecutive years
  • Those selected to report must do so in the form and manner and at the time specified by the Secretary
  • If selected and do not report, then may be subject to a 10 percent payment reduction, unless the hardship exemption
  • Opportunity to request a review of the application of the penalty
  • Information collected available through the CMS Website

AAA Cost Data Collection Objectives

The purpose of the AAA Cost Data Collection is to develop education and service lines to assist the industry in preparing to accurately respond to the federally mandated cost data collection system as designed by the Centers for Medicare and Medicaid Services (CMS). Objectives to include:

  1. Standardization of the education of the cost data collection system including standardization of terms.
  2. The development of a cost data app to be universally distributed and used by ambulance services to report costs.
  3. AAA’s cost data recommendations are considered the industry standard and tools are widely distributed and used by the majority stakeholders of the industry.
  4. Initial (beta) data used to analyze and validate cost collection system, and provide data needed to continue lobbying Congress on additional reimbursement payments.

Proposed Project Director (SME) Scope of Work

In order to achieve the above objectives, the following is the proposed director (SME) scope of work:

  • Review and comment on AAA Cost Data Collection deliverables, including publications, education efforts, and online tools, helping to maximize accessibility and utility while verifying accuracy.
  • In partnership with the Technology and Education contractor, provide industry and ambulance service support, both reactively in answering questions and proactively in presentations both remotely and in person.
  • In collaboration with the AAA Cost Data Collection Faculty, contribute and edit content for the data collection operational definitions.
  • Update website, write articles, member communications and information pieces for distribution and website posting.
  • Working with the Technology and Education contractor, monitor and support the receipt of initial data, reviewing to identify missing fields and outliers; follow-up and clean data as needed.
  • Using data generated by the data collection system, generate articles and reports reflecting analysis and synthesis.
  • As requested, prepare reports and provide counsel to the AAA Board throughout the term of the project.

Proposed Timeline of Work

  • May 1, 2019 Hire SME
  • May–June 2019 Review and finalization of operational definitions
  • Summer 2019 Review of Amber online toolset, support of pilot testing
  • September-December Ongoing education – including train the trainer materials and final pre-launch education
  • Throughout 2019-2020 Ongoing educational and awareness-raising work, development and enhancement of website content

Instructions for Submission of Responses

Please include the following information in your Response.

  • Cover letter indicating cost for providing services as outlines in the RFP.
  • Resume and/or Curriculum Vitae (CV)
  • A list of three references (including phone numbers), as well as a brief description of the project for the reference
  • Any samples you wish to use to showcase your work as a project director and/or SME

Submit the above materials to Maria Bianchi electronically to mbianchi@ambulance.org.

Deadline

We would appreciate a response to the proposal no later than April 20, 2019. If you have any questions, contact Maria Bianchi at 301-758-2927.

Update on Government Shutdown and Sequestration

As the government shutdown drags on the negative impacts continue to grow. If the shutdown continues through January 24, 2019, which is looking likely at this point, current law will require the Trump Administration to cut about $839 million from non-exempt federal benefit programs to avoid increasing the deficit. This is a result of the “PAYGO” (pay as you go) law which requires spending increases or tax cuts to be offset with cuts to programs or additional revenue to avoid increasing the deficit. As the largest nonexempt benefit program, it is likely that Medicare would experience the worst of these cuts through sequestration.

While the Trump Administration has not yet issued a sequestration order, there is a distinct possibility that one could be issued if the shutdown continues much longer. A sequestration order would mean an additional across the board cut to all Medicare providers, including ambulance services. Ambulance service providers are still feeling the impact of the 2% sequestration cut that has been in effect the past few years. Any new cuts would likely start out being targeted at administrative tasks which could slow payments to providers. Temporary cuts would be expensive for the administration to facilitate and is made more challenging by the fact that many important staff members are currently furloughed. There are also some at the Office of Budget and Management (OMB) who believe that these cuts could not actually be administered until the government is reopen.

The AAA will keep members informed of any new developments.

Request for Proposals—SME/Project Director

American Ambulance Association
Request for Proposals
SME/ Project Director
Ambulance Cost Data Collection
November 2018

Overview

The American Ambulance Association (AAA) invites proposals from qualified interested parties (individual and teams) for the purpose of directing the Ambulance Cost Data Project as a Subject Matter Expert (SME).

Introduction

As part of the extension of the Ambulance Medicare Add on payments, legislation passed on February 9, 2018, the Congress mandated that ambulance services provide cost data.  General requirements of the legislation include the following:

  • Requires notice-and-comment rulemaking
  • May use a cost survey
  • Collect (1) cost; (2) revenue; (3) utilization; and (4) other information determined appropriate by the Secretary
  • Include information: (1) needed to evaluate the extent to which costs are related to payment rates; (2) on the utilization of capital equipment and ambulance capacity; and (3) on different types of ground ambulance services furnished in different geographic locations and low population density areas
  • May revise the system over time
  • Select a representative sample of providers and suppliers from whom to collect data
  • Determined based on the type of providers and suppliers and the geographic locations
  • May not be request same provider or supplier to submit data in two consecutive years
  • A selected to report must do so in the form and manner and at the time specified by the Secretary
  • If a selected and do not report, then may be subject to a 10 percent payment reduction, unless the hardship exemption
  • Opportunity to request a review of the application of the penalty
  • Information collected available through the CMS Website

AAA Cost Data Collection Objectives

The purpose of the AAA Cost Data Collection is to develop education and service lines to assist the industry in preparing to accurately respond to the federally mandated cost data collection system as designed by the Centers for Medicare and Medicaid Services (CMS). Objectives to include:

  1. Standardization of the education of the cost data collection system including standardization of terms.
  2. The development of a cost data app to be universally distributed and used by ambulance services to report costs.
  3. AAA’s cost data recommendations are considered the industry standard and tools are widely distributed and used by the majority stakeholders of the industry.
  4. Initial (beta) data used to analyze and validate cost collection system, and provide data needed to continue lobbying Congress on additional reimbursement payments.

Proposed Project Director (SME) Scope of Work

In order to achieve the above objectives, the following is the proposed director (SME) scope of work:

  • Review and comment on AAA Cost Data Collection deliverables, including publications, education efforts, and online tools, helping to maximize accessibility and utility while verifying accuracy.
  • In partnership with the Technology and Education contractor, provide industry and ambulance service support, both reactively in answering questions and proactively in presentations both remotely and in person.
  • In collaboration with the AAA Cost Data Collection Faculty, contribute and edit content for the data collection operational definitions.
  • Update website, write articles, member communications and information pieces for distribution and website posting.
  • Working with the Technology and Education contractor, monitor and support the receipt of initial data, reviewing to identify missing fields and outliers; follow-up and clean data as needed.
  • Using data generated by the data collection system, generate articles and reports reflecting analysis and synthesis.
  • As requested, prepare reports and provide counsel to the AAA Board throughout the term of the project.

Proposed Project Timeline

December, 2018 — Board Consideration of AAA Cost Data Collection Proposal and Budget Request

January 1, 2019 — Hire SME

January–February 2019 — Development of operational definitions

March–April 2019 — Review and finalization of operational definitions

Summer 2019 — Review of Amber online toolset, support of pilot testing

September-December — Ongoing education – including train the trainer materials and final pre-launch education

Throughout 2019 — Ongoing educational and awareness-raising work, development and enhancement of website content

Instructions for Submission of Responses

Please include the following information in your Response.

  • Cover letter indicating cost for providing services as outlines in the RFP.
  • Resume and/or Curriculum Vitae (CV)
  • A list of three references (including phone numbers), as well as a brief description of the project for the reference
  • Any samples you wish to use to showcase your work as a project director and/or SME

Submit the above materials to Maria Bianchi electronically at mbianchi@ambulance.org.

We would appreciate a response to the proposal no later than Friday, December 7, 2018.

If you have any questions, contact Maria Bianchi at 301-758-2927.

Mid-term Election Analysis

As a result of Tuesdays’ elections, Democrats will control the U.S. House of Representatives next Congress and Republicans will have a larger majority in the United States Senate. Presently, Democrats have gained a net of 30 seats in the House with Republicans netting two seats in the Senate. Democrats needed to capture 23 seats from Republicans to gain the majority. There are still several races in the House and Senate to be called which will likely add to those totals.

Akin Gump, the lobbying firm for the AAA, has put together a synopsis of the election results as of this morning and a slide deck on historical trends and the outcome of races called so far.

Key supporters of the industry who will not be returning next Congress include Representatives Peter Roskam (R-IL), Mike Coffman (R-CO) and Erik Paulsen (R-MN). All three members have been supportive of ambulance initiatives with Roskam in his position as Chair of the House Ways and Means Health Subcommittee and Paulsen as a member of the Subcommittee. Coffman sponsored legislation to apply the prudent layperson definition to emergency ambulance services provided to veterans. In late breaking news, the Senate race in Montana was called in favor for Senator Jon Tester (D-MT) who has been very supportive on several EMS policies.

As to the changes in Committee leadership with Democrats taking control of the House, Congressman Richard Neal (D-MA) will become Chair of the Ways and Means Committee and Kevin Brady (R-TX) will become Ranking Member. Congressman Mike Thompson (D-CA) will likely become Chair of the Health Subcommittee with the top candidate for Ranking Member being Devin Nunes (R-CA). On the Energy and Commerce Committee, Congressman Frank Pallone (D-NJ) will become Chair and Greg Walden (R-OR) will become Ranking Member.

In the Senate, Senator Charles Grassley (R-IA) will likely become Chair of the Senate Finance Committee In lieu of Senator Hatch who is retiring. Senator Ron Wyden (D-OR) will continue in his role as Ranking Member of the Committee.

The AAA has good relationships with all the likely Chairs and Ranking Members of the key Committees of jurisdiction as well as with House and Senate leaders of both political parties. Several of them have championed causes for the industry and we will continue to be well-positioned next year to push our initiatives. We will be reaching out to you in the coming weeks to help build upon our list of champions and supporters in the new Congress.

LifeWorks October Feature: Work-Life Balance and Productivity

October Feature: Work-Life Balance and Productivity

Ten Tips for Fitting Work and Life Together

Would you like to move beyond feeling stressed or overwhelmed by your personal and work responsibilities? Or learn how to achieve personal and professional success on your own terms? “Knowing how to manage the way work and life fit together is a modern skill set we all need to succeed,” says Cali Williams Yost, an internationally recognized flexible workplace strategist and author of the books Tweak It: Make What Matters to You Happen Every Day and Work+Life: Finding the Fit That’s Right for You. Here are Yost’s 10 strategies:

  1. Remember that work-life fit is unique for each of us. “Simply put, there is no work-life balance or perfect 5050 split between your work and your personal life,” Yost says. “If you do happen to hit a balance, you can’t maintain it because your realities are always changing, personally and professionally.” There’s also no “right way” to achieve a good work-life fit. Your goal is to find your unique, ever-changing fit, the way your work and personal realities fit together day-to-day and at major life transitions. Don’t compare yourself to others. Find the fit that’s right for you.
    It’s also important to keep in mind that during major life changes — like becoming a parent, caring for an aging relative, relocating with a partner, going back to school, or easing your way into retirement — you may find yourself rethinking how you define success related to money, prestige, advancement, or caregiving. Throughout life, you may need to align and adjust your work and personal realities so they match with your vision and goals for the future.
  2. Harness the power of small actions or “tweaks”. Even small actions can have positive and lasting effects. When you’re feeling overloaded, for example, commit to taking two or three small but meaningful steps toward a better work-life fit. Plan a long weekend away with friends. Clean out your hall closet. Take an online class to learn a new skill. Then do it again and again. Small actions can have a big impact on your sense of well-being and control. To get started, check out more than 200 small, doable get-started actions suggested by 50 work, career, and personal life experts in Yost’s book Tweak It.
  3. Create a combined calendar and priority list. On top of a busy job and home life, how will you fit everything else into your schedule? There’s exercise, eating well, vacation, sleep, career development, time with family and friends, caregiving responsibilities, and just general life maintenance. You can’t do it all. But you can be more intentional and deliberate about how you spend your time.
    First, pull together all your work and personal to-dos and priorities into one combined calendar and list. This will help you determine how you want to prioritize the tweaks — small, meaningful work, career, and personal actions and priorities — to add to your work-life fit. For example, tweaks might include planning all meals and shopping for your groceries on Sunday or getting to exercise class every Tuesday and Saturday. Or they might include researching a vacation one afternoon, going to the movies with your sister, or attending a networking event. Building actions into your schedule makes it far more likely they’ll happen. And you’ll feel better as a result.
  4. Take care of yourself in small ways. Small changes can make a big difference in how you feel. Manage stress during the day by closing your eyes for 15 seconds and taking a few deep breaths. Try to eat more healthfully by adding a vegetable to two of your meals during the day. Turn off the television and your electronic devices an hour before you go to bed to help you get the rest you need.
  5. Preview a skill online before you pay to take a class. In a rapidly changing world, all of us need to keep updating our skills to meet new work and other realities. But going back to school can be expensive and time consuming. Before you invest a substantial amount of money in a class, try to preview a skill online. Watch or listen to any of the hundreds of thousands of videos or podcasts on an infinite number of topics that you can preview by downloading or streaming them. Watch them while you’re commuting, or listen to them while you walk. If you want or need more help than the video or podcast provides, invest in a class
  6. Collect ideas for vacations — then take one. Taking a break to reenergize is more important than ever in our on-the-go world. And many people don’t take vacations just because they don’t know where to go. It takes some research to find a destination that you can afford, and some of us don’t do this until it’s too late. To get inspired, keep a jar or small box where you can store vacation ideas. Every time you hear a friend or relative talk about a wonderful vacation, write down what appeals to you about it and put it there. When you read an article about a place that sounds interesting, put that in the box or jar, too. Once a year, pick a destination from all of the vacation ideas you’ve accumulated.
  7. Get things done while you’re enjoying family and friends. Cook dinner with your kids. When you prepare a meal together, you’re also spending time together. Take a walk with your close friend before work or a tae kwon do class with your partner on the weekend. You’ll be exercising while spending quality time together. At holiday times, plan a cookie exchange and donate some of the cookies to a women’s shelter.
  8. Have 10 technology-free minutes each day with your children. Give the kids time when you aren’t distracted by electronic gadgets. Sit on the floor and do a puzzle. Ask teenagers how their day went, and just listen. Check your email only at certain times of the day, so you aren’t always on it when children need you. When you’re on the phone, turn around and face away from your computer so you aren’t distracted by email. Looking away from the screen will force you to pay attention to the person you’re talking with.
  9. Plan for future caregiving responsibilities. Get a head start if you’re taking care of a grandparent or may be caring for a parent or other relative in the future. Sit down with the adults in your life who may require care. Try to clarify what they want, understand their financial resources, and come up with a plan for meeting their needs and wishes. Try to include in the meeting any family and friends who form a broader network of care, so you don’t have to do it all on your own. Don’t wait for a crisis.
  10. Keep on top of everyday maintenance. Clean as you go, so the work doesn’t pile up. Put a load of laundry in the washing machine in the morning before you leave for work, and put it in the dryer when you get home. Keep a small bucket of cleaning supplies in the bathroom, and wipe down the shower, mirror, and toilet every morning. Set a timer for 10 minutes each weekend and assign each member of your family a task — vacuuming, dusting, straightening up. Check the owner’s manual of your car for the recommended maintenance schedule and write it on your calendar.

For more tips like these, listen to the recording Fitting Work and Life Together on the LifeWorks platform.

Free, confidential counseling for employees of AAA member organizations.

LifeWorks is your employee assistance program (EAP) and well-being resource. We’re here for you any time, 24/7, 365 days a year, with expert advice, resources, referrals to counseling, and connections to specialists including substance abuse and critical incident stress management professionals. If you could benefit from professional help to proactively address a personal or work-related concern, you can turn to LifeWorks.

  • Counseling is available at no cost to you. (Up to three sessions per issue.)
  • To meet individual needs and preferences, counseling is available face-to-face AND live by video.
  • All our counselors are experienced therapists with a minimum Master’s degree in psychology, social work, educational counseling, or other social services field.

Call LifeWorks, toll-free, 24/7, at 800-929-0068.
Visit us online at login.lifeworks.com or by
mobile app (username: theaaa; password: lifeworks)

 

Narberth Ambulance Overcomes Major Hurdles In Its Billing System

Pennsylvania EMS Provider Achieves Major Billing Milestones Through Payor Logic Partnership and ESO Integration

The Volunteer Medical Service Corps of Narberth was established in 1944 by residents of Narberth Borough, a suburb of Philadelphia, to provide transportation and first aid for soldiers returning from World War II via Philadelphia’s ports. The organization, now known as Narberth Ambulance, has expanded over the past 70 years from a small station with two ambulances to a full-fledged EMS service that makes nearly 10,000 trips annually, employs 33 full-time staff, 44 part time employees, and 80 volunteers. Narberth covers four Philadelphia area communities with two stations, seven ambulances, two responder vehicles and one mass casualty/rehab bus.

While Narberth Ambulance has seen tremendous growth and success throughout its history, recent times have brought new challenges. Changing technology in the healthcare industry paired with declining reimbursement over the past several years left Narberth, like many other EMS services, facing issues with its billing system and claims processing. These complications made claims longer to work and payment harder to collect. At the height of this problem, Narberth’s billing team needed from five to ten business days to process a claim.

The Issue at Hand

According to Meg Nelson, billing lead for Narberth, “The first barrier encountered by our billing staff was simply trying to obtain correct demographic and insurance information for our patients.” Narberth faced ongoing issues in efforts to receive face sheets and up-to-date information from local hospitals. Despite access to EHRs at hospitals, repeated follow-up calls became a necessity, hampering the productivity of those involved on both the hospital and EMS sides.

John Roussis, executive director of Narberth Ambulance, also shared his insight on the issues. “Because our data was often incorrect, we experienced a high volume of return mail,” he said. “The administrative burden was a huge challenge with hundreds of steps to hunt down correct addresses, multiple piles of return mail, and extra postage to resend invoices.” Furthermore, decreases in coverage from commercial and government payors made it increasingly difficult to obtain correct, valid and billable insurance information to process claims and collect payment.  Narberth clearly needed to make monumental changes to its claims processing, insurance discovery and payor reimbursement practices to avoid further harm to the organization’s financial stability.

EMS Billing Interoperability Cuts Manual Intervention by 80%

In 2017, Narberth implemented new revenue cycle technology to increase efficiency in each of the previously mentioned areas. The application was seamlessly integrated with ESO, Narberth’s established billing system, to reduce return mail, boost staff productivity and hasten reimbursement.  Here’s how interoperability between the two systems works:

  • The Narberth crew enters information into ESO’s patient care record after a trip completion.
  • Once entered, the data is automatically uploaded in the vendor’s billing module.
  • A part-time staff member verifies the chart for accurate data, enters charges and preps the case for billing.
  • Within ESO, the new technology application from Payor Logic sends an immediate query to find any missing demographics, insurance information or other pertinent details in real time, and populate the ESO billing software with correct, billable information.

With this system in place, Narberth’s billing staff conduct their manual process only if no information is available—a mere 20 percent of the time. Narberth Ambulance has effectively dropped its time to work a claim from an estimated seven days down to only seven minutes.

“We’ve relieved billing burdens and effectively reduced time to process claims by 66 percent,” said Roussis. “We are now performing only one third of the paperwork, calls and claims-related tasks that we handled before. Our team calls the integrated ESO and Payor Logic solution the magic button for EMS billing.”

Payability and Deductibles Next Target

With its billing system now automated and integrated, Narberth’s claims processing efficiency is better than ever—time waste is down and dollars have become far easier to collect. However, Roussis doesn’t want to stop there.

Roussis intends to continue tackling inefficiency. He plans to use Payor Logic to help address communication issues with commercial payors, analyze payment likelihood for self-pay accounts, and improve the organization’s deductible management.

The issues Narberth Ambulance faced are bound to become more common in the EMS world as the healthcare industry becomes more reliant on increasingly complex technology. The most important takeaway in the face of change is that integrated EMS technology solutions are out there to keep billing struggles from distracting providers from their top priority—saving lives.

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

Senator Debbie Stabenow Named Legislator of the Year

For Immediate Release

Senator Debbie Stabenow To Receive Highest Legislative Honor From American Ambulance Association

To Be Recognized As AAA Legislator of the Year

Contact
Amanda Riordan
703-610-9018
ariordan@ambulance.org
www.ambulance.org

Washington, DC – The American Ambulance Association (AAA) will honor Senator Debbie Stabenow of Michigan with its Legislator of the Year Award in appreciation of her advocacy for emergency medical services.

Senator Stabenow is invited to receive this honor at the AAA’s Annual Stars of Life Recognition Ceremony on June 11 in Washington, D.C.

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. The Stars of Life program pays tribute to the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 100 EMS professionals will be honored as 2018 Stars of Life. In addition to Senator Stabenow’s recognition as 2018 Legislator of the Year, 34 United States Senators and Representatives will receive Legislative Recognition Awards for their support of ambulance services.

Senator Stabenow was selected for the Legislator of the Year Award in thanks for leading the effort in the United States Senate that secured a five-year extension of the Medicare ambulance temporary add-on increases of 2% urban and 3% urban and the super rural bonus payment. Senator Stabenow also ensured that other key provisions for the industry were included in the passage of the Bipartisan Budget Act of 2018. Senator Stabenow continues to go above and beyond to ensure that EMS in Michigan and across the country, receive sustainable reimbursement.

AAA President Mark Postma notes, “Senator Stabenow has been a trusted advocate for health care and emergency medical services, both in Michigan and across our country. The AAA is proud to present her with the distinction of Legislator of the Year Award.”

Elected to the U.S. Senate in 2000, Senator Stabenow is the Ranking Member of the Senate Finance Subcommittee on Health Care, Chair of the Democratic Policy and Communications Center, and Co-Chair of the Senate Great Lakes Task Force, and bipartisan Senate Manufacturing Caucus.

In recognition of her ongoing service to the ambulance services of the United States, AAA is proud to call Senator Stabenow our Legislator of the Year.

# # #

About the American Ambulance Association

Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 100 EMS professionals will be honored as the 2018 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

The mission of the American Ambulance Association is to promote health care policies that ensure excellence in the ambulance services industry and provide research, education, and communications programs to enable its members to effectively address the needs of the communities they serve.

Savvik Buying Group: Ambulance Purchasing Made Easy

  • Do you hate the thought of going out to bid?
  • Are you sure you are getting the best pricing?
  • Do you really have the time to do the bidding process?
  • Do you want to see multiple brands?
  • Do you want to customize your units to your specs?
  • Do you want a discount for multiple units?
  • What if someone could help get these quotes done for you?
  • What if you could download all the paperwork to submit to your review committee in just a few clicks?
  • What if you could link to this contract in under 2 minutes?
  • What if I told you that you could do all of this at no charge?

With Savvik Buying Group’s Publicly Awarded Ambulance Bid, you can! As a AAA member you have access to Savvik’s bid, and can save the time and hassle of the bid process. It takes just two minutes to join Savvik’s bid and begin selecting the ambulance that best suites your needs through Savvik’s vendors.

Watch this YouTube video to learn more about how to get started with Savvik’s ambulance bid.

Make a Difference: EMS and Human Trafficking

When we think of trafficking, we generally think of drugs or weapons, not human beings. Yet the problem exists in numerous communities where EMS responders deliver care.

Human trafficking is defined by the United Nations as “the recruitment, transportation, transfer, harboring, or receipt of persons by improper means for an improper purpose.” (End Slavery Now, 2018, para. 1) A more succinct definition comes from Kathryn Brinsfield, MD, MPH, Assistant Secretary for Health Affairs and Chief Medical Officer for the Department of Homeland Security: “Human trafficking is modern-day slavery.” (DHS, 2017, para. 3)

Why is this so important in today’s EMS field? We are the first on scene, we are the ones invited inside where others are not and we are the ones who see an injured person’s environment.  Our interactions with others can help us spot some of the tell-tale indicators.

Unfortunately, there are many reasons people are trafficked:

  • Domestic Slavery: People are brought into private homes to work as slave labor, with no options to leave.
  • Sex Trafficking: Children, men and women are forced into the commercial sex industry
  • Forced and Bonded Labor: People are forced to work under the threat of violence for no pay — often to repay a debt — without the ability to leave
  • Forced Marriage: Women and children are forced to marry another against their will and without their consent.

As an industry, there is much that EMS can do. We must keep our ears and eyes open, and report things that raise red flags in our minds. Some of the most common indicators we will see as emergency responders are:

  • Signs of abuse, wounds or bruising in various stages of healing or malnutrition
  • Scars or mutilations, including tattoos showing ownership
  • Language or cultural barriers preventing injured persons from communicating with you
  • Submissive or nervous appearances
  • Security measures like overly hardened doors or windows preventing movement of people

DHS has a great educational sheet with additional indicators to look for: click here for a printable copy. While a particular situation may turn out not to be what you suspect, report your suspicions regardless so trained law enforcement experts can evaluate the situation. Your hunch may save a life or multiple lives. Call Immigration and Customs Enforcement at 1-866-DHS-2-ICE (1-866-347-2423) or online here. You can also receive additional training here.

References

Slavery Today (2018). Retrieved from   http://www.endslaverynow.org/learn/slavery-today

EMS’s Role in the Effort to End Human Trafficking (2017). Retrieved from https://www.ems.gov/newsletter/marapr2016/end-human-trafficking.html

Changing the Face of EMS for the New Century

EMS has always been the forefront of medicine, delivering care to the sick and injured in various roles dating as far back as the Civil War. It has come a long way from the days of horse and buggy. Yet, where are we going now?

One look at the trajectory of Nursing indicates where we are headed. When Nursing first started, the profession was comprised of caring women who were viewed and treated as indentured servants, subservient to the male dominated physicians. Nursing evolved when the “servant” became educated. What followed were thousands of women beginning to diagnose, conduct research and improve outcomes in the healthcare field. Soon thereafter, they broke free of the care assistant model they were in. I see EMS following the same path.

The ambulance industry started out as transporters, with a curriculum that was adopted and funded by the Department of Transportation (DOT). The industry has roots in DOT, Police Departments, Fire Departments and the military, but are truly physician extenders that should be firmly rooted in Health Departments. EMS is now developing a language, doing research, obtaining national accreditation for our schools, even supporting continuing education with CAPCE. But we need to do more.

Outreach will help accomplish what many have started.  We need to consider the picture the public has of EMS, especially when we have overlooked self-promotion for decades.

Let’s be the ones who show the public what EMS is and is capable of.  I look forward to EMS education mirroring, “The Georgia Trauma Commission,” which collaborated with the Georgia Society of the American College of Surgeons and the Georgia Committee on Trauma to create the “Stop the Bleed” campaign. This inspiring crusade is designed to train school teachers, nurses and staff across the state on how to render immediate and potentially life-saving medical aid to injured students and co-workers while waiting for professional responders to arrive.” (2018, para. 4)  This type of training gives us face time with the public so they can learn what we do and what we do not.

One of the other important outreach programs to help us in this endeavor is the Community Paramedic Program. We are seeing this education transform EMS into new and exciting roles in the community. “First responders frequently respond to calls for social services. So, the emergency responders may know of people who need some sort of services or resources,” (Todd) Babbitt, a former fire chief, said. “This team could help connect those people with the services they need. It’s about getting everybody to work together and communicate.” (2018, para. 4)

What we can do is start to get EMS in front of the public. Teach. And open our historically closed doors to the folks that make it easier to do our jobs. Educate others and learn together how our roles are changing modern day healthcare while embracing the change. Otherwise we risk being left in the dust by our progressive healthcare brethren.

References

(2018, Feb 1st, 2018). Ga. School Nurses Train to Stop the Bleed. The Brunswick News. Retrieved from https://www.emsworld.com/news/219782/ga-school-nurses-train-stop-bleed

(Ed.). (2018, January 30th, 2018). Conn. Fire Chiefs to Form Community Action Team. Norwich Bulletin. Retrieved from https://www.emsworld.com/news/219757/conn-fire-chiefs-form-community-action-team

Is Narcan the Answer?

There has been a lot of talk recently in social media and the news about leaving Narcan behind after a reversal of an opioid overdose. A new voluntary program in Pittsburgh, PA allows the state to pay for Narcan atomizers that EMS can leave with friends and family of OD patients. The media buzz revolves around the idea that we are enabling this cycle of addiction; “There is some pushback that maybe you’re enabling the problem a little bit, but at least in the short term, reduce the chances that person is going to die and you create more opportunities to get them into treatment,” said Mark Pinchalk, patient care coordinator for Pittsburgh EMS.” (Media, 2018, para. 3) I agree with Mr. Pinchalk that as an EMS Provider we are not there to judge, we are there to render aid.

One of my early instructors said, “Scott, your purpose is to leave the patient better than the way you found them.” I have taken that long ago statement to heart ever since, trying to leave the patient better than the way I found them whether that is medically as in a Diabetic whose blood glucose I raise from 20mg/dl to 130mg/dl or the person who receives a ride to the hospital to be  checked out. EMS is about providing care. When we use our own judgements or opinions on our patients, it impedes or influences the care we provide.

These particular cases seem to bring out strong opinions surrounding a delicate issue. Thousands of people die every year from Opioid overdoses. A healthy percentage of them get their start on prescription pain killers. So where do we help? How do we not judge going to the same address three or four times a week to treat the same person in the same situation? These are just some of the tough questions providers and services face every day in America. Although we are trying to hold back the tide with a broom, it is up to us to provide the same level of care each and every time, regardless of the person or situation.

Will leaving Narcan at the scene save lives? Yes, I believe so. Will it encourage more drug use? I can’t be sure. Time will tell.

In comparison, studies show making birth control available to teens actually reduces sexual activity and reported pregnancies. Consider 2017 data that shows “Among adolescent females aged 15 to 19, 42 percent report having sex at least once. For males, that number was 44 percent. The numbers have gradually dropped since 1988, when 51 percent of female and 60 percent of male teens reported having had sex.” (Welch, 2017, para. 4)

So for now, I encourage the opportunity, as the law allows, to provide Narcan, knowing it doesn’t make the problem go away. And I look forward to EMS impacting this youthful epidemic. How? Community Paramedicine are the resource to embrace. Just like any other frequent patient, community paramedics will help those get the services they need including the much-needed follow up care.


Scott F. McConnell is Vice President of EMS Education for OnCourse Learning and one of the Founders of Distance CME, which recently launched a new learning platform. Since its inception in 2010, more than 10,000 learners worldwide have relied on Distance CME to recertify their credentials. Scott is a true believer in sharing not only his perspectives and experiences but also those of other providers in educational settings.

References

Media, C. (Ed.). (2018, Jan, 26th, 2018). Local EMS starts program to leave Naloxone with OD victims. WPXI.com. Retrieved from http://www.wpxi.com/news/top-stories/local-ems-starts-program-to-leave-naloxone-with-od-victims/689842523

Welch, A. (2017, June 22nd, 2017). Are today’s teens more responsible about sex? CBS News. Retrieved from https://www.cbsnews.com/news/teen-sex-trends-birth-control-cdc-report/

CMS ODF and Follow Up Call Cancelled

UPDATE: The CMS Open Door Forum and Follow Up Q&A Call have been postponed until further notice.

CMS’s Office of Information Technology (OIT) will hold a special Open Door Forum on the New Medicare Card Project on Tuesday, January 23 at 2:00 PM Eastern. If you plan to attend, please dial in at least 15 minutes before the call.

Following the CMS call, AAA Senior Vice President of Government Affairs, Tristan North, will moderate a Q&A call for members. To answer your questions, AAA Medicare Consultant, Brian Werfel, Esq.; AAA Medicare Regulatory Committee Chair, Rebecca Williamson; and AAA Medicare Regulatory Vice-Chair, Angie (Lehman) McLain will be on the line.