Tag: 2016

CMS SNF Edits Go Into Effect – April 1, 2019

CMS Set to Implement New Common Working File Edits to Identify Ambulance Services Provided in Connection with Outpatient Hospital Services that should be bundled to the SNF under Consolidated Billing

On November 2, 2018, the Centers for Medicare and Medicaid Services (CMS) issued Transmittal 2176 (Change Request 10955), which would establish a new series of Common Working File (CWF) edits intended to identify ambulance transports furnished in connection with outpatient hospital services that are properly bundled to the skilled nursing facility under the SNF Consolidated Billing regime. These new edits are set to go into effect on April 1, 2019. 

Why these edits are necessary?

In 2017, the HHS Office of the Inspector General conducted an investigation of ground ambulance claims that were furnished to Medicare beneficiaries during the first 100 days of a skilled nursing home (SNF) stay. Under the SNF Consolidated Billing regime, SNFs are paid a per diem, case-mix-adjusted amount that is intended to cover all costs incurred on behalf of their residents.  Federal regulations further provide that, with limited exceptions, the SNF’s per diem payment includes medically necessary ambulance transportation provided during the beneficiary’s Part A stay. The OIG’s report was issued in February 2019.

The OIG conducted a review of all SNF beneficiary days from July 1, 2014 through June 30, 2016 to determine whether the beneficiary day contained a ground ambulance claim line. The OIG excluded beneficiary days where the only ambulance claim line related to: (1) certain emergency or intensive outpatient hospital services or (2) dialysis services, as such ambulance transportation would be excluded from SNF Consolidated Billing. The OIG determined that there were 58,006 qualifying beneficiary days during this period, corresponding to $25.3 million in Medicare payments to ambulance suppliers.

The OIG then selected a random sample of 100 beneficiary days for review. The OIG determined that 78 of these 100 beneficiary days contained an overpayment for the associated ambulance claims, as the services the beneficiary received did not suspend or end their SNF resident status, nor was the transport for dialysis. The OIG determined that ambulance providers were overpaid a total of $41,456 for these ambulance transports. The OIG further determined that beneficiaries (or their secondary insurances) incurred an additional $10,723 in incorrect coinsurance and deductibles.

Based on the results of its review, the OIG estimates that Medicare made a total of $19.9 million in Part B overpayments to ambulance suppliers for transports that should have been bundled to the SNFs under SNF Consolidated Billing regime. The OIG estimated that beneficiaries (and their secondary insurances) incurred an additional $5.2 million in coinsurance and deductibles related to these incorrect payments.

The OIG concluded that the existing edits were inadequate to identify ambulance claims for services associated with hospital outpatient services that did not suspend or end the beneficiary’s SNF resident status, and which were not related to dialysis. The OIG recommended that CMS implement additional edits to identify such ambulance claims.

Overview of new claims processing edits

In response to the OIG’s report, CMS issued Transmittal 2176, which implements a new series of claims processing edits to identify ambulance claims associated with outpatient hospital services that should be bundled to the SNF. As noted above, these edits will go into effect on April 1, 2019.

These new claims processing edits are somewhat complicated. In order to properly understand how these claims edits will work, it is helpful to understand that CMS already has claims processing edits in place to identify hospital outpatient claims that should be bundled to the SNF. These CWF edits operate by referencing a list of Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT) codes that correspond to outpatient hospital services that are expressly excluded from SNF Consolidated Billing. Hospital claims for outpatient services that are submitted with one of these excluded codes bypass the existing CWF edits, and are then sent to the appropriate Medicare Administrative Contractor for further editing and payment. Hospital claims submitted without one of these codes are denied for SNF Consolidated Billing. For convenience, the list of HCPCS and CPT codes excluded from SNF Consolidated Billing is hereinafter referred to as the “Exempted Codes.”

The new edits for ambulance claims will compare Part B ambulance claims to the associated outpatient hospital claim to see whether or not that hospital claim is excluded from SNF Consolidated Billing.

Specifics related to new claims processing edits

Under these new edits, the CWF will reject an incoming ambulance claim whenever the beneficiary is determined to be in an SNF Part A stay if either:

  1. There is no associated outpatient hospital claims for the same date of service on file; or
  2. There is an associated outpatient hospital claim for the same date of service on file (paid or denied), but where that outpatient hospital claim does not contain at least one Exempted Code.

When an incoming ambulance claim is rejected by the CWF, it will be sent to the applicable Medicare Administrative Contractor and rejected (Part A Ambulance Providers) or denied (Part B Ambulance Suppliers) using the applicable Claim Adjustment Reason Code/Remittance Advice Remark Code for SNF Consolidated Billing.  In other words, the ambulance claim will be denied with an indication that youshould bill the SNF.

The Transmittal contains further instructions that the CWF be updated to identify previously rejected ambulance claims upon receipt of an associated hospital claim for the same date of service that contains an Exempted Code. Once identified, the Shared System Maintainer (SSM) is supposed to adjust the previously rejected or denied ambulance claim. At this point, the nature of that “adjustment” is unclear, i.e., it is unknown whether the SSM will automatically reprocess the ambulance claim for payment. The AAA is seeking additional clarification from CMS on this important point.

Potential concerns for ambulance providers and suppliers

Based on the current experience of hospital providers, the AAA is cautiously optimistic that the new edits can be implemented in a way that proper identifies ambulance transports associated with hospital outpatient claims that should be bundled to the SNF vs. those that correctly remain separately payable by Medicare Part B.

However, the AAA has some concerns with the manner in which CMS intends to apply these edits.  Ambulance providers and suppliers are typically in a position to submit their claims earlier than the corresponding hospital, many of which submit claims on a biweekly or monthly cycle.  This creates a potential timing issue. This timing issue arises because the edits will reject any ambulance claim that is submitted without an associated hospital claim on file.  In other words, even if the hospital outpatient service is properly excluded from SNF Consolidated Billing, the ambulance claim will still be rejected if it beats the hospital claim into the system. The hope is that CMS will subsequently reprocess the ambulance claim once the hospital claim hits the system. However, at this point in time, it is unclear whether these claims will be automatically reprocessed, or whether ambulance providers and suppliers will be forced to appeal these claims for payment.

One option available to ambulance providers and suppliers would be to hold these claims for a period of time, in order to allow the hospitals to submit their claims. By waiting for the hospital to submit its claim, you can ensure that your claims will not be denied solely due to the timing issue. This should eliminate the disruption associated with separately payable claims being rejected and then subsequently reprocessed and/or appealed. It would also give you a degree of certainty when billing the SNF for claims that are denied for SNF Consolidated Billing. However, holding claims carries an obvious downside, i.e., it will disrupt your normal cash flow.

To summarize, the implementation of these new edits will force ambulance providers and suppliers to rethink their current claims submission processes for SNF residents. Ambulance providers and suppliers will need to make a decision on whether to hold claims to minimize the potential for problems, or to continue their existing submission practices and deal with any issues as they arise.

AAA webinar on new SNF Consolidated Billing edits

March 27, 2019 | 2:00 PM Eastern
Speakers: Brian Werfel, Esq.
$99 for Members | $198 for Non-Members

Join AAA Medicare Consultant Brian Werfel, Esq., to go over the new SNF Consolidated Billing edits that go into effect April 1, 2019. These edits are being implemented by CMS in response to 2017 investigation by the HHS Office of the Inspector General that determined that CMS lacked the appropriate claims processing edits to properly identify ambulance transports provided in connection with hospital outpatient services that are not expressly excluded from SNF PPS. The implementation of these new edits will force ambulance providers and suppliers to rethink their current claims submission processes for SNF residents. Ambulance providers and suppliers will need to make a decision on what to do with these claims moving forward. Sign up today to make sure your service is ready!

Register for the Webinar

2017 National and State-Specific Medicare Data

The American Ambulance Association is pleased to announce the publication of its 2017 Medicare Payment Data Report. This report is based on the Physician/Supplier Procedure Summary Master File. This report contains information on all Part B and DME claims processed through the Medicare Common Working File and stored in the National Claims History Repository.

The report contains an overview of total Medicare spending nationwide in CY 2017, and then a separate breakdown of Medicare spending in each of the 50 states, the District of Columbia, and the various other U.S. Territories.

For each jurisdiction, the report contains two charts: the first reflects data for all ambulance services, while the second is limited solely to dialysis transports. Each chart lists total spending by procedure code (i.e., base rates and mileage). For comparison purposes, information is also provided on Medicare spending in CY 2016.

2017 National & State-Specific Medicare Data

Questions? Contact Brian Werfel at bwerfel@aol.com.


OIG Report on Overpayments For Non-Emergency Transports

OIG Report – Overpayments For Non-Emergency Ambulance Transports To Non-Covered Destinations

The Office of the Inspector General released its report Medicare Improperly Paid Providers for Non Emergency Ambulance Transports to Destinations Not Covered by Medicare“.

In sum, the OIG reviewed claims that Medicare paid for 2014 – 2016 non-emergency ambulance transports. The review focused on transports to non-covered destinations. OIG found that $8,633,940 was paid by Medicare for non-emergency ambulance transports under codes A0425 (ground mileage), A0426 (ALS non-emergency) and A0428 (BLS non-emergency) during this period of time.

The review was based solely on the claims and not based on a medical review or interviews of providers.

The claims that should not have been paid were to the following destinations:

  • 59% – to diagnostic or therapeutic sites other than a hospital or physician’s office, that did not originate at a SNF.
  • 31% – to a residence or assisted living facility (and not meeting the origin/destination requirement).
  •  6% – to the scene of an acute event.
  •  4% – to a destination code not used for ambulance claims or where no destination modifier was used.
  • <1% – to a physician’s office.

OIG recommended (and CMS agreed) that CMS:

  1. Notify the Medicare Administrative Contractors to recover that portion of the overpayment that is within the 4-year period in which claims can be re-opened.
  2. For the balance of the overpayment that is outside the 4-year period, CMS should provide the information needed for the MACs to notify the providers of the overpayments and have the providers exercise reasonable diligence to investigate and refund improper payments.
  3. Direct the MACs to review the origin/destination requirements for any overpayments following the audit period.
  4. Require the MACs implement edits to ensure they only pay for non-emergency transports that meet the Medicare requirements.

There is a chart in the report that indicates the improper payments for each jurisdiction. It is interesting to note that the overpayments range from a low of $515 (First Coast) to a high of $5,006,696 (Cahaba).

The report can be obtained at: https://go.usa.gov/xU5vf

Ambulance Payment Reform Whiteboard Video

The American Ambulance Association needs your help to build the future of EMS—an innovative industry compensated fairly and recognized appropriately for the critical healthcare it provides. Learn more in the video below, then visit our Payment Reform page to get involved!

Ambulance services across the country are struggling to survive in the face of falling reimbursement, short-sighted regulations, and rising costs. EMS providers of all sizes must share critical cost data, meet with legislators, and speak with one voice as we work to surmount these obstacles and position ambulance services for success today and for many years to come.

Trump Healthcare Transition Analysis

President-elect Donald Trump is naming more members of his transition team as he prepares to form his cabinet and key White House position.  In the healthcare arena Andrew Bremberg will take the lead on transition issues related to the Department of Health and Human Services (HHS). Bremberg, who has been working on the Trump transition team since the Republican National Convention in July, worked at HHS for nearly eight years under the George W. Bush Administration. Bremberg later advised Senate Majority Leader Mitch McConnell on health policy and served on Mitt Romney’s transition team in 2012. Most recently, he worked on Scott Walker’s health care team during the Wisconsin governor’s presidential campaign.  He is viewed as a traditional inside professional with a strong working knowledge of the health care system.

The Trump transition team is currently focused on cabinet-level picks. Candidates to become HHS Secretary in the new Administration reportedly include:  Dr. Ben Carson, a retired neurosurgeon and former GOP presidential candidate; former House Speaker Newt Gingrich; former Louisiana Gov. Bobby Jindal; Rich Bagger (we previously worked with him when he was at Pfizer and we represented the company), executive director of the Trump Transition team and a pharmaceutical executive; and Florida Gov. Rick Scott,  Congressman Tom Price (GA), a Member of the House Ways & Means Committee, has also expressed interest in being Secretary.

Topping the list of health care priorities for Congressional Republicans is repealing and replacing the Affordable Care Act. The GOP will likely seek to pass a budget resolution, and then a reconciliation bill to repeal major portions of the health law, including the individual and employer mandates and various taxes. The budget reconciliation process will allow the Senate to advance a repeal bill with only a 51-vote majority.  Both a FY 17 and FY 18 reconciliation bills are possible

Rep. Kevin Brady (R-TX) is expected to remain as Ways and Means Committee Chairman, and Rep. Pat Tiberi as Chairman of the Health Subcommittee. Republicans will need to fill a few seats on the Committee; Rep. Charles Boustany (R-LA) lost his Senate race, while Rep. Todd Young (R-IN) won his. Rep. Robert Dold (R-IL) lost his re-election bid.  On the Democratic side, it is not clear whether the six seats gained by the Democrats will change the Committee ratios in any way.  Brian Higgins will likely regain his seat on the Ways & Means Committee to fill one of the seats vacated by Charlie Rangel and Jim McDermott.  A fair number of Members on both the Republican and Democratic side are lobbying for positions on the key Ways & Means Committee.

We will continue these updates as we collect additional information on the Trump transition, particularly as it looks at sub-cabinet level positions in HHS and CMS.  I have attached for folks’ review, the Ways & Means Committee document, A Better Way, which discusses their replacement for the ACA and is probably the best starting point for those looking to begin to discern what repeal and replace will look like.  We will provide more updates on this process as they begin to take shape.

CMS List of Medically Unlikely Edits for Ambulance Services

On October 1, 2016, the Centers for Medicare and Medicaid Services (CMS) updated its list of Medically Unlikely Edits (MUEs). The MEU program is designed to reduce the paid claims error rate for Part B claims. The program operates by estimating the maximum number of units of service that a provider/supplier would report under most circumstances for a single beneficiary on a single date of service. A claim that submits units of service in excess of this threshold will typically be denied by the Medicare Administrative Contractor.

For additional information on the CMS Medically Unlikely Edit Program, click here.

Effective October 1, 2016, claims for ambulance services will be subject to the following MUE edits:

HCPCS Code MUE Threshold
A0425 (Ground Ambulance Mileage) 250
A0426 (Ground Ambulance, ALS Non-Emergency) 2
A0427 (Ground Ambulance, ALS Emergency) 2
A0428 (Ground Ambulance, BLS Non-Emergency) 4
A0429 (Ground Ambulance, BLS Emergency) 2
A0430 (Air Ambulance, Fixed Wing) 1
A0431 (Air Ambulance, Helicopter) 1
A0432 (Ground Ambulance, Paramedic Intercept) 1
A0433 (Ground Ambulance, ALS-2) 1
A0434 (Ground Ambulance, Specialty Care Transport) 2
A0435 (Air Ambulance, Fixed Wing Mileage) 999
A0436 (Air Ambulance, Helicopter Mileage) 300


President Postma’s Capital Campaign

At the 2016 AAA Annual Conference & Trade Show, new president Mark Postma announced a visionary capital campaign to build our association’s reserves to $1 million. We invite all members to give as they are able to build a rainy day fund capable of weathering any storm. Thank you in advance for your support and participation.

Funds contributed to the Capital Campaign can only be used by the association following a board vote.

Pledge Now

2016 AMBY Innovation in EMS: Tri-State Ambulance, Patient Transport Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Tri-State Ambulance Awarded a 2016 AMBY for Innovation in EMS

amby-congrats-tri-state-ambulanceAmbulance services which provide 911 coverage frequently have patients who request service but ultimately fail to accept transportation to a hospital for further care. Depending on the service area, non-transports can be 30% or more of all requests for service. These ambulance responses can range from falls or diabetic issues, to motor vehicle crashes and anything in between. It is known that transporting a patient to an emergency department is not always the most appropriate choice for their medical care. Often, a visit or a conversation with their primary care or specialty provider may be a better option.

Due to HIPAA regulations and continuity of care rules, the patient response information, when they are not transported, does not proceed further than a typical quality assurance or billing department review. This ultimately leaves the patient’s primary care provider or other specialty care provider completely unaware that their patient was cared for by another medical professional in an urgent setting. Upon investigation we found that the general public was unaware that their information from the contact with an ambulance service was not being sent to their current providers. In an electronic world, the general assumption by most patients was that all medical situations would be collected in one comprehensive medical record and not separated by service providers. This situation was noticed by a new billing manager who was often the last person to look at a patient’s medical record. It was quickly realized that other health care professionals should be aware of patients who are cared for by an ambulance crew and not transported.

Although there have been tremendous strides made in the Community Paramedic (CP) or Mobile Integrated Health (MIH) programs, the industry is still far from global reimbursement and universal standards. The hope for this project was to establish essential communication that was missing between a patient’s medical provider and the documented ambulance visit. Through this communication, providers may proactively set an appointment with the patient which could help prevent an emergency room visit or ultimate admission and therefore reduce the potential patients that would be subject to a CP or MIH program. As with most aspects of healthcare, it is proven that early intervention has the best long term results and often at a significant cost savings to the system and patient. The best systems would utilize a multifaceted approach that uses early intervention and post care follow up.

The goal of the project was to make available the patient care report from an encounter with an ambulance crew, when not transported, to their permanent medical record of their primary and/or specialty care provider. Secondly, it was intended for a provider to deliver proper follow up care and ultimately improve patient outcomes or experiences. It was thought that patients who receive the proper follow up care are less likely to call for an ambulance again for the same issue, thus reducing repetitive patients. It was also considered that improved follow-up would reduce the potential for the patient to develop more serious medical situations in the future.

<h5>Planning and Implementation</h5>

  • All stakeholders were identified and made aware of the current plight
  • Legal and compliance departments were consulted on all legalities with release of a patient medical records to a third party
  • Analyzed current electronic patient care reporting (ePCR) system for viability
  • Ensured process required minimal resources and would be cost effective
  • Created electronic release of information to third party form that met all legal requirements
  • Educated and trained employees on proper utilization of form • Built paperless IT structure to support secure sharing of information
  • Created procedure for hospital follow-up of patients • Monitored and adjusted processes to ensure goals were being met

The project was first implemented in Q4 of 2013 with some major changes since inception. The basic practice of sending patient medical records to the medical provider of the patient’s choice was implemented and worked smoothly from the start. The process involves an ambulance crew obtaining two signatures from a patient when transport was refused. The first signature is the acknowledgement of the refusal of transport and the second is the voluntary request to disclose their medical record to the provider of their choice. The release of information disclosure is strictly voluntary and complies with HIPAA regulations. After implementation, it was noticed that the process didn’t seem to have a quantifiable way to track improvement in patient results or outcomes. On January 1st of 2015, the new process was executed with two local health systems that routes the patient record directly to a quality assurance nurse for review. Both of these local health systems incorporate large medical clinics which provide medical services to the vast majority of the local population. The nurse would then contact the patient to see how they are doing since the encounter with the ambulance crew and to schedule appointments with their providers if needed. The nurse was also able to see if the patient had come in to urgent care or the emergency department after they refused transport or to see if they have any pending appointments. Dependent on the nurse findings from the telephone call, they had the ability to contact a patient to change an appointment to an earlier date or to see if there are any other services that they can refer to the patient.

The initial impact has proven to be very successful. The first positive impact was with our paramedics and EMTs and their response to the new process. Sending the ePCR to the patient’s medical provider allowed the employees to know that the patient was going to get further care or follow up that they needed. This has enabled the field EMS provider to still feel a sense of completion and satisfaction because they are providing the catalyst for further care. Also, when these patients receive a follow up call or physician visit they are less likely to become a high utilizer, as shown by preliminary data. Reducing unnecessary calls for repetitive patients has also improved employee morale. Further research is being conducted to evaluate the percentage of improvement from the reduction of repetitive patients.

Another positive impact was discovered when patients would ultimately go by other means to an urgent care or emergency department and in turn notify the emergency provider that they were evaluated by EMS. At the request of the emergency department provider, we are then able to send them the patient response information from our interaction. This information provides assessments and other key factors that the attending provider may need to offer effective care. This can all happen in real time because the patient has already provided written authorization for the release of their medical record to the provider.

An unexpected result that has also created a positive impact is the utilization of the hospital’s immense resources. When a patient has authorized us to send their medical records to their healthcare provider it creates a bond that allows us to share information for the benefit of the patient. This makes it possible for us to reach out to social workers or other healthcare resources such as patient advocates to help patients with things that we are not equipped or staffed to handle. A person will utilize the 911 system for an unmet need, even if not medical in nature. We now have an expanded use of resources to meet the needs of patients in our community.

Improvements have been made to our quality assurance program for patients who requested service but refused transportation. With the addition of the follow-up calls by nurses, we were able to track and review patient outcomes when they refused transportation. Being able to ascertain a patient’s final diagnosis by another medical professional versus what was determined in the field has given us valuable information to use for training and education. Before the use of this new method the quality assurance process could only make a determination based on the narrative written by the crew. Now, we are able to have a full circle review of the care and outcome of the patient. As health care continues to evolve with trends towards CP and MIH and possible changes to Medicare reimbursement, reviews like this are becoming ever more important. Additional research is being proposed by a local hospital to do a retrospective analysis to determine the impact of the process on patient outcomes. The study is focused on patients who called 911 related to a fall and are over the age of 55. The purpose of the study is to determine if interventions performed by their provider reduced the likelihood of future falls or injuries related to falls. This is being done in conjunction with data from the hospital and any interactions a patient has had with the ambulance service.

Congratulations to Tri-State Ambulance for their selection as a 2016 AMBY Winner.


2016 AMBY Best Use of Technology: Trinity EMS & Firstwatch, Opioid Epidemic Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Trinity EMS & FirstWatch Opioid Epidemic Project Awarded a 2016 AMBY for Best Use of Technology

Trinity EMS & FirstWatch | Massachusetts

amby-congrats-trinity-ems-with-firstwatchMassachusetts has seen a massive increase in opiate overdoses and deaths. In 2013 there were 918 opiate related deaths in Massachusetts. Massachusetts had 1531 deaths in the first six months of 2016. Many of the communities Trinity EMS serves are on the front lines of this issue. Their EMT’s and paramedics are helping to revive patients every day from an opiate overdose. Understanding the scope of an issue is a critical first step to solving an issue. They started using their PCR data to help frame the issue for their communities. They began tracking the demographics such as age and gender of the patients, time of day and day of the week, and location within the communities. They also monitor the volume to identify spikes in volume in individual communities and system wide. Trinity reported data monthly, one month behind to the health department, public safety partners, methadone clinics, hospitals and city governments. This data was well received. Other services contacted them for help in developing their tracking and reporting. They added FirstWatch to their program to speed up the notifications. Monthly reporting is still valuable. Instant reporting is even better. FirstWatch allows their communities to be notified within an hour of an opiate overdose. Public health and public safety now have this intelligence right away.

The goal was to gather and present data in a cross discipline format for aid with better understanding on the situation. First responders, law enforcement, public health, EMS, and district attorneys, and the press have received and used their data. Trinity wanted to show:

  • The profile of the patients we are seeing
  • The frequency of the patients
  • The location and time of the overdoses
  • The severity of the patients. (Our volume of overdoses have leveled off, the acuity of the patents is still increasing)
  • Our monthly report is a key performance indicator as to the opiate issue at the street level in our communities
  • Our needle pick up data indicated where outdoor intravenous drug use is happening
  • Many of the overdose calls to the 911 centers are not communicated as being overdoses; “fall”, “respiratory”, “unconscious” are common chief complaints at dispatch. This data would not have been collected and reported using chief complaint as a filter

When it became clear the opiate issue was becoming a wide spread crisis Trinity started working the issue. They knew their best area to provide data from was PCRs. They came up with a set of data points they thought would help. They attended many meetings and public events. During those forums dozens of additional questions and theories came forward. Trinity took and implemented all that they had data for. (Example. There was question about social benefits and opiate use. They are able to show on an ongoing basis that there is no correlation between opiate overdoses and the 1st and 15th of the month.)

Before 2015, Trinity reported opiate overdoses usually annually only when requested. Starting in 2015 they reported monthly. They wanted to provide data even quicker. Trinity had seen FirstWatch a few years before. They felt the speed and automation FirstWatch could provide was a critical improvement. The intelligence gathered with knowing in live time of opiate overdoses can’t be overstated. The automation allows that intelligence to be gathered no matter the day or time.

Trinity started working with FirstWatch in December 2015. In May 2016, Trinity put FirstWatch directly into the hands of public health, public safety and public schools. Each discipline has a HIPAA compliant login with access to data specific to their mission. They worked very closely with FirstWatch so they could understand the capabilities within the system. They brought the idea and FirstWatch brought the execution and focus. The FirstWatch platform is amazingly powerful for Trinity, to provide live access is amazing. In June 2016, Trinity participated in a Middlesex County District Attorney opiate task force meeting. Trinity had earlier in the meeting done a 20 minute presentation on the opiate crisis in our city. This provided the 70 people in attendance a fresh look at the data. Towards the end of the meeting conference to alert families and friends of addicts to watch their loved ones, and scheduled “emergency” Narcan administration training for the community. During DA Ryan’s presentation, Trinity received a FirstWatch alert for a 39 year old female opiate overdose from 30 minutes before. Three minutes later they received another alert for a 41 year old female that suffered a fatal opiate overdose. They were able to share that with the group and drive home the DA’s message.

The City Governments, Public Health, Police and Fire Departments in Trinity’s communities were eager to learn about the data they were able to collect, and their data began to become focal points at press conferences and city council meetings. News agencies began contacting Trinity to help paint the picture of the epidemic in feature stories. In sharing the mapping aspect of Firstwatch they hope that these agencies can further understand the epidemic and develop plans to combat it. Trinity has become the de facto subject matter experts of the opiate crisis.

Congratulations to Trinity EMS and FirstWatch for their selection as 2016 AMBY Winners.


2016 AMBY Best Quality Improvement Program: Gold Cross Ambulance, Documentation Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Gold Cross Ambulance’s Documentation Project Project Awarded a 2016 AMBY for Best Quality Improvement Program

Gold Cross Ambulance | Utah

amby-congrats-gold-crossThe documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:

  1. Create a way to measure overall documentation quality.
  2. Establish a formal standard for documentation and educate crews about the documentation expectations.
  3. Improve the overall documentation of the ePCR.
  4. Improve the number of patients with properly collected and documented vital signs.
  5. Improve amount of reimbursement and decrease collection cycle time.

Gold Cross formed a work group to tackle these issues, which consisted of members of the Quality Department, Training Department, Billing Department, and Operations Department. The group meets every other week to evaluate progress and assess the need for adjustments to the system. Mid-year of 2014, the group worked to revise the program for documentation evaluation. A new standard was created based on the ePCR fields. A point system was established for documentation which gave each ePCR field a weighted number of points, equaling 100%. Incomplete or missing fields result in a loss of points for that field, which provided a way to measure documentation performance. The scoring data is tracked in our ePCR quality module, allowing us to analyze and report on the data easily. The feedback on any areas of missed points is sent to the crew via the ePCR messaging system, so it is easily accessible to the crews during regular daily tasks. Feedback is focused on improvement comments instead of punitive comments. Positive feedback is included in each evaluation. The group released an initial version of the General Instructions for the ePCR, which was an internal manual detailing expectations for every field in our ePCR. The focus was to provide clear expectations to all field crews regarding how to properly fill out the ePCR and what content should be included. The training department created an educational program on the online educational software program, detailing the documentation guidelines and testing the crews on the material. The General Instructions for the ePCR were also posted on the company training site, so crews would have easy access at any time. The Quality Department developed a class for the newly hired providers. The class emphasizes the need for quality documentation, outlines the program, and includes actual documentation examples for evaluation and discussion. Patient advocacy through documentation is instilled in the participants of this class. The Billing Department developed a class which is taught at six months after hire. In the class, documentation is reviewed from class participants. The billing department shows how the bill is processed from the documentation, and they discuss common challenges to the billing process. The program has been monitored with continuous PDSA cycles and has been adjusted as needed for continued improvement.

An initial company goal for documentation was set at 90%. From project start to current date, the company-wide documentation averages have increase from 74% at the beginning of the project to 96% currently. Field crews have expressed greater clarity in the company expectations for documentation. The overall average documentation scores by division are posted regularly for the company to view, and this has had the additional benefit of sparking a competitive streak between some of our divisions, further improving the scores. The improvement in collection of vital signs not only improved overall patient care, but resulted in a Performance Improvement Award from the Utah State Bureau of EMS in 2016. The bureau looked at pediatric vital signs and recognized two rural and two urban EMS agencies in the state for their improvements. Gold Cross Eastern Division won the award for a rural agency, and Gold Cross Salt Lake Division won for the urban agency. Their study found our agency improved the collection of pediatric vital signs by 53% in our urban area and 66% in our rural area.

The most important impact of this project is improvement in patient care, which is our primary mission. The goals for complete documentation have encouraged field crews to make sure they complete proper assessments, since they know those areas of the ePCR are evaluated and must be complete. Improvements in assessment result in better differential diagnoses and improved treatment plans and outcomes. The documentation project has positively impacted Gold Cross financially as expected. Reimbursement rates have increased and the time to complete the collection cycle has improved. Due to the documentation improvements, the billing staff spends less time researching information, following up on incomplete documentation, and fighting in appeals.

Congratulations to Gold Cross Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.


2016 AMBY Best Community Impact Program: Medic Ambulance, Reduced Readmissions Project

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Medic Ambulance Reduced Readmissions Project Awarded a 2016 AMBY for Best Community Impact Program

Medic Ambulance | California

amby-congrats-medic-ambulanceMedic Ambulance Service is the exclusive ALS service provider in Solano County, a HRSA-designated medically underserved area with a physician-provider to population ratio of 81.1 per 100,000. In 2014 Medic Ambulance became aware of an opportunity to participate in a Community Paramedicine Pilot initiated through California Ste EMSA. After collaborating with LEMSA and the community hospitals, Medic Ambulance unanimously concluded that the 23% average readmission rates for each CHF and COPD patients was taking a crippling toll on the hospitals’ reimbursement and increasing Emergency Department wait times. Starting in January of 2015, Medic Ambulance Service enrolled six paramedics into approximately 300 hours of additional training focused on the biopsychosocial needs of patients with CHF or COPD. The education has continued through monthly case reviews and peer-to-peer lessons-learned where the entire team brainstorms innovative solutions to the patients’ challenges. From the beginning, Medic Ambulance Service was poised on creating a sustainable model that would persevere past the period of being a pilot or grant funding. They made this goal of preservation well-known to all stakeholders, and after quickly proving the value through low readmission rates they had established a sustainable funding source, happy to pay for Community Paramedicine Services.

Project Goals

  1. Reduce the readmission rates of patients with CHF or COPD.
  2. To create a sustainably funded model to ensure the project remains available to our community and is replicable in other areas.
  3. Provide superior customer service.
  4. Teach patients how to improve their health by appealing to the patient’s values.
  5. To provide these services at a lower cost than was otherwise available.

Project Phases

  • Planning Phase: The project was planned based upon the results of the community needs assessment. The findings indicated that there is a substantial difficulty within the community to access restorative medical aid. Each Community Paramedic underwent over 300 hours of focused training on the management of CHF and COPD, cultural sensitivity, and rehabilitative services.
  • Implementation Phase: To ensure compliance with the strictest regard for patient outcomes and program oversight Medic’s Community Paramedicine Program is IRB approved, reports at least monthly to a Steering Committee with diverse medical and nonmedical expertise, 100% charting review by a Registered Nurse, and utilization of, EMS Survey Team, a third-party patient surveyor. These highly trained Community Paramedics began seeing patients in September of 2015 and the most common question we are asked by the local hospitals is when can we help them lower their readmission rates for patients that don’t have CHF or COPD. With a sustainable and reproducible model we intend to keep filling healthcare gaps and mold healthcare delivery to suit the needs of every community we serve!

Our goals with this project are built upon the IHI Triple AIM to improve the patient experience of care, improve the health of populations, and reduce the per capita cost of health care. We are absolutely meeting these foundational goals!

  • 85 patients have been referred to the program (59 enrolled)
  • 118 visits have been completed

Medic Ambulance measures and objectives reveal that the enrolled population has only a 8.5% unplanned readmission rate; as opposed to a 23% rate of those not enrolled. During home visits it was discovered that:

  • 50.8% of patients had medication errors
  • 48.7% of the patients that thought they were taking all their medications correctly weren’t
  • 72.9% of patients needed help understanding their discharge instructions.

These enrolled patients also self identify an average overall health rating improvement of 22.8% between their pre-enrollment and post -enrollment health. During this same interval the patients’ understanding of their hospital discharge instructions has risen by 16.8%, understanding of when to take medications improved 8.3%, and understanding of their medication side effects improved by 14.1%.

EMS Survey Team, a third party patient surveyor, attempts phone contact with all enrolled patients. These scores are recorded and measured against the 128 different EMS services they contract with. This program is the #1 rated provider with a total score of 96.48/100 and 100% of all responses have been positive.

Patient Feedback

“It’s been a very good experience. She (the Community Paramedic) explained everything so I could understand.” – Patient

“There’s a lot of people out there who need this, especially those without insurance.” – Patient

“My blood pressure started going up and it wouldn’t come down. I had medication but it wasn’t helping.” – Patient who was not taking her medication at the correct frequency.

“She (a patient) feels more comfortable.” – Patient’s daughter “This is a pilot program but everyone so far is very pleased with how it is working.” – Director of case management at a referring hospital. “If I get sick I know they’re gonna be there for me and that I’m not alone.” – Patient

As a third generational, family-owned EMS provider, nothing is more important to us than the community we serve as the exclusive ALS provider. The creation of this program wasn’t created as merely a proof of concept, we continue to grow and adapt this program to meet the needs of the populations through changing the landscape of health care. The impact of this program’s success has been marked with already saving the health care system $137,000 with a projected savings of $685,000 by the end of 2017, improved health literacy in vulnerable populations, reducing overuse on the 9-1-1 and Emergency Department systems, and catalyzing positive health changes through empowerment. It is projected that over 25% of the patients enrolled into this program have a functional health literacy defined as “below basic”, the lowest possible category per the National Assessment of Adult Literacy, compared to 14% of American adults that fall into this category. At this level of health literacy the dates of appointments and clearly defined times to take medications are often understood, but the understanding of how negative lifestyle choices, such as smoking, poor diet, and recreational drug use affect their management of diseases is not universally comprehended.

Congratulations to Medic Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.


2016 AMBY Best Public Relations Campaign: EMSA, CPR Education Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

EMSA CPR Education Program Awarded a 2016 AMBY for Best Public Relations Campaign

Emergency Medical Services Authority (EMSA) | Tulsa, Oklahoma

amby-congrats-emsaEMSA, the Emergency Medical Services Authority, is Oklahoma’s largest provider of pre-hospital emergency medical care. We provide ambulance service to more than 1.1 million residents in central and northeast Oklahoma. EMSA was established in Tulsa in 1977 and later expanded to include Bixby, Jenks and Sand Springs. EMSA began providing service to Oklahoma City in 1990. EMSA is the ambulance provider in 16 cities across the state. As a public trust authority of the City of Tulsa and City of Oklahoma City governments, EMSA is charged with ensuring the highest quality of emergency medical service at the best possible price. There are several entities that work together in the EMSA system, including the Cities of Oklahoma City and Tulsa, the medical director, and the contracted ambulance provider. EMSA oversees all business aspects including ambulances and other capital equipment, maintaining patient records, billing and more. The medical director conducts routine audits and testing of all medics practicing in the system, writes seamless protocols to ensure the continuity of care between first responders and transport medics, researches new treatment modalities and evaluates complaints. EMSA is committed to training and building awareness about CPR in EMSA’s 16 service areas. The program includes a variety of year-round opportunities to learn Hands-Only CPR(TM), as well as leveraging various opportunities to promote CPR education through traditional earned media, digital advertising, and social media. Also, EMSA medics were part of a national challenge to train as many local citizens as possible in Hands-Only CPR, called World CPR Day.

The CPR Education Program had one ultimate goal which was to increase the number of Oklahoma citizens who can effectively do CPR statewide (mostly Hands-Only CPR). The secondary goal was to connect the message of health care expertise and community involvement with EMSA, as an organization, by providing non-emergency interactions with EMSA medics and promoting CPR-related stories in earned media and digital platforms. Two measurable objectives were identified for the CPR Education Program.

Primary Objective

The first objective was to train more than 2,000 Oklahomans on how to conduct Hands-Only CPR on World CPR Day and 10,000 at the Tulsa State Fair and Oklahoma City State Fair. The second specific objective was to utilize earned media, social media, events and public figures to educate the community that EMSA is their CPR resource for training.

For many years EMSA, along with its 16 partnering first-responder agencies, achieved a heart attack survival rate six times higher than the national average. Recognizing that bystander response times were integrated into this health outcome, EMSA noted an opportunity to magnify and improve these successful numbers. The heart attack survival rate results are based on patients in cardiac arrest who received some form of bystander CPR and were found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) on first EMS contact.

Secondary Objective

The American Heart Association Research The American Heart Association conducts numerous studies on the impact of bystander CPR. These studies prove that during cardiac arrest a person’s survival chance increases significantly with immediate CPR, that CPR can be taught in a very short amount of time, and that compression-only CPR is effective for saving lives. When paramedics arrive on-scene, a patient who is in cardiac arrest and is found in a shockable rhythm (an ECG rhythm that is treatable using defibrillation) is more likely to survive if they receive some form of bystander CPR. The impact of bystander CPR has improved significantly in the past decade. In 2010, the AMR bystander CPR rate was 21.4 percent and in 2014 it increased to 40.8 percent.

Every five years, EMSA conducts a citizen survey to review the perception of services. The most recent report (2012) shows 80 percent of people who use EMSA have a positive impression. Additionally, the public responds extremely favorably to medics and paramedics; however, most people don’t meet a medic until they’re experiencing a medical emergency. Utilizing this information EMSA expanded its public events to put medics in front of potential patients more regularly — before they experience an emergency. Although the CPR Campaign primarily focuses on health-outcomes related to cardiac arrest, a secondary benefit is providing one-on-one opportunities for the general public to spend with EMSA medics, allowing those without ambulance-experience to see first-hand the caring and compassionate men and women who work at EMSA.

In order to build community awareness around the health impact of knowing CPR, EMSA focused on two general audiences: the first included citizens of EMSA’s service area without Hands-Only CPR training, the second group was the opinion leaders. The opinion leaders with the highest stakes for improving health outcomes on a statewide basis were determined to be elected officials.

EMSA has conducted CPR training throughout the community for decades. EMSA also partners with other CPR-certification agencies to increase access to CPR education. For the past three years, EMSA has organized an annual special event to train a large number of citizens in Hands-Only CPR and also communicate the importance of learning CPR. In addition, EMSA provides stand-by ambulances at the Oklahoma State Tulsa State fair annually; during the fair EMSA utilizes an informational booth space to provide citizens with an opportunity to learn CPR.

The CPR Education Program consisted of three key areas. The first was participation in large-scale events that provide an opportunity for training a large number of people (World CPR Day and the two State Fairs). These larger events would be used as a catalyst. The second area was building awareness that EMSA offers CPR training, both Hands-Only and traditional CPR, to the general public within their service area. The final area was recruiting a prominent Oklahoman to participate in a CPR training in order to maximize attention to the importance of CPR training for all individuals. All of the focus areas, and the message that CPR saves lives, were promoted through traditional earned media, advertising, and social engagement.

Large-Scale Training Events

World CPR Day is organized on a national level by AMR and on a local level by EMSA. Each year the EMSA communications team strategically identifies partnership events and organizations to bring Hands-Only CPR in front of Tulsa and Oklahoma City-area citizens. There are many options annually because the wide audience-base includes all individuals in EMSA’s service area without Hands-Only CPR training. EMSA hosted CPR trainings throughout coverage areas utilizing ongoing events at businesses and organizations, such as the business board meetings. Some trainings were private and others were public events. Utilizing earned media and social media, World CPR Day was heavily promoted and resulted in strong participation. Reviewing the World CPR date and community events we noticed the two largest events that could incorporate CPR training were the Big 12 Baseball tournament and the Dallas Cowboys Mobile Museum. These two events were slated to attract large crowds of active Tulsans ideal for learning Hands-Only CPR. EMSA worked alongside the Tulsa Regional Chamber to coordinate a training site at Fan Fest, the fair-like celebration that runs concurrently during the Big 12 Baseball Tournaments. EMSA also had the Dallas Cowboys mobile museum for their evening sessions at LaFortune Park. In addition to the large public trainings, EMSA hosted smaller CPR trainings throughout our coverage areas utilizing ongoing events at area businesses and organizations, such as the Jenks Chamber of Commerce Board Meeting. The largest private training was at Roosevelt Middle School in Oklahoma City where EMSA trained more than 600 students. The Tulsa and Oklahoma City State Fairs provide easy-access to large groups of Oklahoma residents who are eager to learn CPR in order to save a life. Although the location and interaction opportunities are optimal, medics do use key message points, such as “It’s most likely a loved one’s life you’ll save,” to encourage passers-by to participate in the training. Thousands of individuals learned Hands-Only CPR at the state fairs last year. CPR Training Requests EMSA generally receives 30 requests per year to train small groups on how to perform CPR. These are businesses and organizations, as well as teams and non-profits. During the CPR Education Program, EMSA promoted CPR training through all owned mediums including its website and social channels. After promoting World CPR Day and the importance of learning Hands-Only CPR, EMSA inquiries for trainings increased by almost 25 percent. Most of the new requests came from government officials or civic-related organizations, which are targeted groups because their circle of influence is generally larger than other groups.

Training High-Profile Oklahoman in Hands-Only CPR

EMSA individuals researched prominent Oklahomans to find who fit with EMSA’s mission and goals. We needed individuals that would create a buzz online and in traditional media. After considering various famous individuals we determined that elected officials were the most inclined to be concerned with the overall health and well-being of Oklahomans. We set our goals high, and invited the Governor to learn Hands-Only CPR. Additionally, we sent requests to various local elected officials to offer a CPR class during a City Council meeting. We were pleased that Oklahoma’s Governor Mary Fallin, the Tulsa City Council and Oklahoma City Council accepted our invitations, and in three separate events, they learned the steps to save a life through CPR. The events created a stir in local newspapers and TV while also creating engagement online through our EMSA social channels and other digital news sources. Promotion EMSA promoted World CPR Day, CPR trainings, and the elected-officials training events throughout the year. Additionally, EMSA hosted several in-studio CPR demonstrations at Oklahoma City and Tulsa media stations. Another media component was promoting feature stories on patients that survive because of CPR. The final promotional component was a digital ad campaign that are PSAs about the three C’s of CPR: check, call, and compress.

See measurable outcomes below; additionally review work samples to view social media samples, earned media samples and more.

  • Measurable Objective: train 2,000 attendees how to do Hands-Only CPR on World CPR Day. Result: Trained 2,585 people 1,201 in Tulsa and 1,384 in OKC Measureable Objective: train 10,000 attendees how to do Hands-only CPR at the two Oklahoma State Fairs. Result: Trained more than 10,000 people at the Tulsa State and Oklahoma State Fairs.
  • Measurable Objective: Utilize social media to increase awareness of World CPR Day Result: More than 20,000 unique social media impressions for various social media posts promoting and celebrating World CPR Day.
  • Measurable Objective: Utilize earned media, social media and World CPR Day to educate the community that EMSA is their CPR resource for training.
  • Result: Following World CPR Day EMSA was contacted by several community groups wanting EMSA medics to teach Hands-Only CPR at their monthly meetings. Additionally, EMSA gained a lot of media coverage and social media activity due to the high-visibility leadership participating in Hands-Only CPR.

The overall impact of the ongoing EMSA CPR program continues to increase the number of Oklahoma residents who can perform CPR. This ultimately affects improved health outcomes. Additionally, this campaign provides one-on-one time with medics which produces a familiarity with the ambulance authority that will provide long-term mutually beneficial outcomes.

Congratulations to EMSA for the CPR Education Program’s selection as a 2016 AMBY Winner for Best Public Relations Campaign.


2016 AMBY Best Community Impact Program: AMR, River Rescue Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

American Medical Response River Rescue Program Awarded a 2016 AMBY for Best Community Impact Program

amby-2016-congrats-amrAMR | Oregon

The Oregon River Safety Program (aka AMR River Rescue Program) is provided by American Medical Response (AMR) as a community service for two communities it serves in Oregon. The program is the only one of its kind exclusively operated by a private EMS provider, supported by strong community partnerships, and was developed after a series of thirteen drowning deaths over five years in the 1990s at two popular river parks. Ten years earlier, AMR developed its Reach and Treat (RAT) Wilderness Medicine Program to provide medical care for people ill or injured on Mount Hood and the surrounding national forest. Since Swift Water Rescue was part of the existing Reach and Treat Teams training and competency, AMR worked with the Troutdale City Council and a group of dedicated civic leaders to launch the River Rescue Program in July, 1999. For the remainder of the summer, AMR used its RAT Team members as Swift Water Rescue Specialists to staff the new River Rescue program.

The program was developed to meet the certification standards of the United States Lifesaving Association (USLA) for open water lifeguarding, and is staffed by Oregon licensed Emergency Medical Technicians and Paramedics. To meet USLA requirements, AMR developed an 80-hour training program with core USLA curriculum as well as additional site-specific training. River Rescue Technicians are not the same as pool lifeguards, but instead are highly trained and certified professionals with expertise in lifeguarding, swift water rescue, and medical care. The AMR River Rescue program received USLA Advanced Lifeguard Agency Certification in April 2012. The United States Lifesaving Association is America’s nonprofit professional association of lifeguards and open water rescuers. The USLA works to reduce the incidence of death and injury in the aquatic environment through public education, national lifeguard standards, training programs, promotion of high levels of lifeguard readiness, and other means.

This year marked the 18th season for the program. From 1999 through 2016, the AMR team performed 97 rescues, more than 1,400 assists of people in distress, and dedicated thousands of hours to prevention activity. Based on pre-program statistics, 66 drownings would have occurred over those years without the program. Each year, the team consists of approximately 20 River Rescue Technicians trained in Swift Water Rescue who provide life guard services seven days a week, ten hours a day at Glenn Otto Park in Troutdale, and at High Rocks Park in Gladstone, Oregon from Memorial Day weekend through Labor Day.

AMR’s Oregon River Safety Program has been highly successful in relegating some of the State’s highest drowning sites for recreational waterways to a footnote in history. The Program has increased swimmer safety through public awareness campaigns; prevention interventions, such as life jacket loaner programs; and community and media partnerships. It has also amassed a wealth of data to guide program enhancement which has documented a significant increase in the use of life jackets for all age groups. Lastly, the Program has prevented drowning through direct and often dramatic rescue interventions by AMR technicians.

From its inception, the goal of AMR’s River Rescue Program has been to prevent loss of life due to drowning and to make the locations AMR guards safer. Primary responsibilities of River Rescue Technicians are to provide public education on water safety, raise awareness of the potential hazards of rivers and open bodies of water, promote life jacket use, deter risky behaviors (such as drug/alcohol use and unsafe ways of floating downriver on makeshift “rafts”), and rapidly respond to swimmers in distress. AMR River Rescue has released a new mission statement for 2016: Drowning prevention through education, vigilance and rescue.

AMR River Rescue utilizes a public health model “Spectrum of Prevention” approach to support the goal of drowning prevention by focusing efforts on: individuals, groups, providers, networks, organizations, and public policy makers. Injury prevention efforts are targeted by utilizing the significant amount of data captured by the program each year to help identify trends. AMR River Rescue has also developed strong partnerships with traditional media to further educational goals, allowing them to reach large television/radio audiences with important water safety messages for visitors to Oregon’s rivers, as well as tips and advice to prevent drowning elsewhere, such as in pools and spas, and in and around the home. In addition to onsite, rivers-edge, education and prevention, River Rescue Team members participate in social media and community events to share information on water and pool safety for children and parents.

Planning and implementation of the program has developed over the course of the last eighteen years. In 1999, after 13 people drowned over a five-year period at Glenn Otto Park on the Sandy River in Troutdale, Oregon, AMR worked with local officials and civic leaders to pioneer an on-site river rescue program using EMS personnel trained as lifeguards specializing in swift water rescue. The program was modeled after ten years of success with the Reach and Treat Team developed by AMR in the late 1980s. AMR’s River Rescue program is distinctly different than the Sheriff’s office and fire departments’ water rescue programs. While they cover long stretches of waterways and can only respond after an incident is reported, AMR’s program focuses on the most dangerous river sections that have the highest drowning mortality sites. To protect these areas, public education and risk mitigation were made priorities and coupled with the River Rescue Technicians’ training in Swift Water Rescue to spot trouble and act immediately.

The window to intervene in a developing drowning and save a life is often less than 30 seconds. After several years of program development, the River Rescue Program received certification from the United States Lifesaving Association (USLA), which is recognized internationally as the “gold standard” for accreditation.* To meet USLA standards, AMR developed a unique 80 hour training program with a core USLA curriculum with additional swift water and medical training. The program is unique in the U.S. and is the only certified agency that provides lifeguards solely in a swift water environment (versus beaches or lakes).

Because prevention is an important component of the program, a life jacket loaner program was developed, offering free daily use of hundreds of personal flotation devices (sizes from infant to adult) to visitors of the parks. In the summer of 2002, after three people drowned in less than a month at High Rocks Park along the Clackamas River, AMR expanded the program to cover the popular river site. Responsibility for the Clackamas River is vested with the Clackamas County Sheriff’s Office, but the shore is governed by two cities, one on each side of the river. The lack of clear jurisdictional responsibility had caused a stalemate over how to improve safety at High Rocks Park for many years until AMR proposed expanding its River Rescue Program to that site and agreed to accept responsibility. (AMR knows the county well – as they have been the 9-1-1 ambulance provider in Clackamas County for decades). High Rocks Park presents much different challenges than Glenn Otto, with 20-25 foot rock cliffs and formations from which adventurers jump into the cold, fast moving water. Both the Sandy and Clackamas River share origin from Mount Hood glaciers and have swift current, cold water and underwater hazards.

The program also serves as a regional resource for water safety public education, water hazard mitigation, deployable rescue swimmers, as an in-water search resource for recovery of drowning fatalities in other areas of local rivers (upon request from law enforcement) and provide services and support to the Regional Clackamas County Water Safety Consortium.

Clackamas County Water Rescue Consortium members include:

  • AMR River Rescue Program
  • Canby Fire District
  • Clackamas County Sheriff’s Office Marine Patrol
  • Clackamas County Fire District 1
  • Estacada Fire District
  • Gladstone Fire Department
  • Lake Oswego Fire Department
  • Tualatin Valley Fire & Rescue
  • Sandy Fire District Recruitment and Training

To prepare for staffing the river parks by Memorial Day weekend, AMR begins each season by recruiting candidates in February. They must pass a rigorous swim test (covering 500 meters in less than 10 minutes without the assistance of any propulsion devices) in order to continue through the selection and training process. New candidates join returning members in a challenging, eighty-hour course led by veteran River Rescue Technicians and other experts. Training topics include:

  • Swift water Hydrology and Hazards
  • Swift water Rescue Tactics
  • Lifeguarding Tactics
  • Observation and scanning
  • Rescue Scene Management
  • Community Education
  • Rescue kayaks
  • Rescue paddleboards
  • Media Relations
  • Staffing River Parks

Teams of 2-3 River Rescue Technicians are on duty at each site, and are in constant radio communications with each other, AMR’s Communications Center, the 9-1-1 Center and local law enforcement officers. An alert is transmitted any time a River Rescue Specialist enters the water to conduct an assist or rescue, and if not canceled within five minutes, a full EMS response is dispatched. According to the USLA, the most challenging assignment for a lifeguard is safeguarding natural bodies of water, referred to as open water. Unlike pools and waterparks, crowd conditions, swift currents, cold water, underwater hazards, weather, and related conditions of open water can change quickly and pose unique obstacles to maintaining water safety. A primary responsibility is to provide constant outreach to warn visitors of the hazards, both new inherent, at each site. AMR technicians monitor water temperature, current speed, underwater hazards and public census at regular intervals every day, including in-water assessments. Even the most seasoned swimmer can be taken by surprise in swift moving water, but are generally less inclined to exercise risky behavior after an on-site expert has informed them of the hazards and possible consequences. Over the years, AMR’s River Rescue Team has become the region’s water safety subject-matter experts whom media outlets and others frequently turn to for water safety messages. Due to the focus on prevention and media interactions, the River Rescue Team receives annual training in prevention messaging and media interaction, including mock on-camera interviews and speaking points which undergo annual revisions based on previous years data.

Over the last 18 years the program has successfully reduced the drowning rate at Glenn Otto and High Rocks parks from approximately 1 in 15,000 to 1 in 256,500. The very first achievement however, was relieving community tension. At the first City Council meeting after the program began, then Councilor and now Mayor Doug Daoust, asked AMR leaders “how it feels to deliver a miracle?” Having received one of the highest compliments it could imagine, and with intense media attention, AMR set about re-instilling the philosophy of extensive selection and training, hypervigilance, and a primary focus on prevention. The official title, Oregon River Safety Program, was so named because water safety and prevention is the core focus of the program. Not only has community awareness and use of lifejackets increased, but families frequently state that they come to one of the parks for the add safety of lifeguards. The drowning rate at Glenn Otto and High Rocks parks has been reduced from approximately 1 in 15,000 to 1 in 256,500, and AMR hopes to continue to improve every year. In 2016 alone two people (a sixteen year old and a six year old) were pulled up from underwater, and an additional 147 adults and children were assisted before submerging. Over 18 years the program has directly intervened in 1,650 lives who were either beginning to or actively drowning, and have made direct prevention contacts to 23,330 people and families. The program:

  • Has saved lives, which has in return, propelled the continuance of the program.
  • Stopped the long history of fatal drownings in young people at the two parks.
  • Success created relief among the communities and community good will towards AMR’s River Rescue Team.
  • Has enhanced strong community partnerships.
  • Raised overall awareness in communities and the region about hazards of rivers in Oregon.
  • Has helped to normalized life jacket use.
  • Developed an avenue for EMTs to transition from River Rescue to AMR Ambulance Operations.
  • Has changed city parks from former “party” hangouts (with alcohol, drug use and risky behavior) to more family-friendly environments, decreasing law enforcement issues.
  • Has seen the number of visitors to the parks increase.
  • Has seen life jacket use improve across all age groups and the implemented life jacket loaner program has seen yearly increasing demand.

Today, AMR funds most of the $160,000 annual program as a community service, assisted by the City of Troutdale with a $10,000 grant most years. An additional $10,000 per year is needed for new/refreshed equipment and is a relatively small portion of the Multnomah and Clackamas County budgets. Seed funding to purchase equipment in the early years was provided by the Troutdale Booster Club and Providence Milwaukie Hospital. The program has also received grants from Safe Kids Portland Metro, Safe Kids Worldwide and the Consumer Product Safety Commission to purchase PFDs for the life jacket loaner program, develop water safety banners, support for water safety educational programs and awareness materials to distribute at events throughout the season.

Congratulations to AMR for the River Rescue Program’s selection as a 2016 AMBY Winner for Best Community Impact Program.


2016 AMBY Best Clinical Outcome: Advanced Medical Transport, Race to the Top Program

Congratulations to the 2016 AMBY Award Winners

Each year, the American Ambulance Association honors best practices, ingenuity, and innovation from EMS providers across the country with our AMBY Awards. 

Advanced Medical Transport’s Ramby-congrats-2016-amtace to the Top Program Awarded the 2016 AMBY for Best Clinical Outcome

Advanced Medical Transport (AMT) | Peoria, IL

Advanced Medical Transport (AMT) developed the Race to the Top Program to provide the communities they serve with some of the top cardiac resuscitation rates in the nation. “By concentrating on eight highly-interdependent elements of a world-class emergency cardiac care and response system, we soldier more forces together and win more battles in the war on sudden cardiac arrest,” said AMT’s Josh Bradshaw.

Even before implementing Race to the Top, AMT’s cardiac arrest resuscitation rates were three times the national average.  However, the leadership team felt that they could push the rates higher through a multifaceted outreach program. The project began in in late 2014, with eight specific, measurable, and actionable objectives:

  • Immediate recognition of sudden cardiac arrest;
  • 911 activation, “First-Care” hands-only CPR, GPS to the rescue (PulsePoint);
  • Access to and utilization of AEDs;
  • Pit crew resuscitation by EMS providers;
  • Deployment of Advanced Practice Paramedics;
  • Advanced biomedical tools;
  • Immediate provider feedback; and
  • Community and caregiver recognition.

AMT began the program with a Return of Spontaneous Circulation rate of 27%, and have now reached 45%, well on the way to their near-60% goal. The national average is just 9%.

In December 2014, AMT became the first downstate Illinois EMS agency to report directly to the Cardiac Arrest Registry to Enhance Survival (CARES), a CDC-approved registry provided by Emory University. CARES participation empowers the AMT team to compare Race to the Top’s results with peer cities in North America. This benchmarking is in and of itself another best practice, and helps to drive ever-better results.

AMT’s key objective was to achieve widespread cultural expectations and awareness that saving lives is a community responsibility. “Saving lives is everyone’s responsibility,” says AMT CEO, Andrew Rand, “by working together we can achieve event better results.”

Congratulations to the entire Advanced Medical Transport Team for Race to the Top’s selection as the 2016 AMBY Winner for Best Clinical Outcome.


Akin Gump Political Report 2016

Akin Gump Strauss Hauer & Feld, LLP, advocates for the American Ambulance Association, have empowered us to share with members their coveted pre-election political report.

Download your copy today, covering hot topic election issues including healthcare, transportation, and more.

Download the Akin Gump Pre-Election Report
(Please note that the report is for members only.)

2016 Board of Director Candidates

Election Timeline | Board Candidates | Ethics Committee Candidates

The 2016 AAA Election is going paperless and this year’s election will be held entirely online. Primary contacts of Active Single State and Multi-State Members are permitted by AAA’s bylaws to vote in board elections.

Election Timeline

Slate of Candidates

Thank you and best of luck to this year’s slate of talented and seasoned board candidates.

President-Elect (1)

President Elect—1 Candidate

Aarron Reinert

aarron-reinertExecutive Director
Lakes Region EMS

Candidate Statement

I am excited to share with you my intent and hope to be your President-elect for our association.
Many of you have taken time to share with me your thoughts about our association and what is required and expect of such an important position as President-elect. You have been candid with me about the hard work that will be required and the expected time commitments. You were also honest with me about the need to ensure the AAA is a priority, through my actions and as well as my words. Your honesty and frankness is exactly why I desire the chance to help lead our organization. My hope is to help lead our organization through these turbulent waters of supplier to provider, payment reform, ensuring member’s services are long-term sustainable, and cultivating a Board culture of trust, accountability, vision, and passionate disagreement that strengthens us, not pulls us apart.

I am reminded of a quote from Margret Wheatley, one of the emerging leadership writers, “leaders do not deny that there is darkness, they simply choose not to live in it.” I look around our association and see leaders who have chosen to rise about the darkness of the daily challenges and inequity of non-governmental ambulance service and our reimbursement system. All of you are leading our nation’s EMS system to an environment of sustainable payments, equity, and equal standing with our governmental partners. How could I not want to be part of such an incredible team.

Thank you! I look forward to the chance to earn your vote and the position of President-elect.

Top 3 Issues in Emergency Healthcare

Leading our nations EMS system to an environment of sustainable payments, equity, and equal standing with our governmental partners, and developing and sustaining our workforce (clinical, non-clinical, and current and future leaders).

Top 3 Priorities for AAA

My desire is to help lead our organization through these turbulent waters of supplier to provider, payment reform, ensuring member’s services are long-term sustainable, and cultivating a Board culture of trust, accountability, vision, and passionate disagreement that strengthens us, not pulls us apart.

Treasurer (2)

Treasurer—2 Candidates

Shawn Baird, MA, Paramedic

Woodburn Ambulance Service, Inc.

Candidate Statement

Successfully guiding our companies through the massive transformation taking place in healthcare is an unprecedented challenge for ambulance service owners and executives. As an owner of a small, independent, 911 and non-emergent ambulance service for the past 21 years I know how critical our American Ambulance Association is to the industry. Reliable up to the minute reimbursement information, outstanding advocacy in Congress, and first class educational and member services all contribute to our companies’ success in providing excellent patient care while maintain the bottom line.

Experienced and innovative leadership is essential for the AAA to continue moving our industry ahead in the new healthcare environment. Leadership that is acutely aware of the need to balance progressive payment reform for tomorrow, with maintaining essential revenue to make payroll today.

My goal as your Treasurer is to assure the financial health of the AAA, while actively engaging on the essential priorities of payment reform and adequate reimbursement for providers. I look forward to serving and applying my experience as a AAA leader, independent ambulance company owner, and industry advocate to the membership of the American Ambulance Association.

Top 3 Issues in Emergency Healthcare

  1. Payment reform in a changing environment.
  2. Significant regulatory changes impacting all business owners and employers.
  3. Growing challenges in employee recruitment, development, and retention.

Top 3 Priorities for AAA

  1. Keeping essential revenue flowing into our companies as we navigate and drive payment reform initiatives beneficial to AAA members.
  2. Assuring that future regulatory changes on issues ranging from vehicle standards to employment practices are positive for AAA members and do not cripple our ability to operate.
  3. Develop strong partnerships with other EMS organizations to leverage our unified strength to meet challenges both known and unexpected.

Douglas “Doug” Hooten

Executive Directorhooten-photo
MedStar Mobile Healthcare

Candidate Statement

America’s healthcare system is transforming at a frenetic pace! Healthcare finance reform is creating a new environment for all types of providers, including ambulance providers. Our customer’s expectations are also changing, with the desire to shift from volume-to-value based economic models. As an appointed member of NEMSAC, and an active member of the Payment Reform Committee, I have gained the unique insight to navigate our industry through the murky financial waters ahead.

From a real-world, practical perspective, I have had the experience of working diligently with numerous external partners to demonstrate and deliver value, and get paid based on the value we bring. At MedStar, we are testing several new payment models, with more to be tested in the near future.

As your Treasurer, one of my goals will be to use this experience to prepare the Association, and its members, to take full advantage of the significant opportunities to test new economic models for our industry.

Working with local and national officials, I too often hear their frustrations about the complexity of the financial models of our industry. We must help our membership enhance their financial acumen and economic agility to try new payment models based on the value we can demonstrate to payers.

Finally, we often hear from our external partners that the ambulance industry has very fragmented messages within the DC beltway and with large national payers. One of my goals will be to work with other national associations help bring external message clarity to the profession.

Top 3 Issues in Emergency Healthcare

1. Transitioning from fee for service to outcome-based payment models.
2. The changing expectations of current customers and entrance of new customers for our services into the market.
3. Demonstrating “value” of our service delivery model, or changing the model to demonstrate value.

Top 3 Priorities for AAA

1. Changing focus away from simply FFS payment to a value-based payment model.
2. Enhancing the financial acumen of our industry leaders to make us more nimble to test new economic models.
3. Collaborating on unified key messages about the value our service line brings to our patients, our community and our payers.

Secretary (1)

Secretary—1 Candidate

Randy Strozyk

strozyk-randySenior Vice President – Operations
American Medical Response

Candidate Statement

Serving as Secretary of the American Ambulance Association the past two years has been a great personal honor and exciting career challenge. I’d like to continue representing you and ask for your vote.

During my career, I’ve been fortunate to work in and study all types and sizes of ambulance services. Though I’ve spent the past 16 years with AMR, I started my career at a small service and distinctly remember the unique pressures we encountered. I’ve considered the concerns and perspectives of providers large and small during my tenure as AAA secretary – and commit to continue being open and accessible moving forward.

In today’s world, EMS providers face a number of serious threats and game-changing opportunities, but we are challenged at times to speak with a clear, unified voice. I have the experience and tenacity to help strengthen our voice and achieve results.

It would be an honor to continue working for you. Please consider supporting me as I seek another term as Secretary of the American Ambulance Association.

Top 3 Issues in Emergency Healthcare

  1. Educating of our nation’s leaders on the critical role AAA members provide to the public and the need for fair reimbursement of the costs of providing that service.
  2. Identifying and capitalizing on innovative new methods for delivering services to the citizens we serve.
  3. Continuing to be the lead organization is crafting future legislation that benefits our industry and patients.

Top 3 Priorities for AAA

  1. Building a powerful coalition between our association and our members to advocate effectively on Capitol Hill for all of our members’ issues, including opposing efforts by the federal government to reduce reimbursement rates for Medicare and Medicaid services.
  2. Recruiting the next generation of leaders to AAA and engaging them in developing our future.
  3. Communicating and promoting the benefits of private ambulance services to policy makers, opinion leaders and the public at large.

Region I (2)

Region I Director—2 Candidates

Region 1


fred-dellavalle-3Alfred “Fred” Della Valle

Vice President Government Relations East Region
American Medical Response

Candidate Statement

As we continue our journey in achieving our goals, I am seeking re-election to the Board of Directors to ensure we continue to focus on the delivery of high quality pre hospital healthcare to the citizens we all serve each and every day.
I continue to advocate for all ambulance providers large and small, urban and rural while continuing to maintain key Congressional relationships in both Houses of Congress. We have made tremendous strides internally within the AAA, while continuing our advocacy efforts, especially, elimination of below cost Medicare reimbursements.
Having served as a host, I have accompanied many of our Stars of Life in meetings with their members of Congress in D.C., guiding them in telling their stories as to why they were selected for such a prestigious award. What an honor!
In 2014 AAA President Jimmy Johnson presented me with the AAA President’s Award for my outstanding commitment and years of service. I continue my professional relationships with members of Congress in order to ensure they remain educated, supportive and aware of the vital role ambulance providers continue to play nationwide.
In an ever-changing healthcare environment and upcoming elections, we need to ensure we remain focused, while maintaining visibility with our Congressional Leaders.
As it would be my honor to continue to serve as your representative on the Board of Directors, I ask again for your support, while thanking you for your past confidence.
As always please do not hesitate to contact me for any insight or assistance.

Top 3 Issues in Emergency Healthcare

1. Provide our care givers with technology, support and training in order to provide optimal care.
2. Explore new ideas and concepts in the delivery of pre-hospital patient care.
3. Educating both local, state, and federal legislators and decision-makers as to the vital role ambulance providers continue to play within the EMS system nationwide.

Top 3 Priorities for AAA

1. Continuing our support to member companies in the way of services and training and educational seminars.
2. On-going diligence in securing adequate funding and initiatives within the Medicare Fee Schedule program.
3. Relationship building, maintaining our integrity and nurturing partnerships with affiliate groups, while remaining the foremost leader in EMS advocacy.

Ronald Quaranto

ron-quaranto-photoChief Operating Officer
Cataldo Ambulance Service

Candidate Statement

I feel that my extensive EMS experience coupled with my current role as Chief Operating Officer for Cataldo Ambulance Service, Inc. makes me the ideal candidate for the Region I Board position. For over ten years I have participated in regional counsels which include, the President of the Board of Directors for the Metropolitan Boston EMS Counsel, and I have participated and chaired several regional committees. In addition, I currently hold the position of Vice President for the Massachusetts Ambulance Association. My operational ability, passion for EMS, and dedication to quality patient care will add tremendous value to the board of the American Ambulance Association.

Top 3 Issues in Emergency Healthcare

1. Most importantly is quality patient care
2. Reimbursement
3. Recruitment and Retention

Top 3 Priorities for AAA

1. Continue to ensure excellence in the ambulance services industry and provide research and educational programs that will have a positive impact on the services to help address the recruitment and retention issues that we in EMS are currently faceing.
2. Enable our members to effectively address the needs of the communities they serve (MIH).
3. Promote health care policies.

Region II (3)

Region II Director—3 Candidates

Region 2


Russell Honeycutt

rusell_honeycutt_photoExecutive Director of Government Affairs
Central EMS

Candidate Statement

I believe that the collaborative effort of a Nationally based association (AAA) is the best hope for delivering reform to all areas of EMS. We have begun in the past two years a project involving cost studies that can transform the reimbursement challenges all EMS Services face and establish a reimbursement system that truly compensates us at a level that allows us to render excellent patient care without taxing the communities that we operate in. My passion is to see this project to completion in order that honest suppliers of EMS are compensated fairly and the bad actors in our industry are no longer allowed to cast aspersion on the hardworking men and women in our industry. Change is coming and we need to be proactive in formulating policy and not have policy dictated to us which results in more costly regulation.

Top 3 Issues in Emergency Healthcare

1. Adequate Reimbursement
2. Reduction in Regulatory Burdens
3. Patient Experience (improving the quality of care)

Top 3 Priorities for AAA

1. Increased reimbursement from federal payers
2. Improved relationships with Congress and federal agencies
3. Develop and influence payment reform

Terence Ramotar

ramotar-headshot_aaa_editedRegional Director
American Medical Response>

Candidate Statement

Faced with declining reimbursement, increasing operational costs, regulatory changes and a changing workforce, ambulance services face pressures that may seem insurmountable. However, value and quality cannot be negotiated. Our industry has a moral mandate to serve our communities with excellence, and in the best interest of the public’s health and well-being.
For over 20 years, I’ve served in several leadership positions for various types of EMS organizations both large and small. Whether a non-profit ambulance squad in a small town or a large system in a major metropolitan area, I’ve experienced firsthand how these pressures impact the services we deliver. The next few years are critical to our sustainability.

I have previously served on the Board of Directors and various committees for the American Ambulance Association. I bring a deep commitment to integrity and a core belief in servant leadership. I also understand that it’s time for my generation to “step up” and become actively involved. With your support, I look forward to providing the leadership necessary to help bring our AAA membership together, advocate on the region’s behalf and champion efforts that provide value to our services.
I wholeheartedly ask for your support in doing so.

Top 3 Issues in Emergency Healthcare

1. Reimbursement at the federal level continues to threaten the quality of the services we provide to our communities. Payment for emergency services continue to shrink below our costs while our expenses rise.
2. Human Resource challenges stress our services nationwide on two fronts. The demand for Paramedics are quickly exceeding the supply. Subsequently, the talent pool is shrinking. Leadership turnover is rising and the next generation of leaders need to be prepared.
3. A Vision for the future in a rapidly changing healthcare environment is becoming an emerging issue in local EMS markets. Healthcare calls for reform, but how EMS becomes part of the collaborative solution is yet to be determined.

Top 3 Priorities for AAA

1. Reimbursement. The AAA needs to continue its strong voice on Capitol Hill and protect against further threats.
2. Membership. Our strength is in numbers. While the AAA membership is strong, there still is the opportunity to become stronger. By delivering value for its services, we can continue to build on a strong foundation.
3. Leadership Development needs to be a strong focus both internally as well as for its membership. By continuing to expand learning opportunities and sharing its wealth of knowledge, the AAA is and should continue to be the primary source for industry information and education.

Larry Wiersch

Chief Executive Officer
Cetronia Ambulance Corps., Inc.

Candidate Statement

I am exceptionally proud of my service to EMS and our AAA Board as a Region II Alternate Director. In these most difficult times of constant change and new healthcare dynamics, I will continue to work hard for our association members to ensure that whatever we do for our industry serves our patients and our dedicated professionals with the very best. We need leadership that understands the need to change, challenges the “status quo” on issues that affect our members, and provides thoughtful ideas that evaluates how it affects all members from a global perspective. Our members, our patients and our communities deserve national leadership that incorporates meaningful processes that supports healthy debate that achieves outcomes with the best possible results.
I believe that my past involvement with the AAA on multiple committees including government affairs, professional standards, federal reimbursement and numerous other special work groups gives me insight into methods that work. While we must not dwell in the past, we must learn from it while moving forward into the future. I promise, that I will do my very best to represent our region, our association, our employees and most importantly our life saving mission. I will always promote quality EMS that represents all provider types, support good governance and embrace healthy change that saves more lives and allows us to deliver on our promise of service to our community.

Top 3 Issues in Emergency Healthcare

The impact of federal reimbursement models changing; regulatory restrictions and government affairs; Innovations and how it presents opportunities as well as challenges to EMS in the future.

Top 3 Priorities for AAA

Leadership; How to engage members to bring forth meaningful change; Strategic direction as well as promotion of quality metrics for the future of private EMS.

Region III (4)

Region III Director—4 Candidates

Region 3


Barbara Bachman

bachman-barbaraChief Financial Officer
Emergent Health Partners / Huron Valley Ambulance

Candidate Statement

I am running for the position of Region 3 Director of the AAA and I am asking for your support and your vote. I am Chief Financial Officer of a medium-sized Michigan ambulance service – a position which I have held for 11 years. I also serve as a member of AAA’s Medicare Regulatory Committee.

I would like your support so that I can help make sure that all independent ambulance operators have a strong voice in Association matters and federal policies – especially Medicare and Medicaid. I am also interested in making sure that the AAA provides strong representation for all of us, and that it is done fairly for all services in Region 3 and across the country. Finally, AAA can’t be an advocate if it does not stay strong financially. That means watching our expenses carefully and keeping dues at a reasonable level which we can all afford.

Thank you for considering my candidacy and I look forward to serving and representing your interests on the AAA Board as a Region 3 Director. Please call or email me if you have questions about any matter that you feel I can help with.

Top 3 Issues in Emergency Healthcare

I believe the top three issues in emergency health care are low reimbursement rates, demonstrating value in a changing healthcare environment, and recruiting and retention of staff. Image management and educating the public are important components of these three issues.

Top 3 Priorities for AAA

AAA needs to continue pursuing its legislative priorities seeking permanent Medicare ambulance relief. We also need to work with state associations to educate the public so that we can attract millennials to our profession. We also need to convince government at all levels to provide funding for EMS education programs. We should actively shape our role in the changing healthcare environment.

Kim Godden

godden-kimVice President, Legal and Corporate Compliance
Superior Air-Ground Ambulance Service, Inc.

Candidate Statement

I am currently concluding my fourth year representing Region III on the American Ambulance Association Board of Directors. I am running for re-election to continue to represent Region III for an additional term. I would like to continue to work closely with fellow board members, AAA staff and contractors and our members to continue to advance Industry initiatives and address the concerns our members are facing. I work closely within the states our company operates in (Illinois, Michigan and Indiana) to advance industry initiatives and concerns. I enjoy being able to bring my legal background, education and experience working in and with the government to the ambulance industry. Being able to work with state, local, and federal government is an integral component of our industry’s success. Region III includes both urban and rural areas and ambulance companies of different sizes, types and disciplines; as a Board Member I make sure that all issues are discussed and decisions are made with all members in mind. I intend to continue to work within Region III to coordinate effort and ideas on a regional level.

Top 3 Issues in Emergency Healthcare

1. Survival due to health care reform and fraud and abuse allegations within the industry
2. Attracting and retaining EMTs in our industry
3. Obtaining proper and fair reimbursement

Top 3 Priorities for AAA

1. Combat allegations of fraud and abuse within our industry
2. Secure proper and fair reimbursement
3. Address national EMT shortage – attracting and retaining EMTs

Michael Pieroni

pieroni-head-shotDirector of Operations
Medical Express Ambulance

Candidate Statement

I have been involved in Illinois EMS since 1987, as a caregiver, a manager and a business owner. My background includes ambulance operations, billing and collections, loss control, human resources, payroll and benefits administration, business development and government relations. I served as the President of the Illinois State Ambulance Association from 2003 until 2013, and remain on the ISAA Board today.

I am keenly aware of the challenges faced by ambulance providers. Having “grown up” in the Chicago private ambulance market, I am no stranger to competition. I take great pride, however, in being a supportive, understanding and sincere representative for our profession as a whole. I feel my specific experiences as a former EMT, ambulance service owner and ISAA Board President have uniquely prepared me for the challenges ahead. In addition, I have attended several AAA reimbursement task force meetings, and feel that it would be my honor to contribute to that work.

Top 3 Issues in Emergency Healthcare

1. The Affordable Care Act, Managed Care, consolidation, and Medicare/Medicaid reform have all made ambulance reimbursement a highly technical minefield. The ability to be paid for the services we provide is paramount.
2. The evolution of Mobile Integrated Healthcare is fast paced and dynamic. While an exciting new aspect of EMS, MIH will need continued development and support at a grassroots level across the country.
3. Recruitment and retention of qualified EMTs and paramedics remains a key challenge for all EMS organizations.

Top 3 Priorities for AAA

1. Navigating the ever-changing landscape of EMS reimbursement is necessary to the survival of any EMS agency, and must be a priority.
2. Development and training of human resource teams to tackle the ongoing shortage of qualified EMS personnel.
3. Innovation and growth. Technological advances and concepts like MIH enable our profession to minimize costs, while creating potential new revenue streams.

Julie Rose

rose-julieCEO/Executive Director
Community Care Ambulance

Candidate Statement

I am requesting your support to continue to serve Region 3 AAA members as your Board representative. I believe I am uniquely positioned to understand your needs as a fellow provider and serving my organization as the Chief executive; appreciating the holistic challenges that face our provider group in today’s current landscape.

I have over 15 years of experience in leading and serving on AAA committees as well as Board positions.

My activity at the state level as Past President of the OAMTA as well as a Board member of the governor appointed Ohio State Emergency, Fire and Medical Transportation Board has further enlightened me about service regulatory issues at the state level as well as reimbursement challenges in dealing with Medicaid.

I would appreciate the opportunity to serve you for another term as Region 3 Board member.

Thank you, Julie Rose

Top 3 Issues in Emergency Healthcare

1. Achieving adequate funding for emergency and non emergency medical transports as funding for MIH is sought
2. Providing viable careers to encourage the entry into EMS leading into leadership positions
3. Safety for patients and providers

Top 3 Priorities for AAA

1. Promoting the value base of private EMS and position in the healthcare continuum
2. Influence the creation of public policy that provides fair reimbursement
3. Provide opportunities to train EMS Leadership for the future

Region IV (3)

Region IV Director—3 Candidates

Region 4


Daniel Gillespie

Dan-imageVice President
Allegiance Ambulance

Candidate Statement

I have been honored to see the AAA members for the past two years and hope for the opportunity to continue to serve our industry within this association. I value the knowledge and experience I have gained in working with such a highly motivated and effective group of professionals as we drive our professional in to the future.

Top 3 Issues in Emergency Healthcare

1. Continued payment reform in CMS
2. New Leadership development and recruitment
3. Moving EMS from being a vendor to a provider

Top 3 Priorities for AAA

1. Support Payment reform
2. Support EMS legislation that recognizes EMS as a provider and provides reimbursement that is reflective of that
3. Creating a national marketing initiative to ignite interest in our industry from the younger generations and end the massive shortages in paramedics and EMTs

Angela Lehman

lehman-angieChief Revenue Officer
Emergency Medical Services Authority

Candidate Statement

I would like to represent Region 4 as a Board of Director for the American Ambulance Association because of the passion I have for this industry, and my knowledge of the payors and regulatory issues and concerns in our region. I have been fortunate to work in many areas of the healthcare sector, and personally, there is no other sector comparable to the ambulance industry. I have had many personal and professional conversations about how I cannot imagine working in a different realm of healthcare again because of the people involved in the industry — from owners, to non-profits to for-profits, and to government entities. Because of this diverse group of individuals, it makes this industry a challenge, and it is even more reason we must work together to advocate for higher reimbursement and better recognition as a healthcare entity. I have been committed to this advocacy for the last six years as evidenced by my roles on the Medicare Regulatory, Professional Standards, and Government Affairs, Education and Payment Reform Committees. I believe I can be a strategic and effective leader for our industry. I have a Bachelor’s Degree in Health Information Management, and currently obtained my Masters of Art in Health and Human Services. I look forward to having the opportunity to serve as one of the Region 4, American Ambulance Association Board of Directors.

Top 3 Issues in Emergency Healthcare

The top issues I see in emergency healthcare are the shortage of staffing with EMTs and Paramedics; the inability to obtain appropriate data to reflect the industry’s cost and quality of patient care; and being reimbursed appropriately.

Top 3 Priorities for AAA

To obtain permanent Medicare add-ons for Medicare reimbursement; to continue to look at and work on different payment methodologies for the industry; and to obtain legislation to provide for a mechanism to obtain cost-survey data and to move the ambulance industry from supplier to provider status.

David Tetrault

tetrault-davidAdministrator/ CEO
St. Francois County Ambulance District

Candidate Statement

My candidate statement for re-election to the Board of Directors Region 4 Seat, I’m asking for your vote to continue our work with bringing EMS forward, continue to fight for small rural services and large services let me be your voice on Capitol Hill in Washington.

I have been dedicated to EMS for over 27 years committed to EMS issues, ability to attend meetings, time to commit to the position of Director for AAA region 4. I will follow through answer concerns with the region and other regions that need our help and expertise. My Board is and have been very willing to support me financially to travel with AAA and administrative support for all activities supporting EMS beyond the borders of my Small Rural Community Ambulance District.

As past president of the Missouri Emergency Medical Services Association and other positions I have been responsible for assisting and participating in planning, preparation, and execution of our annual meetings and training activities. I have also been instrumental in internal audits and the recommendation and implementation of financial procedures for MEMSA. I was a principal player in starting EMS day at the State Capital over 10 years ago and am still actively involved in legislative activities and initiatives.

Top 3 Issues in Emergency Healthcare

1. Healthcare Reform, Medicare and Medicaid issues with understanding EMS
2. Making sure that EMS, stays in front and continues to be recognized in this country as part of the 3 first responders and held in the same light, strength and representation as Police and Fire.
3. Standardization across the country and less fragmentation among EMS providers

Top 3 Priorities for AAA

1. Education, training, focused work on reimbursement for Ambulance services throughout the country
2. Communications to its members and growing strength in numbers and voices across the country
3. Moving EMS forward and continuing to make our voices heard loud and clear, and that we are here to stay. Keeping up with all the healthcare changes and reforming EMS for the future.

Region V (3)

Region V Director—3 Candidates

Region 5


Chris Archuleta

Superior Ambulance Service, Inc.

Candidate Statement

During the past 3 elections I’ve been elected as your alternate for the Board of Directors for Region 5. As your alternate on the AAA’s Board of Directors I’ve been able to watch, listen, and learn of all that a Board member does. I have learned a lot in the past 3 years and have gladly invested time and energy to serve the members of Region 5 and all the AAA members. Until becoming an active participant with the AAA at the Board level, I never fully understood the complexities of the national issues affecting our industry. As a rural and urban medium size provider, I’ve realized how important it is for us in the industry to stay active and voice our concerns with the continuous legislation before Congress and CMS, as their decisions affect our industry, and us at home just trying to run a business. National political issues versus local issues involving us as providers are two huge and different areas that need representation. This is important as each has a different level of importance for our own businesses.

Now that I have the knowledge base of being a AAA Board member, I want to continue to represent those of you in Region 5. As your alternate, I have worked with other Members of our Board and Association on these important issues and I’d like to continue to work for you. What I will bring if you elect me is that I will be a communicator with the members of Region 5. I need to hear from you what is affecting you in the industry so that I can voice your thoughts at the board level, and able to bring your voice to the table. Whether it is in email or just a quick call to our Region 5 members, I will work at following up with you to get your thoughts and feedback, and enhance your communication between you, the AAA, and the AAA Board.

As your Director, I will continue to work to assure our Association represents the needs of all our Members. We need to ensure that all our members are represented from the smallest provider to the largest. We need to ensure that we as small and medium providers, who will get hit the hardest when bad legislation is passed by Congress or by CMS, that our voices are heard. .We need to continue to pursue fair reimbursement for the service that we provide, and we need to make sure that fair legislation is passed that affects us with our businesses at home. We need to accomplish this by having an engaged Director in the process, and one that knows and lives with our concerns. I ask that you again consider me to represent you, and hope that you will give me the opportunity to serve you as Region 5 Director on the AAA Board.

Top 3 Issues in Emergency Healthcare

1. The evolving changes in Federal Regulations that relate to EMS
2. CMS increasing audits upon providers
3. The increasing costs to provide emergency services and not being properly reimbursed for costs by Federal programs

Top 3 Priorities for AAA

1. To continue to work with CMS to have a voice on future regulations placed upon providers
2. To work with Congress to ensure that future legislation will not negatively impact providers
3. To work with CMS to increase reimbursements

JD Fuiten

Metro West Ambulance

Candidate Statement

My experience in urban and rural pre-hospital healthcare has given me a unique perspective of how our service is provided to a variety of communities. The “voice” of the American Ambulance Association and its’ members is comprised of hundreds of ambulance providers much like you and me. In my previous roles with the AAA as Secretary and Region V Director, I have made sure that each of you were heard before congress and other legislative bodies and I hope to have that opportunity again. As an independent provider, I have worked closely with the AAA and its’ membership to promote our industry’s issues to elected officials. As federal reimbursement has not kept pace with the sophistication of the delivery of emergency medicine in the field, members of the AAA have become more organized to lobby our elected officials and I look forward to again leading this effort. EMS is going through dramatic change and the organization I lead has in many ways successfully navigated these dynamic times. As the Region V Director I’d like to work with the AAA to motivate federal and private reimbursement mechanisms in the direction of paying providers who work with their healthcare partners to provide EMS in less costly and innovative ways. Ultimately, these providers are saving money for their patients, the government, and EMS partners. I look forward to the opportunity to serve the members of the AAA once again and am energized to engage our elected officials in meaningful conversations of how EMS is transitioning to meet the needs of the communities we are privileged to serve.

Top 3 Issues in Emergency Healthcare

1. Reimbursement and transition from provider to supplier
2. Transitioning the paramedic to mobile healthcare and demonstrating value
3. Regulation and oversight

Top 3 Priorities for AAA

1. Reimbursement
2. Assisting the Government in developing a mechanism to reimburse mobile paramedics
3. Providing workshops and trainings to create educated and skilled managers in EMS

Paul Pedersen

paul-pedersenManaging Partner
Arizona Ambulance Transport

Candidate Statement

I am a supporter of AAA. The AAA’s work in advocating for members helps to create an environment in which we members can provide the professional services our patients deserve. The AAA offers an excellent array of services to members which need to be promoted more.

Paul Pedersen is a graduate of the University of Arizona and holds a masters degree from St. Mary’s College of California. Pedersen is a 20 year veteran of the Pima County Sheriff’s Department in Tucson, retiring as a lieutenant. He retired as a lieutenant colonel from the U.S. Army Reserve. Pedersen has worked in the private sector managing the installation of public safety radio communications systems. He was the director of Clackamas County Oregon Communications Department and was general manager of Southern Arizona for the Rural/Metro Corporation. He has held board positions with the Red Cross in Tucson, Minneapolis and Portland, Oregon. He has also served as an instructor for numerous law enforcement training courses as well as the Federal Emergency Management Agency.

Top 3 Issues in Emergency Healthcare

1. Reimbursement/funding
2. Changing healthcare systems/delivery
3. Recruitment & retention

Top 3 Priorities for AAA

1. Reimbursement/funding
2. Be a viable and recognized player in healthcare (and the changes therein)
3. Market member benefits

Ethics Committee Candidates

Thank you to the following candidates for the AAA Ethics Committee. Voters may select up to three.

  • Hanan Cohen – Empress EMS
  • Brent Dierking – NorthStar EMS, Inc.
  • John Iazzetta – Alert Ambulance Service, Inc.
  • Jay Jimenez – Allegiance Mobile Health
  • Robert Sims – Lifeguard Ambulance Service
  • Steven Vincent – Gold Cross EMS
  • Rebecca Williamson – Muskogee County EMS

Questions? Please contact acamas@ambulance.org for assistance.

AAA to Participate in 2016 EMS Strong Campaign

AAA is proud to announce its participation in the EMS Strong campaign during this year’s EMS Week. EMS Strong is a campaign that seeks to celebrate, unify and inspire the men and women of our nation’s emergency medical services. Learn more►

EMS Week will take place May 15-21, 2016. We’d love to hear how your organization plans to celebrate. Please fill out this brief form to share your story!


Boustany (R-LA 3rd) Introduces the Timely Payment for Veterans’ Emergency Care Act

On March 3, 2016, Congressman Charles W. Boustany, Jr., MD, republican representative of Louisana’s 3rd district, introduced the Timely Payment for Veterans’ Emergency Care Act. According to data obtained by Boustany from the VA’s Chief Business Office, the VA has a nationwide emergency claims payment backlog of over $788 million.

When the VA fails to pay these medical bills on time, veterans’ credit ratings are put at risk.

Read more about Representative Boustany’s proposed solution on his website.

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