Tag: Arkansas

Pafford Medical Services in 2020

Pafford Medical Services
Hope, Arkansas
1,500 Staff | 98 Quarantined in 2020

Founded in 1967, Pafford Medical Services provides over 80 communities across 8 states and the U.S. Virgin Islands with the latest, most sophisticated level of pre-hospital care. As a family-owned and operated company, Pafford is staffed 24/7/365. Over 1500 members of Team Pafford can be found operating the fleet of 200 ambulances, 4 communications centers, 3 medical fixed-wing aircraft, 3 rotor-wing aircraft to provide communities with proper 911 ambulance coverage.

In addition to the day-to-day operations, the company has become known nationwide for its Special Response Taskforce which assists during national disasters. As the company evolves to cater to the citizens it serves, Pafford took notice of the needs of industries and businesses during the global pandemic and now operates OnSite Healthcare Services in order to safeguard workforces as the world resumes operation amidst COVID-19. Another pillar of the company’s mission is its promise as a contributive community partner by providing educational resources, medical equipment, and scholarships along with medical standby for special events.

With the novel Coronavirus, EMS personnel would need to be properly trained to combat the transmission of the virus. Along with obtaining PPE for their medics, Pafford Medical Services provided additional training while increasing health surveillance, screening, and tracking of employees with the activation of their Emergency Operations Center.

Pafford remained a leader in community discussions and decisions related to COVID-19. Thanks to the diligent work and daily communications with their leadership teams, all of Pafford’s systems remained fully operational.

As the world stopped turning due to COVID-19, Mother Nature did not as hurricane season came out in full force. With 8 named storms and 2 major hurricanes, Pafford’s Special Response Taskforce deployed along the Gulf Coast to provide relief to the affected communities for 75 days.

“We’ll never be able to fully express our gratitude to not only our management teams, but to our boots on the ground who have been in the trenches remaining strong and vigilant,” says CEO, Jamie Pafford-Gresham. “Our men and women have gone beyond the call of duty–– suiting up, serving others, and their communities on the frontlines of healthcare.”

Webinar 6/30 | Financial Sustainability Ideas for EMS

June 30, 2020 | 14:00 ET

Three ambulance leaders with diverse backgrounds share innovative tips for financial sustainability in this fast-paced one hour webinar. From insurance captives to employee engagement to data-driven decision-making, Jamie Pafford-Gresham, P. Sean Tyler, and Wayne Jurecki will lend their unique perspectives on ways to keep service rolling during these extraordinarily challenging times.

Watch On-Demand►

Jamie Pafford-Gresham
CEO, Pafford Medical Services
Director, AAA Board
Chair, AAA Government Affairs Committee
Hope, Arkansas

Wayne Jurecki
COO, Bell Ambulance Service
Director, AAA Board
Milwaukee, Wisconsin

P. Sean Tyler
CEO, Transformative Healthcare
President & CEO, Fallon Ambulance Service
Board Secretary, Massachusetts Ambulance Association
Quincy, Massachusetts

Watch On-Demand►

EMS Week Featured Service | Pafford Medical Services

Pafford Medical Services
Hope, Arkansas
Facebook | Twitter 

Meet Pafford Medical Services

Founded in 1967, Pafford Medical Services continues to provide over 80 communities with the latest, most sophisticated level of pre-hospital care. As a family-owned and operated company, Pafford serves communities across Arkansas, Louisiana, Mississippi, Oklahoma, Pennsylvania, and the U.S. Virgin Islands. With over 1200 members of Team Pafford, over 180 ambulances, 3 medical fixed-wing aircraft, 3 rotor-wing aircraft, 2 communications centers, and our corporate billing office, Pafford is staffed 24/7.

It is Pafford’s mission to provide its communities, healthcare partners, and facilities they serve with the highest standards of mobile healthcare. While providing communities with proper 911 ambulance coverage, the company has become known nationwide for its Special Response Taskforce which assists during national disasters. As the company evolves to cater to the citizens it serves, Pafford took notice of the needs of industries and businesses during the global pandemic and now operates OnSite Healthcare Services in order to safeguard workforces as the world resumes operation amidst COVID-19.  Another pillar of the company’s mission is its promise as a contributive community partner by providing educational resources, medical equipment, and scholarships along with medical standby for special events.

Pafford is fully equipped to provide the following services:

  • ALS/BLS Ground Ambulance Transportation
  • 911 Paramedic Ambulance
  • Mobile Integrated Healthcare Services
  • OnSite Healthcare Services
  • Air Medical Fixed-WingTransporation
  • Air Medical Rotor-Wing Transportation
  • Government and Industrial OnSite Services
  • Event Standby Services
  • Domestic and International Special Response Taskforce
  • Community Education Resources
  • Medical Billing

The Pafford Medical Services COVID-19 Response

It was evident that with the novel coronavirus, crew members would need to be properly trained to combat the transmission of the virus. Along with obtaining PPE for their medics, Pafford Medical Services provided additional, in-depth training and education to crew members all while increasing health surveillance, screening, and tracking of employees. Due to Pafford spanning across 5 states and the U.S. Virgin Islands, the company activated its Emergency Operations Center to provide support to its primary 911 PSAPS.

In these unprecedented times, Pafford Medical Services remained a leader in community discussions and decisions related to COVID-19. To better serve its communities, Pafford dedicated ambulances in their regions to coordinate the transport of COVID cases or suspected COVID cases. All of Pafford’s systems were able to remain fully operational thanks to the diligent work and daily communications with their leadership teams to keep all team members up to date on the latest information for their communities.

“We will never be able to fully express our gratitude to not only our management teams but to our boots on the ground who have been in the trenches remaining strong and vigilant over the past 10 weeks,” says CEO, Jamie Pafford-Gresham. “These men and women have gone above and beyond the call of duty, serving others, their communities, and their country during this global health crisis.”

The Pafford Medical Services Leadership Perspective

“As a rural EMS provider, our challenges on a day-to-day basis require our medics to be prepared to care for our communities, many of which do not have hospitals and with clinics working limited hours, our medics are always there 24/7/365.  We are the Healthcare Safety Net and our team does a wonderful, compassionate job. They don’t back down and provide a vital service to our citizens. During this outbreak, I am proud of not only our EMS team members but the entire EMS system across America for stepping up in such a critical time in our Country.”—Jamie Pafford-Gresham, CEO, Pafford Medical Services

Frontline Voices from Pafford Medical Services

“It takes a servant’s heart and a strong mind. But I count it as pure joy to help those in need.”-Alvin Short, Pafford EMS, Paramedic, Canadian County, OK

EMS is important because even when things get rough, the world keeps getting scarier and sickness continues to rise…we never quit.”—Meghann Jones EMT Pafford EMS, Canadian County, Oklahoma

“EMS is important because it provides immediate medical care to people who need it– bringing the ER to the patient in a timely manner.” Jarlicia Scott FTO/ Paramedic

“EMS is an extremely important part of community safety, doctors don’t make house calls anymore so EMS practitioners stand readily available to provide that extension of care while treating and managing acute illnesses and trauma.”—Randy Murry, EMS Operations Manager, Coahoma County, Mississippi,  Star of Life 2020

How Pafford Medical Services Celebrates EMS Week

Most people that know the Pafford Family, know that celebration is normally in the form of passing the plate, sharing in a meal, and most importantly, fellowship. Pafford Medical Services makes it a point to take a step back and bring families together, to recognize and honor the sacrifices made from all members of the families that have a loved one on the front-lines. This year, team gifts will be given out, but most importantly, Pafford realizes that the ultimate gifts are its people.

Obituary for Steve Williamson

It is with deep sadness we share the passing of beloved family man, friend, colleague, and former AAA President Steve Williamson.

H. Stephen Williamson

Obituary

H. Stephen Williamson, 68, of Hope, Arkansas, formerly of Tulsa, Oklahoma, beloved husband, father, grandfather, brother, and uncle passed away suddenly on November 3, 2018 at his home.

Preceded in death by his mother, Evelyn Williamson, father, Hershel Williamson, and first wife, Pat Williamson, Steve is survived by his best friend and wife Rebecca Williamson (Smith); his two adored daughters Jennifer Thomas (Jason) of Tulsa, Oklahoma, and Ashley Schneeberg (Matt) of Jenks, Oklahoma; his brother, Mark Williamson (Theresa) of Broken Arrow, Oklahoma; and his five step children, Blake Burruss (Rachel), Krista Sands, Holly Chapman (Joel), Sarah Lyn Smith and Jay Darrin Smith. He was an exceptional grandfather to his beautiful grandchildren and step grandchildren, Asa and Will Thomas, Kate and Ava Schneeberg, Barrett Burruss, Addysion Sands, Brycelyn Wiedel, and Gabe Chapman. He is also survived by numerous cousins, nephews, a niece, and his aunt, Blanche Wilson.

H. Stephen Williamson was the president and chief executive officer of Emergency Medical Services Authority (EMSA) since the Authority began operations in 1978, and served for over 39 years. Under Williamson’s guidance, EMSA grew into Oklahoma’s largest EMS provider and one of the country’s most effective ambulance systems, achieving the standing of top 1% of ambulance services nationwide with accreditation by the Commission on Accreditation of Ambulance Services. Due to his visionary leadership and passion for service, EMSA provided outstanding patient care, saving countless lives throughout Tulsa, Oklahoma City, and the surrounding counties. Prior to his tenure at EMSA, he served as administrator of Enid Memorial Hospital. He was a graduate of the University of Tulsa, earning a B.S. in Finance, as well as a Master’s in Public Health from the University of Oklahoma. Prior to his death, Steve was the Chief Financial Officer at Pafford EMS, the largest ambulance service provider in Arkansas.

Steve was a revered national leader in EMS. He held numerous national and state leadership positions including President of the American Ambulance Association, President of the Coalition of Advanced Emergency Medical Systems, Governor’s Appointee to the Oklahoma Emergency Response Systems Advisory Council, and President of the Eastern Oklahoma Chapter of the Muscular Dystrophy Association. He was a graduate of Leadership Oklahoma Class XX.

Family will receive those wishing to pay their respects at a lunch and visitation beginning at 11:00 a.m. on Thursday, November 8, 2018 at Fletcher Hall (attached to the church). Services will immediately follow at 1:00 p.m. at Parish of Christ the King Catholic Church, 1520 South Rockford Avenue, Tulsa, Oklahoma 74120. Internment at Calvary Cemetery 9101 South Harvard Ave, Tulsa, Oklahoma.

In lieu of flowers, donations in Steve’s honor may be made to Bishop Kelly High School, 3905 South Hudson Avenue Tulsa, OK 74135 and the Code Green Campaign, P.O. Box 15365, Spokane Valley, Washington, 99215. Code Green advocates for mental health-, PTSD-, and suicide-awareness for EMS.

Steve touched countless hearts over the course of his extraordinary life. He will be forever loved and missed by all his family, friends, and colleagues.

2017 Distinguished Service Award

Contact: Jessica Marvin
Telephone: 703-610-9018
Email: jmarvin@ambulance.org

AMERICAN AMBULANCE ASSOCIATION HONORS JAMIE PAFFORD-GRESHAM AND SHAWN BAIRD WITH THE 2017 DISTINGUISHED SERVICE AWARD

Washington, DC– McLean, VA — The American Ambulance Association (AAA) is proud to award Jamie Pafford-Gresham and Shawn Baird with the 2017 Distinguished Service Awards.

The Distinguished Service Award is given to individuals who have demonstrated a high level of commitment to the advancement of the AAA. Jamie and Shawn have achieved this distinction through their dedication, passion, and commitment in support of AAA’s Legislative Priorities.

AAA President Mark Postma noted, “Jamie and Shawn have been steadfast in their service on behalf of the AAA. We are proud to celebrate their contributions and achievements to the AAA and our industry by presenting them with Distinguished Service Awards for 2017.”

Shawn and Jamie will be presented with the Distinguished Service Award at the AAA Annual Conference and Tradeshow Awards Reception on Tuesday, November 14, 2017. This event is the premier event for leaders in the ambulance industry, featuring world-class education, networking, and cutting-edge technology.

# # #

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

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

2017 AAA Award Winners Announced

The American Ambulance Association is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference & Trade Show Membership Meeting on Tuesday, November 14, 2017. Please join us in congratulating this year’s winners!

J. Walter Schaeffer Award

Mark Meijer, Life EMS Ambulance
The J. Walter Schaeffer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Mark Meijer has achieved this through his many years of commitment and service to the ambulance industry.

Robert L. Forbuss Lifetime Achievement Award

Fred Della Valle, AMR Connecticut
The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. Fred Della Valle has achieved this through his decades of service, commitment, and dedication to the AAA and its members.

President’s Award

Dr. John Russell, Cape County Private Ambulance
Paul Main, American Ambulance of Visalia
These awards are bestowed by the President to volunteer leaders who have shown commitment to the advancement of the AAA above and beyond the call of duty. This year, the two outstanding volunteers represent tireless work on behalf of the AAA. Dr. Russell is recognized for his ongoing support of AAA’s programs and leadership on clinical and ambulance service standards. Paul Main has achieved this honor for his dedication and service to AAA’s Government Affairs efforts.

Distinguished Service Award

Jamie Pafford-Gresham, Pafford EMS
Shawn Baird, Woodburn Ambulance Service
The American Ambulance Association is proud to award Jamie Pafford-Gresham and Shawn Baird with the 2017 Distinguished Service Awards. Jamie Pafford-Gresham and Shawn Baird have achieved this distinction through their dedication, passion, and commitment in support of AAA’s Legislative Priorities.

2017 Affiliate of the Year

REV
The American Ambulance Association (AAA) is proud to award REV with the 2017 Affiliate of the Year Award. REV has achieved this honor through their support of AAA’s programs and services including our 2017 Legislative Priorities.

EMS Partnership of the Year

James D. Green
National Institute of Occupational Safety and Health
Centers for Disease Control and Prevention
The EMS Partnership of the Year Award is given to an organization or individual whose collaboration with the AAA enhances educational programs, legislative priorities, and/or member benefits. James D. Green and NIOSH have achieved this honor through their commitment to ambulance vehicle and personnel safety standards.

EMS Innovation Award

Savvik Foundation
Savvik Foundation is honored with a special EMS Innovation Award for its commitment to supporting the future of emergency medical services through their grant program.

Status of the American Health Care Act

Today, citing “growing pains” of his Republican majority, Speaker Paul Ryan (R-WI), in consultation with President Donald Trump, determined not to proceed with a planned vote on the American Health Care Act (AHCA), which repealed and replaced important elements of the Affordable Care Act (ACA).  The Speaker indicated that the House Republican Caucus “came up short” in the number of votes needed for the bill.  House Republican Leadership had been moving AHCA through the Chamber at a rapid pace.  The bill was officially released on March 6, and had been changed several times to try to appease various conservative and moderate voting blocs within the Republican Caucus.  The Congressional Budget Office (CBO) originally estimated the bill would reduce federal deficits by $337 billion, and subsequently downgraded the deficit reduction to $150 billion based on additional substantive policy changes to the bill.  The CBO estimates the bill would have increased the country’s number of uninsured by about 24 million people.

In negotiating the provisions of AHCA, the House Republican Leadership had faced a constant seesaw, as efforts to appease one ideological bloc upset the other.  Ultimately, throughout the day in advance of the scheduled vote, an increasing number of moderate Republicans, including Appropriations Committee Chairman Rodney Frelinghuysen (R-NJ), announced they would vote against the bill.  As the moderates disappeared, not enough members of the conservative Freedom Caucus decided to support the bill.

As disarray in the House Republican Caucus occurred, there appeared to be a similar lack of consensus amongst their Republican colleagues on the Senate side.  While Senate Leadership had planned to move the bill directly to the Senate floor as fast as within a week of receipt from the House, there were a number of Senators from a range of political perspectives with serious concerns about the bill.  On one side of the Republican spectrum, Senators Rand Paul (KY), Mike Lee (UT) and Ted Cruz (TX) had planned to push the limits of what can be included in a reconciliation bill to make it more conservative. Senator Paul had advocated for repealing the ACA in full and dealing with the replacement later on. On the other side, more moderate or “purple state” Members like Senators Susan Collins (ME), Lisa Murkowski (AK), Rob Portman (OH), Cory Gardner (CO) and Dean Heller (NV) raised concerns about insurance affordability and the expedited rollback of Medicaid expansion in the House version of the bill. Other Senators who will likely play a prominent role in any further health reform developments include physician Senator Bill Cassidy (LA), and Senator Tom Cotton (AR), who advocated all along to slow the process down. Republicans can only lose two Senators and still pass any health reform bill, with the vote of Vice President Mike Pence breaking the tie.

As a next step, House and Senate Republican Leadership plan to take more time to develop consensus in any future approach to health reform.  How much time is unclear – but it seems unlikely the bill will be the legislative focus in the short term.  Instead, there will likely be a cooling-off period on health reform legislative activity, since the fundamental disagreements within the caucus are not easily fixed.  There will continue to be significant messaging against ACA from conservatives, and there is the potential that the idea of “repeal and delay” may gain more traction.  Nonetheless, in the short term, the Speaker indicated he would move on to other items on his conference’s agenda – including tax reform.  Keep in mind, however, that since health-related tax provisions are a major component of the tax code, it would not be surprising to see some health issues resurface in tax reform.

The Speaker indicated that he expects the ACA marketplace to get worse – specifically citing rising premium costs.  In his own remarks on the failure to pass AHCA, the President suggested the Democrats will own any rising premiums, and provided a rare moment of optimism for the day when he indicated that a bipartisan health care reform bill may be achievable in the future when that happens.   As the Legislative Branch takes time to develop consensus, more focus will be placed on the Executive Branch.

We expect HHS Secretary Tom Price and White House Budget Director Mick Mulvaney to take an increasingly important role in driving the health agenda.  It is unclear at this point whether the Trump Administration will let ACA drift in the wind, take administrative actions to try to improve the marketplace, or even actively work to derail it further.  A likely bellwether as to the Administration’s intent is how it approaches the pending litigation over cost-sharing reduction (CSR) subsidies.  The House had sued the Obama Administration over the program, which funnels federal dollars to insurers to help keep out-of-pocket costs manageable for lower-income individuals, saying the funding had to be appropriated.  But after the inauguration, the House and Trump Administration sought a stay of the case until May 22 to allow time to resolve the issue.  If the Administration agrees to fold, the subsidies would be cut off, leading to further market instability.  If the House folds, the CSR payments would continue into the indefinite future.

From a health care legislative perspective, 2017 will still be far from a quiet year.  The President has proposed significant changes in the funding levels of important discretionary health programs.  Those budget battles will now move more front and center on the legislative agenda.  Furthermore, there continue to be “must pass” pieces of health care legislation, including CHIP reauthorization, FDA User Fee legislation, and certain Medicare extenders legislation.

AAA Members on Capitol Hill

This week, AAA members were once again on Capitol Hill meeting with members of Congress. AAA Government Affairs Committee Chair, Jamie Pafford-Gresham of Pafford EMS, met with entire Congressional Arkansas delegation. While on the Hill, Jamie also met with members from Oklahoma and Mississippi. AAA Board Member, Kim Godden (Superior Air-Ground Ambulance), Payment Reform Committee Chair, Asbel Montes (Acadian Ambulance Service), and AMR VP Federal Reimbursement & Regulatory Affairs, Deb Gault were also on the Hill for meetings this week. Collectively the group met with over twenty Congressional offices this week. Thank you to all of our members for their hard work fighting for permanent Medicare relief. We appreciate you taking the time to visit Washington and meet with your representatives.

Pafford EMS CEO, Jamie Pafford-Gresham, and Sen. John Boozman of Arkansas

Pafford EMS CEO, Jamie Pafford-Gresham, and Sen. Tom Cotton of Arkansas

Have you met recently with a Member of Congress? Are you interested in getting involved with the AAA’s advocacy efforts? If so, email Aidan Camas at acamas@ambulance.org!

Spotlight: Jamie Pafford-Gresham

Jamie Pafford-Gresham
CEO, Pafford EMS
Co-Chair, AAA Government Affairs Committee
Hope, Arkansas, USA
Jamie’s LinkedIn

Tell us a little about Pafford EMS.

Pafford is a family business started by my parents in Magnolia, Arkansas in 1967 with just a station wagon! Some in the industry would call this a “Mom and Pop” organization, but my brothers and I now operate in four states nearly 100 ambulances with 550 employees, three helicopters, two fixed wing medical aircraft and a large billing company. We respond to 90,000 calls a year in 28 counties and parishes. Our corporate office is located in Hope, Arkansas.

Can you share with us a little about Pafford’s culture?

Communicating to our employees our philosophy and beliefs while living by the same set of rules strengthens their understanding of how important it is to us to practice what we preach.

[quote_right]Our mission statement comes from the Bible, and is very simple: Do unto others as you would have them do unto you.[/quote_right]Our mission statement comes from the Bible, and is very simple: Do unto others as you would have them do unto you. We teach our employees to think of each patient as a family member (one you like!) and treat them with the utmost care and respect. A verse I carry with me is Luke 10:33-34.

Because we have such a large service area, I see differences in stations and states; some it seems to be more driven by the local culture of an area. Overall, our Pafford family believe in our commitment to the communities we serve.

Do you have any tips for onboarding new employees?

Hiring quality candidates with the ability to excel in the company is very important. It is the beginning of a great relationship for both employee and employer.

[quote_left]New employees attend a series of training sessions with their field training officers that reinforce our company values.[/quote_left]New employees attend a series of training sessions with their FTOs (field training officers) that reinforce our company values. Unethical behavior is not acceptable. We are in the public eye and dealing with people’s lives, and our rules reflect our policy on such things with disciplinary action outlined in writing. Training and communication of the rules and regulations of our company is key for a successful outcome.

How do you retain employees?

We value each and every employee, and realize that they make sacrifices to be in this line of work. EMS is a very stressful job, with unusual and long hours away from family for shift work. It is also con unhealthy lifestyle with the eating on the go, not to mention the pay is not what most want but is dictated by federal programs that have limited revenues. I have the utmost respect for our crews, and that is one of the reasons that people stay—they realize that they are needed and appreciated.

The long and short of it is that you have to want to be in EMS, and you have to love what you do. The reward for most is the satisfaction of good patient care and positive outcomes, which bring them back to do more good work. We provide many benefits such as a caring environment with good benefits, good pay, and up-to-date equipment with a company that cares about their well-being.

What is your typical day like?

My job duties change from day to day—I wear many hats and the overall well-being of the company rests on my shoulders. (In case you haven’t noticed, I have really broad shoulders.) I am responsible to ensure we keep the communities we serve with the best EMS possible while maintaining proper finances company-wide.

Relationships are a huge part of any successful company, and are key to every executive. I can be found meeting with elected and public officials along with hospital administrators throughout our service area, communicating goals to our managers, and assisting with the billing company’s woes when needed. My husband, Ben, also works within the company, the ambulance discussions are never-ending!

I serve on many boards and commissions along with co-chairing the American Ambulance Association’s Government Affairs Committee.

How has participation in AAA membership and advocacy helped your organization?

I attended my first AAA meeting in 1984. I knew that day that there was something special about the group. The knowledge in the room, with so many diverse types helped me learn from some of the best minds in the country. I served on the board of directors for 15 years, and learned something new every meeting—still do today. To survive in this industry, you need to stay connected with change. The AAA is the way to go!

MAC Novitas March 2016 Updates to Ambulance Services

On March 4, Novitas Solutions, Medicare Administrative Contract managers for several jurisdictions, asked AAA to share the following information with ambulance services.

March 4, 2016 – Letter to Ambulance Providers | March 4, 2016 – Letter to Beneficiaries

Jurisdictions Covered By Novitas

  • The Medicare Administrative Contract (MAC) Jurisdiction L (JL), which spans Pennsylvania, New Jersey, Maryland, Delaware and Washington D.C.;
  • The Medicare Administrative Contract (MAC) Jurisdiction H (JH), which spans Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service (IHS) and Veterans Affairs (VA); and
  • The payment processing for the Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens contract, as authorized under Section 1011 of the 2003 Medicare Modernization Act.