Tag: California

Congressman Mike Thompson to Receive AAA Legislative Honor

Congressman Mike Thompson to
Receive AAA Legislative Recognition Award

For Immediate Release
Contact:
Amanda Riordan
ariordan@ambulance.org
703-610-0264

Washington, DC, – The American Ambulance Association (AAA) will honor Congressman Mike Thompson of California with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Congressman Thompson will be presented this award in June in Washington, DC by AAA’s California Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Golden State are Amanda Wilkinson of American Ambulance of Visalia, Lyle Armstrong of Del Norte Ambulance, as well as Ivan Gonzalez, Chana Alexander, Peter Hastings and Deborah Rath of American Medical Response.

Congressman Thompson was selected for his support of the Medicare ambulance temporary add-on increases of 2% urban and 3% urban and the super rural bonus payment. Also for championing efforts to ensure that rural areas are correctly identified as such under the fee schedule.

AAA President Mark Postma notes, “Congressman Thompson has been a trusted advocate for health care and emergency medical services, both in California and across our country.”

Elected to the U.S. House of Representatives in 1998, Congressman Thompson represents California’s 3rd congressional district. Congressman Thompson serves on the House Ways and Means Committee Subcommittees on Health and Tax Policy, as well as on the Democratic Steering and Policy Committee.

In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Thompson with a Legislative Recognition Award.

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About the American Ambulance Association

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

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as the 2017 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

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

Congressman Devin Nunes Receives AAA Legislative Honor

Congressman Devin Nunes Receives
2017 AAA Legislative Recognition Award

For Immediate Release

Washington, DC – The American Ambulance Association (AAA) will honor Congressman Devin Nunes of California with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Congressman Nunes will be presented this award in June in Washington, DC by AAA’s California Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Golden State are Amanda Wilkinson of American Ambulance of Visalia; Lyle Armstrong of Del Norte Ambulance; and Ivan Gonzalez, Chana Alexander, Peter Hastings and Deborah Rath of American Medical Response.

Congressman Nunes was selected for the Legislative Recognition Award for championing the Medicare Ambulance Access, Fraud Prevention and Reform Act, which would make permanent the current temporary Medicare ambulance add-on increases and the super rural bonus payment. The legislation, HR 745 from the 114th Congress, would also treat ambulance services more like providers of health care, and would require CMS to collect cost data utilizing a survey methodology that would result in usable information for future reform of the Medicare ambulance fee schedule. Congressman Nunes was also chosen for championing efforts to ensure that rural areas are correctly identified as such under the CMS fee schedule.

AAA President Mark Postma notes, “Congressman Nunes has been a trusted advocate for health care and emergency medical services, both in California and across our country. We thank him for his dedication and commitment.”

Congressman Nunes has represented California’s 22nd congressional district since 2003. He is Chairman of the House Permanent Select Committee on Intelligence and a member of the Ways and Means Committee, having previously served as Chairman of the Ways and Means Subcommittee on Trade.

In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Nunes with a Legislative Recognition Award.

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About the American Ambulance Association

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

AAA Stars of Life

The Stars of Life program celebrates the contributions of ambulance professionals who have gone above and beyond the call of duty in service to their communities or the EMS profession. Stars of Life honors the dedication of these heroes while shining light on the critical role EMS plays in our healthcare infrastructure. This year, 101 EMS professionals will be honored as the 2017 Stars of Life. Meet the stars at www.stars.ambulance.org.

AAA Mission Statement

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

2017 AAA Legislative Awards

The American Ambulance Association is proud to announce the winners of the 2017 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing service to the ambulance services of the United States.

2017 AAA Legislator of the Year

Senator Susan Collins (R-ME) – Press Release, Facebook Post, Twitter Post

2017 AAA Legislative Recognition Award Recipients

Senators

Representatives

House Holds Hearing on Veterans Choice Program

The House VA Committee hearing started at 7:30 p.m., but it was well-attended and lasted until 10 p.m. The witnesses included Senator John McCain (R-AZ), VA Secretary David Shulkin, and representatives of the VA Office of Inspector General and the Government Accountability Office. Senator McCain and Secretary Shulkin were both warmly welcomed by Members of the Committee on a bipartisan basis.

Chairman Roe (R-TN) emphasized the need to act quickly to extend the authorization for the Veterans Choice Program, which expires on August 7. To that end, the House VA Committee is voting today on a bill to eliminate the sunset of the program’s authorization. In addition, the Committee will consider broader legislation later this year to make comprehensive reforms to the Choice Program. He noted that the VA has additional funds available but will not be able to spend them once the authorization expires. A copy of Chairman Roe’s opening statement is available here.

Secretary Shulkin testified in support of extending the Choice Program, and he clarified that the VA was not seeking additional funding – just the authority to spend funds already obligated. He noted that the VA already is being forced to deny Choice Program coverage to veterans whose episodes of care would extend beyond the August 7 expiration date (e.g., pregnancy).

Secretary Shulkin also urged Congress to support the VA’s efforts to bring appointment scheduling in-house for care coordination purposes. However, the VA OIG witness noted challenges in records going out to community-based providers and coming back to the VA. The GAO witness also underscored the need for the VA to have better systems in place in order to effectively coordinate care, which will take time to procure and implement. Rep. Brownley (D-CA) echoed that point, calling the VA’s information technology systems a “Model T in a Tesla world.” Rep. Esty (D-CT) also urged improvements in the VA’s information systems and expressed concern that veterans are being improperly billed.

Other Members, including Rep. Wenstrup (R-OH) and Rep. Poliquin (R-ME), raised concerns about continuing delays in the processing of claims and payments to providers. Secretary Shulkin agreed that providers deserve to be paid for their services, noting his own experience as a physician in the private sector. He acknowledged that the VA is not processing enough claims electronically today, and he advised that he plans to pursue options outside the VA for systems procurement going forward.

Many Members also raised serious concerns about treatment of PTSD and mental health conditions for veterans, including Rep. Wenstrup (R-OH), Rep. O’Rourke (D-TX), Rep. Sablan (D-MP), Rep. Banks (R-IN), Rep. Rutherford (R-FL) and Rep. Takano (D-CA). Rep. O’Rourke emphasized that suicide among veterans is the most serious crisis, and Secretary Shulkin agreed that it is his number one priority. The Secretary announced that the VA will begin providing urgent mental health care that also will include individuals other than those service members who were honorably discharged. He added that the VA needs 1,000 more mental health providers, as well as telemental health services, and is looking to expand community partnerships to address suicide.

Rep. Banks noted interest among Indiana veterans in greater access to alternative treatments for PTSD and traumatic brain injury. Secretary Shulkin underscored that he is “most concerned about areas like PTSD, where we do not have effective treatments.” He also advised that the VA has established an “Office of Compassionate Innovation” (separate from the VA’s Center for Innovation), which will focus on finding new approaches to health and physical wellness and explore alternative treatment options for veterans when traditional methods fall short.

Rep. Wenstrup inquired about the VA’s GME and residency programs, as well as its associations with academic institutions. Secretary Shulkin responded that the VA is “doubling down” on partnerships with academic medical institutions.

Chairman Roe concluded his remarks by emphasizing the need to extend the Choice Program authorization soon and to consolidate the VA’s community-based care programs. He also expressed support for the VA’s decision to stop developing its own information technology internally.

February Employment Law Updates

Last month I suggested that many of our states are the incubators for employment legislation and that ambulance services need to keep an eye on legislation at the local level and get involved if the legislation effects your business.  The leader in employment legislation from a state perspective is California.  This article highlights several pieces of legislation that were filed this year that will impact employers.

As I have stated several times in prior posts, webinars, and live sessions, the “Ban the Box” movement is growing momentum.  California has introduced a bill that will extent current “Ban the Box” protections applicable to State and City employers to private employers.  This would prohibit inquiries about a candidate’s criminal history until after a conditional offer of employment was made.

This is just one of the bills that were introduced.  The other include, Right to Work, Veteran’s Preference, and Employees and dependents Reproductive Health protections.  In addition, Assemblyman Freddie Rodriguez introduced legislation that may drastically impact private EMS providers and how they operate their service.

Last December the Department of Labor released final rule revising the claims procedure requirements for disability benefit plans under the Employee Retirement Income Security Act (ERISA).  The new rules are intended to add more procedural safeguards and protections for those filing claims under the plan.  For most employers who purchase or utilize a fully funded disability plan, these new requirements will fall to the insurer.  However, employers should be sure that the carrier is including these requirements in their plans as they are ultimately the plan fiduciaries.  The Society for Human Resource Management has a great article which summarizes the new rule requirements.

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.

 

Ambulance services face huge losses under ACA

From the San Fernando Valley Business Journal

Two consequences of health care reform – lower reimbursement rates and more patients – have put some local ambulance companies on life support as they struggle to balance higher volumes of trips with less money in return. As a result, ambulance companies have left certain regions of the state amid consolidations and closures.

Read the Full Article (PDF Download)

Musings on 2014 Medicare Payment Data…Part 2

Brian S. Werfel, AAA Medicare Consultant

Every year, the Centers for Medicare and Medicaid Services (CMS) releases data on Medicare payments for the preceding year. The 2015 Physician/Supplier Procedure Master File (PSP Master File) was released in late November 2015. This report contains information on all Part B and DME claims processed through the Medicare Common Working File with 2014 dates of service.

In last month’s post, I focused on total Medicare spending. This month, I want to shine the spotlight on Medicare’s payment for ambulance transports to and from dialysis.

It is no secret that the federal government has long viewed dialysis transports with suspicion. In 1994, the HHS Office of the Inspector General (OIG) issued a report citing dialysis transports as an area of concern. In a 2013 report, the OIG cited the dramatic increase in the volume of dialysis transports since the implementation of the Medicare Ambulance Fee Schedule as evidence that the Medicare ambulance benefit is vulnerable to fraud and abuse. Dialysis transports were also featured heavily in the OIG’s 2015 report on questionable billing practices.  A 2013 report by the Medicare Payment Advisory Commission (MedPAC) noted that the utilization of BLS non-emergency transports, dialysis in particular, had grown faster than the utilization of other ambulance levels of service.

The Numbers Don’t Lie…

According to statistics provided by the U.S. Department of Health and Human Services, the population of ESRD patients increased by 85% from 2002 to 2011. Over that same period of time, the OIG noted that the number of covered ambulance transports to and from dialysis increased by more than 269%. In other words, while the ESRD population has grown steadily over time, an increasing number of those patients are transported to and from their dialysis appointments by ambulance.

Medicare payment data confirms this. In 2007, Medicare paid a total of $445.8 million for dialysis transports. In 2014, Medicare paid $717.1 million for dialysis, an increase of 60.86%. The increase is even more dramatic when you consider that Congress mandated a permanent 10% reduction in Medicare’s payments for dialysis transports furnished on or after October 1, 2013. Without that reduction, Medicare’s payments for dialysis would have been closer to $800 million in 2014, an increase of nearly 80%. Over that same period of time, total Medicare payments for ambulance increased by only 27.08%.

Between 2007 and 2014, Medicare’s payments for ambulance services increased by approximately $1.06 billion, with dialysis transports accounting for $354 million. In other words, approximately one-third of the total increase in Medicare spending on ambulance is attributable to dialysis.

If you focus only on BLS non-emergency transports, the impact of dialysis is even more striking. In 2014, Medicare paid $1.139 million for BLS non-emergency transports (not counting mileage). This is almost essentially unchanged from the $1.131 million it spent in 2010. However, during that same period, payments for BLS non-emergency transports to dialysis increased from $513.7 million to $558.4 million. Put another way, if you remove transports for dialysis, Medicare’s payments for BLS non-emergency transports (and non-emergency transports in general) actually declined over the past five years.

In its 2013 report on ambulance utilization, the OIG noted that dialysis transports had increased to 19% of all covered ambulance transports in 2011, up from 9% in 2002. Note: in 2014, dialysis transports had dropped to 17.1% of all covered transports, suggesting we may start to see the pendulum shifting back a bit.

Our industry may ultimately look back on 2013 as a tipping point. That year marked the first time that the total volume of BLS non-emergency transports to and from dialysis exceeded the number of BLS non-emergency transports to or from places other than dialysis.

But They don’t Tell the Full Story Either…

While the overall trend has been upwards, the increase in dialysis transports is not a national phenomenon. Rather, this increase is largely confined to a handful of states.

As noted above, Medicare’s payments for dialysis transports increased by approximately $45 million between 2010 and 2014. During that same period, Medicare’s payments for dialysis transports in New Jersey increased by $50.7 million. You read that right, if you exclude New Jersey, total Medicare payments for dialysis would have declined nationwide. If you have ever asked: “Why was New Jersey selected to be one of the initial 3 states for the prior authorization program?”, you have your answer.

Other states that saw significant increases over that period include:

State 2010 Dialysis Payments 2013 (2014)

Dialysis Payments

California $87.7 million $106.0 million
Georgia $25.5 million $69.9 million (2014)
Illinois $13.5 million $19.3 million (2014)
Louisiana $4.0 million $6.4 million
Michigan $12.7 million $17.5 million
New York $23.5 million $30.1 million (2014)
South Carolina $51.1 million $62.4 million
Virginia $25.3 million $30.2 million
West Virginia $7.9 million $9.9 million (2014)

If your state is not one of the ones listed above, chances are Medicare’s payments for dialysis are lower today than they were 5 years ago. This includes a number of states and/or territories that, historically, have been recognized as having a so-called “dialysis problem.” For example, total payments for dialysis have declined in Texas from $86.7 million in 2010 (itself a significant reduction from 2007) down to $53.8 million in 2014. This is likely the result of ongoing enforcement efforts in the state, including a moratorium on the enrollment of new ambulance providers. Pennsylvania, also selected to be part of the initial prior authorization program, saw payments for dialysis transports drop to $39.2 million in 2014, down from $62.6 million in 2010.

As I look at this data, two thoughts come to mind. The first is that, to the extent you agree that there is a problem with dialysis transports (and I am one of those that does), it is clear that the problem is largely confined to a handful of states.

The second is that our overall perspective on our industry may need to change. Traditionally, we have viewed the industry through the prism of “emergency” vs. “non-emergency.” And there are valid operations reasons to distinguish between these two categories. However, I can’t help but wonder if that worldview isn’t overly simplistic these days. Maybe we need to start viewing our industry as having three components, emergencies, non-emergencies, and dialysis.


 

AAA members, submit a Medicare question to Brian! Not yet a member? Learn more.

Spotlight: Mark Postma

Mark Postma
Vice President, Paramedics Plus
President-Elect, AAA Board
Chair, Commission on Accreditation of Ambulance Services (CAAS)
Largo, Florida, USA

Can you please tell us a little about yourself? How did you come to work in EMS?

I grew up in a small town outside Sioux Falls, South Dakota, and obtained my EMT license at age 16. I became a paramedic in 1984 and began working in Davenport, Iowa at MEDIC EMS. After working there for 20 years and becoming Executive Director, I began at SUNSTAR Paramedics in 2004. I am the COO for SUNSTAR and Vice President of Paramedics Plus operations (Sioux Falls, Fort Wayne, and Oakland).

I have been married 31 years to my great wife, Lisa. I have two children: Delaney, a registered nurse at Florida Hospital in Orlando; and my son, Parker, a sophomore at the University of Florida. My hobbies are basketball, boating, and IndyCar Racing.

What do you enjoy most about your job?

It is very diverse. As the Vice President, I really oversee daily operations and have great people who work for me. They are local and report out how things are going, daily achievements and challenges.

Paramedics Plus/ETMC is a great organization and is focused on providing great care over financial constraints. I work for a great boss, Ron Schwartz, who fully understands the industry and its daily challenges. We are both from the Midwest and work together on issues.

What is your biggest professional challenge?

Sometimes it is just a challenge wearing my CAAS Chairman hat, AAA hat, SUNSTAR hat and Paramedics Plus hat. Everyday you have to decide which issues need to be the priority. Just glad I own an iPad and have a great staff!

What is your typical day like?

I wake up at 0500 eveyday and read emails and try to read at least 2 newspapers. After that, I run 2-5 miles depending on my schedule. The only days I take off are travel days.

After getting to work or on an airplane, it is interacting with staff until our daily PULSE meetings. Most afternoons are teleconferences from all of our operations or AAA meetings.

I go to lunch with my staff every day whether I am in Pinellas or one of the other operations. Evenings are usually laid back, but the weekends are boating and basketball. I am usually in bed at 9:00 pm!

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

I have been very involved with the Commission on Accreditation of Ambulance Services (CAAS) as the representative for the AAA for the past 20 years. I am currently the Chairman of the Board and have enjoyed the AAA/CAAS relationship.

Transitioning to the AAA President will have its challenges as it is a huge responsibility. The AAA represents EMS in America, and I would like to see members embrace our organization as the “”go to”” organizations for challenges in our industry.

The AAA membership and advocacy is immeasurable in how it helps our organization every day!

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