Tag: Florida

AAA’s Terence Ramotar on Morning Joe

Terence Ramotar, President of the Florida Ambulance Association and AAA Board member, discusses how the coronavirus crisis in Florida is impacting ambulance services on MSNBC’s Morning Joe!

This morning, AAA Alternate Director and Florida Ambulance Association President Terence Ramotar made a compelling case…

Posted by American Ambulance Association on Thursday, July 16, 2020

WSJ | TX, AZ and FL have been some of the worst-hit states in recent days

From the Wall Street Journal on July 5

Some Hospitals in Southern, Western U.S. States Near Capacity Amid Coronavirus Outbreaks

Top officials in southern and western U.S. cities and states with growing coronavirus cases sounded the alarm Sunday, saying hospitals were near capacity and that stricter social-distancing enforcement was needed to stem the growing outbreaks.

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40 Under 40: Jeremy Tinter (Sunstar Paramedics – Largo, FL)

40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
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Jeremy Tinter
Director of Clinical Services
Sunstar Paramedics
Largo, FL

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LinkedIn
Nominated by: John Peterson (Sunstar Paramedics – Largo, FL)

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Biography:

Jeremy Tinter is Patientcare Logistics Solutions’ Director of Clinical Services for the Pinellas County Florida Operation. Jeremy served as the Clinical Services Coordinator for Sunstar Paramedics from June 2015 to June 2016 and held various positions ranging from Field Training Officer, Critical Care Paramedic, and Assistant Supervisor over the past 10 years. Jeremy’s emergency medical services career has not only been in clinical care but also focused on education and training. Jeremy holds many instructor ratings ranging from AHA to NAEMT, leads the simulation lab for Pinellas County, and has been responsible for the successful clearing of clinicians to the field. A certified Paramedic in the state of Florida, Jeremy has also served as an adjunct, non-credit faculty/CME Instructor at St. Petersburg College and has taught continuing education classes through the Pinellas County Authority CME Program to EMTs, Paramedics, and Nurses.

Jeremy was the proud recipient of the 2016 American Ambulance Association’s “Star of Life” award.

Jeremy is a native of Florida and a longtime resident of Pinellas County. Jeremy earned a bachelor’s degree from the University of South Florida (USF) and is a graduate of the EMS Leadership Academy, class of 2016. Jeremy is currently working on his Master degree at USF.

In his free time, Jeremy plays classical guitar, jogs, enjoys photography, and going to the movies.

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Reason for Nomination:

In just a few years as Director, Jeremy Tinter has made significant process changes and improvements that have streamlined the hiring and training processes at Sunstar. Under his leadership, the Clinical Services Department was recognized at the state level as Educator of the Year for the State of Florida in 2017. Jeremy’s department was also recognized on the national level by the American Ambulance Association as an AMBY award winner that same year.

Jeremy has shared his best practices with other EMS providers by being published in JEMS. Jeremy has also been a guest speaker at the American Ambulance Association’s annual conference as well as at the Midwest EMS Expo.

Jeremy serves as volunteer on the board of directors at 211 Tampa Bay and is a graduate of the Leadership Pinellas program class of 2019. Jeremy definitely deserves to be recognized as one of the 40 under 40 to watch in EMS.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

2019 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2019 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize  mobile healthcare. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation, and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on November 5 in Nashville. Please join us in congratulating our 2019 winners!

Clinical Outcome Program

Medic Ambulance Service Inc.
CPR Initiative

Community Impact Program

Advanced Medical Transport
CPR Race to the Top

American Medical Response (Manchester/Nashua, NH)
Safe Station Project

Sunstar Paramedics
Health & Safety Fair

Employee Programs

American Medical Response (Buffalo, NY)
Recruitment/Training Program

Northstar EMS, Inc
Medical Director Engagement Through Technology

Public Relations Campaign

Acadian Ambulance Service
Hometown Hero Initiative

Mecklenburg EMS Agency
Bystander CPR Initiative With Pulsepoint

Once again, join us in celebrating the 2019 winners! Learn more about the AMBYs.

President’s Perspective: April 2018

Dear Fellow AAA Member,

Spring has sprung, and the American Ambulance Association is busier than ever working on your behalf to build the future of EMS.

The AAA is pleased to announce that since our last Response Times update, Congress has passed the 5-year extension of the Medicare ambulance add-ons. The extension included the AAA’s preferred method of cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data and avoiding overly burdening or onerously penalizing the ambulance services. This legislation was a true victory for the AAA and the entire industry. Learn more►

This success would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress. In particular, the AAA would like to thank Senator Debbie Stabenow for spearheading our legislation and ensuring that the Senate language prevailed. In recognition of Senator Stabenow’s support, she has been named the AAA’s 2018 Legislator of the Year. The AAA would also like to thank Senators Schumer, Roberts, Collins, Leahy, Hatch, Wyden, Thune, and many others who will be receiving AAA Legislative Recognition Awards this year. The successful passage of this legislation would not have occurred without also having strong champions in the House of Representatives. The AAA is sincerely thankful to Representative Devin Nunes (2015 Legislator of the Year Award winner) for his continued leadership in the House on this issue. The AAA also wishes to thank Representatives Sewell, Upton, Welch, Walden, Neal, Brady, Pallone, and Speaker Ryan for supporting this crucial extension of the Medicare add-on payments.
Despite this success, the AAA is not resting on its laurels. AAA Committees, staff, and consultants are taking proactive steps to ensure that the new cost data system both collects meaningful data and is not overly burdensome on providers. The AAA will continue to update members as this process moves forward. Thank you, again, for your support. We truly couldn’t have made it this far without you!

Get Involved!

In mid-May, AAA will open the nominations process for our board of directors. (Full details and criteria for participation will be posted then.) In the meantime, I encourage you to consider becoming more involved with the American Ambulance Association by joining a committee with open positions, and following us on Facebook and Twitter.

Stars of Life

I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network.

I hope you will enjoy meeting the 2018 class of Stars as we share their stories and accomplishments on our website and social media.

Haven’t yet nominated a Star? It’s not too late! The deadline has been extended to this Friday, April 20. Nominate a Star►

Education

The Education Committee has been hard at work developing the program for the 2018 AAA Annual Conference & Trade Show. We look forward to announcing the full agenda in June, and hope that you will join us in exciting Las Vegas September 6–8. (Yes, I said September! Our conference is two months earlier than usual this year.)

Regional & Online Education

In the meantime, why not learn from our experts at an AAA Supervisor SimLab workshop? If you’re short on time, AAA is also proud to offer a wide variety of live and on-demand webinars on human resources, reimbursement, compliance, and other topics.

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2018!

—POST
Mark Postma
President
American Ambulance Association
“Representing EMS in America”

2017 AMBY Winner: Sunstar Paramedic

Sunstar Paramedics Named 2017 AMBY Award Winner

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

Washington, DC– McLean, VA — The American Ambulance Association (AAA) has named Sunstar Paramedics a recipient of the 2017 AMBY Award in the Public Relations Campaign category. Each year, the AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members.

Sunstar Paramedics is being recognized with an AMBY Award in recognition of their process improvement program for new hires. The program identified the need to streamline the pre-hire process, improve the quality of training of the new EMTs and Paramedics, and provide the Field Training Officers (FTO) with more leadership skills and abilities.

Representatives from Sunstar Paramedics will receive their AMBY at the AAA Awards Reception during the 2017 Annual Conference & Tradeshow in Las Vegas.

The mission of the AMBY Awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. For additional information about the AMBY Awards or how to submit a nomination for next year, visit https://ambulance.org/amby-awards/

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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 non-emergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views pre-hospital 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 Affiliate of the Year Award

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

AMERICAN AMBULANCE ASSOCIATION HONORS REV WITH THE 2017 AFFILIATE OF THE YEAR AWARD

Washington, DC– McLean, VA — The American Ambulance Association (AAA) is proud to award REV with the 2017 Affiliate of the Year Award.

The Affiliate of the Year Award is given to the vendor who supports the programs of the association. REV has achieved this honor through their support of AAA’s programs and services including our 2017 Legislative Priorities.

AAA President Mark Postma noted, “REV has been an outstanding supporter of the AAA’s programs and services over this past year. It is an honor to celebrate their contributions to the AAA and our industry by presenting them with the Affiliate of the Year Award for 2017.”

Representatives for REV will be presented the Affiliate of the Year 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.

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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 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.

American Ambulance Association Announces 2017 AMBY Award Winners

The American Ambulance Association is proud to announce the recipients of the 2017 AMBY Awards. The AMBYs highlight excellence in EMS and the ingenuity and entrepreneurial spirit that epitomize AAA members. The mission of the awards is to showcase creativity and innovation in the ambulance industry by fostering a culture of collaboration, cooperation and a passion for excellence in patient care. This year’s awards will be presented at the Annual Conference & Trade Show Awards Reception on Tuesday, November 14, 2017. Please join us in congratulating our 2017 winners!

Community Impact Program

NorthStar EMS, Inc.
St. Charles County Ambulance District

Employee Programs

MEDIC EMS Agency (North Carolina)

Quality Improvement Programs

MEDIC EMS Agency (North Carolina)

Public Relations Campaign

Medic Ambulance Service, Inc. (California)
Sunstar Paramedics

Other Programs

Porter EMS

Learn more about the AMBYs.

President’s Perspective: October 2017

Dear Fellow AAA Members,

As I reflect on the past few months, I am awed by the dedication of ambulance services across the nation as they responded to emergencies ranging from hurricanes to wildfires to the Las Vegas MCI. As always, EMS aided their communities with humanity, efficiency, and deep-rooted professionalism. The outcomes of each of these incidents would assuredly have been far worse without the selfless service of our fellow healthcare providers.

I was privileged to see this commitment to excellence firsthand as our staff at Sunstar responded to Hurricane Maria here in Florida, assisted by hundreds of EMTs, Paramedics, and strike team leaders who drove hours or days to help. Thanks to each of you for your service in our country’s time of need.

Advocacy Update

The AAA continues working hard to ensure the Medicare add-on payments don’t expire at the end of this year. In the Senate, S. 967 would make the add-on payments permanent. In the House, two versions of a bill (H.R. 3236, H.R. 3729) would extend the payments for five years. Extensions of Medicare provider provisions, including the ambulance add-on payments, will likely be addressed closer to the end of the year.

We have seen progress already in the House on the ambulance add-ons. On September 11, the House Ways and Means Committee marked up H.R. 3729, the Comprehensive Operations, Sustainability, and Transport Act of 2017. Similar to H.R. 3236, which the AAA supports, H.R. 3729 would extend the Medicare add-on payments for five years and require ambulance service suppliers to report cost data. However, H.R. 3729 would subject suppliers to an overpayment penalty which could potentially put all Medicare payments at risk for a supplier who does not submit timely, accurate, and complete data.

H.R. 3729 also includes a 22% across-the-board cut to all ambulance providers and suppliers for non-emergency BLS transports to and from dialysis centers. The 22% cut was the figure estimated as necessary to offset the cost of the five-year extension of the add-on payments. Since then, the AAA was able to demonstrate to the Congressional Budget Office (CBO) that our estimate of a five-year extension of the add-ons was the more appropriate approach. As a result, AAA has received a commitment from the Ways and Means Committee to lower the amount of any cut to cover the lower estimate. However, the AAA opposes any across-the-board cut and is working with the Committee and the bill sponsors to focus on addressing fraud and abuse within the dialysis transport benefit.

The AAA is working with key congressional offices as well as industry stakeholders to make changes to H.R. 3729. We remain hopeful that we can come to a consensus on these outstanding issues.

Meanwhile, on the Senate side, S. 967 is up to 12 co-sponsors with the addition of Sen. Cotton (R-AR), Sen. Boozman (R-AR), and Sen. Cassidy (R-LA). AAA encourages members to continue reaching out to their Senators to ask them to co-sponsor S. 967. The AAA will keep you updated on our progress working on extending the add-ons. Thank you for your continued support.

AAA Annual Conference & Trade Show

As we face this challenging political and regulatory climate, it is essential that ambulance leaders stay abreast of new developments and best practices in reimbursement, operations, leadership, and human resources. In addition to myriad industry experts, this year’s AAA Annual Conference & Trade Show program features three inspiring keynotes—Steven M.R. CoveyMel Robbins, and Dr. Zubin “ZDoggMD” Damania—plus a ceremony honoring AMBY Award winners for their community impact.

I hope that you will join me and hundreds of our colleagues for networking, learning, and fun in Las Vegas November 13–15. Online registration for Annual is open now.

AAA Board Election

It’s that time again! The 2017 AAA Board of Directors election is underway. This year, active members will elect Regional Directors (Regions 1–5) and new members of the Ethics Committee. Voting opened on Wednesday, October 11th, and closes at 11:59pm Eastern on Thursday, November 2nd. Best of luck to all of the candidates! (If you are the primary contact for an active member organization and did not receive your e-ballot, please contact acamas@ambulance.org.)

Renew Your Support of AAA

Has your organization yet renewed its AAA membership? Your continued support is critically important as AAA fights for fair ambulance reimbursement. Membership also include benefits such as free use of the Savvik Buying Group, complimentary CISM and EAP-based counseling for your employees, and access to industry experts on Medicare, operations, and HR.

If you have already renewed, please accept our most sincere thanks. If you have not yet submitted payment for this year’s membership, I encourage you to renew online or reach out to staff at info@ambulance.org for assistance.

Capital Campaign

Lastly, many of you are aware that during my presidency I began a Capital Campaign to raise $1,000,000 to help sustain our organization and to increase our “rainy day” fund. The funds raised by this effort can only be used in the case of a majority vote by the Board of Directors.

Today, we have raised $250,000 of the $1,000,000 goal, for which I am grateful to our member supporters. But this is not enoughwe need to be strong when a crises hits our industry and we must deploy more resources for our advocacy programs. If you have already given, I would ask that you consider another commitment to this fund. If you have not already contributed, I respectfully ask you to support your national association as it works to fight for the future of ambulance services. Thank you in advance! Contribute online now.

It continues to be my pleasure to serve so many talented, dedicated healthcare professionals. Thank you again for your service, and I look forward to seeing you at AAA Annual in Las Vegas!

—POST!
Mark Postma—President
American Ambulance Association
Representing EMS in America

In Memory of Lahiri Garcia & Paul Besaw (AMR Palm Beach/Broward)

The American Ambulance Association was deeply saddened to learn that Lahiri Garcia (51) and Paul Besaw (36) were killed on June 1 in the line of duty. Both were longstanding and respected team members at AMR Palm Beach/Broward County in Florida.

In an interview with WPTV, AMR Regional Director Bill Hall said, “The AMR family has lost two amazing people. They were dedicated husbands, fathers, friends and teammates. Our thoughts are with both families during this difficult time. Lahiri and Paul will be greatly missed. Garcia and Besaw were committed to caring for others, and together they had nearly 40 years of service for AMR and the community.”

“Thank you all for your kind thoughts and sentiments during the past few days. This week, we celebrate the lives of our fallen colleagues, Paul Besaw and Lahiri Garcia, who tragically lost their lives in an unfortunate ambulance accident last Thursday morning,” said Terance Ramotar, regional director of AMR. “These two gentleman have dedicated their lives to the EMS profession and we are preparing a tribute on Thursday to honor their service.”

A processional, followed by funeral services, is scheduled for Thursday, June 8, 2017, at Courtyard Gardens of Jupiter, FL, located at 1790 Indian Creek Drive West, Jupiter, FL. The staging will be on Indian Creek Drive West, and the processional will begin at approximately 9 a.m. The processional ends at Christ Fellowship Church (5343 Northlake Blvd, Palm Beach Gardens, FL), where formal funeral services for Besaw and Garcia are to be held.

The AAA extends its deepest condolences to the Garcia and Besaw families, as well as their friends and colleagues.

Former Employee Plants False Story Against AAA President

AAA Fully Supports Mr. Mark Postma, Sunstar COO

FOR IMMEDIATE RELEASE
Contact:
Amanda Riordan
Sr Director of Membership & Marketing, AAA
703-610-0264
ariordan@ambulance.org

McLean, VA–The American Ambulance Association has recently become aware of baseless Facebook and “prank” news site allegations of arrest leveled against our President, Mr. Mark Postma. Mr. Postma is Chief Operating Officer of Sunstar Paramedics in Largo, Florida.

These scurrilous claims were posted to social media in the form of a fake news story created by a former employee. Mr. Postma and Sunstar Paramedics have requested the post’s immediate removal from Facebook as well as Channel 23 News, a “prank” news site. Additionally, the Pinellas County Sheriff’s Department has been investigating the defamatory posting.

Mr. Postma and Sunstar Paramedics have the full support of the American Ambulance Association as they take all steps necessary to delete this libelous story and defend Mr. Postma’s sterling reputation.

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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 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.

 

 

 

President’s Perspective April 2017

Dear Fellow AAA Member,

As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. The AAA Board, Government Affairs Committee, advocacy consultants, and staff have been working diligently to build support on Capitol Hill to ensure that this critical revenue remains in place.

As we continue to connect with policymakers in preparation for the introduction of our legislation, I ask that you pay special attention to the requests for advocacy action you receive from the AAA. Now, more than ever, we need the active participation of each member organization to ensure our collective future!

Capital Campaign and Financial Status

In addition to representing our members’ current interests in Washington, AAA strives to serve ambulance providers over the longer term. It is key that the Association build a pool of capital for use in case of an unexpected legislative or regulatory threat, or once-in-a-blue-moon strategic opportunity. For these reasons, I announced the creation of a Capital Campaign the day I assumed the office of President. Funds contributed to this campaign are managed separately from other assets, and can only be accessed after a full AAA Board vote.

To date, we have raised more than $250,000 of our $1mm goal through the generous contributions of our fellow members. My deepest thanks to all who have given. If you have not done so already, please consider donating today.

In addition to the Capital Campaign, we continue to build the overall financial strength of our association. Through close management of the budget, streamlined regional meetings, and increased membership, AAA continues to thrive. Thank you to Shawn Baird, Finance Chair, and David Tetrault, Membership Chair, and both committees for your hard work. It is paying off!

Stars of Life

I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network.

I hope you will enjoy meeting the 2017 class of Stars as we share their stories and accomplishments on our website and social media.

Education

The Education Committee has been hard at work developing the program for the 2017 AAA Annual Conference & Trade Show. We look forward to announcing the full agenda in June, and hope that you will join us in exciting Las Vegas this November.

In the meantime, why not learn from our experts at an AAA Live! Workshop here at Sunstar Paramedics on May 3, or at Superior Air-Ground Ambulance in Illinois in July? If you’re short on time, AAA is also proud to offer a wide variety of engaging webinars on human resources, reimbursement, compliance, and other topics.

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2017!

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

 

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.

2015 Medicare Data Shows Evident of Crackdown on Non-Emergency Transport

2015 Medicare Payment Data Offers Evidence of Nationwide Crackdown on Non-Emergency Ground Ambulance Transportation; Impact Varies Dramatically by Medicare Administrative Contractor

Every year, CMS releases data on aggregate Medicare payments for the preceding year. This file is referred to as the Physician/Supplier Procedure Master File (PSP Master File). This past month, CMS released the 2016 PSP Master File, which contains information on all Part B and DME claims processed through the Medicare Common Working File with 2015 dates of service.

In September’s blog post, I discussed the results of the first year of the prior authorization demonstration project for repetitive, scheduled non-emergency ground ambulance transports. During this first year, the project was limited to three states: New Jersey, Pennsylvania, and South Carolina. The data confirms that these three states saw a dramatic reduction in Medicare’s approved payments for dialysis transports.

This month, I will be discussing the national payment trends for non-emergency ground ambulance transports, and, in particular, Basic Life Support non-emergencies.

In 2015, Medicare paid approximately $990 million for BLS non-emergency transports. This is 13% less than what it paid for BLS non-emergency transports in 2014 ($1.14 billion). Please note that these figures only reflect payments for the base rate; when the payments for the associated mileage are included, the reduction is even more dramatic.

In actual terms, this means Medicare Administrative Contractors (MACs) approved nearly 1 million fewer BLS non-emergency transports in 2015 (5.86 million) than they approved in 2014 (6.81 million). Roughly 75% of this reduction can be directly attributed to the prior authorization program in the three states listed above. Note: the reduction in approved dialysis transports in New Jersey accounts for nearly half of the national decline). However, that leaves nearly 250,000 fewer approved transports in the remaining 47 states. This reduction was not the result of fewer claims being submitted in 2015; the number of submitted claims was actually higher in 2015 than 2014. Rather, the data shows that this reduction is the result of the MACs actively denying many more claims than in year’s past.

I believe these reductions are the direct result of a step-up in the enforcement activities of the MACs, which I also believe has the tacit, if not outright, approval of CMS.

To test this thesis, I looked at the state-by-state data to see if any trends could be found. What I found was that 28 states saw increases in the total number of approved BLS non-emergency transports in 2015, with 19 states seeing decreases. However, on its face, that number is somewhat deceiving. The states that saw increases tended: (1) to see either relatively small increases or (2) had relatively low utilization rates to begin with. The states that saw decreases tended to be larger states with higher utilization rates, and those decreases tended to be larger in percentage terms. For instance, California saw a 21.5% decrease in the number of approved BLS non-emergency transports. Ohio saw an 11.7% decrease.

Digging deeper, it becomes clear that a state’s overall change in payments for BLS non-emergencies is almost perfectly correlated with its change in payments for dialysis transports. In other words, to the extent the state saw an overall reduction in payments for BLS non-emergencies, that reduction – – in nearly all cases – – was the result of the total payments for dialysis decreasing by more than any offsetting increase in the total payments for non-dialysis transports.

These relative changes in dialysis were also highly correlated with the MAC that administers Medicare claims in that state. To the extent your state saw a reduction in dialysis payments, it is highly likely that neighboring states administered by the same MAC saw similar reductions in payments. The following charts will help illustrate this point:

2016-11-29-werfel-non-emergency-crackdown-chart-1As you can see, all three states within Cahaba’s jurisdiction saw a net increase in the total payments for dialysis. While the increases themselves were quite minor in Alabama and Tennessee, Georgia saw an 11.8% increase in total payments for dialysis. Similarly, both Florida and Puerto Rico saw significant increases in the approved payments for dialysis.

By contrast, every state in National Government Services’ (NGS’) jurisdiction with more than 1,000 paid dialysis transports in 2015 saw a net reduction in the total payments for dialysis. These reductions ranged from a relatively minor reduction of 1.17% in New York to a nearly two-thirds (64.58%) reduction in Minnesota.

2016-11-29-werfel-non-emergency-crackdown-chart-2This trend was present in all remaining jurisdictions, although the results were more mixed. For example, with the exception of South Carolina, the three remaining states administered by Palmetto all saw increases. Likewise, the majority of states administered by WPS saw decreases. This included Indiana, which has a sizeable dialysis population. Among WPS states, only Missouri saw a small (3.90%) increase.

California saw a 31.76% decrease in its payments for dialysis. The only other Noridian states with more than 1,000 paid dialysis trips were Hawaii and Washington, which both saw increases.

Novitas presents a more complicated picture, with several large states, such as Texas, seeing double-digit increases in payments for dialysis, while other large states saw sizeable decreases.

All in all, the data suggests that CMS and its contractors continue to pay close attention to the non-emergency side of our business, particularly BLS non-emergency transports. These transports have been under scrutiny for many years, as reports from the Office of Inspector General, the Government Accountability Office and other federal agencies have flagged this portion of our industry as being particularly prone to overutilization (and, in some cases, outright fraud).  However, this heightened scrutiny is not being uniformly applied across-the-board. The data suggests that certain MACs have been far more aggressive in targeting these sorts of trips across their entire jurisdictions, while others seem content to target specific (typically large) states within their jurisdictions. This could serve as a template for how MACs will approach prior authorization in their jurisdictions.

‘Praemonitus, Praemunitus’     

Latin Proverb, loosely translated to “forewarned is forearmed.”

 

 

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!

Spotlight: John Peterson

John Peterson
Chief Administrative Officer
Sunstar/Paramedics Plus
Largo, FL

Can you please tell us a little about yourself?

I am originally from Apple Valley, Minnesota, a suburb of Minneapolis. I attended college in Chicago where I met my wife, Sarah. She is also a native Minnesotan. In 2003 we made the move to Florida for warmer weather. We enjoy Florida living, including kayaking and spending time at the beach. We are avid NFL football fans and are season ticket holders to the Tampa Bay Buccaneers. Of course, our Minnesota Vikings purple pride still remains. One thing that some people don’t know about me is that besides being a paramedic, I am also a board certified Occupational Therapist.

How did you come to work in the industry? How long have you been involved?

My first experience in EMS came when I injured my back playing football in high school. This became my first ambulance ride and was an experience I’ll never forget. After graduating from college I had a friend who was working for a private ambulance service. He told me that the company he worked for was paying for people to go to EMT school and then providing them with full time employment. I jumped at this opportunity and never looked back. I fell in love with EMS and became a paramedic as soon as I could after EMT school. I worked as a paid on-call firefighter/EMT and as a paramedic/firefighter in Illinois before moving to Florida. I have gradually worked my way up through the ranks at Paramedics Plus and now have the opportunity to be the CAO for Sunstar.

What do you enjoy most about your job?

What I enjoy most about my job is the chance to make a positive change that improves the work life for our employees and provides the highest possible quality of service to our community.

What is your biggest professional challenge?

I think my biggest professional challenge currently is recruitment and retention of paramedics. The EMS industry appears to be seeing a reduction in interest from younger people in the workforce. This is at least in part due to wages and work schedules that struggle to compete with other healthcare industries.

What is your typical day like?

My typical day starts with 30 minutes on the elliptical machine. Once at the office, I try to get through as many emails as I can before the meetings of the day start. I spend a lot of time leading and attending meetings as we work to improve efficiency and provide the highest quality of service possible. The email and phone communications last all day. It’s hard to ignore those smart phones.

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

One of the things I appreciate most about the AAA is the opportunity for EMS organizations from around the country to work together on projects that have positive industry-wide impact. It think is important that the AAA promotes a one team, one mission approach that puts aside agency competition for the betterment of the industry as a whole. The annual conference provides excellent educational and networking benefits and the daily digest emails help keep me informed of what is happening in the industry. I am looking forward to furthering my involvement with the AAA.

CMS Extends Ambulance Enrollment Moratoria

On July 25, 2015, CMS issued a notice extending the temporary moratorium for enrollment of new ambulance suppliers in the Texas counties of Brazoria, Chambers, Fort Bend, Galveston, Harris, Liberty, Montgomery and Waller, as well as in Philadelphia and the surrounding counties of Bucks, Delaware, Montgomery (Pennsylvania), Burlington, Camden and Gloucester (New Jersey). This notice will appear in the Federal Register on July 28, 2015.