Tag: Georgia

AJC | Georgia EMS crews near ‘breaking point’

From the Atlanta Journal-Constitution on January 8

On a recent day, a Dawsonville ambulance worker was trying to rush a patient with dangerously high blood pressure to the hospital.

But after a brief call, she learned its emergency department was on “diversion,” meaning her patient could wait more than an hour for a bed, tying up the ambulance from responding to other calls.

“I have been hung up … and told to go else where!” she posted on the social media page of a statewide group of emergency medical personnel.

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SouthStar EMS in 2020

SouthStar EMS
Augusta, Georgia
144 Staff | 0 Quarantined in 2020

SouthStar EMS traces its history to 1976. We serve the greater Metro Augusta Georgia area as the sole source ambulance & stretcher van provider for the VA Medical Center for 10+ years; also we are a long term partner with Aiken County EMS 911 in Aiken South Carolina for 11 years+. In our Georgia operations, we provide emergency & non-emergency medical transport for every Hospital & SNF + the State of Georgia Hospitals, State Prison Hospital, Federal Prison for ground & air transports and 70 other health agencies. We back up the county EMS 911 service when requested. SouthStar is the first provider in the USA to have 100% of our alternative services, Certified Transportation Specialist by NEMTAC. Our CEO is a charter member of NAEMT and a State of Georgia NAEMT Advocate, who started in EMS in 1969. Our training facility is an NREMT recognized training center. Our training officer is an NREMT-P, and we teach a wide variety of classes and certification programs for our company and the public and partner with Hospitals and other health care agencies. We are active in our communities supporting a plethora of events and stand-by for high school football, horse events, etc.

SouthStar early on took precautions with Covid-19, having gone thru a number of previous airborne infection situations.

We began an effort to use face masks as a routine part of our patient care approach. We began making our own kits of gowns, masks, gloves, and experimented with a variety of gown styles. We got involved with local health department efforts and partnered with all our health care agencies as they developed custom protocols at their facilities. We began daily temperature checks on all our patient care staff and charted individually. We were requested to help with COVID Testing in Georgia & South Carolina, partnering with the State of Georgia & State of South Carolina. We offered our mobile emergency room to help with rural testing and field evaluations. We are still active with protective measures in all our operations. We have had 9 positive tested employees, who were immediately quarantined up to 10+ days, or till asymptomatic. We strive diligently to protect our staff and patients with aggressive disinfection of each unit after a transport. Each of our units has disinfectants and mist sprayers for use.

AJC | Vaccine campaign dawns in Georgia; Kemp attends 2nd day of doses

From the Atlanta Journal Constitution on December 16

Vaccine campaign dawns in Georgia; Kemp attends 2nd day of doses

… Chatham EMS Chief Chuck Kearns got the call Tuesday. His paramedics are in line for vaccination appointments next week, and his staff immediately prepared a blast email to go out first thing Wednesday on how to sign up.

“We’ve had over 100 personnel who’ve gone into quarantine at one time or another since March,” Kearns said. “When they got the result of tests for quarantine, days were cut in half. We’ve had a few dozen of our employees test positive and some were hospitalized.” He added that this is the 10th epidemic he’s worked as a paramedic, starting with AIDS. To him, his staff’s vaccines are arriving fast enough.

“We’re very relieved,” Kearns said.

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AJC | New COVID-19 cases push hospitals to capacity

From the Atlanta Journal-Constitution,  featuring AAA Board leader Chuck Kearns.

On a recent day, several ambulances packed the hospital bays outside one hospital’s emergency room, as an unusual number of paramedics waited in the hallway with their patients in cots, ready to drop them off. But there were no beds to receive them, and crews can’t leave until patients are admitted. That can take hours, said  Chuck Kearns, chief of Chatham County EMS, the region’s 911 provider.

“One patient was held for seven hours; it’s unheard of,‘’ Kearns said.

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AJC | Ambulance companies hit hard by COVID costs

From the Atlanta Journal Constitution by Yamil Berard on  July 17, 2020

“We are gravely concerned that various factors related to this pandemic are pushing ambulance services to the breaking point,‘’ Georgia ambulance executive Pete Quinones wrote to a top official at the Georgia Department of Community Health.

One request by the Georgia Ambulance Providers Association has been to urge the Georgia Trauma Commission to release up to $29 million in block grants to support EMS staffing over the next six months.

“Without that, we don’t have the financial ability to keep a state of readiness,‘’ said Terence Ramotar, director of government affairs for the southeast region for American Medical Response, the exclusive 911 ambulance provider for DeKalb County.

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40 Under 40: Luke Culleny (Chatham EMS – Savannah, GA)

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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Luke Culleny
Paramedic / IT Coordinator
Chatham EMS
Savannah, GA

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LinkedIn
Nominated by: Phil Koster
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Biography:

Luke Culleny holds a Bachelor’s Degree in Film and Television as well as many other technology based certifications. Luke was first exposed to EMS during his time as a Associate Producer in film and fell in love with public safety. Luke returned to school and is a four-year veteran of Chatham EMS as an EMT, then Paramedic. Luke frequently works ambulance shifts as his IT schedule allows. Luke’s hobbies include woodworking and filming (including drone use).
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Reason for Nomination:

Luke Culleny maintains a passion for EMS which combines with his love, experience, and knowledge of IT systems and multi media. This combination has resulted in multiple significant advancements at Chatham EMS. Luke has successfully overseen dispatch CAD and ePCR software launches along with projects to assure ECG transmissions to receiving ERs. Whereas this may be standard for some, Luke pushes IT abilities by developing better interfaces to report frequency of ECG transmissions to help drive improved clinical performance and education. Luke also works to develop CAD to CAD to ePCR interfaces to move information to crews faster and easier by eliminating steps and links. Much of Luke’s work is not seen by field crews, but has had a tremendous impact on service delivery.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: William Pitt (Puckett EMS – Chattanooga, TN)

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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William Pitt
Vice President of Operations, Southeast Tennessee/Northwest Georgia
Puckett EMS (Member of the Priority Ambulance family of companies)
Chattanooga, TN

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LinkedIn
Nominated by: Amanda Jennings (Priority Ambulance – Knoxville, TN)
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Biography:

Will Pitt has more than 15 years of experience in the emergency medical service field. As Vice President of Operations, Pitt oversees a 250-person team serving 10 hospitals and five counties with 9-1-1 service in Southeast Tennessee and Northwest Georgia for Puckett EMS.

During Pitt’s time at Puckett EMS, the service has seen a 40 percent increase in service volume in his region. Pitt has also been instrumental in the design and launch of the Puckett EMS Training Academy, the largest initial education program in the region. The academy provides annual opportunities for EMT, EMT-Advanced, and Paramedic certification training to the region.

Prior to his work at Puckett, Pitt spent seven years at Walker County Fire and Emergency Services where he advanced from the field to senior management ultimately serving as the Chief of EMS. During his tenure, Pitt created a quality improvement and education division that included initial education programs from EMTs and paramedics.

Pitt has also been involved in local professional organizations. Pitt has served as the Chairman for the Georgia Region I EMS Council and Treasurer for the Southeast EMS Director’s Association. Additionally, Pitt has been a board member of the Northwest Georgia EMS Systems and the Southeast Tennessee Regional MedComm Committee.

Pitt has received numerous awards, including being named the Georgia Association of EMS Statewide Educator of the Year in 2015.

Pitt holds a Master’s Degree in Business Administration from Columbia Southern University and a Bachelor’s Degree in Biological Anthropology and Anatomy from Duke University.
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Reason for Nomination:

Throughout every step of his career, Will Pitt has advanced the EMS industry in the region by developing and structuring educational opportunities and recruiting new individuals to EMS.
Recognizing a need for EMS education and training in the region, Will launched a partnership between Puckett EMS and Faithful Guardian Training Center to create the Puckett EMS Training Academy. The Academy provides annual EMT and paramedic level certification courses multiple times a year and is the largest provider of initial certification training in the region.

In the Northwest Georgia and Southeast Tennessee, like many locations in the United States, the pipeline of new professionals entering the EMS industry has been trending downward. In response to this, Pitt launched an accelerated 8-week EMT-Basic class that is completely free to the students and provides a training wage so that students can be in training full-time. By removing some of the financial barriers to beginning a career in EMS, the response to the course has been overwhelming. The academy has already graduated its first class and is currently training its second class. Additionally, Pitt is in the process of developing a program in conjunction with local high schools to provide EMT training to seniors as part of a work-based learning program.

Pitt volunteers his time in regional industry leadership having served as Chairman for the Georgia Region I EMS Council and Treasurer for the Southeast EMS Director’s Association. Pitt is actively involved in fostering collaboration across EMS agencies to improve public health and service in the region.

In 2014, Pitt was part of the group of state officials and leaders that developed the state’s first Disaster Assistance Response Task Force, which provides an organized framework and standardized education for disaster response in North Georgia. This project provides a mechanism by which the EMS leadership in a county experiencing a disaster situation can immediately mobilize dozens of ambulances and hundreds of personnel to address large-scale emergencies.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

2018 AMBY Award Winners Announced

The American Ambulance Association is proud to announce the recipients of the 2018 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 September 7, 2018. Please join us in congratulating our 2018 winners!

Clinical Outcome Program

Medic Ambulance Service, Inc. | Vallejo, CA

Community Impact Program

NorthStar EMS, Inc. | Tuscaloosa, AL

Employee Programs

Hall Ambulance Service, Inc. | Bakersfield, CA

Innovation in EMS

Priority Ambulance | Knoxville, TN

Mercy Ambulance Service, Inc. | Savannah, GA

Public Relations Campaign

MEDIC EMS Agency | Charlotte, NC

Hall Ambulance Service, Inc. | Bakersfield, CA

Quality Improvement Program

Sunstar Paramedics | Largo, FL

Patient and Employee Safety Program

Priority Ambulance | Knoxville, TN

Once again, join us in celebrating the 2018 winners! Learn more about the AMBYs.

 

July Brings Legal Changes for Employers in Many States

Oregon Statewide Transit Tax

Important notice to ambulance service employers based in the state of Oregon: there is a new statewide transit tax taking effect on July 1, 2018. Beginning July 1st, employers must start withholding a tax of 1/10th of 1% from the wages of Oregon residents or from non-residents who perform services in Oregon. The Department of Revenue has published detailed information on the statewide tax with a list of available resources to assist employers with compliance.

Iowa Lowers Standard for Positive Alcohol Tests

Effective July 1, 2018, Iowa employers may lower their standard for taking employment action for positive alcohol tests from the old state standard of .04 to .02. Iowa has one of the strictest employment drug and alcohol testing requirements in the country. Employers are required to have a written policy that is distributed to all employees and job candidates for their review. Employers must establish a drug and alcohol awareness program alerting employees of the dangers of drug and alcohol use in the workplace, and most employees must be provided an option to enter a rehabilitation program instead of being disciplined. In addition, all supervisory staff must attend a two-hour initial drug and alcohol training and a one-hour annual refresher.

Rhode Island Paid Sick Leave

Rhode Island has followed a growing list of states and municipalities that have enacted paid sick leave for employers with 18 or more employees. In October, the Health and Safe Families and Workplaces Act was signed by Governor Gina Raimondo. The new paid sick leave law takes effect July 1, 2018. Under the new law, employees will accrue one hour of paid sick time for every 35 hours worked, up to a maximum of 24 hours in a calendar year in 2018. That rate will increase to 32 hours in 2019 and 40 hours in 2020.

Under the new law, employers must allow employees to use paid sick time for the employee’s or employee’s family members illness, injury, or health condition; when the employee’s workplace or child’s school is closed due to a public health emergency; or for reasons related to domestic violence, sexual assault, or stalking. Employers cannot take adverse employment action against employees utilizing leave under this Act.

Employers need to prepare by amending any relevant paid time off policies, ensuring that there is an adequate mechanism for tracking the accrual and use of paid sick leave, and educating all management staff on the provisions of the new paid sick time law to ensure compliance. The new Sick Time Regulations provide additional compliance guidance.

Pay History Inquiries

Effective July 1, 2018, a new law in Vermont prohibits employers from making salary history inquiries from job candidates. Vermont joins several other states and municipalities that have enacted pay equity measures.

Joining the State of Vermont, the City of San Francisco has enacted a ban on asking job applicants about their salary or pay histories. The Parity in Pay Ordinance, signed by May Ed Lee, takes effect on July 1, 2018. The Ordinance bans employers, including City contractors and subcontractors, from considering current or past salaries in hiring candidates for employment. In addition, the Ordinance prohibits employers from asking job applicants about pay history or disclosing a current or former employee’s salary history without their authorization. A statewide ban on asking applicants about their pay histories took effect this past January.

It is recommended that employers in all states, whether legally prohibited or not, remove any reference on their job applications to an employee’s current or past wage/salary. In addition, employers should amend their pre-hire process to eliminate any pay history inquiries. This will provide employers with the best protections against allegations of pay discrimination claims.

Massachusetts Pay Equity

Back in August, 2016, Governor Baker signed An Act to Establish Pay Equity (MEPA) which takes effect on July 1, 2018. The new law is aimed at ending discrimination in the workplace by ensuring that individuals who perform “comparable” work earn competitive salaries. Additionally, the bill prohibits employers from making salary or wage history inquiries with job candidates and provides protections for employees to freely discuss their salaries with other employees.

The new law is aimed at preventing the perpetuation of past employer discriminatory pay practices by prohibiting the employer from basing a salary decision on the candidate’s current or past salary. Employers need to ensure that there are no inquiries on their employment applications or requested during the pre-hire process. Additionally, employers should amend any policies and procedures that might discourage employee discussions about wages.

Lastly, employers should perform a pay equity audit to identify potential wage disparities that may exist in their workplace. Employers who perform a good-faith, reasonable self-evaluation to identify pay disparities will be able to assert an affirmative defense to claims of violations of the Act. The Massachusetts Attorney General has issued guidance and a pay equity toolkit to assist employers with compliance.

California Expands National Origin Discrimination Protections

Effective July 1, 2018, amendments to the California Fair Employment and Housing Act (FEHA) will expand the national origins protections for employer discriminatory practices for applicants and employees to include:

  1. physical, cultural, or linguistics characteristics associated with a national origin group;
  2. marriage to or association with persons of a national origin group;
  3. tribal affiliation;
  4. membership in, or in association with, an organization identified with or seeking to promote the interests of a national origin group;
  5. attendance or participation in schools, churches, temples, mosques, or other religious institutions generally used by persons of a national origin group; and
  6. name that is associated with a national origin group

The Regulations provide protections that include prohibitions on employees adopting “English only” language rules in the workplace, unless the restriction is justified by business necessity, narrowly tailored, and was meaningfully communicated to employees. Discrimination based on an employee’s accent, height and weight (unless job-related and consistent with business necessity), and immigration status.

2018 OSHA Electronic Injury Reporting Deadline

Last year we notified AAA members that they must begin electronically reporting their workplace injury data to OSHA starting December 1, 2017 for 2016. This is just a reminder to all employers that they must electronically report their 2017 workplace injury data through the OSHA Injury Tracking Application (ITA) no later than July 1, 2018. Previously, for employers who had state-level work injury provisions, OSHA did not require injury reporting until the state enacted the appropriate tools to collect the injury data. This has changed, as OSHA announced on April 30, 2018 that employers in states that have not completed the adoption of a state rule yet must also report their 2017 injury data through the OSHA ITA. If any member has not set up their account with OSHA on the ITA, we strongly suggest that you do so immediately. The AAA can assist members in ensuring that they are compliant with this reporting requirement.

Georgia Hands Free Law

Georgia has enacted the Hands-Free Georgia Act (House Bill 673) which becomes effective July 1, 2018. The law makes it illegal for all motor vehicle drivers to “physically hold or support, with any part of his/her body” a wireless device. In addition, drivers are prohibited from writing, sending, or reading any text-based communications, including instant messages, email, or internet data usage. The law requires that a driver utilize an earpiece or hands-free device for all purposes while driving and may not touch their device. This includes utilizing any device for navigational purposes, even while stopped at a traffic signal.

There are exceptions to the new law for reporting traffic accidents: medical emergencies, fires, criminal activity, or hazardous road conditions. The exceptions do include first responders, including EMS agencies during the performance of their official duties. I believe that it is important for agencies to provide very clear communications regarding mobile device usage. I strongly suggest that any employee guidance states that the use of hand-held devices be limited to what is required to facilitate or affect patient care. It is recommended that when the use of a device is necessary, the technician or dispatcher make the notification, provided it does not interfere with monitoring or providing direct care to the patient. For more information or guidance visit the Heads Up Georgia website.

South Dakota Data Breach Law

South Dakota has enacted a new Data Breach Notification Law (SB62) for any entity conducting business in South Dakota that has or retains computerized personal or protected information of South Dakota residents. The law has a very broad definition of personal information and includes “social security numbers, driver’s license numbers, credit card or financial information, health information, identification numbers assigned by an employer for authentication purposes, username or email addresses with passwords, security questions, etc.”

The breach notification obligation attaches when the information holder reasonably believes that personal or protected information has been acquired by an unauthorized person. The law states that they must notify the affected individual within 60 days. Breaches affecting 250 or more individuals must also be reported to the South Dakota Attorney General. If the information holder reasonably believes that the breach will not likely result in harm to the affected individual, no disclosure is necessary provided they investigate and maintain documentation of the investigation for at least three years. Employers should review their data privacy policies and practices to ensure they comply with the new law.

Vermont Recreational Marijuana

Starting July 1, 2018, the State of Vermont has legalized recreational marijuana under a measure passed by the Vermont legislature (H.B. 511). The new law permits residents to grow and possesses up to one ounce of marijuana without facing criminal penalties. This law does not prohibit employers from having policies that prohibit marijuana use. The law also provides that employers do not have to accommodate the use or transportation of marijuana in the workplace. However, employers are advised to review their current workplace drug policies and practices to ensure that their practices are consistent with the new state law.

Vermont has a long-standing prohibition of random drug testing of employees, except when required or permitted under Federal law. Under Federal law, Federal contractors and grantees must maintain a drug-free workplace under the Drug Free Workplace Act. It is important that employers seek legal consultation if an employee notifies the employer that they are using marijuana for a condition that might qualify as a “disability” under the Americans with Disabilities Act (ADA). The Vermont Attorney General has published a Guide to Vermont’s Laws on Marijuana in the Workplace to assist employers with compliance.

Alabama Governor Signs REPLICA Compact

Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact.

REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact,  recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states..

Learn more about how REPLICA participation can help your state at http://www.emsreplica.org.

REPLICA Compact Enacted

REPLICA Meets Goal, Interstate Compact Becomes Official

May 8, 2017
For Immediate Release
Contact:
Sue Prentiss
603-381-9195
prentiss@emsreplica.org

May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of
Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official.
Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS
licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas,
Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.

Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual
to provide pre-hospital care across state lines under authorized circumstances. According to Keith
Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA
represents a collective, nationwide effort to address the problems faced by responders when needing
to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to
“increase access to healthcare, reduce regulatory barriers for EMS responders, and place an
umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages
also noted that the partnership with the National Registry of Emergency Medical Technicians
(NREMT) has been essential during the advocacy and implementation phases. “We are grateful for
their continued support and contributions.”

Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS,
fire, law enforcement organizations and associations as well as key federal partners in the design and
drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize
the development of the Commission.

The compact calls for establishment of an Interstate Commission with each state that has passed
REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states
will be able to rapidly share personnel licensure information, develop policy focused only on cross
border EMS practice, and hold EMS personnel originating in other states accountable in an
unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development
and hosting of the coordinated database.

Twelve national associations and organizations support REPLICA. Three states have REPLICA bills
under consideration in their legislative sessions. Learn more at www.emsreplica.org.

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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.”

 

 

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.


 

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