Tag: Illinois

El Paso Emergency Squad in 2020

El Paso Emergency Squad
El Paso, Illinois
40 Staff | 0 Quarantined in 2020

Provide 911 service to the El Paso Fire Protection District and provide Critical Care Tier ll transfers for the area hospitals

Our area nursing home facilities have been hotspots for COVID resulting in repeated transports of Positive patients.

40 Under 40: Lauren Emanuelson (Advanced Medical Transport – Peoria, IL)

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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Lauren Emanuelson
Director of Resuscitation
Advanced Medical Transport of Central Illinois
Peoria, IL

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Nominated by: Josh Bradshaw (Advanced Medical Transport of Central Illinois – Peoria, IL)
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Biography:

Lauren began her career in EMS over 11 years ago as an EMT in Peru, Illinois and is now a Pre-Hospital Registered Nurse and Cardiac Arrest Resuscitation trainer at Advanced Medical Transport (AMT) in Peoria, Illinois. AMT receives approximately 65,000 calls for service and completes approximately 57,000 transports per year, responding to an average of 250 cardiac arrests per year. In 2017, Lauren was promoted to the Director of Resuscitation overseeing Quality Improvement and Quality Assurance activities, training and education for both BLS and ALS field providers as well as collaboration with the office of the Medical Director, first responder agencies, and hospital partners. Lauren is a member of the American Ambulance Association’s Professional Standards Committee where she shares her knowledge to set best practices for the industry.

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Reason for Nomination:

Lauren has taken a very robust program, expanded it, and pushed it to greater heights. The Race to the Top program is data-driven and evidence-based, and Lauren has achieved the best measurable results we have ever seen with the project. AMT began the program with a Return of Spontaneous Circulation rate of 27%, and have now reached 45%, well on the way to their near-60% goal. The national average is just 9%. Under Lauren’s leadership, AMT’s Race to the Top program received a 2019 AMBY Award. Lauren’s skills, knowledge, and passion for her work are evident in everything she does.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: Chase Hodges (Superior Air-Ground Ambulance Service – Bolingbrook, IL)

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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Chase Hodges
General Manager Illinois
Superior Air-Ground Ambulance Service
Bolingbrook, IL

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LinkedIn
Nominated by: Kim Godden (AAA Board of Directors, Superior Air-Ground Ambulance Service – Elmhurst, IL)

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Biography:

As the General Manager, Chase has been instrumental in reshaping the culture of EMS at Superior Ambulance. Chase’s view on safety as not a part time commitment, but a true full time commitment has helped reduced accidents by 40%. Chase sits on Superior’s retention committee, Field Training Officer and training committee, and policy and procedures committee. Chase is also a part of Superior’s Special Event team which provides EMS for events happening all over the Chicago Land area, and is a member of the Ebola transport team.

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Reason for Nomination:

Chase is being nominated for this honor for many reasons that cannot be fully expressed in such few words. Chase started in EMS with our company as a para-transit driver and also worked as a dispatcher and EMT before being chosen as a General Manager overseeing several stations, including one of our largest stations located in Chicago. Chase oversees 248 employees and through his positive attitude and understanding of every aspect of EMS, he is able to make sure staff is customer focused and patient driven. Chase also assists with our company’s recruitment and retention efforts and is always the first one (even when it involves coming into work while on vacation) to participate with important government relations meetings and ambulance ride-along events which help not only our company but the EMS industry overall.

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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.

Congrats to CAAS Accreditations & Recerts

Congratulations to the AAA members who received Commission on the Accreditation of Ambulance Services (CAAS) accreditation or reaccreditation in November and December!

New certifications

  • Superior Air-Ground Ambulance (Elmhurst, IL)

Recertifications

  • Ambucare (Bremen, GA)
  • American Medical Response Central Mississippi (Jackson, MS)
  • American Medical Response, Los Angeles (Irwindale, CA)
  • American Medical Response, San Diego (San Diego, CA)
  • American Medical Response of West Michigan (Grand Rapids, MI)
  • American Medical Response South Mississippi (Gulfport, MS)
  • Lifeguard Ambulance Service (Milton, FL)
  • Metro West Ambulance (Hillsboro, OR)
  • Richmond Ambulance Authority (Richmond, VA)

Congressman Peter Roskam Receives AAA Legislative Honor

Congressman Peter Roskam Receives
2017 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 Peter Roskam of Illinois with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Congressman Roskam will be presented the honor in June in Washington, DC by AAA’s Illinois Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Prairie State are Eric Eizenga, Kyle Wolber, and Ellen Fleming of Superior Air-Ground Ambulance Service as well as Jeff Odenthal of Abbott EMS/American Medical Response.

Congressman Roskam was selected for his support of the Medicare ambulance temporary add-on increases and the super rural bonus payment.

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

Congressman Roskam has represented Illinois’s 6th congressional district since 2007. He is the current Chair of the House Ways and Means Subcommittee on Tax Policy, as well as a member of the Subcommittee on Health.

In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Roskam 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

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”

 

AAA Members on Capitol Hill

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

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

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

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

AAA Board Member Meets with VP Mike Pence

AAA Board Member and Chair of the AAA’s new Non-Emergency Task Force, Kim Godden, Vice President of Legal & Government Relations at Superior Air-Ground Ambulance Service, Inc., recently had the opportunity to meet with new Vice President, Mike Pence. Kim worked with the Vice President during his time as Governor of Indiana and used this meeting to remind the Vice President of issues facing ambulance services around the country. Kim was also able to relay to Vice President Pence how important permanent Medicare relief is for ambulance services around the country. Thank you, Kim, for all of your hard work on the AAA’s advocacy efforts!

Superior Air-Ground Ambulance Service, Inc. President/CEO, David Hill III, Vice President, Mike Pence,
and Superior VP of Legal & Government Relations

 

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

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.”

 

 

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

Congratulations to the 2016 AMBY Award Winners

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

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

Advanced Medical Transport (AMT) | Peoria, IL

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

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

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

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

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

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

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

 

Spotlight: SSM Health Cardinal Glennon Children’s Hospital STARS Program

The Special Needs Tracking & Awareness Response System (STARS), was founded just over two years ago at SSM Health Cardinal Glennon’s Children’s Hospital in St. Louis, Missouri. The team at Cardinal Glennon realized that they needed to do something to address the growing number of children in the U.S. with special health care needs, many of whom are at a higher risk for repeated ambulance transports.

As an EMT for over 18 years, Patricia Casey, the Missouri Coordinator of the STARS Program, knows how intimidating it can be for a first responder to walk into a home that in many ways may look like a hospital room. Children with special health care needs can require many different types of in home medical equipment that first responders are often not familiar with. The STARS Program aims to make the job of the first responders easier while making children with medical needs and their parents more comfortable with ambulances in case they need to be transported in one.

Cardinal Glennon works with local ambulance districts to enroll children with special medical needs in that district’s STAR Program. Once a child is registered in STARS, they are given a unique patient identification number and a home visit is scheduled with the patient and their family to compile pertinent medical history. Participating ambulance companies then create a book with all of the stars in their area so that their first responders have access to the medical information on the go. If a STAR needs to be transported, their caregiver can relay their STAR number to the dispatcher who will then let the first responders know. First responders can then look up crucial medical information about the STARS patient, so they can be better prepared when they arrive on scene.

Knowing that many medical devices in the homes of the STARS may be foreign to first responders, Cardinal Glennon’s staff provides free necessary trainings all around Missouri and now Illinois. Shelby Cox works as the Team Lead for EMS outreach, and Josh Dugal, RN, is the EMT-P STARS Coordinator for Illinois. Together with Casey, they help keep the program running smoothly. Each participating ambulance company appoints a STARS coordinator on their staff who will make biannual home visits and make sure the STARS medical information is up to date. Cardinal Glennon also sets up regular opportunities for STARS to visit their local first responders. Giving STARS the chance to get familiar with an ambulance and their local first responders prior to a medical emergency has been proven to help out both parties when an emergency occurs.

A paramedic who has responded to STARS calls explains that “the STARS system permitted me to have advanced medical knowledge before I walked through the door. There was no time lost backtracking to learn the patient’s history or baseline in the midst of a chaotic scene”. In addition to helping the first responders, the STARS program has been a huge reassurance to the parents of STARS whose children may often need medical assistance.

To learn more about Cardinal Glennon’s STARS program, visit their website or check them out on Facebook. Also check out Patricia Casey’s Article on the STARS Program which includes testimonials from both parents and first responders who have participated in the program.
Thanks to the entire team at Cardinal Glennon for your great work!

Do you know of other innovative programs being run by ambulance services? Share with the AAA so that we might feature those programs on the AAA Blog as well.

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: Kim Godden

Kim Godden
Vice President of Legal and Government Relations
Superior Air-Ground Ambulance Service (Michigan, Indiana, Illinois)
Region 3 Alternate, American Ambulance Association Board
Elmhurst, IL

Tell us a little about yourself.

I grew up in Barlett, Illinois, a Chicago suburb. I received my BA in History and Political Science from Purdue University and my law degree from DePaul University College of Law.

After graduating from Purdue, I worked for the Illinois Attorney General’s Office while attending law school in the evening. While with the Attorney General’s office, I was an policy analyst/attorney for criminal justice and victims’ rights initiatives. During this time, I reviewed, drafted, and testified on various legislative and regulatory initiatives.

In 2007, I was able to bring this experience to the ambulance industry when I joined Superior. In addition to sitting on the AAA board, I also sit on the boards of the Illinois State Ambulance Association and the Indiana EMS Association. I also participate on the government affairs committee for the Michigan Association of Ambulance Services.

In addition to overseeing government relations and regulatory and compliance matters for Superior, I oversee the legal department which manages litigation, contracts, real estate and employment matters.

Kim with her family.
Kim with her family.

I have been married to my husband, Nick, for 16 years and we have two daughters, Hannah (8) and Amelia (6). As for hobbies, kids and work keep me busy, however, when I have a chance, I enjoy running and reading (not at the same time).

What do you enjoy most about your job?

I enjoy problem-solving and advocating for such an amazing industry. The ambulance industry is often overlooked and misunderstood. EMS providers are busy caring for patients, therefore, we rarely have time to create awareness and support for our industry – I get to beat the drum for private EMS!

What is your biggest professional challenge?

My biggest challenge is changing the perception that private industry isn’t as good or worthwhile as public agencies. There is a misconception that because a company is for-profit, their goals, mission, and level of compassion differ from those of a public or nonprofit entity. Superior employs over 2000 dedicated, devoted EMS professionals—whether caring for patients, working in dispatch, or managing the back office, our entire team is dedicated to bringing the best care and customer service to our patients.
[quote_right]Superior employs over 2000 dedicated, devoted EMS professionals—whether caring for patients, working in dispatch, or managing the back office, our entire team is dedicated to bringing the best care and customer service to our patients.[/quote_right]

What is your typical day like?

Every day is different due to travel and attendance at various meetings. On a typical day, I try to drop my daughters off at school at 8:30 and I am in the office by 9:15. Usually the day is filled with meetings and conference calls on a myriad of topics, with the constant interruption of emails that need attention and various “walk-ins” for legal consultation. No two days are the same, which I enjoy. I am usually home by 7:00 p.m., and after bedtime stories, I am back on the computer responding to the day’s emails or catching up on reading. My 2016 resolution is to unplug and try to leave work at work, but we all know that EMS is a 24-hour business, so I won’t be 100% successful and it will occasionally follow me home.

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

As we know, with advances in healthcare, people are living longer, and there is frequent need to move patients between nursing facilities and hospitals. We have also seen the advent for advanced level care for patients. Most inter-facility transports involve the discharge of a patient back to a nursing facility, or moving a patient from one facility to another for specialized care. Superior and our colleagues who provide these services are an important part of EMS and the overall continuum of care.

Our organization performs a high percentage of inter-facility transports, and being able to advocate and share the perspective of an agency who performs this discipline has been worthwhile not only to Superior, but to the industry as a whole. Being able to discuss with other providers our shared and differing challenges is important as we craft regulations for the future.

I enjoy working with my fellow board members and AAA staff. We don’t always agree, however we respect one another’s opinions and in the end, this leads to better policy and advocacy for our industry.


Explore AAA membership, or learn more about our advocacy for ambulance services across the country.

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.