Tag: Louisiana

EMS Week Featured Service | Pafford Medical Services

Pafford Medical Services
Hope, Arkansas
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Meet Pafford Medical Services

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

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

Pafford is fully equipped to provide the following services:

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

The Pafford Medical Services COVID-19 Response

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

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

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

The Pafford Medical Services Leadership Perspective

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

Frontline Voices from Pafford Medical Services

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

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

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

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

How Pafford Medical Services Celebrates EMS Week

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

PEW Stateline | Many Health Providers on Brink of Insolvency

Thank you to PEW Stateline journalist Michael Ollove for taking the time to learn about EMS economics from AAA Payment Reform Chair Asbel Montes and Professional Ambulance Association of Wisconsin President Chris Anderson.

Stay-at-home orders have paused many activities that resulted in emergency calls, such as traffic accidents and shootings, said Chris Anderson, director of operations for Bell Ambulance in Wisconsin. As for non-emergency transportation, many people want to avoid health facilities now if they can, he said.

Asbel Montes, a senior vice president with Acadian Companies, a Louisiana-based firm operating 500 ambulances in Louisiana, Mississippi, Tennessee and Texas, said emergency calls have dropped by 30% and non-emergency calls by 70%.

Read the full article►

NBC Nightly News | EMS workers speak out from front lines of coronavirus crisis

On April 15, NBC nightly news profiled the front line COVID-19 response in a segment featuring members Acadian Ambulance, Empress EMS, Medstar (MI), and the Fire Department of New York. Thank you to Lester Holt and Stephanie Gosk for sharing mobile healthcare’s value and perspective during the pandemic.


Emergency responders, used to trauma and danger, say it’s impossible to get used to their new reality during the coronavirus pandemic. “You’re coming to work to deal with death all day,” one New York EMS worker says.

40 Under 40: Corey Chapman (Acadian Ambulance Service – Lafayette, LA)

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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Corey Chapman
Director of Revenue Cycle
Acadian Ambulance Service
Lafayette, LA

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Nominated by: Rachel Harracksingh

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Biography:

Corey Chapman has worked at Acadian Ambulance Service since 2013. Corey has a Bachelor’s Degree in Behavioral Science and a Master’s Degree in Business Administration from the University of Louisiana Lafayette. In addition to his work at Acadian, Corey is also a Board Member for the American Cancer Society of Louisiana and the Junior Achievement of Louisiana. Coey is passionate about patient care and moving the EMS industry forward.
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Reason for Nomination:

Corey Chapman is passionate about process re-engineering and improvements. During his tenure at Acadian Ambulance Service over the past six years, Corey has provided project management leadership around contracts, membership and corporate compliance initiatives. Corey was promoted in January to Director of Revenue Cycle where he leads a team of approximately 200 employees.

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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.

Debut of Unit 68 Film Ft. Acadian Ambulance

Unit 68 premiered worldwide on YouTube today. The short film was written and directed by David K. Jarreau, a Paramedic with Acadian Ambulance Service, and features an Acadian ambulance. The film depicts a young boy, Mack, and his experience with a mysterious ambulance that forever changes his life. The film is loosely based on real-life experiences faced by Unit 68 In Baton Rouge, LA. Jarreau stated on Baton Rouge’s Local 33 news that part his motivation to create this film was to address today’s shortage of EMS personnel. He hopes that the film will inspire young viewers to aspire to careers in EMS.

Watch the video above, or on YouTube.

Senator Bill Cassidy Receives AAA Legislative Honor

Senator Bill Cassidy to Receive
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 Senator Bill Cassidy of Louisiana with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Senator Cassidy will be presented this award in June in Washington, DC by AAA’s Louisiana Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Bayou State are Tyler Niblett, and Coty M. Peardon, of Acadian Ambulance Service.

Senator Cassidy was selected for the Legislative Recognition Award for championing the Protecting Patient Access to Emergency Medications Act. This legislation is intended to ensure that Paramedics and EMTs can continue to administer life-saving drugs to patients.

AAA President Mark Postma notes, “Senator Cassidy has been a trusted advocate for health care and emergency medical services, both in Louisiana and across our country. The AAA is proud to present him with a Legislative Recognition Award.”
Elected to the Senate in 2014, Senator Cassidy serves on the Health, Education, Labor & Pensions (HELP), Energy and Natural Resources, Finance, Veterans Affairs, and Joint Economic Committees. In addition to his service in the Senate, for nearly three decades Senator Cassidy has provided care for uninsured and underinsured patients in Louisiana’s charity hospital system in his capacity as a medical doctor.

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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

Status of the American Health Care Act

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

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

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

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

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

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

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

AAA Members on Capitol Hill

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

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

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

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

Acadian’s Asbel Montes on Ambulance Payment Reform

“EMS is instrumental to the healthcare fabric of our country. As the healthcare industry continues to innovate, it is imperative to recognize the value that EMS brings to the pre- and post-hospital environment. EMS providers are the only gatekeepers to the healthcare system in many communities.

73% of all ambulance suppliers credentialed with Medicare bill the program less than 1,000 transports per year. It is imperative that any cost data collection system reporting requirements consider this to ensure the reliability of the data and the administrative burden to ambulance providers and suppliers.”

Asbel Montes
Vice President of Governmental Relations & Reimbursement, Acadian Ambulance
Co-Chair, American Ambulance Association Payment Reform Committee

Spotlight: Jamie Pafford-Gresham

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

Tell us a little about Pafford EMS.

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

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

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

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

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

Do you have any tips for onboarding new employees?

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

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

How do you retain employees?

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

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

What is your typical day like?

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

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

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

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

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

MAC Novitas March 2016 Updates to Ambulance Services

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

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

Jurisdictions Covered By Novitas

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

Boustany (R-LA 3rd) Introduces the Timely Payment for Veterans’ Emergency Care Act

On March 3, 2016, Congressman Charles W. Boustany, Jr., MD, republican representative of Louisana’s 3rd district, introduced the Timely Payment for Veterans’ Emergency Care Act. According to data obtained by Boustany from the VA’s Chief Business Office, the VA has a nationwide emergency claims payment backlog of over $788 million.

When the VA fails to pay these medical bills on time, veterans’ credit ratings are put at risk.

Read more about Representative Boustany’s proposed solution on his website.

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: Asbel Montes

Asbel Montes
Vice President, Acadian Ambulance Service, Inc
Lafayette, Louisiana, USA
Follow Asbel on Twitter at @asbelmontes
Asbel’s LinkedIn

Can you please tell us a little about yourself?

I was born in San Bernardino, CA and lived there until I was five. My dad was in the Air Force. When I was five, he felt the call to become a pastor in North Carolina and was discharged from the Air Force.

I am married and have one daughter who is fifteen years old.

I have played the piano since I was eight years old and used to be the music minister for my dad and my brother-in-law, until my career became too demanding to do both.

I am an avid read of non-fiction and fiction. I enjoy a great political or legal thriller.

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

I started in the ambulance industry at the age of 21. I answered an ad in the newspaper for an account manager position for an ambulance billing company in North Carolina. I have been in the revenue cycle space for almost 19 years.

What do you enjoy most about your job?

I enjoy the people I work with at Acadian. Acadian Ambulance Service has a culture where the employees truly care about the success of the company. This culture is prevalent throughout the organization from senior leadership to front-line staff.

What is your biggest professional challenge?

My biggest challenge is the federal and state regulations that continue to negatively impact our industry from Medicare, Medicaid, and insurance companies. This has a downstream effect on increasing our cost per claim due to the excessive administrative burden, as well as reducing our revenue per transport.

What is your typical day like?

My day starts at 4:45 am. I like to meditate and read for about an hour before getting to the office by 7:00 am. My day is packed with meetings and typically culminates with me leaving the office around 6:00 pm.

I travel extensively between Austin, Baton Rouge, and Washington, DC.

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

The American Ambulance Association has been beneficial in helping to create a united front in the ambulance industry for important initiatives on Capitol hill.

The Acadian Effect

By Desiree LaFont, Education & Events Director, American Ambulance Association

October 2015

In a previous life I worked for a hospitality-related association. Within that industry there was something known as the “Gaylord Effect”—when Gaylord Hotels would open a property in a city, all of the other businesses in the area, including other hotel brands, benefitted. High standards, a sterling reputation, and the ultimate in customer service meant Gaylord booked convention and leisure business on a scale few could rival. Everyone from the local cab drivers to the bartenders to the surrounding hotels profited from the huge influx of travelers. Where once feared as the luxury brand that would crush the competition, they were soon seen as a desirable ally. So fast forward a few years, and I have a new life working for the American Ambulance Association (AAA), but I often think about the Gaylord brand and their ability to change a city with their commitment to their customers. If you are wondering what any of this has to do with ambulance services, I’m about to get to that.

On a recent trip to Louisiana to document the tenth anniversary of Hurricane Katrina and the role AAA members had in the recovery, the AAA’s Director of Membership, Amanda Riordan, and I had the opportunity to visit Acadian Ambulance. Armed with a local videographer, a short list of questions, and a crippling doubt in our ability to capture what is arguably the most important private EMS story in recent history, we arrived at Acadian’s Air Med Station in Lafayette, Louisiana.

Lafayette Headquarters

Our first interview was with Marc Creswell, Acadian’s Air Med Operations Manager. Marc’s story is incredible for a number of reasons, and I won’t attempt to retell all of it here, but I will tell you Marc is the kind of guy that could have inspired the phrase, “when the going gets tough, the tough get going.” This is the guy you want in your foxhole. And to be honest, we could have completed our interview with Marc, packed up, and had more than enough material to tell a great story about Acadian and Katrina, but Acadian was just getting started.

We spent the remainder of the day interviewing Dee Dee Sewell, their Critical Support Intervention Specialist; Clay Henry, Acadian’s Vice President of Operations, Communications Center; Blane Comeaux, President of Acadian Total Security; and Chairman and CEO Richard Zuschlag. Everyone, including Mr. Zuschlag, gave us more time then we could have hoped for and held nothing back. They shared a great many operational details, but always through the lens of the story of the people behind all those unseen efforts and rescues.

Downtown New Orleans

Dee Dee at work in Lafayette
Dee Dee at work in Lafayette

The next day we visited downtown New Orleans to meet with Steven Kuiper, Regional Vice President for Acadian. Within minutes, I felt like I was hearing the story of Katrina for the first time. Steven shared facts, but, once again, it was wrapped in the story of the people around him—the suffering and the heroism he personally observed on the ground.

And, then came the big finish; Janie Fuller, Paramedic Field Supervisor and lifelong resident of St. Bernard Parish. Janie accompanied us to the Mayor’s Office to interview Deputy Mayor Andy Kopplin and New Orleans Director of EMS Dr. Jeffrey Elder. She then gave us the insiders’ tour of her parish and showed us exactly where the levees were breached. Her entire hometown was under eighteen feet of water in 15 minutes, but by nightfall Janie had commandeered an airboat and was taking a cardiac patient to I-10 and Causeway for evacuation. Needless to say, Janie is a force of nature herself, and no matter what dark alley a call takes her down, this lady is coming out alive and so is her patient.

Telling the Story

[quote_right]What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.[/quote_right]What emerged over the course of those two days of interviews was the amazing story of what Acadian, and private EMS, were able to accomplish in the midst of the hurricane’s devastation. Hospitals were shuttered, law enforcement was overrun, citizens were cut off, and conditions for everyone—including EMS—were unspeakable. Despite this, medics in the area stayed and other ambulance services rolled in.

Hundreds of ambulances with trained medics rolled in to help New Orleans and countless communities throughout Louisiana, Mississippi and Alabama. Whether or not they knew how bad the situation was, they still went in. No one can ever calculate what that response meant to the City of New Orleans and the other affected areas, but I think we all have a sense of how much worse it would have been without the timely response of private EMS. What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.
So after an incredible 48 hours in Louisiana we had to head home, and I left with a heavy heart. I wanted to stay a little longer. No, I wanted to stay a lot longer. But why? As I sat on the plane home, it hit me. It was the Acadian Effect. Acadian is that big, shining example of what an innovative, self-determined private EMS company can mean to the population they serve. How you can put people first and come out a winner. How when you put people first everyone benefits. Telling the incredible Acadian success story benefits all of EMS because it typifies the EMS culture of going beyond what’s required and how maintaining human dignity is an essential part of patient care.

So let’s tell that story! Let’s tell the story of Acadian and Katrina. Let’s tell the story of Sandy, Joplin, the Boston Bombing, and the thousands of times a day private EMS responds to 9-1-1 with compassion and highly skilled medical knowledge because that’s your chosen profession. Let’s tell the story until the press, the public and the legislators are telling it for us.

Our heartfelt thanks to Acadian and every AAA member we have the privilege of serving.

Want More?

Watch AAA’s Katrina & Rita retrospective video that features many of the subjects of this blog post.

Acadian Ambulance High School Champions Livonia

Acadian’s High School Champions Program Leads the Way

Founded in 1971 in with just eight staff and two vehicles, Acadian Ambulance has grown over the years to more than 4000 employees with a fleet of 400 ground ambulances, helicopters, fixed-wing airplanes, and van and bus transports. Their territory has expanded from Lafayette Parish, Louisiana, to stations spanning large swaths of Louisiana, Texas, and Mississippi.

How does such a large and varied service feed their talent pipeline? In addition to many other strategies, Acadian is leading the industry in its efforts to engage young adults in EMS through its High School Champions program, a division of their National EMS Academy.

Porter Taylor, Acadian's Director of Operations
Porter Taylor, Acadian’s Director of Operations

To learn more about the ins-and-outs of the program, AAA caught up with Porter Taylor, Acadian’s Director of Operations. Taylor has been in EMS for 29 years, since he joined Acadian Ambulance as a college sophomore. “I love making a difference in people’s lives. When I was working on a unit it was the patient, and now, almost 30 years later, it is the employees that I love helping.”

Establishing High School Champions was not a linear path. Initially, Acadian would send medics to career fairs and school functions to introduce the field and promote its National EMS Academy (NEMSA) as an opportunity after graduation. “There are a lot of technical grants out there, and a critical staffing need for EMS in general. We wanted to create an avenue for educating students about the benefits of becoming EMTs to support our staffing needs long term,” said Taylor.

Although these medic visits were effective, Acadian wanted to expand the fledgling program’s scope and reach. He began visiting area high schools and meeting with school boards and directors more than a year ago to build relationships and explore opportunities. The partnerships he built added another facet to the High School Champion initiative wherein Acadian continues to promote NEMSA, coupled with an effort to get the schools to incorporate an EMT program as an elective prior to graduation. “[I wanted] to introduce them to our company and our support of this technical career path. My goal was to let the teachers and technical program directors know that Acadian has jobs for their students upon the successful completion of the program. Once students turn 18, Acadian will be able to offer them a rewarding  position with good pay and benefits and with continuing education opportunities.”

Acadian Operations Manager Justin Cox was instrumental in the implementation at Livonia High School, a recent addition to the program. In concert with his professional know-how, Cox had a personal connection to the school—his thirteen year old daughter attends Livonia.

Collaborating with the administration, Acadian now works with schools like Livonia to introduce EMS career paths at the end of high school, a time when students are making key choices about their futures. Students can start the EMT training program as an elective prior to graduation and take the national certification exam upon turning 18. Students spend 2-3 hours 3 days a week, during their junior and senior years preparing. “It is a joy to work on this program,” said Taylor, “It is a privilege to help young people make a career choice that is full of rewards.”

Does your service have a great program that is making a difference in your area? Let us know in the comments section below, or email ariordan@ambulance.org.