Tag: Massachusetts

Brewster Ambulance Service in 2020

Brewster Ambulance Service
Weymouth, Massachusetts
1,800 Staff | 39 Quarantined in 2020

Brewsters Ambulance Service is committed to industry-changing innovation that has served to improve the landscape of EMS throughout Massachusetts and the Country.
With the current Brewster family leadership of Mark Brewster and his brother George Jr., the Brewster family reputation for quality customer service and excellence in clinical and emergency medical transport service continues to raise the bar for EMS delivery.
Brewster Ambulance Service employs approximately 1,800 employees in Massachusetts, New Hampshire, Rhode Island and Florida. Our current fleet is comprised of over 350 vehicles and in New England alone we completed over 275,000 transports annually.

Since January of 2020 Brewster Ambulance Service has increased their posture and approach to clinician and patient protection in the setting of the current pandemic with new policies and procedures as well as personal protection equipment for crew and patient safety.

In addition Brewster Ambulance Service has been a leader in the Commonwealth of Massachusetts with Covid-19 testing. Testing sites have included EOPSS first responder drive through sites at Gillette stadium in Foxboro and the Big E in Springfield. In addition Brewster was selected by The Department of Corrections for testing of all Corrections officers and inmates to prevent the spread of Covid-19 at all 16 detention facilities. This testing knowledge allowed for the expansion of testing to large Academic institutions for routine Covid-19 testing of College staff and students providing over 100,000 tests.

JEMS | Armstrong Ambulance Tackles COVID-19 Together

From the Journal of Emergency Medical Services on July 8, 2020.

To cope with the unprecedented challenge that remains before them, Armstrong’s first responders have been finding the support they need in numerous ways, whether it be from a member of the team, those working in a similar industry, or members of the many communities they serve delivering food and messages of encouragement to local bases.

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Webinar 6/30 | Financial Sustainability Ideas for EMS

June 30, 2020 | 14:00 ET

Three ambulance leaders with diverse backgrounds share innovative tips for financial sustainability in this fast-paced one hour webinar. From insurance captives to employee engagement to data-driven decision-making, Jamie Pafford-Gresham, P. Sean Tyler, and Wayne Jurecki will lend their unique perspectives on ways to keep service rolling during these extraordinarily challenging times.

Watch On-Demand►

Jamie Pafford-Gresham
CEO, Pafford Medical Services
Director, AAA Board
Chair, AAA Government Affairs Committee
Hope, Arkansas

Wayne Jurecki
COO, Bell Ambulance Service
Director, AAA Board
Milwaukee, Wisconsin

P. Sean Tyler
CEO, Transformative Healthcare
President & CEO, Fallon Ambulance Service
Board Secretary, Massachusetts Ambulance Association
Quincy, Massachusetts

Watch On-Demand►

Massachusetts | Convoy of Champions

A parade of more than 50 ambulances, representing more than 20,000 paramedics, EMTs, and 911 dispatchers, traveled from UMass Medical Center in Worcester, Massachusetts to the warning track inside Fenway Park on Wednesday, May 20. The Boston Red Sox, Mayor Marty Walsh, state officials, and healthcare professionals joined the Massachusetts Ambulance Association, the Professional Fire Fighters of Massachusetts, and municipal ambulance providers in celebrating these front line heroes during National EMS Week.

Once inside the park, the EMS professionals were greeted by video tributes from dignitaries and celebrities and a select number of live speakers following safe social distancing guidelines.

The event takes on even greater significance this year because of the unprecedented response to the COVID-19 crisis from EMS professionals and their colleagues across the state’s medical community.

The Commonwealth’s EMS professionals have been crucial in responding to the current COVID-19 pandemic. Massachusetts has been among the nation’s hardest-hit states, experiencing the third most deaths and fourth-most cases of the novel coronavirus.

During the current public health crisis, EMS professionals have helped manage testing and treatment for homebound patients and provided supplemental support for hospitals and neighborhood health centers, in addition to its duties in responding to daily emergencies.

Watch the Facebook Live Video

Thank you to everyone who participated in yesterday’s #ConvoyofChampions parade in celebration of #EMS! The event was a…

Posted by Massachusetts Ambulance Association on Thursday, May 21, 2020

EMS Week Featured Service | Cataldo Ambulance

Cataldo Ambulance
Somerville, Massachusetts
Facebook | Twitter

Meet Cataldo Ambulance

Cataldo Ambulance Service was founded in 1977, and serves Eastern Massachusetts, providing 911 emergency response and EMD services, non-emergency ALS, BLS, and chair car transportation, and EMS education and training. In 2019 Cataldo was awarded the first license in Massachusetts for mobile integrated healthcare (MIH), and in 2020, was selected as a Massachusetts provider for the innovative new ET3 initiative. Cataldo is proud to have 800 staff and a fleet of 99 ambulances and 6 SmartCare Mobile Integrated Healthcare vehicles.

The Cataldo Ambulance COVID-19 Response

It was early on during the Massachusetts State of Emergency that the local healthcare community realized the value of having mobile integrated healthcare resources available to support assessing and testing patients, as well as managing mildly symptomatic COVID+ patients at home. Our SmartCare MIH team was suddenly in high demand and actively supporting efforts for many major hospitals and healthcare organizations throughout the Greater Boston area.

The Cataldo Ambulance Leadership Perspective

“I have never been more proud of our staff. Our front line responders continue to step up and support our communities with the highest level of professionalism and clinical excellence imaginable. Our Communications Center and support staff are equally impressive in their dedication and commitment.”
Diana Cataldo, Founder

Frontline Voices from Cataldo Ambulance

“When that 911 call comes in, it’s pretty important that it gets handled the right way and the right level of support is deployed. Those critical seconds spent fielding a call can make all the difference in the outcome for a patient.”

Tim Gorman, Emergency Medical Dispatcher

“I started out as an EMT.  Now I’m a Paramedic, sharing what I’ve learned in the field with others. I absolutely believe that what we do every day makes a difference to the people we serve.”

Ryan Kelley, Paramedic

How Cataldo Ambulance Celebrates EMS Week

Our organization will acknowledge EMS Week in May, but our formal celebration will be when we can be together in August. This coincides with our 43rd anniversary,  gives us something to look forward to and will allow us to share our appreciation with more of our team, and hopefully, in a less stressful environment.

Gowns | Merrow Forloh Reusable

AAA Professional Standards Committee Chair Bill Mergendahl has offered to coordinate a bulk order of Merrow Forloh reusable gowns.

Although each gown is pricey ($40/pp), they are made of extremely high-quality ripstop material and can be washed 100 times, making them comparable to a $0.40 disposable.  Additionally, they can be sprayed with standard outdoor gear water repellant and be good for another 100 washes.  One size fits all.

These gowns are American made in Fall River, Massachusetts, which avoids a number of the quality assurance problems many member organizations have experienced with imports.

The goal is to pull together a group order of 10,000 pieces for delivery in 3–4 weeks. Pro EMS will coordinate splitting the payments between providers.

Please see the attached brochure, then contact wmerg@proems.com if you would like to participate.

HealthAffairs: Hospital Capacity And Projected Need for COVID-19 Patient Care

Harvard’s Thomas C. Tsai, Benjamin H. Jacobson, and Ashish K. Jha have released to HealthAffairs their projections for hospital capacity and projected need for COVID-19. An excerpt is below.

Based on work by Lispsitch and colleagues, we used a middle-level estimate of COVID-19 infection rate of 40 percent. We assumed lengths of stay based on published studies. We calculated the capacity gap between current bed occupancy and anticipated COVID-19 demand assuming six, 12 and 18 month transmission curves. In our primary model, we made the very aggressive assumption that 50 percent of currently occupied beds could be freed up to care for COVID-19 patients.

Nationally, based on 40 percent prevalence of COVID-19 over the course of the pandemic, we estimate that 98,876,254 individuals will be infected, 20,598,725 individuals will likely require hospitalization and 4,430,245 individuals will need ICU-level care. We found that inpatient and ICU bed capacity to handle expected patient volumes varied significantly by Hospital Referral Region (See exhibits 1 and 2).

If the infection curve is not flattened and the pandemic is concentrated in a 6-month period, that would leave a capacity gap of 1,373,248 inpatient beds (274 percent potentially available capacity) and 295,350 ICU beds (508 percent potentially available capacity). If the curve of transmission is flattened to 12 months, then the needed inpatient and ICU beds would be reduced to 137 percent and 254 percent of current capacity. However, if hospitals can indeed reduce current bed occupancy by 50 percent and flatten the transmission curve to 18 months, then the capacity needed would be reduced to 89 percent of inpatient and 166 percent of ICU beds. If the infection rate is only 20 percent (low end of current estimates), we would largely be able to meet the needs for inpatient care if we flatten the curve to 12 months.

40 Under 40: Rachel Taradash (Pro EMS – Cambridge, MA)

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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Rachel Taradash
Assistant Director – Pro EMS Center for MEDICS
Professional Ambulance Service (Pro EMS)
Cambridge, MA

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LinkedIn
Nominated by: Rob Lawrence (AAA Board of Directors)

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Biography:

Rachel Taradash is the Assistant Director for the Pro EMS Center for Medics, a position she has held for the last five years. Pro Center for Medics was the first nationally accredited paramedic program in the state of Massachusetts and offers one of the most rigorous paramedic programs in the U.S., as well as a variety of specialty courses that are designed to allow EMS service providers to achieve the highest standards in the industry. Rachel is responsible for the development of the center’s academic content and implementation of the clinical curriculum. Rachel is a natural educator and has a Bachelor of Arts degree in Education, which combined with her previous experience as a high school teacher enables her to ensure that the highest possible standard of education and training is delivered.

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Reason for Nomination:

The 40 under 40 are being highlighted by the American Ambulance Association to recognize those they believe are the future of the EMS and Mobile Healthcare profession. As a Paramedic, clinician and professionally trained educator, Rachel is developing and delivering the highest possible level of EMS clinicians of the future. Rachel is enthusiastic and dedicated to this essential task and well-deserving of this recognition.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: Gibson McCullagh (Pro EMS – Cambridge, MA)

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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Gibson McCullagh
Director of Special Projects & Strategic Initiatives
Professional Ambulance Service (Pro EMS)
Cambridge, MA

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LinkedIn
Nominated by: Rob Lawrence (AAA Board of Directors)

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Biography:

During college, Gibson worked with a variety of EMS agencies, including fire-based, private, volunteer, and collegiate. Gibson was the founding EMS Chief of Hobart & William Smith EMS, a student run ambulance service in Geneva, New York. Gibson’s academic capstone work was on the regulatory role of the US Federal Government within modern EMS. After college, Gibson moved to Cambridge where he graduated from the Pro EMS Center for MEDICS’ paramedic program.

From 2013 until 2015 Gibson served as the Systems of Care Coordinator at the Massachusetts Department of Public Health, Office of EMS. Much of Gibson’s work was focused on identifying and implementing best practices through regulation and protocol. Gibson assisted in the implementation of a series of EMS regulatory reforms (national standards adoption) to strengthen Massachusetts’ workforce, protocols, education, and medical director involvement.

Since 2015 Gibson has held the position of Director of Special Projects at Pro EMS. In that role, Gibson worked to develop Prodigy, pursued institutional accreditation, implemented clinical demonstration projects, and functions as the Clinical Liaison and advisor to Harvard University’s program, Crimson EMS. Gibson remains actively involved in collegiate EMS at the national level and serves as an Executive Board Member for the Metropolitan Boston EMS Council.

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Reason for Nomination:

The American Ambulance Association’s (AAA) 40 under 40 wonderfully recognizes Gibson’s already impressive achievements. Gibson is recipient of the 2019 AAA President’s Award. Gibson was honored for his service as a rising mobile healthcare leader who will help shape the future of the EMS industry. As Vice Chair of the AAA Professional Standards Committee Gibson is lending his voice on the national stage. Gibson’s work as a member of Pro EMS’s leadership team is shaping the direction of the organization and influencing the development of EMS across the North East. Simply put, Gibson is one to watch.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: James DiClemente (Pro EMS – Cambridge, MA)

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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James DiClemente
Director Pro EMS Center for MEDICS
Professional Ambulance Service (Pro EMS)
Cambridge, MA

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LinkedIn
Nominated by: Rob Lawrence (AAA Board of Directors)

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Biography:

As Director for the Center for MEDICS, James’s primary responsibility is to design and implement all training and education for Pro EMS employees and more than a dozen outside agencies who contract their training through Pro EMS and Pro EMS Center for MEDICS. This includes creating and delivering H.A.L.O training, new employee orientation, and other training sessions as needed. James also maintains the simulation facilities and equipment used at Pro and Center for MEDICS.

As the Paramedic Program Director, James graduates two large cohorts of students per year, ensuring they receive a comprehensive experience resulting in an impressive National Registry pass rate. James and his team have developed a unique program focusing on the benefits of simulation in a paramedic program and he continues to implement cutting edge technology to maximize efficiency. In 2012, James was recognized with Educator of the Year award by the Metropolitan Boston Emergency Medical Services Council. James is a member of the National Association of EMTs and National Association of EMT Educators. James serves as Community Training Center Faculty in all American Heart Association disciplines and is a content developer and lead educator in the Center for MEDICS’s distance learning platform. James began working at Pro EMS in 2008 and graduated from the Paramedic Program at Pro EMS Center for MEDICS in 2010.

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Reason for Nomination:

James has been the cornerstone of the Pro EMS center for MEDICS in Cambridge MA for the last eight years. James has developed and implemented educational programs for over 800 EMS professionals with a pass rate in the high 90th percentile. James was instrumental in the creation of Pro EMS’s own Learning Management System – Prodigy which to date has trained over 5,000 providers through its distributive education methods.

In addition to this remarkable work, James is also a MEDscience instructor at Harvard Medical School where he has created simulations and learning material for those enrolled. The on-line Prodigy system is shortly about to be scaled up onto a national platform and James will inevitably be a thought leader in this arena on a national level very soon.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

2019 AAA Award Winners Announced

The American Ambulance Association is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference & Trade Show Membership Meeting on Tuesday, November 5, 2019. Please join us in congratulating this year’s winners!

J. Walter Schaefer Award

Dr. John Becknell

The J. Walter Schaefer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Dr. John Becknell has achieved this honor for his lifelong commitment to improving the health and wellness of mobile healthcare professionals.

Robert L. Forbuss Lifetime Achievement Award

Dr. John Russell

The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. your decades of service, commitment, and dedication to the private ambulance industry, the AAA, and its members. Dr. John Russell has achieved this through his many years of service to the AAA as a volunteer leader.

President’s Award

These awards are bestowed by the President to volunteer leaders who have shown commitment to the advancement of the AAA, above and beyond the call of duty.

Wayne Jurecki

The American Ambulance Association is proud to honor Wayne Jurecki with the 2019 President’s Award. Wayne is being honored for his servant leadership and consummate professionalism, and commitment to the AAA.

Gibson McCullagh

The American Ambulance Association is proud to honor Gibson McCullagh with the 2019 President’s Award. Gibson is being honored for his service as a rising mobile healthcare leader who will help shape the future of our industry.

2019 Affiliate of the Year

Stryker

The American Ambulance Association (AAA) is proud to award Stryker with the 2019 Affiliate of the Year Award. Stryker has achieved this honor through their ongoing support of AAA’s educational programs and events.

EMS Partnership of the Year

The Savvik Foundation

The EMS Partnership of the Year Award is given to an organization or individual whose collaboration with the AAA enhances educational programs, legislative priorities, and/or member benefits. The Savvik Foundation has achieved this honor by developing a grant program for small providers to receive cost collection education.

Distinguished Service Award

Aidan V. Camas

AAA Manager of Federal & State Government Affairs Aidan V. Camas is receiving a 2019 Distinguished Service Award in recognition of his dedication and commitment to the AAA’s advocacy efforts.

Join us once again in congratulating the 2019 winners! Learn more about the Annual Conference & Trade Show.

 

Statement for NBC Nightly News Balance Billing Story 3/9/18

Last night, NBC Nightly News with Lester Holt ran a segment on ambulance balance billing. Although provided with a brief one-paragraph statement in advance, they chose to use less than one sentence of it during the broadcast. We have reproduced our original statement below to provide additional context.

For a better understanding of the forces driving the costs behind ambulance care, please see this recent longer media response by American Ambulance Association President Mark Postma.

Video Story

Original Statement Provided by American Ambulance Association

Emailed to Eric Salzman on January 28, 2018 | Very brief due to TV news format
Ambulance providers, both private and public, serve their communities with lifesaving on-demand mobile healthcare 24/7, regardless of patients’ ability to pay. Ambulance services are saddled with a high cost of readiness as they keep certified personnel, sophisticated technology, and costly medications ready round-the-clock. Medicare, Medicaid, and private insurance often reimburse ambulance services at rates below the costs of providing this care, endangering their ability to continue serving families in their time of extreme need. Ambulance services bill patients as a last resort: This necessity is driven by a complex combination of rising patient deductibles, reduced insurance coverage, and unfair contractual negotiation techniques employed by insurers that leave patients with uncovered balances. Like most issues in our healthcare landscape, there are no quick fixes for these challenges. However, as dedicated healthcare professionals, we welcome ongoing public dialogue about how to bring sustainable reimbursement to ambulance providers in order to reduce cost-shifting to patients.

EMS Week Contest Winners Announced

EMS professionals across the country recently celebrated EMS Week, held May 21-27, by hosting a variety of activities, memorials and both fun-filled and informative events. The AAA asked our members to tell us about some of their favorite ways they honored and celebrated their profession throughout the week, and we have selected three stories as our EMS Week contest winners. Here are some of the highlights:

LifeCare Medical Transports (Fredericksburg, VA): “This year’s EMS Week began with us honoring those who gave their lives so that others might live, at our National EMS Memorial Service. On Sunday, May 21, we co-hosted the EMS Service Cyclists for a dinner on their stop in Fredericksburg, VA. The remainder of the week consisted of fun yet educational online EMS Challenges each day, with participants being entered into raffles for great prizes. All employees received a letter from our leadership, as well as EMS gift bags.”

Armstrong Ambulance Service (Arlington, MA): “We love celebrating our employees every year with a week-long celebration of EMS Week. We annually begin the week with breakfast catered to the bases. This year, we brought carnival food trucks to the bases for a catered lunch of fair food favorites, including hot dogs, hamburgers, sausages and fried dough. On Friday, an ice cream truck visited the bases with sweet treats!

One of our favorite traditions is our EMS Week scavenger hunt. Field crews are given a list of tasks that allow them to interact with our community and that they must complete within 12 hours. The submissions are always hilarious! Throughout the week, we also hold various giveaways for local concerts, Red Sox games and gift certificates.”


McGregor Memorial EMS (Durham, NH): During the week, preschoolers and parents participated in the educational “Boo-Boo Bus” activity, in which children placed band-aids on teddy bears, and kids also participated in several coloring activities.

We also do “CPR on the Street,” in which we set up a tent and table with educational materials on CPR, and we have several mannequins that the public can use to learn “hands-only” CPR.

Finally, there is a volunteer-created place mat that we distributed to local restaurants. We distributed 600 place mats and crayons that were full of informational tidbits, as well as coloring areas and a maze puzzle.”

Thank you to all those who participated, and congratulations to our winners!

Congressman Richard Neal to Receive AAA Legislative Honor

Congressman Richard Neal to
Receive AAA Legislative Recognition Award

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

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

Congressman Neal will be presented this award in June in Washington, DC by AAA’s Massachusetts Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the Bay State are Kerry Flynn, and Beth Keegan of Armstrong Ambulance Service; Matthew Miner, Mark Hogue, and Paige Hoffman of Action Ambulance Service Inc.; and Deanne Lione, and Andrea Ball of Cataldo Ambulance Service.

Congressman Neal was selected for the Legislative Recognition Award for being a champion of the Medicare Ambulance Access, Fraud Prevention and Reform Act which would make permanent the current temporary Medicare ambulance add-on increases of 2% urban and 3% urban and the super rural bonus payment. The legislation, HR 745 from the 114th Congress, would also treat ambulance services more like providers of health care services and require CMS to collect cost data utilizing a survey methodology that would result in usable information for future reform of the Medicare ambulance fee schedule.

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

Congressman Neal has represented the 1st Congressional District of Massachusetts since 1989. He is the Ranking Member of the House Ways and Means Committee, a member of the Joint Committee on Taxation, and a member of the House Democratic Policy and Communications Committee.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘Praemonitus, Praemunitus’     

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

 

 

Spotlight: Ron Quaranto, Cataldo Ambulance

ron-quaranto-photoRon Quaranto
Chief Operating Officer, Cataldo Ambulance Service
Vice President, Massachusetts Ambulance Association
AAA Board, Director Region 1
Somerville, MA

Tell us a little about yourself, please.

I grew up in Natick, Massachusetts and graduated Natick High School in 1988. I am married and have two children; my daughter, Courtney, is 19 and my son, Justin, is 16. I like to exercise. I enjoy hockey, which I play two days a week, and I run 3–4 days a week.

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

In 1989, I began my career at Chaulk Ambulance in Natick, Massachusetts as a chair car driver while taking their EMT course. I worked as an EMT for many years and became a base Supervisor. I went to Paramedic School in 1994, and was certified as a Nationally Registered Paramedic in 1995. I then became a Field Supervisor for AMR and quickly moved up the ranks to Director of Operations overseeing operations from Boston to Worcester. In 2006 I moved over to Cataldo Ambulance Service, where I am currently employed as their COO.

What do you enjoy most about your job?

I enjoy helping people. I like being in my position to help our staff, especially assuring they have the necessary tools and skill set to treat our patient to the best of their ability. I have always enjoyed being in Operations because you never know what the day is going to throw at you. I enjoy staying busy.

What is your biggest professional challenge?

I would say at this time one of the biggest professional challenges I have is making sure we have enough staff to service our patients and accounts to the best of our ability. I also find it challenging to stay connected to our 825 employees spread out over 20 base locations. I feel that staying in touch with employees and having regular face time and good communication with the staff is critical.

What is your typical day like?

My typical day is making sure all departments that report to me have the tools they need to perform their assigned responsibilities. I never have a day where I find I have nothing to do. Follow-through is a priority to me, so making sure tasks are complete and we are responsive to our employees and customers is paramount. I am always looking ahead to see what we can do to raise the bar and become a better service.

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

Participation in the AAA has helped me and our service tremendously. Having access to the resources provided by the AAA as well as having the network of EMS professionals to reach out to share best practices has been extremely valuable to me.

2016 AMBY Best Use of Technology: Trinity EMS & Firstwatch, Opioid Epidemic Project

Congratulations to the 2016 AMBY Award Winners

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

Trinity EMS & FirstWatch Opioid Epidemic Project Awarded a 2016 AMBY for Best Use of Technology

Trinity EMS & FirstWatch | Massachusetts

amby-congrats-trinity-ems-with-firstwatchMassachusetts has seen a massive increase in opiate overdoses and deaths. In 2013 there were 918 opiate related deaths in Massachusetts. Massachusetts had 1531 deaths in the first six months of 2016. Many of the communities Trinity EMS serves are on the front lines of this issue. Their EMT’s and paramedics are helping to revive patients every day from an opiate overdose. Understanding the scope of an issue is a critical first step to solving an issue. They started using their PCR data to help frame the issue for their communities. They began tracking the demographics such as age and gender of the patients, time of day and day of the week, and location within the communities. They also monitor the volume to identify spikes in volume in individual communities and system wide. Trinity reported data monthly, one month behind to the health department, public safety partners, methadone clinics, hospitals and city governments. This data was well received. Other services contacted them for help in developing their tracking and reporting. They added FirstWatch to their program to speed up the notifications. Monthly reporting is still valuable. Instant reporting is even better. FirstWatch allows their communities to be notified within an hour of an opiate overdose. Public health and public safety now have this intelligence right away.

The goal was to gather and present data in a cross discipline format for aid with better understanding on the situation. First responders, law enforcement, public health, EMS, and district attorneys, and the press have received and used their data. Trinity wanted to show:

  • The profile of the patients we are seeing
  • The frequency of the patients
  • The location and time of the overdoses
  • The severity of the patients. (Our volume of overdoses have leveled off, the acuity of the patents is still increasing)
  • Our monthly report is a key performance indicator as to the opiate issue at the street level in our communities
  • Our needle pick up data indicated where outdoor intravenous drug use is happening
  • Many of the overdose calls to the 911 centers are not communicated as being overdoses; “fall”, “respiratory”, “unconscious” are common chief complaints at dispatch. This data would not have been collected and reported using chief complaint as a filter

When it became clear the opiate issue was becoming a wide spread crisis Trinity started working the issue. They knew their best area to provide data from was PCRs. They came up with a set of data points they thought would help. They attended many meetings and public events. During those forums dozens of additional questions and theories came forward. Trinity took and implemented all that they had data for. (Example. There was question about social benefits and opiate use. They are able to show on an ongoing basis that there is no correlation between opiate overdoses and the 1st and 15th of the month.)

Before 2015, Trinity reported opiate overdoses usually annually only when requested. Starting in 2015 they reported monthly. They wanted to provide data even quicker. Trinity had seen FirstWatch a few years before. They felt the speed and automation FirstWatch could provide was a critical improvement. The intelligence gathered with knowing in live time of opiate overdoses can’t be overstated. The automation allows that intelligence to be gathered no matter the day or time.

Trinity started working with FirstWatch in December 2015. In May 2016, Trinity put FirstWatch directly into the hands of public health, public safety and public schools. Each discipline has a HIPAA compliant login with access to data specific to their mission. They worked very closely with FirstWatch so they could understand the capabilities within the system. They brought the idea and FirstWatch brought the execution and focus. The FirstWatch platform is amazingly powerful for Trinity, to provide live access is amazing. In June 2016, Trinity participated in a Middlesex County District Attorney opiate task force meeting. Trinity had earlier in the meeting done a 20 minute presentation on the opiate crisis in our city. This provided the 70 people in attendance a fresh look at the data. Towards the end of the meeting conference to alert families and friends of addicts to watch their loved ones, and scheduled “emergency” Narcan administration training for the community. During DA Ryan’s presentation, Trinity received a FirstWatch alert for a 39 year old female opiate overdose from 30 minutes before. Three minutes later they received another alert for a 41 year old female that suffered a fatal opiate overdose. They were able to share that with the group and drive home the DA’s message.

The City Governments, Public Health, Police and Fire Departments in Trinity’s communities were eager to learn about the data they were able to collect, and their data began to become focal points at press conferences and city council meetings. News agencies began contacting Trinity to help paint the picture of the epidemic in feature stories. In sharing the mapping aspect of Firstwatch they hope that these agencies can further understand the epidemic and develop plans to combat it. Trinity has become the de facto subject matter experts of the opiate crisis.

Congratulations to Trinity EMS and FirstWatch for their selection as 2016 AMBY Winners.

 

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