Tag: Minnesota

President’s Perspective January 2019

Dear Fellow AAA Members,

Happy New Year from the American Ambulance Association! We enter this new year ready to rise together as an industry to face the mobile healthcare’s challenges and opportunities.

Advocacy Update

The AAA worked hard in the 115th Congress to achieve many legislative and regulatory wins for the industry. Thanks to the AAA Board, volunteer leaders, staff and consultants, and members alike, we were able to accomplish many of our goals to improve payment policies and overall regulations that will benefit AAA members and the industry as a whole. Last year, the AAA ensured the inclusion and passage of a 5-year extension of the ambulance Medicare add-on payments through December 31, 2022 as part of the Bipartisan Budget Act of 2018. The AAA also successfully pushed our preferred method for data cost collection using a survey which is the most likely to provide useful data for future payment reform as well as be the least burdensome on ambulance service providers.

In coordination with particular AAA members, the AAA worked with Senator Collins to include report language to accompany the FY2019 Senate VA Appropriations bill which directs the VA to use the prudent layperson standard for determining emergency ambulance services coverage. The AAA also supported the efforts of the IAFC and NAEMT in passage of language from the SIREN Act (S. 2830, H.R. 5429) that reauthorizes the Rural EMS Grant program. These grants will now provide funds up to $200,000 for training, equipment, and personnel retention in rural areas. The grants also require a 10% contribution by the grant recipient. While the AAA had advocated that language be revised to ensure small rural for-profit providers would still be able to apply for grants, we are pleased to see this program reauthorized. We appreciate the leadership role of the IAFC and NAEMT in pushing the issue.

Looking Ahead

With the 116th Congress now in session, the AAA has ambitious plans to build on our successes this year. Following passage of the extension of the Medicare ambulance add-on payments, the AAA has successfully worked with CMS and the RAND corporation in the development of the cost collection system in order to ensure that the result is feasible for our industry. The AAA has established itself and our members as a main stakeholder throughout the cost collection development process and look forward to remaining involved this year.

The AAA is eager to introduce a larger piece of legislation that will contribute to the long-term sustainability of the industry. This legislation will address issues such as inadequate reimbursement, the need for innovative payment models, the lack of equitable polices, and more.

The AAA is also looking at re-introducing legislation again this Congress that did not pass last year. This would include legislation to restructure the offset included in the Bipartisan Budget Act of 2018 to pay for the 5-year extension of Medicare add-on payments and the Veterans Reimbursement for Emergency Ambulance Services Act (VREASA). Please look for an additional in-depth update on our legislative priorities in the coming weeks.

As you can see, the AAA has a busy legislative year ahead. With many important legislative priorities, we will continue to lean on our members for their support and encourage you all to continue to build relationships with your Members of Congress.

Ambulance Cost Education (ACE)

New federal cost data collection requirements for ambulance services go into effect January 1, 2020. To help ambulance services prepare, our expert faculty has developed comprehensive Ambulance Cost Education (ACE) webinars, regional workshops, and online resources. With AAA ACE, your service will have all the tools needed to comply with federally mandated cost collection. Don’t wait! An ACE subscription is the turn-key solution to prepare for ambulance cost collection. Learn more about our affordable packages today.

Stars of Life

Each year, the American Ambulance Association showcases the value of ambulance services across the country through the Stars of Life program. I look forward to seeing many of you this June in Washington D.C., as we shine a light on the importance of ambulance services to our healthcare network. Stars and their guests, accompanied by executive hosts, are celebrated in a series of events in our nation’s capital. Nominate the Stars of your service today, and let’s help AAA celebrate the best in EMS! (Early Bird registration rates close March 31).

Renew Your Support of AAA

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

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

AAA Annual Conference & Trade Show

After many years in Las Vegas, we are excited to take the 2019 AAA Annual Conference & Trade Show to bustling Nashville, Tennessee. AAA Annual is the can’t-miss educational opportunity for ambulance leaders interested in bringing excellence in reimbursement, operations, and human resources to their services! I hope that you will join me and hundreds of our colleagues for networking, learning, and fun November 4-6Early bird registration is open now!

Thank You, Members!

I am thankful to our members who dedicate their time and talent to AAA’s board, committees, and task forces. It is your commitment and passion that allows AAA to move mobile healthcare forward.

Aarron Reinert
President
American Ambulance Association

Release: Midwest EMS Expo Announced!

State and National Ambulance Associations Unite to Bring Key Education to Midwestern EMS Providers

Midwest EMS Expo | May 2–3, 2018 | La Crosse Center

La Crosse, WI– The American Ambulance Association (AAA), Minnesota Ambulance Association (MAA), and Professional Ambulance Association of Wisconsin (PAAW) today officially announced the launch of the Midwest EMS Expo conference and trade show. This event will take place annually in La Crosse, Wisconsin beginning in May 2018, and will feature content from national- and state-level ambulance experts.

“AAA is proud to partner with PAAW and MAA in the development of the Midwest EMS Expo. We look forward to bringing together the best in ambulance expertise to deliver a powerful educational experience for EMS leaders,” said American Ambulance Association President Mark Postma.

The program will open on Wednesday, May 2, with key updates from the American Ambulance Association’s renowned experts on EMS reimbursement and advocacy. Highlights include a federal legislative overview by AAA President Mark Postma, as well as strategies for maximizing revenue from reimbursement gurus Asbel Montes, Brian Werfel, Brian Choate, and Scott Moore.

Thursday, May 3rd’s programming was developed collaboratively by the Minnesota Ambulance Association and Professional Ambulance Association of Wisconsin. The day will begin with speaker Captain Ray Dupuis of the Watertown Police Department. In this riveting keynote, he will share what happened in first minutes after the explosions at the marathon finish line, then explain police and EMS action plans that day. Don’t miss this opportunity to learn from a seasoned public servant who helped to lead his city in its darkest hour.

Additional conference topics include employee recruitment and retention, billing and compliance, executive leadership, community paramedicine, employment law, managing across generations, EMS resilience, and many more. For a complete conference agenda, visit www.midwestemsexpo.com/schedule.

According to PAAW President Dana Sechler, “The Midwest EMS Expo will offer a platform for the exchange of ideas and information among ambulance leaders of all levels. Given the constantly changing nature of EMS, it is critical to bring this educational and networking opportunity to our region.”

In addition to powerful educational content, the Midwest EMS Expo will offer attendees the opportunity to experience the best in products, services, and vehicles for EMS providers. Gold Sponsor Savvik Buying Group will be joined by Silver Sponsor Cindy Elbert Insurance Services, Bronze Sponsor eCore, and dozens more exhibitors on the show floor. For a complete list of current vendors, please visit www.midwestemsexpo.com/exhibitors.

Conference registration is now open, with member early-bird rates as low as $200 per attendee. Sponsorship, booths, and vehicle spaces are also available online at low introductory rates. To register for the Midwest EMS Expo or view the complete schedule of events, please visit www.midwestemsexpo.com.

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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. www.ambulance.org

About the Minnesota Ambulance Association

The Minnesota Ambulance Association represents Minnesota’s EMS providers by working with and monitoring legislation that impacts EMS, recruitment & retention, financial issues, education & leadership. We work closely with our peers in the hospitals, fire service, police, emergency managers, sheriffs & other associations. www.mnems.org

About the Professional Ambulance Association of Wisconsin

The Professional Ambulance Association of Wisconsin (PAAW) was founded in 2005 to represent the interests of ambulance services in the state of Wisconsin. In addition, PAAW works to create and promote opportunities for collaboration and networking between ambulance service executives, directors, and managers. PAAW serves as an EMS stakeholder group to promote excellence and quality in the ambulance industry in Wisconsin. www.paaw.us

Congressman Erik Paulsen to Receive AAA Legislative Honor

Congressman Erik Paulsen 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 Erik Paulsen of Minnesota with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services.

Congressman Paulsen will be presented this award in June in Washington, DC by AAA’s Minnesota Stars of Life—EMS personnel selected for their excellence and dedication. This year’s Stars from the North Star State are Doug Volin, and Brian Galowitz of Lakes Region EMS, and Angela Jarrett of Mayo Clinic.

Congressman Paulsen was selected for the Legislative Recognition Award for his support of the Medicare ambulance temporary add-on increases of 2% urban and 3% urban and the super rural bonus payment.

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

Elected to the U.S. House of Representatives in 2008 from Minnesota’s 3rd congressional district, Congressman Paulsen serves on the House Ways and Means Committee Subcommittees on Health and Trade, and on the Joint Economic Committee.

In appreciation of his ongoing service to the ambulance services of the United States, AAA is proud to honor Congressman Paulsen with a Legislative Recognition Award.

# # #

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.”

 

 

Wall Street Journal: Paramedics Aren’t Just for Emergencies

Yesterday’s Wall Street Journal featured several promising community paramedicine programs, as well as some great quantitative results.

“Paramedics are a readily deployable, nimble, clinically trained resource who can help close a gap in American health care,” Dr. Schoenwetter says…

From March 2014 to June 2015, the Geisinger mobile health team prevented 42 hospitalizations, 33 emergency department visits and 168 inpatient days among 704 patients who had a home visit from a paramedic, Geisinger calculates. In the case of heart-failure patients, hospital admissions and emergency-room visits were reduced by 50%, and the rate of hospital readmissions within 30 days fell by 15%. Patient satisfaction scores for the program were 100%.”

Read the full article on wsj.com. (Hat tip to Matt Zavadsky.)

Spotlight: Aarron Reinert

Aarron Reinert
Isanti, Minnesota, USA
Executive Director, Lakes Region EMS
Treasurer, American Ambulance Association

Tell us a little about yourself.

This is my 25th year as a paramedic. I began my EMS career as a volunteer in a small rural ambulance service in central Minnesota. During my career I have had a number of different leadership experiences, including leading small rural services and large metropolitan services, as well as working for theMinnesota state EMS office.

Today I serve as the Executive Director for Lakes Region EMS. Lakes Region EMS is a rural ambulance service serving Minnesota and Wisconsin composed of 73 full-time staff with a Paramedic/EMT staffing pattern. Previous to Lakes Region EMS, I was the Field Services Manager for the Minnesota Emergency Medical Services Regulatory Board. At the EMSRB, my projects included creating and implementing a statewide web-based data collection system, developing statewide EMS communication systems, and coordinating EMS bioterrorism preparedness.

I am also active on behalf of our industry on the national level. I serve on the board of directors for the National Registry of EMTs (NREMT), am a past board member for Advocates for EMS, and National EMS Management Association (NEMSMA), and was the chair for the National EMS Advisory Council (NEMSAC). NEMSAC is a statutory advisory board whose members are appointed by the Secretary of Transportation to advise all of the federal government on EMS issues.

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

25 years. I was attending college in Willmar, MInnesota studying computer science and needed a part time job. The local ambulance service was looking for volunteers. As a former Boy Scout and Eagle Scout I thought the EMT class would be easy and fun, and, long story short, I fell in love. I left college, went to paramedic school, and continued with the volunteer service where I became the leader in 1994.

What do you enjoy most about your job?

I love working with my team. For me, they are my family. I am humbled and honored every day with the incredible things they do.

What is your biggest professional challenge?

Finding the time to do what I know is most the most important, listening to my staff, and deeply understanding their needs.

What is your typical day like?

I travel for my organization and our industry almost half the time. My day might be in a meeting in D.C., or meeting with my team at our offices. No day is the same.

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

Too many ways to list, but a few examples:

1.     Helping me to grow as a leader

2.     Connecting with experts all across the nation

3.     Learning new and better ways to lead my organization.