Tag: Nevada

NBC | Covid package, federal program offer lifeline and herald change for ambulances services

March 18, 2021, 3:54 PM EDT

Features Empress EMS and REMSA!

By Phil McCausland
During the height of the pandemic, a quiet financial crisis was brewing for ambulance companies.

As hospitals became overwhelmed and patients begged not to be taken to crowded emergency rooms for fear of potential infection, paramedics and emergency medical technicians began treating patients where they met them — outside homes, alongside roadways, in parking lots.

The trouble is that ambulance companies are only paid to transport people, not for treating them.

Now, an aid package in the American Rescue Plan and a new federal health care program could provide a financial lifeline for ambulance companies and herald a permanent shift in emergency medicine as a whole.

The attempt to reimburse ambulance companies began with a bill introduced by Sens. Catherine Cortez Masto, D-Nev., and Bill Cassidy, R-La., but the legislation was ultimately rolled into the $1.9 trillion Covid relief bill. Cortez Masto voted for the plan, and Cassidy did not.

“Our first responders have gone above and beyond in caring for patients during the pandemic, and it’s just wrong that ambulance companies weren’t getting paid unless they took patients to the hospital,” Cortez Masto said.

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Senate Passes Ambulance Treatment in Place Language

On Saturday, the U.S. Senate passed language for Medicare coverage of emergency treatment in place of lower acuity patients by ground ambulance services providers and suppliers during the COVID-19 public health emergency (PHE). The language is from S. 149 by Senators Cortez Masto (D-NV) and Cassidy (R-LA) and passed as part of the $1.9 Trillion American Rescue Plan (H.R. 1319). The House is scheduled to vote and expected to pass the package tomorrow.

The American Ambulance Association along with the International Association of Fire Chiefs, International Association of Firefighters, National Association of EMTs and National Volunteer Fire Council pushed for passage of the bill language.

S. 149 would authorize the Centers for Medicare and Medicaid Services (CMS) to waive the transport requirement under Medicare for treatment in place for 9-1-1 or equivalent ambulance responses in which community EMS protocols dictate that the patient not be transported to a facility. The waiver would apply during the public health emergency.

Similar to other waivers provided by Congress for Medicare coverage during the pandemic, CMS would not be required to implement the policy. However, CMS has done so in all other situations and has also made the coverage retroactive to the beginning of the PHE. Upon passage of the language, the AAA will strongly advocate for CMS to implement the waiver and make it retroactive.

The AAA will be offering educational services to our members on the requirements of the proposed new policy and how to bill for covered services.

Treatment In Place in Senate Draft

Ambulance Treatment in Place Bill Included in Senate Draft Budget Reconciliation Package

The draft bill by Senate Democrats on a Budget Reconciliation package includes the language of S. 149 which would waive the transport requirement under Medicare for certain 9-1-1 ground ambulance services during the public health emergency. The Senate is expected to consider the package as soon as tomorrow.

Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) introduced S. 149 on February 3 which is supported by the AAA, International Association of Fire Chiefs, International Association of Firefighters, National Volunteer Fire Council and National Association of EMTs.

Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient.  Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of the transportation requirement. S. 149would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”

The House has already passed their version of Budget Reconciliation and would still need to pass a Senate version before sending to the President. S. 149 would provide CMS with the authority and, if passed, the AAA would advocate for the agency to exercise that authority and follow through with the waiver starting at the beginning of the public health emergency.

Senators Wyden & Cortez Masto Propose Mobile Crisis Response Teams

From Chairman Ron Wyden on February 18

FOR IMMEDIATE RELEASE

Contact: Taylor Harvey   

February 18, 2021

 

WYDEN, CORTEZ MASTO, SENATORS PROPOSE FUNDING TO IMPROVE PUBLIC SAFETY WITH MOBILE CRISIS RESPONSE TEAMS

After Down Payment on the Policy Included in Reconciliation Relief Legislation, CAHOOTS Act Builds on Proven Models to Help Americans with Mental Illness and Enhances Medicaid Funding to States

Washington, D.C. – Senate Finance Committee Chair Ron Wyden, D-Ore., Senator Catherine Cortez Masto, D-Nev., and six senators today proposed a bill to help states adopt mobile crisis response teams that can be dispatched when a person is experiencing a mental health or substance use disorder (SUD) crisis instead of immediately involving law enforcement. The funding is provided through an enhanced federal match rate for state Medicaid programs.

“I’m proud there is a down payment on CAHOOTS in the emergency relief package moving through Congress now,” Wyden said. “Every day there are stories across the country of Americans in mental distress getting killed or mistreated because they did not receive the emergency mental health services they needed. White Bird Clinic in Eugene, Oregon has been a pioneer for years in this area, and it’s high time the CAHOOTS model is made available to states and local governments across the country. I am eager to get the down payment signed into law and continue working to get further investments in mobile crisis services made under the bill across the finish line.”  

“Individuals experiencing a behavioral health crisis deserve to be treated with compassion and care by health care and social workers,” Cortez Masto said. “These professionals are extensively trained in deescalating situations and addressing mental health crises, and this legislation would help more states across the country fund mobile crisis teams. I’m hopeful that these investments in community-based crisis intervention services will be included in the final version of the current coronavirus relief package, and I’ll continue to advocate for effective, trauma-informed care for those in need.” 

Earlier this month, the House Energy and Commerce Committee included provision in its budget reconciliation language for COVID-19 relief that makes an investment in these services by funding state Medicaid programs at an enhanced 85 percent federal match if they choose to provide qualifying community-based crisis intervention services and funding state planning grants to apply for the option. The pandemic has taken a serious toll on the mental health and wellbeing of Americans with studies showing a four-fold increase in the rates of anxiety and depressive disorders since the beginning of the pandemic.

The bill, the Crisis Assistance Helping Out On The Streets (CAHOOTS) Act, grants states further enhanced federal Medicaid funding for three years to provide community-based mobile crisis services to individuals experiencing a mental health or SUD crisis. It also provides $25 million for planning grants to states and evaluations to help establish or build out mobile crisis programs and evaluate them.

Senators Jeff Merkley, D-Ore., Bob Casey, D-Pa., Tina Smith, D-Minn., Dianne Feinstein, D-Calif., Sheldon Whitehouse, D-R.I., and Bernie Sanders, D-Vt., are co-sponsors of the CAHOOTS Act.

A one page summary of the bill can be found here. Legislative text can be found here.

Senators Cortez Masto and Cassidy Introduce Bill on Ambulance Treatment in Place

Yesterday, Senators Catherine Cortez Masto (D- NV) and Bill Cassidy, MD (R-LA) introduced legislation (S. 149) to allow for Medicare reimbursement under certain circumstances of treatment in place by ground ambulance service organizations during the COVID-19 public health emergency. The AAA applauds the efforts of Senators Cortez Masto and Bill Cassidy as well as the Senate Finance Committee and Leadership.

S. 149 would provide the Centers for Medicare and Medicaid Services (CMS) with the authority to waive the requirement that a patient be transported to a medical facility in order for the ground ambulance service provider or supplier to receive Medicare reimbursement. The waiver would apply to 9-1-1 emergency ambulance services in which the transport did not occur as a result of “community-wide EMS protocols” due to the public health emergency. While the bill would not apply to situations in which a patient declines transport due to COVID-19 exposure concerns as advocated by the AAA, S. 149 is a significant step in the right direction to recognize ground ambulance services not being reimbursed during the pandemic.

The American Ambulance Association (AAA) along with the International Association of Fire Chiefs (IAFC), International Association of Firefighters (IAFF) and National Association of Emergency Medical Technicians (NAEMT) have spearheaded efforts for the Congress to provide CMS with waiver authority for treatment in place. We will be pushing to include the language of S. 149 in the COVID-19 stimulus package currently being negotiated between the White House and the Congress.

For the official statement of the AAA on the introduction of S. 149, please click here.

S.149 Treatment In Place

The American Ambulance Association Urges Immediate Passage of  S. 149 to Allow CMS to Support Local Ground Ambulance Service Responses to the Public Health Emergency

Treatment in Place Supports Patients and Sustains 9-1-1 EMS Providers During the COVID-19 Pandemic

Washington, DC, February 2, 2021 – The American Ambulance Association (AAA), our nation’s voice for ground ambulance service organizations commends Senators Catherine Cortez Masto (D-NV) and Bill Cassidy, M.D. (R-LA) for the introduction of S. 149 and urges its immediate passage. This legislation would remove a statutory barrier that has stopped ground ambulance service organizations from being reimbursed for health care services they provide consistent with local emergency medical service (EMS) protocols.

“S. 149 will empower ground ambulance service organizations to better meet the emergency medical needs of their communities, which are struggling during the pandemic,” stated AAA President Shawn Baird. “I applaud Senators Cortez Masto and Cassidy for their leadership on introducing this vital piece of legislation, as well as the Senate Finance Committee and Leadership for their support of these efforts.”

Under S. 149, the Centers for Medicare and Medicaid Services (CMS) would have the authority to waive the requirement that a patient must be transported to a medical facility in order for a ground ambulance service organization responding to a 9-1-1 emergency call to be reimbursed by Medicare when there is a community-wide EMS protocol restricting the transport of the patient.  “Ground ambulance service organizations whose paramedics and EMTs are on the frontlines of this pandemic are struggling financially due to the reduction in ambulance transports and higher costs such associated with responding to medical emergencies that cannot be reimbursed because of this transportation requirement,” said Baird. “This bill would greatly help address part of that problem and recognizes the critical role that ground ambulance service organizations are playing in controlling hospital surges and reducing the spread of COVID-19 .”

The legislation would benefit patients by reducing their risk of exposure to the virus, which is often the focus of the local protocols requiring them to remain at home. It would also help hospitals experiencing surges during the pandemic by allowing hospital beds to be reserved for higher acuity patients.

The AAA will help push for swift passage of the bill. President Baird called on the Congress to address the legislation as part of negotiations on a new COVID-19 economic relief package. “The American Ambulance Association fully endorses S. 149 and we ask for all members of Congress to help their ground ambulance service organizations, their patients, and the communities they serve by supporting passage of this bill.”

About the American Ambulance Association

The American Ambulance Association safeguards the future of mobile healthcare through advocacy, thought leadership, and education. AAA advances sustainable EMS policy, empowering our members to serve their communities with high-quality on-demand healthcare. For more than 40 years, we have proudly represented those who care for people first. For more information about the AAA visit our website at www.ambulance.org.

REMSA in 2020

REMSA
Reno, Nevada
500 Staff | 300 Quarantined in 2020

REMSA is a high-performance, high-value, out-of-hospital healthcare provider and emergency medical services agency headquartered in Reno, Nevada. Since 1986, through an exclusive franchise agreement, REMSA has served the region as a private, nonprofit, community-based organization funded only by user fees with no local tax subsidy. REMSA’s ground ambulance program responds to ~80,000 calls for service and transports ~57,000 patients annually. REMSA is composed of Care Flight – a ground and air critical care transport provider, the Center for Prehospital Education – a licensed, post-secondary education institution and its fully accredited medical dispatch center which manages ~250,000 calls annually and offers a co-located Nurse Health Line. REMSA and Care Flight are Always Ready.

Despite civil unrest, record-breaking heat and weeks of heavy smoke due to wildfires, as well as the global pandemic, employees remained optimistic, committed to safety and provided compassionate, clinically-excellent patient care. We are pleased that our Logistics department anticipated the need for PPE and stockpiled enough for providers and patients as well as donations to first response partners. The health district, overwhelmed by calls, asked us to launch and staff a 24/7 COVID-19 call center; from March through September, 28,514 calls were answered. More than 60 process and practice changes were made including an employer match of an additional 80 hours of paid time off for sick employees, pandemic protocol call-taking and a tiered response system. In other news, we launched on-demand healthcare programs, graduated paramedics, offered CPR training, added ambulances to our fleet, refurbished a mobile operations center and earned CAMTS reaccreditation. Plus, we announced a new team of FTOs, delivered 200 flu shots to homebound citizens and consistently outperformed other organizations of similar size on the EMS Survey.

REMSA’s Tiered System Featured on Aging & Awesome

Recently, Reno’s REMSA launched a tiered response model. The news segment from Aging and Awesome featured below offers a clear explanation about how using a variety of healthcare provider levels for an out-of-hospital medical response is an effective and safe way to help patients access the healthcare they need – which can range from an urgent ambulance transport to the emergency room or access to a telehealth provider.

Great Idea | REMSA’s Thank You Notes Page

Reno, Nevada’s REMSA provides nationally recognized ground ambulance service within Washoe County, Nevada. Don’t miss their amazing new “Thank a Healthcare Provider” page, where members of their community are able to share digital thank you notes with REMSA’s Paramedics, EMTs, telecommunicators, pilots, and nurses as well as administrative and operations staff.

Check Out the REMSA Thank You Page

40 Under 40: Glen Simpson (Community Ambulance – Henderson, NV)

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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Glen Simpson
Director of Special Operations
Community Ambulance
Henderson, NV

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LinkedIn
Nominated by: Janet Smith (Community Ambulance – Henderson, NV)
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Biography:

Since 2016, Glen Simpson, AEMT has been the Director of Special Operations for Henderson, NV based Community Ambulance. Simpson offers event venues and producers his more than 15 years of experience designing special medical standby plans and coordinating their implementation in Southern Nevada. Between the years 2008 and 2012, Glen personally oversaw the further development of special event medical services for his former employer, Medic West Ambulance. In 2012, Glen moved into the Operations Manager position for American Medical Response’s special event medical services in Las Vegas.

Focused on crowd management and employee and patient safety, Glen has successfully earned the repeat business of numerous major events like the Electric Daisy Carnival, Rock in Rio, Route 91 Harvest Festival, and many more. Simpson credits his success to fostering and maintaining excellent relationships with venues, producers, and the public safety officials in Clark County, Nevada. Additionally, Glen’s approach to employee training, his meticulous attention to detail and continual follow-up with venue and event producers has distinguished him as “expert” in the niche field of special event medical services. Glen is a frequent conference speaker regarding Special Event Medical Services. Most recently, Glen spent most of 2018 and 2019 presenting at more than 30 venues in the U.S. and abroad regarding his role during the October 1, 2017 mass shooting at the Harvest Festival held in Las Vegas.

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Reason for Nomination:

Glen has worked tirelessly to influence the international perception of special event medical standby personnel as being much more than a “backpack and a flashlight”. Glen has used the numerous presentations he has given around the world over the last two years to redefine and highlight the essential role that special event medical personnel play during any type of incident (large or small). Additionally, Glen has and continues to present before regional and national venue manager audiences. These executives who are pulled in a dozen different directions when securing crowd-drawing events for their facilities, are urged to reconsider contracting with an ambulance provider for event services just to satisfy an event’s medical standby insurance requirements or as just a box to check.

Glen’s experiences being the manager leading his “boots on the ground” employees during the 1 October 2017 Mass Shooting at the Route 91 Harvest Festival event in Las Vegas influences the work he does today. Glen offers his audiences sound counsel about the importance of good public safety relationships. Glen details the requirements for preparing for anything, treating the injured should violence occur, and for managing the first aid needs of event participants and attendees. Glen and his personnel have also engaged in Stop the Bleed training for event personnel and security forces.

Glen has been published for his account of the 1 October tragedy by JEMS Magazine and by EMS1.com. The New York Times covered Glen’s account of the atrocity and The Las Vegas Sun also recognized Glen and his special event crews. Glen and his special event employees were lauded during the 2018 HealthCare Heroes event in Las Vegas and their 1 Oct. story was covered by the event’s sponsor, Nevada Magazine. Glen and his team were also recognized by the American Ambulance Association at the association’s annual meeting in Las Vegas in 2017. Glen and his employees also received an honorary plaque from Clark County Commissioners for the company’s performance during the 1 October 2017 mass shooting. They were also honored by U.S. Representative Dina Titus whose remarks were read into the congressional record on October 24, 2017. Community Ambulance also received a Certificate of Recognition from the Clark County School District Community Partnership Office and from Henderson, Nevada’s Mayor, Debra March.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

40 Under 40: Adam Heinz (REMSA – Reno, NV)

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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Adam Heinz
Executive Director Integrated Health
REMSA
Reno, NV

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Linked In | Twitter
Nominated By: Alexia Jobson (REMSA – Reno, NV)

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Biography:

Adam Heinz is the Executive Director of Integrated Health for Regional Emergency Medical Services Authority (REMSA) in Reno, Nevada. With an intense focus on leading and engaging teams to provide compassionate, clinically excellent prehospital care, Adam brings 18 years of Emergency Medical Services (EMS) experience to the organization. Having progressed in roles from Paramedic to EMS Supervisor, Clinical Development Manager to Director of Clinical Communications, Adam is now responsible for advancing REMSA’s innovative mobile health care projects. Through collaboration with regional partners, regulators, and elected officials, Adam represents the organization on a local, state, and national level. In addition, Adam overs sees REMSA’s clinical division and its Center for Prehospital Education.

Adam is a proud alumnus of the University of Nevada Reno where he earned a bachelor’s degree in psychology. Currently, Adam is pursuing a Master of Business Administration degree with an emphasis in healthcare leadership. In addition to being a Nationally Registered Paramedic (NRP), Adam is certified as a Nevada State EMS Instructor and as an Advanced Emergency Medical Dispatcher (AEMD).

Currently, Adam serves on the Clinical Practices and Standards, and Mobile Integrated Health Committees of the National Association of EMS Physicians and was recently invited to be on the board of directors for Well Care Medical and Behavioral Health Clinic in Reno, Nevada.

Having given presentations at the PeaceHealth Neuroscience Clinical Symposium and the American Heart Association’s Annual Regional Conference, Adam is considered a leading thinker and advocate for the prehospital and mobile health care industry.

Adam is a lifelong resident of northern Nevada. Adam and his wife Heather, an emergency department registered nurse, have two children, Ella (4) and Bentley (2). Adam, a self-proclaimed “Disneyphile” speaks conversational French, enjoys international travel, and has an interest in the history of medicine.

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Reason for Nomination:

Passionate, articulate, supportive, confident, organized, honest, loyal, and transformational leader are just some of the ways Adam Heinz is described by his colleagues and the leadership at REMSA. Adam has an unyielding commitment to advancing the EMS industry by innovating, leading, and pursuing excellence. Starting as a Paramedic with REMSA 12 years ago, Adam has progressed through leadership positions to his current role as Executive Director of Integrated Health. Along the way, Adam consistently meets or beats budget objectives for his non-profit, non-tax-subsidized employer, implements forward-looking projects such as Alternative Destination Transport and Alpha/Omega protocols, leads groundbreaking initiatives such as REMSA’s AED drone delivery project. Additionally, Adam engages with front-line providers through educational opportunities, hosting EMS skills competitions, and highlighting exceptional care in the field at the weekly medical leadership meeting.

Adam’s contributions range from volunteering to serve on REMSA’s Employee Wellness Action Committee to the more sizable task of successfully leading REMSA’s Clinical Communications Center through two re-accreditation cycles which resulted in the International Academy of Emergency Dispatch (IAED) recognizing the center as a mentor for other dispatch agencies interested in seeking accreditation. What’s unique and universally appreciated about Adam is that he approaches all tasks no matter how big or small, with the same vigor and enthusiasm. Adam is trusted to represent REMSA on the Washoe County Health District/District Board of Health, the region’s EMS Oversight Committee, and the Truckee Meadows Fire Protection District Board. Adam is well respected among his peers in the community and actively builds relationships with community stakeholders and public safety officials.

“Many of the relationships we (REMSA) have with our healthcare partners, co-responding agencies, and community leaders today are a direct result of the framework that Adam has put in place.” – Jason Hatfield, NRP, Clinical Coordinator, hiREMSA

Adam simultaneously displays a seriousness that conveys the importance of EMS work and a playfulness that eases the often heavy tone of EMS work. Adam continues to work patch-to-patch with ground field providers and dispatchers during regular shifts, special events, and when the system needs additional support. Adam is a mentor to staff all throughout the organization and regularly shares complimentary emails highlighting a job well done.

“You can find Adam grabbing a headset to help out in the communications center as well as jumping on an ambulance to run calls which provides an opportunity to engage in the front-line staff experience.” – Sarah Vonarx, Applications Administrator/AEMD, REMSA

Over the last two and a half years, Adam has made a commitment to working closely with the public affairs department to raise awareness about EMS, safety, health, and wellness. Adam now serves as REMSA’s primary on-camera media spokesperson, at-the-ready to assist with interviews on topics that range from flu shots and heat exhaustion to reimbursement, system status management, and the misuse of 911. Adam is a tremendous asset to REMSA as it positions itself as a high-performance, high-value EMS system and the regional mobile health care expert.

Adam has received two official recognitions for outstanding service throughout his career. In 2012 Adam was honored with an Achievement Award in response to the Reno Air Races tragedy which killed 11 people and injured 69 more during a spectator special event. In 2013, Adam was given the Meritorious Award for successfully resuscitating a young fan that suffered cardiac arrest at a University of Nevada Reno sporting event.

Adam is particularly enthusiastic about enhancing the different professions across the EMS and mobile healthcare industry. Adam conceptualized and launched a standardized uniform, badge, and collar brass look for all leadership levels at REMSA. In addition, Adam advocates for accountability across all provider levels and encourages all employees to represent REMSA’s brand proudly and with integrity. Finally, Adam believes that prehospital care and the profession of Paramedicine should be standardized and recognized at the university level.

Adam’s energy, high ethical standards, and intellect inspire people around him to do their best.

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View all of the 2020 Mobile Healthcare 40 Under 40 Honorees

January Law Changes– OR, NJ, NY, NV

Oregon Pregnancy Accommodations Law

 

Following many other states, the new law prohibits employers from deny employment opportunities to applicants or employees who need reasonable accommodations due to or related to their pregnancy or childbirth. 

New Jersey Pay Inquiry Restrictions

 

This law prohibits screening candidates based upon an applicant’s prior wage history. It is also illegal to establish a job candidate’s salary or benefits compensation based upon their prior salary or wage history.

New York Pay Inquiry Restrictions

 

This law prohibits all employers from inquiring about a job candidate’s wage history or relying on prior wage levels in establishing compensation or benefits.

Nevada Pre-Employment Marijuana Testing Restrictions

 

This law exempts employees who are firefighters, EMTs or who operate motor vehicles during the course of their duties.  While this would eliminate many positions within an EMS agency.  EMS employers who are not Federal Contractors or Grantees, need to heed these restrictions for those positions within their organization that do not fit into one of the exempt positions below.

In Memory of Patrick Wells Smith

Patrick Wells Smith, age 65, passed away unexpectedly on June 21, 2019, at his home in Reno, Nev.  He was well-known as a nationally-respected innovator and icon in the Emergency Medical Services (EMS) industry. Most recently he was the President and CEO of REMSA (Regional Emergency Medical Services Authority) and Care Flight, based in Reno, from January 1990 through March 2013 and then President of SEMSA (Sierra Emergency Medical Services Authority) also based in Reno,  from April 2013 to June 2018.

He was born on November 17, 1953 in Minneapolis, Minnesota, to parents Ted Arvel Smith and Margaret Wells Smith. He was the second of three children. He attended Minnetonka High School, got his start as an EMT in 1973 as a college student in Minnesota, and soon began taking on supervisory roles for EMS agencies in Minnesota and Oregon. In 1980 he was hired as an assistant director of Metropolitan Ambulance Services Trust in Kansas City where he consulted to establish EMS systems in Fort Wayne, IN.; Pinellas County, FL; Fort Worth, TX; and Little Rock, AK. He worked as Vice President of Eastern Ambulance in Syracuse New York after that before moving to Reno. 

He was well known for his innovation and leadership in EMS systems design and medical 911 communications systems. One of his most fascinating stories was his role as a first responder at the 1981 collapse of the walkway at the Hyatt Regency in Kansas City where he was one of the initial responders on site. It killed 114 people and injured 216. That experience inspired the ways he help REMSA to prepare for many crises in which the team needed to respond with speed and outstanding systems, but still compassion.

During his time at REMSA he created and fostered programs such as the special events coverage team, community and professional education teams, and the TEMS program which attaches specially-trained paramedics from REMSA to the SWAT teams of local law enforcement. He received numerous local and national awards, including the Secretary of Defense Employer Support Freedom Award for small businesses in 2008 where he was awarded the opportunity to meet the President of the United States.

He was proudest in his professional life when talking about his REMSA/Care Flight team. “It’s about the people,” he would often say. He was a proud and loving father and grandfather who passed on his devotion to Disney and instilled a deep loyalty to the Minnesota Vikings in his family. 

He was very active at the leadership level volunteering in the American Ambulance Association, and also NAPUM, National Association of Public Utility Model, which was a group of EMS organizations across the nation, each with the unique structure of a Public Utility Model, which provided guaranteed quality of care, response times and coverage without tax subsidies. REMSA had been one of those PUMs since its creation in 1986.

He is survived by his five children: Michelle Bergren (Matt), Aaron Smith (Divya), Danielle Sanford (Michael), Theodore Smith (Hailey), and Allison Hahn (Mark), his seven grandchildren: Blake, Sage, Bode, Rishi, Rohan, Hadley, and Cole, his nephews Jason  and Jeremy Smith, and the mother of his children and ex-wife, Linda Smith, who remained his good friend and co-parent/grandparent, as well as his many other friends and EMS and medical profession colleagues.

He was preceded in death by his parents, his sister Diana Smith and his brother James Smith. 

A celebration of life will be held on Tuesday July 2, from 4 to 7pm at 10379 Dixon Lane in Reno. 

In lieu of flowers, the family requests donations to Truckee Meadows Community College to the Patrick Smith Memorial Scholarship, which will be for students who want to study to become an Emergency Medical Technician, or a Paramedic. 

Please send donations to:

TMCC Foundation
7000 Dandini Blvd, RDMT 200
Reno, Nevada 89512-3999 

You can also donate online at: https://www.tmcc.edu/foundation/support-tmcc/make-gift. In the “Leave a Comment” box just note your donation is for the Patrick Smith Memorial Scholarship.

Nevada Passes Law that Restricts Employer Drug Test Use in Hiring

A new Nevada law that bans employers from refusing to hire job candidates who fail a drug test due to the presence of marijuana has specifically carved out Fire, EMS, or employers whose employees must operate a motor vehicle.  The new law, which was signed by Governor Sisolak on June 5th makes it unlawful for most employers to fail to hire a job candidate on the basis of failing a drug screen due to the presence of marijuana.  Nevada is the first state to pass a law of this nature.  The new law takes effect in 2020.

Many employers are struggling to address their employee’s drug use and its impact on the workplace as thirty-three (33) states and the District of Columbia have passed laws that legalize marijuana in some form.  This is particularly difficult with EMS and public safety employers.  Generally, most EMS and public safety employers prohibit employee use of marijuana and other drugs because they are federal contractors and are subject to the Drug Free Workplace Act.  Other employers prohibit employee drug use because EMS personnel perform “safety sensitive” positions as defined under the Department of Transportation Regulations.  However, those employers who are not subject to the Drug Free Workplace Act must be sensitive to this law for those employees that do not perform safety sensitive functions.  Employees in those non-safety sensitive positions, such as administrative duties, may be protected by laws like the law that was just passed in Nevada.

It is critical that employers understand their rights and responsibilities as it applies to drug testing and workplace drug use.  The American Ambulance Association can assist member companies who are struggling to make sense of this new law and what they can do to control drug use in their workplace. The AAA held numerous EMS Supervisor SimLabs last year which put EMS Supervisors and Managers through the paces of conducting an investigation of a Sexual Harassment allegation.  We are excited to announce that we are adding to the SimLab offerings with a new workshop specifically geared for Workplace Drug Use & Reasonable Suspicion in EMS.  To learn more about this, or any EMS Supervisor SimLab, please contact the AAA.

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.

ACA Repeal & Reform – What It Means for Ambulance Services

By: Tristan North and Kathy Lester, JD, MPH

This is the first of a two part Member Advisory by Tristan North and Kathy Lester on ACA Repeal & Reform. To continue reading, see Part Two: ACA Repeal & Reform – What It Means for Ambulance Services (Pt. 2).

Overview

A top priority of President Trump and congressional Republicans is to repeal and replace the Affordable Care Act (ACA). Since Republicans retook control of Congress in 2012 after passage of the ACA in 2010, they have sought to repeal the ACA. However, they had not developed a consensus on a replacement package, as they knew then-President Obama would veto the repeal bill. Now with President Trump in the White House and Republicans controlling the House and Senate, Republicans in the House have agreed upon a package and moved it through three Committees of jurisdiction: the Ways and Means Committee, the Energy and Commerce Committee, and the Budget Committee. Republicans in the Senate are less aligned and are said to be working on their own package, which is likely to differ in important ways from the House version.
For ambulance services, there are several key components to watch. These are:

  • Coverage for ambulance services. Expressed in terms of providing more flexibility, there is concern that some insurers are pushing and some Republicans agree that the concept of a minimum set of covered services (essential health benefits (EHB)) should be narrowed or even eliminated. Currently, only emergency services are included as an EHB, but through the designation of benchmark plans, non-emergency services have also been covered. If the benchmark plans requirements are modified, coverage for non-emergency services could become an issue.
  • Medicaid expansion. The Administration has sent a clear signal that it plans to roll back the expansion of Medicaid, which provide coverage to many Americans who had signed up under the ACA. For ambulance services in expansion States, the elimination of this program could result in more uncompensated care problems.
  • Coverage more generally. Republicans have clearly indicated a desire to eliminate the individual mandate. This could have two effects that may impact ambulance services. First, if people are not required to have coverage there are many who will not have it. It is not certain whether without coverage these individuals will be able to pay for the services they receive, which could lead to more uncompensated care. Second, individuals who do not purchase health insurance often are younger and healthier. Without such individuals in the risk pool, it is possible that premiums and other cost-sharing requirements will increase making it more likely for sicker individuals who cannot afford care becoming uninsured.
  • Employer costs and obligations. The House Republican legislation includes several provisions that relax the obligations and/or provide tax relief to employers providing health insurance. Such provisions could be beneficial to ambulance services in terms of providing health care coverage for their employees.

In addition, there are a few other provisions that the current bills being considered do not modify, but potential could be part of the discussions at some point or in subsequent Medicare legislation.  Of these, there are three that would directly impact ambulance services.

  • Productivity Adjustment. As part of the ACA, the annual inflation updates for the Medicare ambulance fee schedule rates are now subject to a productivity adjustment, which reduces the amount of the update. CMS subtracts a projection of the non-farm business multi-factor productivity adjustment (MFP) from the Consumer Price Index – Urban to determine the update amount.
  • Inflation Index Below Zero. Prior to the ACA, the Medicare inflation update for ambulance rates could not be a negative percentage. Under ACA policies, the update may be a negative percentage. For example, in 2011, the CPI-U was 1.1 percent and the productivity adjustment was 1.2 percent, which resulted in a cut to the rates of 0.1 percent. In 2016, the CPI-U was 0.1 percent and the productivity adjustment was 0.5 percent, which resulted in a cut of 0.4 percent. 
  • GPCI Increases. The ACA made a temporary change to the practice expense component of the physician geographical price cost index (GPCI), which is the entire GPCI for reimbursement under the Medicare ambulance fee schedule. The change established a minimum 1.0 GPCI for ambulance payments from January 1, 2010, to December 31, 2010. As a result of these changes, rates under the Medicare ambulance fee schedule for localities with a GPCI of less than 1.0 saw an additional temporary increase in reimbursement rates. Localities with a GPCI of 1.0 or higher were not be affected by the provision. The provision was retroactive to January 1, 2010 and the increases escalated for 2011 before expiring on December 31, 2011.

The ACA also established a permanent GPCI floor of 1.0 for “frontier” States which took effect in 2011. The designation of a “frontier” applies to those states in which 50 percent of the counties are frontier which have less than 6 people per square mile. The designation is updated with the original frontier states consisting of Montana, North Dakota, South Dakota, Utah and Wyoming. Utah is no longer deemed frontier and Nevada has been added to the list. While a complete repeal of the ACA would not impact the temporary GPCI increases as the provisions were temporary, it would eliminate frontier status.

Community Paramedicine’s Growth Hindered by Reimbursement Issues

From Politico’s “Reimbursement issues block paramedics from expanded role“—

Despite the track record of [community paramedicine] initiatives in places like Nevada and Texas, where paramedics are providing in-home care, coordinating patient services and saving millions in the process, Medicare, Medicaid and most private insurance plans still won’t reimburse for such work. The program successes to date are only beginning to change that…

Nationwide, the impact from reducing ambulance calls and demands on ERs while freeing up doctors could be huge. A 2013 study in Health Affairs estimated that more flexible reimbursement for paramedicine approaches could save Medicare $283 million to $560 million annually and similar sums for private insurers.

Kaiser Health News: REMSA Paramedics Steer Non-Emergency Patients Away From ERs

Innovation in Reno
REMSA program empowers EMS, helps patient outcomes, and cuts costs.

Yesterday Kaiser Health News reported that AAA member organization Regional Emergency Medical Services Authority (REMSA), is serving its community in innovative ways that reduce healthcare costs and improve patient outcomes. Initiatives led by REMSA CEO Jim Gubbels empower Reno paramedics to lower the number of preventable emergency room visits and close gaps in primary health care.

Using a $9.8 million federal grant, [REMSA CEO Jim Gubbels’] agency launched three different projects. In addition to providing paramedic home visits and offering patients options besides the ER, the agency started a nurse-run health line to give people with health questions another number to call in non-emergency situations.

An early evaluation by the University of Nevada, Reno, which was based on insurance claims and hospital data, shows that the projects saved $5.5 million in 2013 and 2014. They helped avoid 3,483 emergency department visits, 674 ambulance transports and 59 hospital re-admissions, according to the preliminary data. The federal government plans to do its own evaluation.

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