Tag: Utah

AAA Comments on Pandemic and All-Hazards Preparedness Act (PAHPA)

Written by AAA Staff on March 29, 2023. Posted in Legislative.

March 28, 2023

The Honorable Bernie Sanders
Chair
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510

The Honorable Bob Casey
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510

The Honorable Bill Cassidy
Ranking Member
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510

The Honorable Mitt Romney
Health, Education, Labor, & Pensions Committee
United States Senate
Washington, DC 20510

Dear Chair Sanders, Ranking Member Cassidy, Senator Casey, and Senate Romney,

I am writing on behalf of the American Ambulance Association (AAA) to provide comments on policies the Committee should consider during the reauthorization of the Pandemic and All- Hazards Preparedness Act (PAHPA).

The members of the AAA provide mobile health care services to more than 75 percent of Americans. These essential mobile health care services include the local operation of the 9-1- 1 emergency medical services (EMS) system, as well as both emergent and non-emergency interfacility care transition ambulance services and transportation. Often ground ambulance service organizations are the first medical professionals to interact with individuals in need of a health care encounter. These organizations also serve as the health care safety net for many small communities, especially those located in rural areas where other providers and suppliers have reduced their hours of operation or left the community altogether. As such, these organizations play a critical and unique role in the country’s health care infrastructure.

Ground ambulance services are essential to our nation’s emergency medical response system, whether they are needed for a pandemic, natural disaster, or terrorist attack. The country’s EMS system requires federal support to ensure the availability of a well-trained workforce to provide these ground ambulance services. Ground ambulance services are also essential to protecting patient access to the right level of facility-based treatment options.

I. Support for Jurisdictional Preparedness and Response Capacity: Hospital Preparedness Program / ASPR activities financed through the general HHP budget

The AAA supports continued funding for the Hospital Preparedness Program (HPP). Our members have been working closely with the Assistant Secretary for Planning and Evaluation (ASPR) to find ways to direct some of the currently allocated HPP dollars to support ground ambulance services, particularly to address the workforce crisis and support expanded recruitment and training for emergency medical technicians (EMTs) and paramedics. During these discussions, it has become clear that more direct language authorizing the use of a specified portion of the HPP funds to support non-governmental and governmental ground ambulance services would allow ASPR to tackle this issue in a timelier manner.

Ground ambulance service organizations are facing crippling staffing challenges that threaten the provision of crucial emergency healthcare services at a time of maximum need. As we face a pandemic that waxes and wanes but does not end, our 9-1-1 infrastructure remains at risk due to these severe workforce shortages. The 2022 Ambulance Employee Workforce Turnover Study by the American Ambulance Association (AAA) and Newton 360 – the most sweeping survey of its kind involving nearly 20,000 employees working at 258 EMS organizations — found that overall turnover among paramedics and EMTs ranges from 20 to 30 percent annually with organizations on average having 30% of their paramedic positions open and 29% of their EMT positions.

The Congress and the President recognized the crisis and the FY23 Consolidated Appropriations called on ASRP to address this shortage by implementing a grant program to support non- governmental and governmental ground ambulance suppliers and providers through the HPP to address emergency medical services preparedness and response in light of the workforce shortage. While this language is helpful, the AAA recognizes that authorizing authority would provide a more sustainable approach to support an EMS workforce grant program.

Such a program would be consistent with the goals of ASRP. The FY24 HHS Budget in Brief highlights to goal of making “transformative investments in pandemic preparedness and biodefense across HHS public health agencies to enable an agile, coordinated, and comprehensive public health response to future threats and protect American lives, families, and the economy.” (HHS Budget in Brief 142). Ground ambulance medical services are an essential part of this preparedness and response goal.

Our nation’s ground ambulance service organizations, EMTs, and paramedics need Congress to address the EMS workforce challenges facing these front-line health care workers by including direct authority to use $50 million of the HPP funding to establish an EMS workforce grant program to address the crippling EMS workforce shortage, including in underserved, rural, and tribal areas and/or address health disparities related to accessing prehospital ground ambulance healthcare services, including critical care transport. The grants would be available to governmental and non-governmental EMS organizations to support the recruitment and training of emergency medical technicians and paramedics. The program would emphasize ensuring a well-trained and adequate ground ambulance services workforce in underserved, rural, and tribal areas and/or addressing health disparities related to accessing prehospital ground ambulance health care services.

This program is critically important to supporting the non-governmental and governmental ground ambulance service organizations that are the backbone of the country’s first emergency medical response system. The dollars would be used to provide grants directly to non- governmental and governmental ground ambulance service organizations to support training and retention programs, such as paying for initial training; providing tuition for community colleges EMT/ paramedic training courses; paying for required continuing education courses; supporting costs related to licensure and certification; and supporting individuals in underserved areas with transportation, child care, or similar services to promote accessing training.

II. Gaps in Current Activities and Capabilities: Gaps in HHS’ capabilities and what activities or authorities needed to fulfill intent of PAHPA and related laws

The most significant gap in PAHPA and HHS on preparedness and readiness activities is the exclusion of non-governmental entities from many of the federal programs targeted to first responders and EMS. This oversight results in more than one-third of local communities and their citizens not being able to access or benefit from the programs and funding that Congress intended be provided to support them. The AAA requests that the Committee recognize the decision-making authority to rely on non-governmental ground ambulance service organizations and provide access to programs that are currently available to governmental organizations.

During the pandemic, non-governmental local community ground ambulance organizations were not permitted to apply for or participant in many of the federal grant programs in place during the pandemic. As a result, these programs fell short of the goal of supporting preparedness and response activities at the local level.

The distinction between governmental and non-governmental appears to be based on outdated assumptions that first responders are only governmental or not-for-profit entities. This assumption ignores the decisions of state and local governments to contract with private ground ambulance service providers and suppliers to provide 911 or equivalent services. The federal government should respect these local decisions and support all ground ambulance services as first-responders and EMS.

One example of this problem is the FEMA public assistance grant program that reimbursed “first responders” for PPE and other expenses related to the response to COVID-19. When non- governmental (including not-for-profit) emergency ambulance service organizations sought direct reimbursement under the program, they were turned away. This differential treatment impacts communities across the United States, including those in Arkansas, California, Colorado, Florida, Georgia, Indiana, Louisiana, Massachusetts, Mississippi, Nevada, New York, Oregon, Texas, and Wisconsin, among others.

Appendix A includes list of some of the program the AAA has identified that should reviewed and updated to include non-governmental entities.

The solution to this problem is to use the more inclusive language that the Congress adopted in the Homeland Security Act of 2002 (6 U.S.C. § 101) on non-governmental and governmental entities within the definition of “emergency response providers.” This language provides access to all ground ambulance services and the communities they serve to funding when available to support preparedness and response activities.

III. Conclusion

On behalf of ground ambulance service organizations of the AAA, I want to thank you for the opportunity to provide comments on the PAHPA. We look forward to working with your team as you continue develop these policies.

Sincerely,

Randy Strozyk President

Appendix A: Grant Program for Review

ASSISTANCE TO FIREFIGHTERS GRANT (AFG)

http://www.firegrantsupport.com/afg/faq/08/faq_emer.aspx#q1

The grant program prohibits “for-profit” organizations from applying for grant funding.

STAFFING FOR ADEQUATE FIRE AND EMERGENCY RESPONSE (SAFER)

Retrieved from http://www.firegrantsupport.com/safer/faq/08/faq_elig.aspx#q1

Only fire departments and volunteer firefighter interest organizations are eligible for SAFER grants.

FEDERAL DISASTER RELIEF FUNDS

$45B to reimburse activities such as medical response, procurement of PPE National Guard deployment, coordination of logistics, implementation of safety measures, and provision of community services. According to FEMA, these funds will cover overtime and backfill costs; the costs of supplies, such as disinfectants, medical supplies and PPE; and apparatus usage. (The federal government will cover 75% of these costs.) NAEMT recommends FEMA’s new sheet on FEMA’s Simplified Public Assistance Application. In addition, you should consult with their state emergency managers to begin the process of being reimbursed. Eligible to apply: Public and some non-profit services.

Emergency Management Baseline Assessment Grant Program

The Emergency Management Baseline Assessment Grant (EMBAG) program provides non- disaster funding to support developing, maintaining, and revising voluntary national-level standards and peer-review assessment processes for emergency management and using these standards and processes to assess state, local, tribal, and territorial emergency management programs and professionals.

Nonprofit Security Grant Program

The Nonprofit Security Grant Program (NSGP) provides funding support for target hardening and other physical security enhancements and activities to nonprofit organizations that are at high risk of terrorist attack.

SIREN ACT

The Siren Act supports public and non-profit rural EMS agencies through grants to train and recruit staff, fund continuing education, and purchase equipment and supplies from naloxone and first aid kits to power stretchers or new ambulances.

ASPR – NATIONAL BIOTERRORISM HOSPITAL PREPAREDNESS PROGRAM

Eligibility requirements exclude for-profit private EMS.

PUBLIC SAFETY OFFICERS’ DEATH BENEFIT

Public Safety Officers’ Benefits Improvements Act of 2011 (S. 1696).

Added non-profits (but still excluded for profits) in the Public Safety Officers’ Benefit (PSOB) program. This legislation extended the federal death benefit coverage to paramedics and emergency medical technicians (EMTs) who work for a private non-profit emergency medical

services (EMS) agency and die in the line of duty and thank you for including the language of the Dale Long Emergency Medical Service Providers Protection Act (S. 385) in this new bill. Congress established the Public Safety Officer Benefit program to provide assistance to the survivors of police officers, firefighters and paramedics and emergency medical technicians in the event of their death in the line of duty. The benefit, however, currently only applies to those public safety officers employed by a federal, state, or local government entity and non-profits.

URBAN AREA SECURITY INITIATIVE (UASI) & METROPOLITAN MEDICAL RESPONSE SYSTEM (MMRS)

Retrieved from http://www.iowahomelandsecurity.org/Portals/0/CountyCoordinators/Grants/FFY09HSGPguida nce.pdf

Inclusion of Emergency Medical Services (EMS) Providers

DHS requires State and local governments to include emergency medical services (EMS) providers in their State and Urban Area homeland security plans. In accordance with this requirement, and as States, territories, localities, and tribes complete their application materials for the FY 2009 HSGP, DHS reminds our homeland security partners of the importance for proactive inclusion of various State, regional, and local response disciplines who have important roles and responsibilities in prevention, deterrence, protection, and response activities. Inclusion should take place with respect to planning, organization, equipment, training, and exercise efforts. Response disciplines include, but are not limited to: governmental and nongovernmental emergency medical, firefighting, and law enforcement services; public health; hospitals; emergency management; hazardous materials; public safety communications; public works; and governmental leadership and administration personnel.

INTEROPERABLE COMMUNICATIONS GRANTS

Retrieved from http://www.fema.gov/government/grant/iecgp/index.shtm

Eligibility and Funding

The Governor of each State and territory has designated a State Administrative Agency (SAA), which can apply for and administer the funds under IECGP. The SAA is the only agency eligible to apply for IECGP funds.

TECHNOLOGY TRANSFER PROGRAM (CEDAP)

Retrieved from http://ojp.usdoj.gov/odp/docs/cedap_factsheet_2008.pdf

Eligibility

Eligible applicants include law enforcement agencies, fire, and other emergency responders who demonstrate that the equipment will be used to improve their ability and capacity to respond to a major critical incident or work with other first responders. Awardees must not have received technology funding under the Urban Areas Security Initiative, or the Assistance to Firefighters Grants program since Oct. 1, 2006. Organizations must submit applications through the Responder Knowledge Base (RKB) website at www.rkb.us.

Spotlight: Gold Cross Ambulance Celebrates 50 Years in Business

Written by Aidan Camas on April 3, 2018. Posted in News, Service, Spotlight.

Gold Cross Ambulance Celebrates 50th Anniversary!

When Gene Moffitt founded Gold Cross Ambulance in March 1968, he didn’t know that 50 years later the company would be where it is today, the longest-running and largest private ambulance service in Utah.

At its core, Gold Cross is a family-run business. In fact, Gold Cross started out of the Moffitts’ home after he rented two Cadillac ambulances. In the beginning, Moffitt and two or three other employees responded to calls from the family home, where his wife, Julia, oversaw dispatch operations while caring for their young children. Julia has been central to the business since the beginning and has played an essential role in Gold Cross’s continued success.

Today Gold Cross employs over 500 people, operates around 140 ambulances, and responds to hundreds of 911 calls a day. Despite this growth, Gold Cross remains a family business with deep roots in the community—something that the Moffitts are very proud of.

Moffitt points to a couple of factors that have made Gold Cross’s journey a successful one. First, he’s always had a knack for being in the right places at the right time. But he believes that being honorable to the commitment he has made to provide high-quality healthcare to the people of Utah has been critical to his company’s ongoing success. “Success has not come to Gold Cross without much sacrifice over the years,” Moffitt says. “Growing and expanding has not been an easy process, but with dedication and a bit of luck, Gold Cross has been able to overcome the many trials and tribulations we’ve faced.”

Of course when you’ve been in business for 50 years, you’ll have seen many changes to your industry. Moffitt says one of the biggest changes he’s witnessed has been the buyouts of many ambulance services over the years, and that’s something he believes has been both good and bad for the industry. “When large companies buy out smaller ones,” he explains, “the connection of the ambulance service to the community that there was in the past is lost.” Moffitt notes that Gold Cross has never tried to go into another area unless it has been asked to. “Going into a new area to provide service is a delicate process,” he says. ”You must re-prove yourself to the community while being sensitive to the locals and to employees who may come over from the previous provider.” As a family-run business, nurturing the bond between Gold Cross and the communities it serves has always been very important to the Moffitt family.

Looking back on a more personal level, Moffitt has many memories he is proud of. The other day he came across a photo of one of the first babies that Gold Cross transported by ambulance in 1968 or 1969. Gold Cross worked closely with Dr. Larry Jung, a pioneering neonatologist, to help him provide life-saving care to children in Utah. “I’m in awe of how the medical community has really evolved over the last 50 years to give sick newborns and infants a better chance to live,” Moffitt says, smiling. “The baby in that photo would now be 50 years old!”

Gold Cross was also involved in the first heart transplant that took place in Utah. Gold Cross helped the hospital move the patient back and forth with the tremendous amount of equipment necessary for the procedure. The company also played a large role in the Salt Lake City Olympics back in 2002.

Moffitt also made many lifelong friendships because of his involvement with the AAA, including through his work as a past President of the association. He notes that the early AAA days were very important to his work at Gold Cross, giving his ambulance service access to resources and information that Gold Cross would not have had on its own. “The AAA helps foster a friendly relationship amongst providers,” he adds, “and members are very willing to share information about best practices and other experiences.”

Moffitt is working on bringing the company’s past and present together very visually, while giving a confident nod to the future. Gold Cross is refurbishing its remaining 1960 Cadillac ambulances and has also purchased a new ambulance to celebrate the 50^th anniversary. When the brand-new ambulance is shown off alongside the 1960s ambulance, it will give a clear picture of where Gold Cross has come from and where the company is going.

New Gold Cross 50th Anniversary Ambulance

And of course there will be numerous celebrations with staff and family, both of whom have been critical to Gold Cross’s success over the years.

One thing that has stayed exactly the same? Moffitt’s vision for Gold Cross—“to provide quality medical care and customer service to anyone, regardless of race, creed, color, religion, or the ability to pay.”

Please join the AAA in congratulating Gene, Julia, the Moffitt family, and Gold Cross Ambulance on 50 years of providing high-quality healthcare to the people of Utah.

Congratulations, and here’s to many more successful years!

REPLICA Compact Enacted

Written by Suzanne Prentiss on May 9, 2017. Posted in News, Press, Professional Standards.

REPLICA Meets Goal, Interstate Compact Becomes Official

May 8, 2017
For Immediate Release
Contact:
Sue Prentiss
603-381-9195
prentiss@emsreplica.org

May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of
Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official.
Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS
licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas,
Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.

Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual
to provide pre-hospital care across state lines under authorized circumstances. According to Keith
Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA
represents a collective, nationwide effort to address the problems faced by responders when needing
to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to
“increase access to healthcare, reduce regulatory barriers for EMS responders, and place an
umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages
also noted that the partnership with the National Registry of Emergency Medical Technicians
(NREMT) has been essential during the advocacy and implementation phases. “We are grateful for
their continued support and contributions.”

Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS,
fire, law enforcement organizations and associations as well as key federal partners in the design and
drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize
the development of the Commission.

The compact calls for establishment of an Interstate Commission with each state that has passed
REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states
will be able to rapidly share personnel licensure information, develop policy focused only on cross
border EMS practice, and hold EMS personnel originating in other states accountable in an
unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development
and hosting of the coordinated database.

Twelve national associations and organizations support REPLICA. Three states have REPLICA bills
under consideration in their legislative sessions. Learn more at www.emsreplica.org.

###

ACA Repeal & Reform – What It Means for Ambulance Services

Written by Tristan North on March 20, 2017. Posted in Government Affairs, Member Advisories.

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.

2016 AMBY Best Quality Improvement Program: Gold Cross Ambulance, Documentation Program

Written by Amanda Riordan on November 5, 2016. Posted in AMBY, Awards, Community, News.

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.

Gold Cross Ambulance’s Documentation Project Project Awarded a 2016 AMBY for Best Quality Improvement Program

Gold Cross Ambulance | Utah

The documentation review process at Gold Cross Ambulance had not changed much since the day of paper trip tickets. Retrospective documentation feedback was being given to crews, but they were not fully utilizing the capabilities of their technology to analyze the feedback and make significant improvements. Gold Cross Ambulance hypothesized that improved documentation goals would lead to better patient care and increased reimbursements. They knew they needed to make improvements in the review process and to better utilize the technology that was already in place. In addition to the documentation goals, they identified the opportunity to work some small, but significant, clinical improvements into a documentation project. One initial focus of clinical improvement was making sure the field crews were obtaining at least two sets of vital signs on every patient, and properly documenting these vital signs in the electronic patient care report (ePCR). Of all the performance indicators we measure, trending of vital signs touches every patient contacted. Educators from Utah EMS for Children shared research citing “inadequate recognition of and response to hypotension and hypoxia was associated with higher odds of disability and death” (Hewes H., 2016). This was such a basic thing to measure, but it had potential to impact every contacted patient. Gold Cross know that vital signs were an area in which they could improve, while also meeting their documentation goals. To do so, they implemented the following:

Create a way to measure overall documentation quality.
Establish a formal standard for documentation and educate crews about the documentation expectations.
Improve the overall documentation of the ePCR.
Improve the number of patients with properly collected and documented vital signs.
Improve amount of reimbursement and decrease collection cycle time.

Gold Cross formed a work group to tackle these issues, which consisted of members of the Quality Department, Training Department, Billing Department, and Operations Department. The group meets every other week to evaluate progress and assess the need for adjustments to the system. Mid-year of 2014, the group worked to revise the program for documentation evaluation. A new standard was created based on the ePCR fields. A point system was established for documentation which gave each ePCR field a weighted number of points, equaling 100%. Incomplete or missing fields result in a loss of points for that field, which provided a way to measure documentation performance. The scoring data is tracked in our ePCR quality module, allowing us to analyze and report on the data easily. The feedback on any areas of missed points is sent to the crew via the ePCR messaging system, so it is easily accessible to the crews during regular daily tasks. Feedback is focused on improvement comments instead of punitive comments. Positive feedback is included in each evaluation. The group released an initial version of the General Instructions for the ePCR, which was an internal manual detailing expectations for every field in our ePCR. The focus was to provide clear expectations to all field crews regarding how to properly fill out the ePCR and what content should be included. The training department created an educational program on the online educational software program, detailing the documentation guidelines and testing the crews on the material. The General Instructions for the ePCR were also posted on the company training site, so crews would have easy access at any time. The Quality Department developed a class for the newly hired providers. The class emphasizes the need for quality documentation, outlines the program, and includes actual documentation examples for evaluation and discussion. Patient advocacy through documentation is instilled in the participants of this class. The Billing Department developed a class which is taught at six months after hire. In the class, documentation is reviewed from class participants. The billing department shows how the bill is processed from the documentation, and they discuss common challenges to the billing process. The program has been monitored with continuous PDSA cycles and has been adjusted as needed for continued improvement.

An initial company goal for documentation was set at 90%. From project start to current date, the company-wide documentation averages have increase from 74% at the beginning of the project to 96% currently. Field crews have expressed greater clarity in the company expectations for documentation. The overall average documentation scores by division are posted regularly for the company to view, and this has had the additional benefit of sparking a competitive streak between some of our divisions, further improving the scores. The improvement in collection of vital signs not only improved overall patient care, but resulted in a Performance Improvement Award from the Utah State Bureau of EMS in 2016. The bureau looked at pediatric vital signs and recognized two rural and two urban EMS agencies in the state for their improvements. Gold Cross Eastern Division won the award for a rural agency, and Gold Cross Salt Lake Division won for the urban agency. Their study found our agency improved the collection of pediatric vital signs by 53% in our urban area and 66% in our rural area.

The most important impact of this project is improvement in patient care, which is our primary mission. The goals for complete documentation have encouraged field crews to make sure they complete proper assessments, since they know those areas of the ePCR are evaluated and must be complete. Improvements in assessment result in better differential diagnoses and improved treatment plans and outcomes. The documentation project has positively impacted Gold Cross financially as expected. Reimbursement rates have increased and the time to complete the collection cycle has improved. Due to the documentation improvements, the billing staff spends less time researching information, following up on incomplete documentation, and fighting in appeals.

Congratulations to Gold Cross Ambulance for the Reduced Readmissions Project’s selection as a 2016 AMBY Winner for Best Community Impact Program.