Gold Cross Ambulance
Salt Lake City, Utah
Gold Cross Ambulance was founded in 1968 with the vision of providing quality medical care and customer service to anyone regardless of race, creed, color, religion. or the ability to pay.
Gold Cross Ambulance employs highly trained and certified paramedics, EMTs, and other medical professionals. With a fleet of specially-equipped emergency vehicles and a state-of-the-art communications center, Gold Cross responds to calls in Salt Lake, St George, Uintah, Utah, Washington Iron, and Juab Counties.
Gold Cross Ambulance exceeds all established standards for emergency response protocols and is fully integrated with other local, county, state, and national emergency response agencies to assure a seamless benefit to the community. The company is certified by the Commission on Accreditation of Ambulance Services (CAAS) and is the first ambulance provider in Utah to achieve this national distinction. Gold Cross is the 112th Center for Excellence with ACE Accreditation from the International Academies of Emergency Dispatch IAED.
In 2020, Gold Cross Ambulance in Salt Lake City, Utah met the challenges of COVID-19 by closing their buildings to non-employees and assessing the impact on EMTs and Paramedics. Extensive measures were implemented to protect employees, patients, and the communities they serve. As management learned more about the virus, they adapted and refined best practices.
Gold Cross established protocols to determine if a patient was exhibiting signs of COVID-19 so EMS crews could don PPE. Ambulances were routinely taken out of service and crews performed a stringent two-hour decontamination process.
In addition to COVID-19 cases, Gold Cross teams were shaken by a 5.7 magnitude earthquake on March 18, but continued working. September 8, Salt Lake experienced hurricane-force winds that uprooted hundreds of trees, and Gold Cross crews were ready to assist. October 7, Salt Lake welcome the Vice Presidential Debate and Gold Cross worked closely with the Secret Service to assure the safety of the candidates.
2020 tested the company’s capability to respond to unprecedented events. Gold Cross has affirmed that they can withstand any crisis and are ready to react quickly and effectively.
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 50th 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.
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!
Governor Kay Ivey recently signed into law Alabama’s REPLICA legislation, HB250. Alabama joins ten other states—Colorado, Texas, Virginia, Idaho, Kansas, Tennessee, Utah, Wyoming, Mississippi, and Georgia—in this forward-thinking interstate compact.
REPLICA, the Recognition of EMS Personnel Licensure Interstate Compact, recognizes the day-to-day movement of EMS personnel across state lines. It extends the privilege to practice under authorized circumstances to EMS personnel based on their home state license, as well as allows for the rapid exchange of licensure history between Compact member states..
REPLICA Meets Goal, Interstate Compact Becomes Official
May 8, 2017
For Immediate Release
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.
Washington, DC– The American Ambulance Association (AAA) will honor Senator Orrin Hatch of Utah with a Legislative Recognition Award in appreciation of his advocacy for emergency medical services. Senator Hatch will be presented this award by representatives of Gold Cross Ambulance, a trusted family-owned EMS provider in the Salt Lake area.
Senator Hatch receives the Legislative Recognition Award for his leadership on health care issues, as well as his support of the Medicare temporary ambulance add-on payments. Senator Hatch also supported a system for collecting ambulance cost data utilizing a survey methodology that would likely result in usable information while preventing an undue burden on ambulance providers.
AAA President Mark Postma notes, “Senator Hatch has demonstrated outstanding leadership and dedication to health care and emergency medical services, both in Utah and across our country. The AAA is proud to present him with Legislative Recognition Award.”
Now in his seventh term as Utah’s senator, Orrin Hatch is the most senior Republican in the Senate. He is the Chairman of the Senate Committee on Finance. He is also a member (and former Chairman) of the Judiciary Committee; a member (and former Chairman) of the Senate Health, Education, Labor, and Pensions Committee; and a member of the Joint Committee on Taxation.
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About the American Ambulance Association
Founded in 1979, the AAA represents hundreds of ambulance services across the United States that participate in emergency and nonemergency care and medical transportation. The Association serves as a voice and clearinghouse for ambulance services, and views prehospital care not only as a public service, but also as an essential part of the total public health care system.
AAA 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.
The American Ambulance Association is proud to announce the winners of the 2017 AAA Legislative Awards, in recognition of their strong advocacy for emergency medical services. Each legislator was chosen for their ongoing service to the ambulance services of the United States.
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.
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.
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.