News & Updates

Our neighbors to the north have typically been a bit more transformative in EMS delivery than we in the states!

We know this because a couple of the AIMHI member agencies are high performance / high value members of AIMHI.

This model makes a lot of clinical, operational, and financial sense, and allows skilled EMS clinicians to not only respond to the low-acuity 911 calls, but also allows EMS crews in the field to triage patients who do not meet clinical criteria for a transport to the ED, to be treated in place, with a CP follow-up visit.

Very innovative, and patient-centric approach to system redesign!

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P.E.I.'s new paramedic units aimed at reducing demands on ambulances, ERs

Units could help free up ambulances in rural parts like Souris, West Prince

Stu Neatby · Journalist

5/8/24

https://www.saltwire.com/atlantic-canada/news/peis-new-paramedic-units-aimed-at-reducing-demands-on-ambulances-ers-100963025/

Health decision-makers say a new non-ambulatory unit could help keep more ambulances in rural areas like West Prince and Eastern Kings.

On May 7, Health Minister Mark McLane announced the province’s ambulatory provider, Island EMS, has officially launched new community paramedic response units (CPRU) – paramedic units intended to help 911 calls for patients with lower acuity needs.

McLane said as many as 35 per cent of 911 calls are from patients who don’t need to go to hospitals. He said the new CPRU units will be staffed by advanced care paramedics who can provide in-home treatments or referrals.

"This could save the patient a ride to the emergency department if they don't need to go there. Paramedics will connect the patient with appropriate care within the community," McLane said at a news conference the Island EMS office in Charlottetown.

The new units have been operating in an unofficial capacity since the fall, but Tuesday’s announcement signalled that the appropriate policy protocols for these CPRU teams are in place.

In lieu of ambulances, the CPRU paramedics will be transported via a Chevy Traverse or Subaru Outback stamped with the word "paramedic" on the hood.

Wait times

The province’s ambulance response times have grown longer across the board in both urban and rural community over the last year.

The wait times are longest in Souris, O’Leary and Alberton, which have median response times longer than 20 minutes. This compares to just over 15 minutes in Charlottetown, 12 minutes in Summerside and just over 12 and a half minutes in Stratford.

James Orchard, general manager of P.E.I. operations for Island EMS, said the new units will help free up ambulances, particularly those based in areas around Souris, Montague, O’Leary and Alberton, to get to emergencies faster.

Orchard said around half of 911 calls are based in Charlottetown.

"A lot of times the rural ambulances are being drawn into the centres because that's where the call volumes are. But, of course, all it takes is one call out in a very rural area and now we're behind the eight-ball to get to that call,” Orchard said.

"These units can handle that volume so that our rural ambulances are not pulled into it.”

Across P.E.I., the median ambulance response time was 14 minutes and 41 seconds for the period between Jan. 1 and March 31 of 2024. That’s 3 minutes and 24 seconds longer than the same time period in 2023.

Two of the community paramedic response units will be based in Charlottetown while one will be located in Summerside.

Helping patients

Orchard said patients often do not know how to navigate the health system. He said paramedics are well situated to be “advocates and navigators” for patients.

“People don't know what resources are really, in some cases, just down the street for them. In a lot of those cases, those resources are available, we just don't know about them," he said.

Dr. Scott Cameron, the provincial medical director for emergency health services, said these units could also help alleviate some of the stresses in emergency rooms.

“When 911 is called and paramedics arrive on the scene, patients will be triaged. Patients must meet the clinical indicators to be transported to the emergency department,” Cameron said at the May 7 news conference.

“If they do not meet clinical indicators for transport, Island EMS paramedics will leverage the CPRU team as necessary."

Tyler Graves, the president of the Paramedic Association of P.E.I. and a member of the new units, says the new units will allow more advanced care paramedics like himself to work to their full scope of practice.

"It's a huge opportunity for paramedics to just kind of prove that we can practise at a higher level,” Graves said. "But then also for the communities, it helps get people out of the hospital and keeps them out of the hospital if there's things that we can be doing at home."

Source Article

This action is helpful, since many EMS systems are using telehealth for service delivery, as well as participating in Hospital at Home programs.

Further, the extension of the Ambulance Access Act of 2024 is crucial to EMS system sustainability.

The House Ways and Means Committee has been staunch advocate of advancing the EMS profession! Their actions today are a further demonstration of their commitment to help patient’s access care, and EMS systems.

Recall that Dr. Ed Racht and I were invited to provide testimony at the Ways and Means Committee Field Hearing at GMR’s North Texas Headquarters. Committee members expressed support for EMS systems, and payment reform to include reimbursement for Treatment in Place (TIP).

To view the EMS specific parts of that hearing, click this link.

Following that hearing, Ways and Means Committee Chair, Jason Smith, met with several of us during NAEMT’s EMS on the Hill Day in April!

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House committee advances bill to extend telehealth rules

MICHAEL MCAULIFF

May 08, 2024

https://www.modernhealthcare.com/politics-policy/telehealth-rules-waiver-extension-congress

Congress took the first step Wednesday to extend expiring telehealth rules, hospital at home services and other programs aimed at rural hospitals.

The House Ways and Means Committee passed the Preserving Telehealth, Hospital, and Ambulance Access Act of 2024 by a vote of 31-0, setting it up for passage by the full House later this year.

The bill would extend for two years telehealth rules adopted during the pandemic that are due to expire at the end of the year, as well as extend similar rules for Medicare's hospital at home program for five years.

The measure also expands the practitioners eligible to bill Medicare for telehealth services to physical therapists, occupational therapists, audiologists and speech language pathologists. And it allows federally qualified health centers and rural health clinics bill Medicare for telehealth services, and delays in-person visit requirements for remote mental healthcare.

"One of our top priorities on this committee is helping every American access healthcare in the community where they live, work and raise a family. In rural America, in small towns, families often struggle to get healthcare," Ways and Means Committee Chair Jason Smith (R-Mo.) said. "Without this bill, beneficiaries will no longer be able to talk to their doctors or receive acute hospital care from the comfort of their home, starting at the end of this year."

While the bill received broad bipartisan support, many of the Democrats on the committee complained that Republicans failed to include significant fraud prevention measures.

"it's difficult to view this bill as progress with regard to fraud since it gives [the Centers for Medicare and Medicaid Services] no new authority, and no new enforcement tools," said Rep. Lloyd Doggett (D-Texas).

"There's much more to do here to protect consumers," said the ranking Democrat on the committee, Rep. Richard Neal (Mass.)

Republicans agreed that more should be done to target fraud, but suggested it should be addressed in a different, broader bill.

One potentially controversial provision in the bill requires pharmacy benefit managers that work with Medicare Part D plans to de-link the compensation they pay themselves from the rebates they secure based on drugs' high list prices. Rep. Brad Schneider (D-Ill.) said the provision will save the government about $500 million, although official estimates were not yet available. The provision does not apply to the broader commercial market, though Schneider and Rep. Nicole Malliotakis (R-N.Y.) both called for expansion of the provision to the commercial market. Large PBMs oppose such provisions.

Other extensions in the bill cover Medicare’s Low Volume Adjustment and the Medicare-Dependent Hospital Program, which give rural hospitals bonus payments, and are due to expire at the end of 2024. The payments would be extended until September 2025. The bill includes a nine-month extension for Medicare add-on payments for ambulance services in areas with poor access. Republicans opposed amendments to add more time to the extensions, saying they were not paid for.

The committee is still considering several other bills designed to ease stresses on rural hospitals. Among them:

• The Preserving Emergency Access in Key Sites Act of 2024, which would boost ambulance payments for hospitals in locations that are hard to reach.
• The Rural Hospital Stabilization Act of 2024 to boost grants to rural hospitals.
• The Rural Physician Workforce Preservation Act of 2024 to require that 10% of 1,200 recently approved Medicare graduate medical education training slots go to rural hospitals.
• The Second Chances for Rural Hospitals Act of 2024, which would allow rural hospitals that closed as long ago as 2017 to reopen as Rural Emergency Hospitals, which receive $276,000 monthly payments from Medicare to support 24-hour emergency services.

Democrats suggested that because of objections they raised, the bills would not pass in the Democratic-controlled Senate. Republicans argued that the House should not worry what the Senate might do.

Whether the Senate ever takes up the specific bills, passing them through the committee and likely through the full House makes them available for negotiations that are likely to begin once the November elections are over and Congress grapples with unfinished business.

"Many of these bills won't become law," Neal said. "There's much more we could have done and likely we will do, post-election time."

Kudos to the team at Atrium Health on this amazing accreditation!

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Atrium Health Earns First Accreditation in Mobile Healthcare, Paramedicine

'The accreditation serves as a symbol of excellence'

By SARAH ROSE • News Writer

May 7, 2024

https://www.ainonline.com/aviation-news/general-aviation/2024-05-07/atrium-health-earns-first-accreditation-mobile-healthcare

The Commission on Accreditation of Medical Transport Services (CAMTS) announced that Atrium Health’s Mobile Integrated Health, Mobile Medicine from Charlotte, North Carolina, is the first entity that has earned full accreditation under CAMTS Mobile Integrated Healthcare (MIH) Accreditation Standards.

“For Atrium Health’s Mobile Integrated Health team, this accreditation signifies our organization's commitment to providing safe, high-quality medical care by meeting specific criteria related to safety, equipment, quality, training, and operational procedures to patients in our communities. This accreditation serves as a symbol of excellence within the industry, and we are proud to have it.” said Atrium MIH director Amanda Williams.

For accreditation, the program completes a self-assessment using a standards compliance tool. Once submitted, the standards compliance tool is reviewed for compliance and completeness before site surveyors visit the program to interview the staff.

“We knew it would be a while after we published the standards for programs to apply and complete the process," said CAMTS executive director Eileen Frazer. "Most programs need as much as a year to prepare documents, policies and procedures, education records, meeting minutes, safety documents, etcetera to meet the standards. We ask for a lot of documentation and interview a lot of people in the program as part of the process.”

Another example of a growing number of state legislature’s stepping up to make EMS reimbursement reform a priority. 

This bill not only provides a mechanism for reimbursement for Treatment in Place and Transport to Alternate Destinations, but also removes patients from balance billing disputes by requiring state regulated health plans to reimburse EMS at billed charges, or at least 325% of the Medicare allowable fee.

It was announced yesterday that Governor Tate Reeves signed this bill into law!

Link to the legislation below.

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Bill to increase third-party reimbursements for EMS headed to governor

By Anthony Warren

Apr. 24, 2024

https://www.wlbt.com/2024/04/24/bill-increase-third-party-reimbursements-ems-headed-governor/

JACKSON, Miss. (WLBT) - A bill that will increase compensation for ambulance service providers is on its way to the governor’s desk.

On Wednesday, the state House of Representatives adopted the committee report for H.B. 1489, the “Mississippi Triage, Treat and Transport to Alternative Destination Act,” a bill that would, in part, increase how much insurance companies must pay ambulance firms for services provided.

The House approved the committee report on a 119-0 vote, with three representatives absent or not voting.

The Senate approved the report last week on a 50-0 vote, with one senator absent or not voting, and another senator voting present.

Julia Clarke, president of the Mississippi Ambulance Alliance, was sitting in the House gallery when the measure was approved.

“With this legislation, Mississippi would join our neighbors [in] Louisiana, Texas, Arkansas, and other states in recognizing this is a first-responder cost-of-readiness issue for ambulance providers large and small,” she said. “I’m so pleased they [passed] it.”

Under the act, third-party payors would be required to pay for treatment in place when a patient is not transported to a hospital.

That amount would be the local fees set by the city or county contract or 325 percent of Medicare, whichever is greater. In the absence of a local rate, the ambulance provider would be paid their billed charges or 325 percent of Medicare, whichever is greater, Clarke explained.

Figures provided by the Ambulance Alliance show EMS providers in the state charge between $988 and $1,224.82 for a basic life support emergency response in urban areas. Medicare reimburses those companies just $398.56.

Basic Life Support ambulances are staffed with two EMTs, rather than an EMT and a paramedic. EMTs are trained to provide emergency first aid, assess a person’s condition and determine the treatment needed, and administer some medications, such as epinephrine, according to WebMD.

State Health Officer Dr. Daniel Edney backed the measure, saying the funding will be a major boost for EMS providers, who are currently not paid when a patient refuses transport, or if they’re transported to a facility other than a hospital.

“If an ambulance goes to a home and there’s a diabetic whose blood sugar has dropped, they correct it and stabilize the patient, and the patient [who needs] to go to the ER chooses not to go, then they’re not reimbursed for the services they just provided, which makes no sense,” he said.

“They need to be reimbursed for the care that [they’re] rendering and the cost of that care, which includes running an ambulance and doing all the things it takes to have an ambulance ready to go.”

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Governor Tate Reeves signed into law HB1489

https://billstatus.ls.state.ms.us/documents/2024/pdf/HB/1400-1499/HB1489SG.pdf

From their legislative team:

As a summary, the 1489 bill mandates for Health Benefit Plan Private Insurance to:

• To pay for Treatment in Place (TIP) (lines 61- 96)

• Pay for trips that are Transported to Alternate Destinations (TAD) (lines 39 -54)

• The reimbursement rate for an ambulance service provider whose operators assess, triage, treat or transport an enrollee to an alternative destination shall be not less than the minimum allowable reimbursement for advanced life support rate with mileage to the scene. (line 87-91)

• Out of Network Ambulance to reimbursed for all covered services, which will now include TIP and TAD, at the greater of:
• • Contracted rates between ambulance service and county, municipality, special district or by ordinance (lines 95-103)
  • 325 % of Medicare for respective services originating in the respective geographical area (lines 107-109)
  • The ambulance providers billed charges in the absence of contracted rates between ambulance service and county, municipality, special district or by ordinance (line 104-111)

The importance of receiving the Net Savings to Medicare information from CMS cannot be understated! 

It serves as a basis for the economic valuation that Congress, as well as state and local governments can use to demonstrate the financial savings of changing the EMS economic model from a reimbursement for TRANSPORT, to reimbursement for on scene Treatment in Place (TIP).

Release of this data helps facilitate a Congressional request to the Congressional Budget Office (CBO) to provide a CBO for current the legislation in the House and Senate to reimburse ambulance agencies for TIP services.

Links to the full report in the release below.

Snapshot:

FOR IMMEDIATE RELEASE ET3 Savings Data Supports EMS Treatment in Place Legislation Clinton, Miss. — The National Association of Emergency Medical Technicians (NAEMT) received the data in response to a Freedom of Information Act (FOIA) (5 U.S.C. § 552) request seeking documents from the recently ended Emergency Triage, Treatment and Transport (ET3) pilot program. The report shows that the average Net Savings to Medicare (NSM) per Medicare beneficiary was $537.53 when a patient was treated-in-place instead of taking an ambulance ride to the hospital emergency room, which is one of the most expensive places to receive health care.  EXECUTIVE SUMMARY: Newly available federal data from the Centers for Medicare & Medicaid Services (CMS) demonstrates more than $500 in Net Savings to Medicare per patient encounter under the recently ended ET3 pilot program. The results validate the need for passage of NAEMT-supported federal legislation to enable payment for EMS Treatment in Place (TIP). The ET3 program’s per patient savings to the Medicare program was documented in a March 2023 external fiscal analysis presented to CMS as part of the Development of Performance-Based Payment (PBP) Eligibility and Methodology. This data validates the economic value of EMS Treatment in Place (TIP) payment models and the need for Congressional action to enable payment for TIP. “This data from CMS’ external evaluator proves the significant savings to the Medicare program. We also have patient experience data from patients enrolled in the ET3 program demonstrating that patients who are not transported to the ER have higher patient satisfaction with the EMS response,” said Matt Zavadsky, Chair of NAEMT’s EMS Economics Committee and a member of the CMS ET3 Model Quality Workgroup. “This proves the economic and patient experience benefit of changing the EMS payment model from payment for transport, to payment for the care we provide.” NAEMT has long advocated for providing ambulance agencies the flexibility to navigate patients to the right care in the right setting through federal and state reimbursement of TIP. Medicare currently does not cover TIP as a benefit; therefore, EMS is not reimbursed for care unless a patient is brought to the hospital. The current EMS economic model incentivizes transportation to a hospital emergency department, even when a less expensive level of care is appropriate.   Reimbursing EMS agencies for TIP will save Medicare billions of dollars on unnecessary emergency department visits, enhance patient experience, shorten task times for EMS agencies struggling with workforce shortages, help decompress overcrowded hospitals and emergency departments, and meet patients’ needs without long waits at the hospital. To view the ET3 economic evaluation, click here. To view the current legislation in Congress authorizing CMS to pay for TIP, click here and here. About NAEMT

Without commenting on the continued frustration of the media referring to ambulance ‘rides’, negating the fact that personnel provide medical care, what this report hints at, but does not specifically state, is that most new state legislation requires insurers to pay essentially billed charges, hence limiting out of pocket expense to the patient’s deductible or coinsurance.

You can see recently passed state legislation at the National Conference of State Legislatures’ EMS Bill Tracker here: https://www.ncsl.org/health/emergency-medical-services-legislation-database

Or view other example EMS legislation at NAEMT’s database here: https://naemt.org/advocacy/sample-state-ems-legislation

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More states are adding protections against big ambulance bills

March 27, 2024

Maya Goldman & Tina Reed

https://www.axios.com/2024/03/27/surprise-medical-bills-ambulance-health-costs

More states are jumping in to shield patients from large, unexpected bills for ambulance rides in the absence of federal protections.

Why it matters: Ground ambulances are a major source of surprise bills, and it's unlikely Congress will pursue nationwide protections anytime soon after excluding them from the landmark No Surprises Act in 2020.

The big picture: Patients in an emergency can hardly shop around for an ambulance covered by insurance. More than half of ambulance rides are out of network, putting patients on the hook for surprise bills that typically cost hundreds of dollars.

• Congress carved out ground ambulances from its surprise billing legislation that prevents patients from paying more than the in-network cost for care unwittingly received out of network.
• At the time, it was seen as too challenging to figure out regulation for this unique corner of the health care system, and lawmakers ordered further study.

Driving the news: Washington state last week became the 16th state to pass consumer protections for ambulance bills, and Indiana's governor signed a similar bill earlier this month.

• Just two states had some protections for ambulance bills in the 1990s, but momentum has grown since passage of the No Surprises Act.
• Four states passed ambulance billing laws in 2023, and more are looking to take up legislation.

How it works: State laws cap patient costs for out-of-network ambulance rides at what the patient would pay if it was covered by insurance, and health plans are on the hook for the rest.

• Some state laws, like the new one in Washington that takes effect next year, peg health plan charges to local or Medicare rates.
• Other states, like Delaware and Maine, settle payments through an arbitration system, similar to the federal surprise billing law.
• Colorado only bans surprise bills at privately run ambulances, which accounted for about 30% of emergency rides nationwide in 2020, per KFF. Meanwhile, Maryland only covers those provided by fire departments and other public agencies.

The ambulance industry has largely been on board with how states are approaching these laws, Tristan North, a lobbyist for the American Ambulance Association, told Axios.

• But insurers have raised concerns that some states are setting benchmark rates far above what Medicare pays, said a spokesperson for insurance trade group AHIP.

Yes, but: The state laws are ultimately limited, because most employer-sponsored health plans — a huge chunk of the private market — fall under federal regulation.

• "It's good to know that Washington has this new law now, but we're hoping to see it go one step further to the federal level," said Christy Shum, who received a bill for about $7,000 when her infant son was transferred from one hospital to another last year.
• Shum's employer-sponsored insurance initially covered only about $1,000 for the out-of-network ride, but the charges were eventually wiped without much explanation, Shum said.

What's next: A commission created by the No Surprises Act to study ground ambulances will soon formally submit recommendations to lawmakers, which will include a $100 cap on patient costs and linking insurer payments to locally regulated rates when possible.

• President Biden recently called for extending surprise billing protections to ground ambulances, but there's little expectation that lawmakers will take up legislation this year.
• This Congress has struggled to pass modest bipartisan payment changes, and some of the biggest champions of the No Surprises Act are no longer in office.

The bottom line: "We really need to build the groundswell of support — more than we already have, apparently — to see Congress address it," said Patricia Kelmar, a director at Public Interest Research Group and member of the federal ambulance billing advisory committee.

A link to download the report is at the end of the report.

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Ambulance service in N.H. faces problems from big surprise patient bills to struggling companies

By DAVID BROOKS

03-24-2024

https://www.concordmonitor.com/ambulance-new-hampshire-insurance-54480768

Ambulance service might be one of the most basic and important parts of the health-care system, but it’s also a financial mess in New Hampshire, both for patients and private companies.

“We’ve talked to consumers who say, ‘I’ve fallen at home and clearly need to be seen in an emergency room, but I sat there thinking, ‘Can I wait it out, to try and get a family member to take me to the hospital?’ ” said D.J. Bettencourt, commissioner of the New Hampshire Insurance Department. “Someone who is in need of urgent transportation to a hospital should not be having to think about whether or not their particular health coverage is in network with that (ambulance company).”

A high-profile example occurred in February when a hiker suffering from hypothermia and frostbite was carried off Mount Washington in extreme winter weather following an 11-hour rescue, only to drive himself to the hospital because he feared how much an ambulance ride would cost.

At the same time, Bettencourt said, “We began seeing reports this summer that private ambulance providers were experiencing significant financial distress … particularly in rural areas of the state.”

One issue is that around 80% of transportation covers people using Medicare or Medicaid, “which do not pay anywhere near” the cost, Bettencourt said. That’s particularly true in rural areas, where spread-out population makes it very expensive for a private, profit-driven company to maintain 24/7 coverage.

Municipal services, which are part of fire department or other emergency service budgets, see less immediate financial straits but face many of the overall headwinds, he said.

Problems like these are not unique to New Hampshire and have caused legislators in Washington and Concord to consider various changes to billing, network assignments and reimbursement rates, including some bills percolating through the State House. They also prompted the state Insurance Department to hold an “ambulance summit” that has resulted in a lengthy report issued Friday carrying a number of recommendations for lawmakers to consider.

“This is a perfect opportunity to talk about an issue that has lingered on for … two decades now,” said Bettencourt.

One thing that is clear, he said: “We’re going to need higher (reimbursement) rates (from insurers), particularly in the rural and super-rural areas of the state.”

The report makes several recommendations.

One is to ban on “balance billing,” in which patients have to pay the difference between the ambulance service cost and the amount that the insurance company will cover. The difference can be hundreds or even thousands of dollars if the patient’s health insurance doesn’t consider the ambulance firm to be part of the network.

That is a particular problem, said Deputy Insurance Commissioner Keith Nyhan, because particularly in rural areas, there’s often only one ambulance service available.

“In an emergency situation in particular, consumers have no option to choose whether the ambulance company is in-network or out-of-network. They just show up,” Nyhan said.

Consumers concerned about a balance bill can call the Insurance Department’s consumer service hotline, 800-852-3416 or email consumerservices@ins.nh.gov to get help.

Also recommended in the report is direct payment, a big desire for ambulance providers.

The problem, Bettencourt said, is that when insurance companies cut a reimbursement check for the ambulance provider they sent it to the patient who owns the policy, and expect the patient to pay the ambulance.

“In many cases the consumer is unsure why they’ve gotten this check and run off with it. They think, ‘Oh, this must be a reimbursement’ … so it never makes its way to the provider,” he said.

Both of those suggestions have been included in separate bills making their way through the legislature.

The recommendation says that the changes should be part of overall changes to the system that include gathering better data from all providers, private and public, and doing a better job monitoring costs and availability of service.

Congress is also considering legislation to limit balance billing for ground ambulances, although it’s unclear when or if that will go through.

The full report can be found on the New Hampshire Insurance Department website at https://www.nh.gov/insurance/reports/documents/nhid-ambulance-summit-final-report-20240319.pdf.

Another example of the challenging times for communities and their EMS systems, regardless of provider type, trying and combat the workforce shortage.

The most recent national EMS media tracker has documented over 1,800 local and national news reports about EMS since 2021, with 74% of the reports citing the EMS staffing and economic crisis.

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Conn. FD drops experience requirement to increase number of EMS applicants

Wallingford officials removed the one-year experience requirement hoping it will lead to an increase in applicants

March 06, 2024

https://www.ctinsider.com/recordjournal/recordjournal/article/wallingford-emt-fire-hiring-jobs-town-council-18695604.php

WALLINGFORD, Conn. — The fire department has reduced its work experience requirements for EMS workers in response to an ongoing employee shortage.

Previously requiring at least a year of experience, the town opted to change its qualifications in response to a sharp reduction in applications.

The guidelines for EMS personnel were revised four years ago, when the department was looking to fill 16 positions, and had 38 people apply. But in 2023, the town received only two applicants for open positions during the year. The department currently has three EMT vacancies, as three members who were previously EMTs were hired as firefighters.

Two of those members left for other departments.

According to Human Resources Director James Hutt, he and Fire Chief Joseph Czentnar had discussions between themselves and with Mayor Vincent Cervoni and determined that the one-year experience requirement wasn’t necessary.

“To meet the needs, the chief and I met, we discussed it with the mayor, the chief was confident that the one-year experience requirement was not necessary,” Hutt said.

This is part of an ongoing employee shortage across the fire department. Czentnar said recently that the department had five vacant full-time positions due to long-term injuries firefighters have sustained while on duty. As a result, many existing full-time members have had to put in more overtime to cover their shifts.

The department has undertaken several initiatives to try to bolster its numbers and increase awareness in the community about the need for volunteers and full-time positions. In recent years they’ve been more active at approaching students at job fairs and have even opened an Instagram account to advertise openings.

“We’re finding the pool of candidates for EMTs and paramedics is very small, and we’re competing statewide from a small pool of candidates,” said Czentnar. “EMS in the state of Connecticut and regionally is an impending failure. There’s a lack of people that want to get into public safety, and typically emergency services. We’re having a difficult time recruiting firefighters, paramedics, EMTs.”

Councilor Craig Fishbein questioned the decision to reduce the experience requirement to bolster the numbers when the lack of applicants could be attributed to other factors.

“When this division was started it needed to be stood up very quickly, and we needed experienced people to come in and a one-year minimum was determined to be the minimum criteria for it at that time,” Czentnar said in response at the meeting. “Since then we’ve implemented a field training evaluation program throughout the department where we have certified field training instructors and those people would go through an orientation with the new folks that come in. This brings it in line with all our other job descriptions.”

There was no minimum one-year requirement for any other position in the fire department.

Despite the decrease in experience, due to contractual agreements, the pay for the EMT positions isn’t being changed — with an average salary of $78,000. EMTs would go through an orientation and training period where they accompany an existing team, and after an evaluation will be added to the rotating schedule once they’re deemed ready for duty. The training takes around four weeks.

Base salary without overtime, according to the chief, is in the $40,000 range, which is lower compared to other towns. The distinction, said Czentnar, is most other EMT agencies are private and for-profit — so while they will pay more, he said their department offers better working conditions and better work environment working with the municipality.

Democratic Town Councilor Jesse Reynolds expressed concern about the amount of base pay without overtime, stating that given the current state of the market people who wanted to do EMT work wouldn’t be able to afford to live in town on that salary.

“That’s something we should consider if we want people to work here, and live here, and want to stay here they have to be able to afford that. I’d like to hear more about what we could do in the future to improve that situation,” Reynolds said. Czentnar said that they were currently developing plans in the future to react competitively to the market.

“I support this. I see this as a necessary reaction to the supply and demand of the market for staff,” added Town Councilor Tom Laffin.

The motion was approved following a unanimous vote of the Town Council.

One of the interesting statements in this news article is that their transport rate “climbed to 48% in 2023”, up from 35% in 2021.

While every community is different, even with our multiple programs designed enhance patient experience and reduce healthcare expenditures by avoiding preventable transports to the ER, MedStar’s average transport rate is 80.3%, compared to the referenced national data from ESO of 83%.

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In 'doorbell recording' case, Phoenix firefighters violated ambulance refusal policy

ABC15 Investigators: Why Phoenix firefighters convince people not to use the city ambulances and what's changing now

Mar 06, 2024

https://www.abc15.com/news/local-news/investigations/in-doorbell-recording-case-phoenix-firefighters-violated-ambulance-refusal-policy

PHOENIX — A Phoenix fire crew, caught on a doorbell camera video dissuading a sick woman from taking an ambulance to the hospital, violated multiple city policies, according to the fire department's administrative investigation.

ABC15's airing of that video prompted the investigation about the August 2021 medical call to Haydee Pate's south Phoenix home. She had COVID and was having difficulty breathing at the time of the 911 call.

Pate was sitting outside on a bench when the Phoenix fire captain, a paramedic, and a firefighter/EMT arrived in a fire engine.

"Do you just want to take her to the hospital?" Paramedic Caleb Kountz asked Pate's son who was standing in the driveway.

"Yeah, she wants to go to the hospital," the son replied.

"Do you want to take her?" the paramedic asked.

Pate later explained to ABC15 that her son needed to remain at home to care for her young daughter. Both were also sick with COVID.

As minutes pass, the crew takes Pate's vital signs but doesn't call for an ambulance.

"That ambulance is $1,500 bucks," Captain Gerald Ingallina said. "I mean, we'll take her, but if you have $1,500 bucks, I know what I'd like to do with $1,500 bucks."

After the firefighters left, Pate's son ended up driving her to the hospital, and she was admitted for pneumonia.

"It's been over two years, and not even once did I receive any apology," Pate said in an interview with ABC15 last month.

But she did receive a copy of the administrative investigation, which found all three crew members violated multiple fire department rules including failing to follow a 2021 memo about refusal of treatment and transport, as well as not protecting the public.

Pate still has questions about who signed the medical report as the patient "refusing" ambulance service because she says it wasn't her.

"That's not even close, that's not my initials, that's not my signature," Pate said.

The fire captain who responded to Pate's house retired before the investigation was completed, but the firefighter and paramedic remain with the department. Phoenix fire officials would not say what discipline they received, if any. A spokeswoman did write to ABC15, saying the department "strives to address any complaint consistently within our policies and values" and "necessary corrective actions are taken".

"Very bad," Pate said about her experience. "I don't want that to happen to [anybody] else."

ABC15 has covered multiple cases of ambulance denials in Phoenix over the past two years, including at least one death, despite the city's longstanding policy that everyone who wants an ambulance gets one.

The administrative investigation in Pate's case also included an explanation from one firefighter about why they would persuade a relative to drive a patient instead of using a city ambulance.

"It takes time for an ambulance to get to them, it takes time for us to load them up, and it takes time to get them to the hospital," firefighter Christopher Flores told investigators, according to the PFD report. "Sometimes, time is crucial."

When the investigator asked, if time was crucial, wouldn't it be wiser to have a medic versus someone who is not trained, Flores responded, "Yeah."

"They contradict themselves back and forth with their comments," Pate said after reading the report. "It just made me wonder 'what's going on.'"

In a statement to ABC15, the Phoenix Fire Department said it wants to assure the public that the department "is committed to providing the highest levels of customer service."

At the same time, PFD data may partly explain why firefighters may feel time pressure. There have been an increased number of 911 medical calls and longer ambulance response times in recent years.

The ESO EMS Index, which looks at the big-picture performance of emergency medical providers across the country, calculated nationwide data from 2021 finding, on average 83% of people who called 911 for medical help got an ambulance ride to the hospital. Just 17% were non-transport cases. But Phoenix's ambulance transport data, which the agency provided to ABC15, showed a much lower ambulance use rate. In 2021, patients made hospital runs on just 35% of calls.

When questioned about the disparity, a Phoenix Fire Department spokeswoman responded that patient transport percentage rates can vary significantly from one jurisdiction to another. As a result, any comparison of Phoenix to any other reported percentage would require a thorough review to ensure that all variables are consistent.

Phoenix's data shows the city's ambulance transport rate climbed to 48% in 2023 after firefighters were trained on a new state law saying paramedics and EMTs "may not counsel a patient to decline emergency medical services transportation."

"I've been thinking, maybe, there's not enough ambulances," Pate said.

Trying to increase the available ambulances and reduce response times, the fire department is asking Phoenix City Council this week to approve a plan to convert 10 part-time ambulances to 6 full-time ambulances. More than 50 jobs would be added to staff those ambulances.

MedStar Mobile Healthcare – Mobile Integrated Health Designated Age-Friendly

March 4, 2024

https://www.unthsc.edu/daily-news/medstar-mobile-healthcare-mobile-integrated-health-designated-age-friendly-6/

The Institute for Healthcare Improvement recently recognized MedStar Mobile Healthcare – Mobile Integrated Health as an Age-Friendly Health System Participant. 

MedStar is the first emergency service provider to be recognized for their efforts in implementing age-friendly care, which includes a focus on fall prevention. 

Health Resources and Services Administration Geriatrics Workforce Enhancement Program (HRSA GWEP) funding has supported a Geriatric Practice Leadership Institute to educate and support healthcare organization teams across the country for implementing age-friendly initiatives within their services and practice. 

As a result, several teams have received recognition as an Age-Friendly Health System (AFHS) Committed to Care Excellence – including our own HSC Health Center for Older Adults and HSC Health Family Medicine Clinics, and now MedStar as well.

This designation is also in alignment with the city of Fort Worth, which has been recognized as Age-Friendly and Dementia-Friendly, as well as educational efforts.

Students who are involved with EMS experiences become familiar with these data-driven, evidence-based Age-Friendly approaches for older adult care that then align with care received in HSC Health clinics.

As part of the Age-Friendly Health Systems movement, we are among the first health systems in the country to implement age-friendly health care.

MedStar now joins an international group of more than 2,700 health systems working to tailor care to patients’ goals and preferences and to deliver care that is consistently of the highest quality.

The four essential elements of an Age-Friendly Health System are known as the 4Ms:

• What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.
• Medication: If medication is necessary, use Age-Friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
• Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.
• Mobility: Ensure that older adults move safely every day to maintain function, prevent falls, and do What Matters.

You can learn more in the Guide to Using the 4Ms in the Care of Older Adults.