News & Updates

In cooperation with the American Ambulance Associationwe and others have created a running compilation of local and national news stories relating to EMS delivery, powered by EMSIntel.org. Since January 2021, 2,513 news reports have been chronicled, with 44% highlighting the EMS staffing crisis, and 37% highlighting the funding crisis. Combined reports of staffing and/or funding account for 80.7% of the media reports! 163 reports cite EMS system closures/takeovers, or agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.


Click below for an up to date list of these news stories, with links to the source documents.

Media Log Rolling Totals Protected.xlsx

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  • 5 Dec 2024 12:01 PM | Matt Zavadsky (Administrator)

    A very comprehensive news report from the Boston Globe that highlights the many challenges across the country for beleaguered EMS agencies, regardless of provider type.

    No highlights on this one - it's all an important read!

    A PDF version of the story can be accessed below:

    Boston Globe Report - Where were all the ambulances.pdf

    ---------------- 

    When a Winthrop toddler stopped breathing, where were all the ambulances?

    A Globe investigation reveals a broken EMS system that has become dangerous, and in some cases deadly.

    By Adam Piore, Globe Staff

    December 5, 2024

    https://www.bostonglobe.com/2024/12/05/metro/when-winthrop-toddler-stopped-breathing-where-were-all-ambulances/

    About 15 minutes after her 2-year-old daughter went into cardiac arrest, Andrea Feeley realized an ambulance was not coming to save her.

    Just before 10:30 a.m. that January morning, Feeley was kneeling in front of the couch trying to entice her curly-haired little girl, Yuna, to take a drink of Pedialyte when she suddenly went limp and stopped breathing. Yuna had been sent home from day care two days earlier with a low-grade fever, but until that morning Feeley had no reason to believe she was seriously ill.

    Feeley’s son called 911. Within minutes, town firefighters converged on Feeley’s tidy, two-story clapboard home in Winthrop and took over chest compressions and CPR on the toddler. It was immediately clear she needed the kind of advanced life support that trained paramedics could provide.

    “Better step up that ambulance,” Captain Dan Flynn radioed.

    But there was a problem. Action Ambulance Service, the private company that provides ambulance service to Winthrop, did not have an ambulance available to respond to the call, the dispatcher said.

    “Is she breathing yet?” Feeley kept asking. “Is she breathing?”

    Finally, as the minutes ticked away, and no one showed up, Fire Chief Scott Wiley gathered up Yuna, still wearing her “CoComelon” pajamas, carried her outside to his Chevy Tahoe, and drove her to Mass. General. But it was too late. A team of doctors and a chaplain soon found Feeley sitting in a private waiting room and delivered the news: Yuna was dead.

    What happened the morning of Yuna’s death was the result of a broken EMS system across Massachusetts that means there isn’t always an ambulance or ambulance staff immediately available when patients critically need care, a Globe investigation found.

    When one city’s ambulances are tied up, as in Yuna’s case, other towns are supposed to provide ambulances to cover for them. But there is no central or regionalized system to track the location of

    ambulances in real time, and no one evaluating whether the number of ambulances on the road is sufficient.

    For ambulances that are in operation, chronic staffing shortages mean sometimes badly needed ambulances that are supposed to be in the field stay parked in garages, unused.

    And when the ambulances are staffed, in some cases the same overworked EMTs and paramedics are sent out over and over again during long shifts that can result in serious mistakes, interviews and documents reviewed by the Globe suggest. Numerous ambulance staffers said that double and triple shifts are not uncommon.

    The Globe identified three deaths, including two in Winthrop, that occurred in the months immediately preceding Yuna’s death in which paramedics were subsequently investigated by the state for negligence.

    In at least two of those cases, exhaustion and burnout clearly played a role.

    The Globe reviewed hundreds of pages of documents, including incident reports filed by ambulance companies with the state and follow-up investigations conducted by the Department of Public Health’s Office of Emergency Medical Services, the state agency charged with regulating them. The Globe also analyzed town-by-town ambulance response times, visited ambulance stations to speak with front-line workers, and conducted more than 50 interviews with industry experts, current and former EMTs and paramedics, CEOs, emergency medicine doctors, and others.

    In response to questions from the Globe, Department of Public Health officials said serious incidents and complaints involving ambulances are up across the state.

    “We know that some of these issues are related to the overarching health care landscape, which has become increasingly stressed,” the statement said. “There is a pressing need for more EMTs and paramedics to handle the increasing demand for emergency medical services.”

    ‘A poor patient outcome’

    What happened at the home of Yuna Feeley provides a stark illustration of the potential consequences of this seriously overtaxed system.

    On that January morning when Feeley’s son called 911, both of Action’s Winthrop ambulances were responding to other calls.

    Like all but nine of the state’s 362 municipalities, Winthrop relies on help from neighboring towns through the state’s “mutual aid” system when demand for ambulances exceeds supply.

    When Action’s dispatcher received Feeley’s son’s call, they immediately contacted two ambulance companies in neighboring towns and asked if they could help.

    When those services said their ambulances were busy, the Winthrop dispatcher requested help through the Boston Area Mutual Aid Network, or BAMA, a communication hub for emergency responders in Boston and surrounding communities.

    “The Winthrop & surrounding 911 systems were taxed, and unfortunately there was a poor patient outcome,” an Action Ambulance executive would later write.

    As Wiley tore down the streets of Winthrop into East Boston and hurtled through the Sumner Tunnel at speeds reaching 85 miles an hour and headed toward Mass. General Hospital, two firefighters worked furiously in the back seat to keep Yuna alive. One gently gripped the underside of her jaw and pressed a ventilation bag over her mouth to keep the seal, slowly infusing oxygen into her lungs.

    The other performed chest compressions. They stopped only once, pressing their backs against the SUV windows to avoid touching the little girl as a defibrillator delivered a jolt of electricity to her heart.

    Had paramedics been with the child, they could have given her more advanced emergency care, experts told the Globe. They might have applied drugs such as epinephrine or used more advanced defibrillators with a better chance to shock her heart back into action.

    They could have given her IV fluids to ensure her blood continued to reach her vital organs and supply them with enough nutrients and oxygen to keep them from failing.

    Yuna’s official cause of death is listed as “necrotizing pneumonia in the setting of RSV and strep,” according to an autopsy report Feeley received from the state medical examiner’s office.

    In the wake of Yuna’s death, the Department of Public Health promised a “thorough investigation.” The results, released in May after the Globe submitted a public record request, consist of a four page document, written by an executive with Action Ambulance, the company that runs EMS service in Winthrop, and reviewed and accepted without comment by the Department of Public Health.

    Action Ambulance followed “all appropriate policies and procedures,” the executive concluded.

    But for Feeley, her daughter’s death did not feel like the result of anything that resembled proper protocol.

    After the hospital workers told her Yuna was dead, she was haunted by the feeling that something had gone irrevocably wrong.

    “They asked us if we wanted to go in and say goodbye to her,” Feeley said. “So we did that. But I was not allowed to touch her. That was hard.”

    Not enough ambulances or staff

    The ambulance company best positioned to help Action the morning of Yuna’s death was Cataldo Ambulance, which has an outpost with two ambulances in nearby Revere.

    But Cataldo, like many ambulance companies around the state, had been facing staffing shortages so severe its ambulances sometimes sit in garages because there’s no one available to staff them, said Dennis Cataldo, president and CEO of Cataldo.

    “You can’t staff ambulances without people,” Cataldo, who is also president of the Massachusetts Ambulance Association, said.

    The supply of ambulances in Massachusetts is determined in part by what each local market can support. While some towns run their own EMS services, about 80 percent of the state’s licensed ambulances are operated by private companies that bid for the right to serve each town’s population.

    One notable exception is Boston, which runs a nationally recognized public EMS service through the city health department. It is fully unionized and receives city subsidies that account for more than 25 percent of its budget.

    In most cases, however, the companies’ revenue depends on reimbursements pegged to Medicaid and Medicare rates, which have failed to keep up with rising costs, Cataldo said. That hampers the companies’ ability to staff their ambulances.

    At the time of Yuna’s death, about 15 percent of Cataldo’s positions remained unfilled, about where staffing is today.

    More lives lost

    A review of state investigative documents suggests the staffing shortages have become dangerous. In the two years leading to Yuna’s passing, at least two people in Winthrop were declared dead while receiving treatment from Action Ambulance paramedics, according to state investigative documents contained in the Globe’s public records request.

    In one of the cases, a paramedic on an ambulance was summoned to a marina not far from the Feeley home to treat a patient in cardiac arrest in 2022. She forgot a medicine bag in the ambulance, failed to

    administer potentially life-saving medicine, did not shock the patient’s heart correctly, and misrepresented her actions to a state medical control doctor, the physician charged with exercising clinical oversight, whose permission is needed to cease resuscitative efforts.

    As a result, the control officer prematurely signed off on her request to cease efforts to revive him.

    In an interview with a state investigator, she said she had been “working a lot of hours” and wasn’t feeling well but “felt she had to stay on the shift because she was the only paramedic on duty.”

    “I knew I should have gone home. . . . I think about this call every day since it happened,” she said.

    She surrendered her license after Action accused her of “gross negligence.”

    A few months later, in March 2023, another Winthrop paramedic pressured an inexperienced EMT to intubate a patient in cardiac arrest, using a technique the EMT was not legally qualified to perform.

    “Just do it,” the paramedic told her, according to a complaint investigation report obtained by the Globe through a public records request. “I want to go to lunch.”

    The paramedic then called a designated medical control doctor to seek permission to cease resuscitation efforts, reporting that the patient’s heart had stopped beating, when in fact there were still

    signs of activity, and lied about the extent of the efforts made to revive him. State investigators later determined this resulted in a “failure to transport a treatable patient.” The state revoked the paramedic’s license until at least 2025.

    In a third incident from 2023, an Action paramedic operating in Western Massachusetts misdiagnosed a patient suffering from sepsis and pneumonia and administered a series of medications that sent him into cardiac arrest, eventually causing him to die of anoxic brain injury, according to a state investigation.

    Michael Woronka, president and chief executive of Action Ambulance Service, said the three deaths identified by the Globe reflect an “error rate” that compares favorably to that of his competitors, since his

    company has tens of thousands of patient interactions a year. “If other services don’t have a similar error rate, then they’re not reporting them because everyone’s going to have an error rate,” Woronka said, adding that it was his company’s own “quality assurance systems” that initially identified and reported the incidents.

    Cataldo, speaking in his role as president of the Massachusetts Ambulance Association, said such deaths are extremely rare.

    The Globe was unable to determine whether the negligence cases and deaths it reviewed were outliers: The deaths were contained in a batch of documents obtained through public records requests submitted in January and February, but the state failed to provide all the requested documents, citing understaffing and a backlog of other requests.

    There are no national standards for an acceptable error rate or any published data on clinical error rates, because most clinical errors are not reported to state regulatory agencies, and are instead handled internally by local agencies and medical directors, said Matt Zavadsky, past president of the national association of EMTs and a nationally recognized expert on EMS.

    Action has been singled out by the state before. In 2017, the state issued the company two consecutive “provisional licenses,” the equivalent of putting the company on probation, citing a failure to properly store and account for controlled substances and a number of equipment code violations, among other problems. But the state later withdrew the provisional licenses as part of a legal settlement after Action sued for $10 million, claiming it had been denied an opportunity to defend itself. To make the case it had been unfairly targeted, Action documented a wide array of violations by its competitors — including an instance in which a competitor fielded an ambulance with passenger side floor boards that had rotted out, providing a view of the concrete passing beneath the vehicle.

    Possible fixes

    In the months leading up to Yuna’s death, there were ample warnings that the state’s EMS system was stressed to the breaking point. Six months prior to her death, the union representing Boston EMS, the largest municipal EMS system in New England, warned that staffing shortages had grown so severe that public safety was at risk. A spokeswoman for Boston EMS said the company has made significant progress in filling staffing shortages in recent months, thanks to an advertising campaign on city buses and federal grants that offer scholarships and helped fund recruitment efforts, among other things.

    Just a month before Yuna’s death, the Board of the Metropolitan Boston Emergency Medical Services Council, an advisory group consisting of hospital medical directors, EMS coordinators, and first responders, signed a letter to Kate Walsh, secretary of health and human services about “the staffing crisis we face.” In a statement to the Globe, a spokesperson for the Executive Office of Health and Human Services acknowledged the shortage of EMTs and paramedics and said the agency had made investments and regulatory changes to address the issue. “We will continue to work with municipalities, ambulance providers and health care facilities on additional improvements to ensure residents receive ambulance service and high-quality medical care when they need it and prevent tragedies like this.”

    Last year, the state allowed staffing of Advanced Life Support level ambulances with a single EMT and a first responder driver, rather than two certified EMTs. And it has invested nearly $60 million across fiscal years 2024 and 2025 in Medicaid reimbursement rates for EMTs.

    But many say it’s not enough.

    One way to address the problem may be through regionalization. Efforts to overhaul the state’s ambulance system have been hampered in part by a “culture of parochialism” that relies on town- and city based services, when a growing number of states, including California, Maryland, and North Carolina, have regionalized, county based services that are better able to track and manage limited resources, said Zavadsky, the EMS expert.

    Smitty Pignatelli, a state representative from the Berkshires, has been lobbying state officials to implement policies that will make it easier for towns to make the politically unpopular decision to raise taxes to pay EMTs and paramedics more competitive wages and add more ambulances.

    Back in Winthrop, Feeley is struggling to come to grips with Yuna’s death. She still sometimes slips into the present tense when talking about her little girl — about her hazel eyes, fair skin, and dirty-blond ringlets. About the astonishing level of joy she could derive from a plastic dinosaur.

    “If an ambulance had come, could they have intubated her?” Feeley wonders. “Could they have given her something? What if there was something on the ambulance that they could have done?”

    Wiley, Winthrop’s fire chief, is also haunted by what might have been.

    “Maybe having an ambulance wouldn’t have made a difference, but it would’ve given her a better shot,” he said from behind his desk a few months after her death.

    ”We’re all parents. Some of us are grandparents. It’s devastating. It’s not supposed to happen. It’s a horrible, horrible thing.”



  • 4 Dec 2024 10:57 AM | Matt Zavadsky (Administrator)

    Kudos to the New York State Department of Health State Emergency Medical Services Council on the release of this report.

    It depicts a dire state of the EMS workforce, and agencies, in New York.

    This is a model initiative that other states should undertake to further illustrate the EMS workforce and economic crisis.


    Findings of note in the report:

    "The number of active certified EMS responders in New York has declined by 17.5% from 2019 to 2022, according to the NYS Department of Health Division of State Emergency Medical Services."

    "The total number of ambulance services in NYS has decreased by 9% over the past 10 years from 1,078 to 982."

    "58.4% of NYS EMS agencies indicated that the decline in number of certified responders diminished their ability to cover calls or scheduled shifts."

    "62% of EMS leadership respondents had an unfavorable outlook on their agency’s ability to recruit enough certified EMS responders to adequately serve the community in the future."

    "When asked about their reasons for planning to leave EMS, respondents cited inadequate pay/benefits (65.7%) and the availability of better job opportunities outside of EMS (51.3%) as two primary factors contributing to their decisions."

    "The combined data and findings underscore critical challenges in the EMS sector, especially the severe and growing career and volunteer workforce shortage, the need for adequate and stable EMS funding and payment rates, and the importance of improving compensation and benefits and creating attractive career pathways to retain EMS professionals so that communities receive quality emergency medical care."

    Click here to view and download the report: 2024 NYS EMS Workforce Report - Release Date 2024.09.16 V.001.pdf

    The current American Ambulance Association, Prodigy EMS, Academy of International Mobile Healthcare Integration media tracker powered by EMSIntel.org, has cataloged 2,513 local and national media reports about EMS since 2021.  81% of the reports cite staffing and/or economic issues.

    Click here to view or download the news tracker: https://aimhi.mobi/news/


  • 27 Nov 2024 10:20 AM | Matt Zavadsky (Administrator)

    While it is not often that we get excited about an OIG opinion, this one is significant because the CMS OIG referenced the clinical and fiscal benefits associated with TIP!

    From the Opinion:

    Nevertheless, for the following reasons, we believe the risk of fraud and abuse presented by the Proposed Arrangement is sufficiently low under the Federal anti-kickback statute for OIG to issue a favorable advisory opinion, and, for the following reasons and in an exercise of our discretion, we would not impose sanctions under the Beneficiary Inducements CMP.

    Third, even when a Federal health care program pays for the TIP services furnished under the Proposed Arrangement, the Proposed Arrangement appears unlikely to increase costs to Federal health care programs and may ensure an appropriate level of care for patients to whom Requestor furnishes EMS services in response to a 911 call. More specifically, TIP services may be a viable option, in certain circumstances, to improve quality of care and avoid unnecessary transports to hospital emergency departments. Consequently, TIP services have the potential to lower costs for Federal health care programs while also delivering timely, appropriate, and medically necessary care to patients on-site who do not also require transportation to a hospital.

    --------------------------

    The Office of Inspector General (OIG) just issued a favorable Advisory Opinion to a municipal EMS Agency regarding its proposal to bill patients’ insurance plans—and waive any patient cost-sharing amounts—for treatment-in-place (TIP) services provided to patients who are not transported.  

    While the OIG has already issued favorable opinions and a regulatory safe harbor (42 CFR § 1001.952(k)(4)) concerning cost-sharing waivers for emergency ambulance transports, this is the first time the OIG has addressed cost-sharing waivers related to non-transport services. 

    Key Takeaways

    Medicare Part B does not currently cover TIP services.  However, Advisory Opinion 24-09 indicates that the OIG is favorable to cost-sharing waivers related to TIP services that are covered by state Medicaid programs and Medicare Advantage plans. Moreover, the OIG seems to indicate that if Medicare Part B covered TIP services in the future, cost-sharing waivers would be permitted under the conditions outlined in the Opinion. 

    The OIG emphasizes the advantages of TIP services, stating:

    “[T]o the extent the Proposed Arrangement avoids an ambulance transport or subsequent hospital care, [it] could reduce costs to Federal health care programs overall, thereby mitigating the risk of inappropriately increased costs to Federal health care programs. Further, the TIP services furnished by Requestor under the Proposed Arrangement may result in patients receiving care more quickly and efficiently and at a more appropriate level of care . . . More specifically, TIP services may be a viable option, in certain circumstances, to improve quality of care and avoid unnecessary transports to hospital emergency departments. Consequently, TIP services have the potential to lower costs for Federal health care programs while also delivering timely, appropriate, and medically necessary care to patients on-site who do not also require transportation to a hospital.”

    Note: Agencies must separately consider any implications of cost-sharing waivers for TIP services concerning non-Federal healthcare payers. There may be limitations under state law or a contract with a private healthcare payer. Finally, while indicative of the OIG’s stance on this practice, like all OIG advisory opinions, Advisory Opinion 24-09 cannot be relied upon by any other agency, and agencies are encouraged to obtain expert advice concerning their specific situation when considering cost-sharing waivers.   

    More About the Opinions and Circumstances

    The county-based ambulance service proposed implementing a charge for TIP services furnished in connection with 911 responses - limited to emergency responses only (i.e., only responses that meet the definition of “emergency response” at 42 CFR § 414.605). Their charge for TIP services would be based on the level of care furnished to the patient and would not exceed amounts currently submitted for payment for the same level of care furnished in connection with an ambulance transport. The charge would be imposed regardless of the patient’s health insurance (e.g., regardless of whether the patient is enrolled in commercial insurance or a Federal healthcare program), whenever it provides an emergency response and furnishes care to a patient at the scene but does not transport the patient by ambulance. The ambulance service proposed accepting any health insurance payment (including Federal healthcare programs) for TIP services as payment in full and not billing patients for any cost-sharing amounts (e.g., copayments)  associated with covered TIP services. This waiver would apply to both County residents and nonresidents and be applied uniformly to all patients who receive TIP services. 

     

    The OIG cited the following reasons why it believes the risk of fraud and abuse is “sufficiently low” under the Federal anti-kickback statute (AKS) and why the OIG would be favorable to the Proposed Arrangement:

     

    1. Uniformity of Waiver.  The ambulance service would uniformly apply its cost-sharing waiver policy for all individuals who receive TIP services in connection with an emergency response regardless of payor.
    2. Minimal Implication to Federal Payers. The OIG noted that neither Medicare Part B nor the State Medicaid program in the ambulance service’s state currently covers TIP services.  Only a handful of Medicare Advantage plans and certain Medicaid programs in states adjacent to the service’s home state currently cover TIP services. Thus, in most circumstances, the Proposed Arrangement would result in no costs to Federal healthcare programs. 
    3. No Increased Costs. Citing TIP's benefits, the OIG stated that the Proposed Arrangement was unlikely to increase costs to Federal health care programs and may ensure an appropriate level of patient care. 


  • 27 Nov 2024 6:28 AM | Matt Zavadsky (Administrator)

    Continuing examples of the EMS staffing crisis across the U.S.

    Issues like this continues to beg the question about the logic of shutting down ambulances due to lack of a paramedic as opposed to staffing the ambulances with EMTs, especially when, according to national, evidence-based research, the vast majority EMS patient can be effectively treated by EMTs, without the need for ALS personnel.

    A recent national webinar with EMS physicians, innovative agency chiefs, and public policy officials, along with a summary of this research can be found here: https://aimhi.mobi/ondemand/13420011

    ------------------------

    Staffing issues leave Pepperell fire station empty for one night

    By Louisa Moller

    November 25, 2024

    https://www.cbsnews.com/amp/boston/news/staffing-pepperell-fire-station-empty-one-night/

    PEPPERELL - Staffing issues at the Pepperell Fire Department came to a head Sunday night, when the fire station was completely empty after 5 p.m.

    "Due to staffing issues, there is no Ambulance for Pepperell we will be relying on other towns for coverage. There isn't a single person working tonight at your fire station," Pepperell Firefighters IAFF Local 5018 wrote in Facebook post.

    Out of its eight full-time positions, Pepperell fire has only three filled right now. Two full time staff left over the summer and another person is on medical leave.

    "I just couldn't fill it. I'm worried about running our career staff into the ground in mental health and a long with the demands of the job," fire Chief Brian Borneman told WBZ-TV.

    Staffing issues are plaguing emergency services statewide as multiple departments compete for a smaller pool of applicants. Borneman says Pepperell covers the shortages by using on call and per diem staff or mutual aid from other towns.

    "And we're kind of the smaller fish in the sea. So, we're competing with the bigger places all the time for that same talent pool," Borneman said.

    The chief finds himself in a tough position. Even when he finds job candidates, each paramedic requires two years of training before they can start.

    "If your next question is, 'what's the answer,' I don't have a good answer. I don't know what that is," he said.

    Hospital closure compounds the problem 

    The closure of Nashoba Valley Medical Center in Ayer has compounded the problem. While Borneman says Pepperell can transport its patients to another hospital in Nashua, New Hampshire in almost the same amount of time, the closure is causing transport delays in other towns which assist Pepperell with mutual aid.

    "What I really worry about is how we're so interdependent. That's across the state. All of our towns, we support them, they support us. And when their transport times become more significant or wall times at a hospital, it starts having this ripple effect across the state," he said.

  • 27 Nov 2024 6:26 AM | Matt Zavadsky (Administrator)

    This is outstanding news for the EMS profession!

    View the full bill below:
    https://www.congress.gov/bill/118th-congress/senate-bill/5400

    There are currently 12 bills in Congress that are very beneficial to EMS providers, agencies, and the communities we serve. 

    Please take an active role in national advocacy organizations to help get these initiatives through the legislative process!

    Current EMS Economic Legislation

    Manchin, Collins Introduce Bipartisan Improving Access to Emergency Medical Services Act

    https://www.manchin.senate.gov/newsroom/press-releases/manchin-collins-introduce-bipartisan-improving-access-to-emergency-medical-services-act 

    Washington, DC – This week, U.S. Senators Joe Manchin (I-WV) and Susan Collins (R-ME) introduced the Improving Access to Emergency Medical Services (EMS) Act. This bipartisan legislation would create a pilot program to allow Medicare to reimburse for treat-in-place EMS services for certain medical issues, which would expand access to these critical health services, especially in rural communities, while reducing unnecessary emergency room visits and expenses.

    “I’m proud to introduce the bipartisan Improving Access to Emergency Medical Services (EMS) Act with Senator Collins to advance the treat-in-place model in West Virginia, Maine and throughout the country,” Senator Manchin. “This model is essential for ensuring Americans, especially in rural communities, can receive the care they need without unnecessary and expensive emergency room visits. I encourage my colleagues on both sides of the aisle to support this important effort that cuts costs and bolsters access to quality, affordable health services for our constituents.”

    “Having access to high-quality emergency medical services is essential for individuals in rural communities across Maine and the nation,” said Senator Collins. “This bipartisan bill would expand the treat-in-place model for EMS services, reducing unnecessary emergency room visits, lowering costs, and easing the strain on our state’s hospital and EMS workforces.”

    The bill would allow seniors on Medicare to receive at-home emergency medical services to treat minor medical incidents. In West Virginia, patients on state insurance can receive care from EMS providers for diabetes evaluation, asthma/COPD evaluation, and seizure evaluation at the scene of the call without having to transport patients to the hospital. In addition to the services provided by EMS, part of the protocol would be to advise the patient to follow-up with their primary care provider to ensure continuity of care.

    Representatives Mike Carey (R-OH), Lloyd Doggett (D-TX), Carol Miller (R-WV) and Debbie Dingell (D-MI) introduced companion legislation in the House, where it has the support of the National Rural Health Association, International Association of Fire Chiefs, International Association of Firefighters, American Ambulance Association, Congressional Fire Service Institute, National Association of Towns and Townships and the National Association of Emergency Medical Technicians.

    Last year, Senator Manchin led the West Virginia delegation in urging the Centers for Medicare & Medicaid Services (CMS) Administrator to consider the treat-in-place model to address the workforce challenges faced by West Virginia hospitals and EMS providers.



  • 17 Nov 2024 10:02 PM | Matt Zavadsky (Administrator)

    Earlier this year, the Academy of International Mobile Healthcare Integration (AIMHI) released our bi-annual 2024 Benchmark Report. While that report covered high-level metrics, respondents supplied a plethora of valuable, granular detail regarding operational and financial metrics.

    We are releasing this BONUS EDITION of the Benchmark Report, detailing the Financial Metrics achieved by these High-Performance/High Value (HP/HV) EMS systems.

    We encourage public policy officials and EMS system leaders to compare their performance metrics with these systems.

    If you would like any assistance developing your metrics, please feel free to contact us at hello@aimhi.mobi

    Key Takeaways from this Report include:

    • 59.7% of emergency services provided by participating AIMHI agencies were billed at the ALS-Emergency level, and 36.1% were billed at the BLS-Emergency level.
    • The average expense per transport for participating AIMHI agencies was $532.47. The average expense per capita was $72.88.
    • Among participating AIMHI agencies, the Average Patient Charge (APC) was $1,343.12, with a low of $740.00 and a high of $1,969.52.
    • Among participating AIMHI agencies, the average reimbursement per transport was $427.58. Average patient self-pay reimbursement was $53.47, average Medicaid reimbursement was $228.09, average Medicare reimbursement was $435.94 and average commercial insurance reimbursement was $859.43. On average, Medicare Advantage reimbursement was $50 less than Fee for Service Medicare.
    • Commercially insured patients represented 16.2% of the patients served, but 32.9% of the patient services revenue received.


    Click the link below to view and download the full BONUS EDITION: Financial KPIs Report:

    2024 High Performance-High Value EMS Delivery KPIs - Financial.pdf

    ------------------------

    Our desire in releasing these performance metrics is to assist local policy makers and EMS leaders evaluate their EMS system’s performance, balanced with the needs and desires of the community the system serves.

    These are examples of financial KPIs for some of America’s highest performing EMS systems.

    No two systems are alike, and variables such as cost of service delivery, payer mix, average patient charge and revenue cycle management procedures could impact the economic sustainability of the local EMS agency.






  • 11 Nov 2024 3:47 PM | Matt Zavadsky (Administrator)

    Earlier this year, the Academy of International Mobile Healthcare Integration (AIMHI) released our bi-annual 2024 Benchmark Report. While that report covered high-level metrics, respondents supplied a plethora of valuable, granular detail regarding operational and financial metrics.

    We are releasing this BONUS EDITION of the Benchmark Report, detailing the Operational Metrics achieved by these High-Performance/High Value (HP/HV) EMS systems.

    We encourage public policy officials and EMS system leaders to compare their performance metrics with these systems.

    If you would like any assistance developing your metrics, please feel free to contact us at hello@aimhi.mobi

    Key Takeaways from this Report include:

    The per-Capita response rate for participating AIMHI member agencies was 0.18961, meaning a ‘typical’ 100,000 population community would generate 18,961 EMS responses.

    To meet this response demand, participating AIMHI agencies scheduled an average of 0.37305 unit hours per Capita, meaning an average of 37,305 ambulance unit hours per 100,000 population, or the equivalent of 4.3 ambulances per 100,000 people.

    Response Unit Hour Utilization (UHU-R) for AIMHI agencies participating in the survey was 0.508, essentially meaning on average, an on-duty ambulance was assigned to a response 50.8% of the time they were on-duty.

    Respondents reported achieving an average of 90.1% scheduling efficiency, meaning they were able to provide 90.1% of the planned unit hours.

    Click the link below to view and download the full BONUS EDITION: Operational KPIs Report:

    2024 High Performance-High Value EMS Delivery KPIs - Operational - FINAL.pdf

    ------------------------

    Our desire in releasing these performance metrics is to assist local policy makers and EMS leaders evaluate their EMS system’s performance, balanced with the needs and desires of the community the system serves.

    These are examples of operational KPIs for some of America’s highest performing EMS systems.

    No two systems are alike, and variables such as how long it takes to complete an EMS response due to factors such as travel distances, hospital delays and desired response times could impact the resources needed to effectively serve the community.


  • 5 Nov 2024 12:25 PM | Matt Zavadsky (Administrator)

    The results would be exceptionally valuable information for the industry!

    Announcing the National EMS Documentation Survey

    PWW|AG is excited to announce the National EMS Documentation Survey, which will identify attitudes, challenges, and issues inherent in documenting EMS patient interactions. EMS leaders have consistently identified high quality clinical and operational documentation as one of their organizations' most vexing and persistent challenges.

    The National EMS Documentation Survey may be completed by any individual with a role in EMS, including EMS practitioners, medical directors, EMS leaders, managers and executives, EMS billing and revenue cycle management professionals, and others. The Survey will measure critical issues such as:

    • EMS provider and leadership attitudes toward patient care report (PCR) documentation;
    • Comfort with and ease of use of EMS PCR technology;
    • Sufficiency of time allocated to PCR documentation;
    • Need for training and education on EMS documentation issues;

    The Survey takes an estimated 10-15 minutes to complete. The results will help provide insight and research into improving EMS patient care reporting documentation and will help provide the tools and support that EMS professionals need to produce high-quality documentation.
    To access the Survey, visit:

    https://www.surveymonkey.com/r/EMSDocumentationSurvey or use the QR code below.
     


  • 4 Nov 2024 5:47 AM | Matt Zavadsky (Administrator)

    Outstanding guidance from this recently released Consensus Statement of the National Association of EMS Physicians International Association of Fire Chiefs and the International Association of Chiefs of Police on best practices for collaboration between law enforcement and emergency medical services during acute behavioral emergencies.

    Two of the principal authors of the National Consensus Statement, Drs. Kupas and Miller, will be presenting an overview of the paper at the upcoming EMS Law and Policy Symposium on Medical Civil Rights in Emergency Services.  The Symposium will be held this Thursday, November 7th, at the Widener University Commonwealth Law School in Harrisburg, PA. 

    Symposium registration is free, and the program will be available remotely via Zoom. 

    In addition to a discussion of the new Consensus Statement, the Symposium will also include attorneys from the litigation team on the Elijah McClain case in Colorado, and representatives of the Harvard-affiliated Medical Civil Rights Initiative. For more information and to register, visit:

    https://commonwealthlaw.widener.edu/current-students/law-school/events/detail/3516/

    ------------------------------------ 

    Consensus Statement of the National Association of EMS Physicians International Association of Fire Chiefs and the International Association of Chiefs of Police: Best Practices for Collaboration Between Law Enforcement and Emergency Medical Services During Acute Behavioral Emergencies

    https://pubmed.ncbi.nlm.nih.gov/39264840/

    There must be an awareness of the potential for bias such as anchoring bias, ascertainment bias, and confirmation bias. We must make a conscious effort at an independent assessment of the individual. The goal is to optimize the individual’s safety with the minimal use of force or restraint, yet still provide for the safety of first responders and bystanders.

    Medical Evaluation

    The potentially competing priorities of LE and EMS also need to be recognized and addressed as part of conjoint education and training to ensure collaboration in the assessment and any required clinical treatment of these individuals.

    Optimally, LE should give a short, objective summary to EMS on the circumstances of the encounter. This summary should include the reason for the encounter, pertinent observed behaviors, medical history that may have been volunteered by the individual or bystanders, descriptions of any use of force and/or the use of less lethal weapons that may have been employed, as well as any other potential sources of trauma.

    Emergency medical services must have access to the patient for clinical assessment, which may require transition from LE positioning and restraints to medical positioning and restraints. Law enforcement may provide input on the threat posed by transitions so that the team can collaborate to arrive at the safest solution that allows for the provision of any needed clinical care.

    Foremost is the need to identify and treat a potentially life-threatening medical condition, including, but not limited to, hypoxia, hypoglycemia, metabolic derangements, hyperthermia, cardiac conditions, and trauma. The EMS clinicians must also be cognizant of possible toxidromes as a potential cause of the patient’s behavior, which may require immediate treatment.

    Restraints and Patient Positioning

    A decision to utilize pharmacologic management shall be made solely by EMS based upon their independent patient assessment and in strict accordance with EMS protocols and medical director oversight.

    Transport

    In some cases, LE may choose to transport the individual either to a medical facility or directly to a facility for legal remand. In these situations, it is important – when indicated – that EMS be utilized as a resource in these decisions. Although EMS clinicians may be asked by LE to evaluate an individual prior to transport to a detention facility, they should not provide a medical “clearance” without a complete clinical assessment.

    Some of these individuals require advanced medical assessment and interventions not available to EMS. In situations when EMS is transporting, LE and EMS should ensure there are sufficient personnel with the appropriate scope of practice to address medical contingencies and continue any required physical restraint during transport. The monitoring and care in this setting should be delineated by EMS agency protocols and policies.


  • 1 Nov 2024 10:27 AM | Matt Zavadsky (Administrator)

    An interesting and growing trend as the EMS economics crisis presses on.
     
    Agencies and communities that subsidize EMS now billing neighboring communities for mutual aid, especially jurisdictions who are not providing public funding, and as such, have difficulty with EMS responses.
     
    The public policy argument is that a community paying for EMS delivery should not have the resources they are funding responding outside their community to provide primary EMS response to neighboring communities whose systems are unable to response, due to lack of funding.
     
    A survey on EMS Economics published by NAEMT in 2023 revealed the cost trends in mutual by some agencies.

    ---------------------- 

    Rapho supervisors OK solicitor to defend against invoice from MESA
    ROCHELLE A. SHENK
    Oct 29, 2024
     
    https://lancasteronline.com/news/regional/rapho-supervisors-ok-solicitor-to-defend-against-invoice-from-mesa/
     
    When: Rapho supervisors meeting, Oct. 17.
     
    What happened: Supervisors authorized the township’s solicitor, Susan Peipher of Apple, Yost & Zee, to defend against efforts by Municipal Emergency Services Authority to collect charges against the township for medical services provided to township residents.
     
    Cost: The township received a $6,200 invoice from MESA for services rendered to residents in September.
     
    Background: MESA was formed in an attempt to create a fiscally sustainable model for providing emergency medical services in the region Northwest EMS formerly served. Northwest EMS had been the township’s emergency medical services provider; however, supervisors voted against joining MESA. Since January, Rapho’s emergency medical services provider has been Penn State Health Life Lion.
     
    Township discussion: Township Manager Randall Wenger said he had discussed MESA’s invoice with Lori Shenk, the township’s emergency management coordinator. Shenk, who is also a first responder and had served as Northwest EMS community outreach manager, said she had concerns with the township paying the invoice without discussing it with the solicitor. She said she felt it could set a precedent.
     
    Quotable: In an Oct. 18 email Shenk said, “To the best of my knowledge/understanding, Rapho Township does not have a contract or agreement with MESA and I do not know municipal law or the laws pertaining to the authority, therefore I believe it’s prudent for the township to have their solicitor determine if there is an obligation to pay any invoices from MESA.”
     
    MESA viewpoint: Justin Risser, MESA treasurer and Conoy Township supervisor, said in an Oct. 18 phone call that Rapho is one of four municipalities served by Penn State Health Life Lion to receive an invoice for mutual aid service for September. Risser said mutual aid represents about 10% of MESA’s calls, and residents in the municipalities that are part of MESA are paying for it. Mutual aid occurs when a municipality’s emergency service provider is unable to provide service and another provider is called.
     
    More: Risser said MESA noticed an issue with mutual aid calls to cover for Life Lion since the beginning of the year, but they’ve increased over time. The residents in the four municipalities that were invoiced also will receive an invoice for the difference between what their insurance pays and the cost for the specific service, Risser said. With the four municipalities, he said MESA is trying to cover a shortfall in the payment for the cost of service.
     
    Quotable: “We want to help out (by providing mutual aid), but it’s not fair to our residents (who) are paying a fee for our services,” he said. “The intent of these invoices to municipalities is to encourage them to have a conversation with their provider. Their provider (Life Lion) is not being truthful with the municipalities about their coverage rate.”

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