The Downfall of the U.S. Healthcare System-- Is EMS To Blame

[Christopher.Collins]

I agree spenac. However, as usual we as a profession need to be educated enough to make a thorough assessment and then determination to transport or not. Until that happens we will continue to take people to the ED when they could easily be treated at their Primary Care Physician. Wait, the ED is their PCP.

Hows this for thourough...?

Dispatched for a toothache:

Find a 20 y/o M CAOx3 no cheif complaint at this time stating... "I need to get a refill on my pain meds. I just had my wisdom teeth removed this month (begining of month call was at the end). I dont want to go with my friend on his scooter, I might fall off." Quite blaitantly said that he called 9-1-1 cuz he needed a ride.

The hospital, a Level II Trauma center no less, was less than 2 miles away and quite litterally straight down the road.

Oh God if I could be allowed to force any one patient in my career to refuse (not even thinking about patients to come in the future) Id have used it then.

[spenac]

Hows this for thourough...?

Dispatched for a toothache:

Find a 20 y/o M CAOx3 no cheif complaint at this time stating... "I need to get a refill on my pain meds. I just had my wisdom teeth removed this month (begining of month call was at the end). I dont want to go with my friend on his scooter, I might fall off." Quite blaitantly said that he called 9-1-1 cuz he needed a ride.

The hospital, a Level II Trauma center no less, was less than 2 miles away and quite litterally straight down the road.

Oh God if I could be allowed to force any one patient in my career to refuse (not even thinking about patients to come in the future) Id have used it then.

I've actually had patients request us to take them to the store. They got mad when told ER or nothing. Of course a couple said ER then and I said sorry as you do not have an immediate threat to life or limb we are unable to take you. Sign here. Good bye.

[UMSTUDENT]

Unfortunately, I believe there are many groups who are directly responsible for the disabled state of the American healthcare system. EMS isn't one of those organizations.

First, the future of health care, IMHO, is in the patient's home. This has many connotations.

A) General wellness on the part of the patient. Proper diet, education on disease prevention, and a national effort to stop these diseases at the door before they occur.

Bringing preventive medicine and basic health care maintenance to the home of those populations most at risk and who most directly impact the health care system financially. Maintenance of diabetes, COPD, basic cardiac conditions...these can be done by mid-level practitioners (PA, NP, or a Master's Prepared Paramedic equivalent). Advances in diagnostic technology in the next 10 years will only advance the possibilities.

I believe EMS is the solution to these problems. I also believe that the eventual socialization of medicine, with its advantages and disadvantages, will probably pave-the-way for this development. The fragmented economy which is the current U.S. Health Care system allows for too many players to be involved in the purchasing of services. When Uncle Sam has to foot the bill AND be the primary entity responsible for this bill, I think you'll see bureaucrats scramble for a quick, efficient solution to expensive hospital bills and money sucking EDs. There will be multiple solutions, but I think we make one of the best.

The problem lies in the 48 million Americans who are uninsured. Add in those over 65 and anyone else who decides to take advantage of the system and you have a heavy financial burden to bare. Too many things are already happening: a shortage of residents entering family practice specialties and overcrowded EDs. 48+ million people need to get access somehow...

We need to be vigilant in our push for higher education standards while simultaneously engaging our leaders in the front lines of this public health issue.

[cosgrojo]

The system is broken because nobody actually knows what the system is or how to use it. It is obvious just from watching this discussion that everyone has a different idea of how things are supposed to be done. The overwhelming problem is that large companies and billing agencies all have similar disagreements. Everybody has a different interpretation, while most just continue to keep doing things the way they always have because they assume they are right. I work for a private service who is perpetually resigning corporate integrity agreements every year because we refuse to change our billing and auditing systems to keep up with Medicare guidelines. Instead of changing to their system, we just keep paying the fines and re-upping the bogus 1 hour con-ed class for Medicare. I've pointed out inconsistencies to my auditors/supervisors in the past in respect to Medicare billing rules... and they tell me I am wrong and they demand to know who told me that?!?!? I respond that no one told me that, I pulled it off of the Medicare website available to anyone with 15 minutes of research time to burn. They always tell me that they don't believe me because if that was true, we would be billing it this way. That makes me chuckle.

People can be smacked in the face with truth, and still ignore it. This is the real problem with our system. Nobody knows what they are doing, but they all think they are doing it right. Unless someone knows of a way to cure egotism... our problems will persist.

[Jyannotti308]

I think you need to re-read your text book and your state and local laws. You have the right to say no. We do it at my service alot. Just because someone calls 911 doesnt mean they have a true emergency.

I am an Emt in Alabama and as much as we would like to say no,it is against the law.If they call 911 I am required by law to transport that person to the hospitol,to not do so is abandonment.However ,noone said that once you get to the hospitol you can't put them out in triage where they will be seen according to their priority.The reason alot of people do not go POV is because they think if they come in by ambulance they will be seen faster.So the problem falls on legal systems and the receiving facility,you are obligated.

[Lone Star]

I think rather than trying to blame EMS for the 'downfall of the US healthcare system', maybe we should put the blame right where it belongs:

[align=center:bd2d401a53]FBI: Hospital used homeless as 'human pawns'

CEO arrested for billing unneeded procedures for phony patients[/align:bd2d401a53]

LOS ANGELES - A hospital CEO was arrested Wednesday in what authorities said was a scheme to recruit homeless people as phony patients and bill government programs for millions of dollars in unnecessary health services.

Federal agents raided three medical centers and the city of Los Angeles sued the hospitals, saying they used homeless people as "human pawns."

More charges are expected, a federal prosecutor said

Hospitals in Los Angeles and Orange counties submitted phony Medicare and Medi-Cal bills for hundreds, perhaps thousands, of homeless patients — including drug addicts and the mentally ill — recruited from downtown's Skid Row, state and federal authorities allege.

While treating minor problems that did not require hospitalization, such as dehydration, exhaustion or yeast infections, the hospitals allegedly kept homeless patients in beds for as long as three days and charged the government for the stays.

Over four years, a mentally ill woman identified as "Recruit X" was admitted to all three hospitals for conditions she said she never had, such as shortness of breath and chest pains.

After her stays, she would be returned to Skid Row and use money she received for participating in the scheme to buy crack cocaine, authorities alleged. She was never treated for drug addiction.

Reports of homeless dumping prompted investigation

The investigation was sparked in 2006 by a Los Angeles police investigation of reports that hospitals were dumping homeless patients on the streets.

Search warrants were served at City of Angels Medical Center, Los Angeles Metropolitan Medical Center and Tustin Hospital and Medical Center, the FBI said.

FBI agents arrested Rudra Sabaratnam, CEO of City of Angels hospital, and Estill Mitts, operator of a Skid Row health assessment center, FBI spokeswoman Laura Eimiller said. They were in federal custody and were expected to be arraigned Wednesday afternoon.

A 21-count indictment unsealed Wednesday charged both men with conspiring to receive and take kickbacks for patient referrals and to commit health care fraud. Sabaratnam also was charged with paying kickbacks and Mitts was charged with money laundering and tax evasion.

If convicted, Sabaratnam could face 50 years in federal prison, and Mitts could face 140 years, authorities said.

U.S. Attorney Thomas O'Brien said he expects additional charges in the case.

"This is one of several major medical fraud investigations that are ongoing," he said. "There's too much money being illegally stripped from public health care programs and the potential impact to those with a legitimate need is too great to let such fraud escape federal prosecution."

There were no residential phone listings in Los Angeles for Sabaratnam or Mitts and it was not immediately known if they had attorneys.

Representatives of the hospitals did not immediately respond to calls seeking comment. Los Angeles Metropolitan and the Tustin hospital are owned by Pacific Health Corp. and Los Angeles-based Intercare Health Systems owns City of Angels.

The city attorney's office said it filed a lawsuit against the corporate owners of the three hospitals — along with Sabaratnam, several doctors and others — in connection with the alleged scheme.

Kickbacks of up to $20,000 a month

Frank Mateljan, a spokesman for the city attorney's office, said Skid Row workers "were receiving kickbacks up to $20,000 a month from some of these hospitals and they were delivering between 30 and 50 patients a month."

Mitts ran the 7th Street Assessment Center, which screens people for health needs and takes them to hospitals if necessary.

The lawsuit said the "patients" were picked up by recruiters who sent them to the 7th Street center, where they were given phony diagnoses and forms were filled out justifying their eligibility for government medical programs.

Medi-Cal and Medicare would be billed for the ambulance and hospital stay, Mateljan said.

After their hospital stays, the homeless patients would be returned to Skid Row shelters, but "they would go back multiple times," he said.

In the lawsuit, "Recruit X" said she "received very little medical treatment, and none of the treatment that she received was necessary."

At least once, she suffered a serious drop in blood pressure after she was given a nitroglycerin patch for a nonexistent cardiopulmonary condition, the suit claimed.

[letmesleep]

Let me start off with saying that I was keeping up with this thread, but today just skimmed though some posts that I had not read yet.

I think it's fair to say that there are many factors in play here, but as far as EMS being to blame, we have to take our hit as well. In the past it was not uncommon to show up to a call, and transport to the ED just based off the request of the Pt. Now we are trying to reverse said Hx because of multiple issues, but Medicaid being the biggest reason. Medicaid has started requiring us to more or less justify transports, thus forcing us to cut back on the unnecessary movement of the public to the ED. (stand by, my dog just slobbered on my arm....damn it). I do understand the reasoning for the changes to the payment system, and this is were most of the "billing forms" are coming from. Having to get signatures from those not needing EMS transport after being advised of such is just one HUGE change since I started. This has also become a generational issue. We are now seeing the children of the Pts from 15 years ago using EMS in the same manner as their parents did while they were "growing up" (I use that term loosely). This is where our struggle to educate takes effect, Pts today saw their parents using EMS as a means of transport for every little thing from splinters in the fingers to cold-like symptoms. Trying to explain to the Pts of today that their insurance (medicaid) will not pay for this is near impossible, and that they should find other means to the ED or (light bulb just went off) a doctor's office.

I think that we have some of the burden to bare because of our past, but to take total credit for the decline of health care in the US is ridiculous.............

[Jyannotti308]

Sounds like Wishard her in Indianapolis. LOL

I've actually had patients request us to take them to the store. They got mad when told ER or nothing. Of course a couple said ER then and I said sorry as you do not have an immediate threat to life or limb we are unable to take you. Sign here. Good bye.

[triemal04]

letmesleep-

You've got a good point with medicare refusing to pay the full cost, if any, for transports that aren't neccasary. And while this may not affect the healthcare system as a whole, it definitely impacts EMS services; there are some out there, but the number of services that allow their providers to refuse to take a pt are still on the low side. It's better in some areas, but the "you call we haul" mentality is still the most prevalent theory it seems. So services still take the jackass with a toothache and never get paid (since that douche won't be paying). I don't neccasarily have a problem with medicare refusing to pay for that type of call, but I do have a problem with the service getting stuck with the bill. And unfortunately, while the answer to this problem is easy, I don't see it happening anytime soon.

This isn't to say that medicare is doing the right thing with how they reimburse services; they aren't. Far as I know, there is still a cap on how much they will pay, and it's generally less than what the service should get (not sure, so anymore info is appreciated). Having accountability is great, not paying for BS is fine, but shortchanging the services isn't. And making these decisions without input from the field is asking for trouble. Which is what's happening now; more and more places are losing money on their emergency transports. Not a good thing.

To be honest, I don't know that we really have all that much of the blame for healthcare problems at our feet. You can say that ER's are being overburdened with BS complaints being brought in by EMS, but I'm guessing a fair amount (not all) of those people would still make it in on their own. You can say that EMS is getting money that isn't "deserved" from medicare, but that problem (if it ever was) has been taken care of and now it's the opposite. Personally, I think the biggest problem with healthcare, besides the lack of funding for it and the extremely high insurance rates, is unrealistic expectations on the part of the average person. Everybody wants their problem solved NOW, no matter how trivial or unsolvable it is. Everybody has seen to much TV where the nice doctor spends weeks figuring out the obscure problem and everyone lives happily ever after. Not the way it really happens. But people will still keep trying.

Oh well. In the mean time just remember: EMS-when you absolutely, positively can't afford a taxi!