CCEMT-P just what does it stand for

[letmesleep]

Rid, let me start off by admitting that I know nothing about you or where you work. If you have been able to bring in that kind of money for your service thats great, but only if that is the objective of your service. I work for a tax based 9-1-1 service that serves the residents of the district. It is a district that covers 244sq miles and approx 30% is farm land, we have a major Interstate that cuts it in half (north to south), and we are approx 30miles from St Louis. With all that said the last objective is to make a "buck" off the backs of our taxpayers. As I stated before there is NO need for an extra charge to the residents of this district just because we sport an extra couple of letters on our title. We provide the same amount of EMS care as any one with the CC. Many of us have taken the class, and I do believe it is worth taking, but only in the interest of knowledge and CEUs. I have NO problem with you wearing your title proudly, and as stated above making more money for your service, by all means, have at it. I will take offense tho at your uncalled for accusations and continued attempts at insulting any one of us who don't see the need for your CC to treat PTs. I believe your statement was along the lines of: "If one don't like the title so be it", but as far as sour grapes, your trying to compare apples to apples my friend. There is nothing in the back of a truck that the CC ALLOWS you to do over and beyond my skill level. We handle transfers from the local hospital here that need to go to a higher level facility. We have vents on our trucks, we can handle drips....of any kind (much like you), if we get a balloon pump transfer out of the crap hole they call a cath lab, throw in a nurse and we are down the road.

I am all for furthering our knowledge base as medics, and quite honestly if any one wants to display their accomplishments on the paperwork you sign, on the collar, or on a sleeve then go right ahead. We should be proud, but don't knock those of us down just because we choose to wear a duty shirt that simply states......Paramedic!

[Ridryder 911]

You don't charge for your services? I too work in a rural third party type system and the reason I am promoting change is to be able to keep it. Why should we in EMS not be able to be reimbursed accordingly? Want to maintain those rigs, keep your staff, ever get a raise? Even potentially lower your overhead for the tax base?

Sorry, this is the reason for billing SCT. Since you are from the St. Louis area, I suggest you look at your neighbors and why they are able to expand and flourish. Examples alike Central Jackson Fire District and others.

Billing appropriately is not "placing" a burden on the residents, as much as raising taxes for off set the loss that was acquired. When in fact, insurance and Medicare could had supplemented financial losses. The reason to be able to bill for the services is the reason such a division was made, if you are able and are providing the services; why not receive appropriate payments? Your service deserves it.

Sorry, healthcare is all about the money received. Don't believe me, stop the paychecks... stop paying for fuel and supplies. Look around on the number of EMS services closings or redistricting because of lack of funding. If one (EMS Service) is not savvy of the financial end of medicine, it will loose.. somehow.

R/r 911

[letmesleep]

I think there was a misunderstanding somewhere. We do bill for services, but don't have the need for increasing that cost to our taxpayers. We do have property tax, and have past a sales tax to start off setting that cost to the tax payers. I'm quite clear that it takes money to run an ambulance every year, but is there really a need to rake the residence we serve if there is other money out there? If so, are you really serving those residents as responsibly as possible? I have never believed that it was our job to keep the poor (that we tend to run on the most)....poor, but by continuously running on these people then hitting them with huge charges such as the ones discussed here, we are doing exactly that. Savvy? I call it irresponsible, but if thats how things need to be done at your service then so be it.

[Ridryder 911]

I think there was a misunderstanding somewhere. We do bill for services, but don't have the need for increasing that cost to our taxpayers. We do have property tax, and have past a sales tax to start off setting that cost to the tax payers. I'm quite clear that it takes money to run an ambulance every year, but is there really a need to rake the residence we serve if there is other money out there? If so, are you really serving those residents as responsibly as possible? I have never believed that it was our job to keep the poor (that we tend to run on the most)....poor, but by continuously running on these people then hitting them with huge charges such as the ones discussed here, we are doing exactly that. Savvy? I call it irresponsible, but if thats how things need to be done at your service then so be it.

I believe there is a misunderstanding. How are you offsetting the costs by having a different level of charges? I bet, if you investigate you have ALS I or ALS II with multiple charges. As well, look into the billing.. speciality care is only charged when those calls are appropriate, not on every call.

The citizens will pay for it one way or another, personally I much rather charge it to those that required the services and not to the broad spectrum of tax payers.

R/r 911

[letmesleep]

Rid, lets stop for a second, let me ask you if you are charging for ALS I and ALS II? If so are you also charging for SCT on top of that (when needed)? Is there a charge for transport milage? I do know that we charge for ALS I and ALS II, but there is no extra charge for SCT, and we also charge for loaded miles. I also agree with not charging the broad spectrum of tax payers, and I will also state that money brought in from transports are used solely by my district for supplies and maintainance for our equipment, it does not fund my pay or benefits other than keeping that money available in the annual budget.

I never once said that this class and cert was a waste of time and/ or energy, but I don't feel that it is always a need beyond education and billing.

I think the mud is starting to clear a little (hopefully).

[UMSTUDENT]

I think I can clarify some of the problems here, especially since I sat in the same building as the people who run the CCEMT-P program almost every day for 4 years. That program kept the lights on in the very classrooms where I completed my undergraduate education.

First, CCEMT-P is a continuing education course the same as many others you may encounter in your profession. UMBC does not license individuals to practice these skills, but simply provides the vessel by which the education is provided. This course would be somewhat equivalent to taking a 2 week, 8-hour-a-day, ACLS course. The course is meant to bridge that gap between prehospital, emergency medicine ("street EMS") and prehospital transport EMS. Sadly, most paramedic programs don't spend nearly enough time on the pharmacology and other dynamic aspects of the hospital world. From my understanding, the UMBC program covers things like indwelling catheters, vents, ventilation mechanics, pumps, LVADs, advanced airway management, etc.

Second, the course it taught around the country via cooperative agreements with UMBC. From what I've gathered, institutions become accredited to teach the material as provided by UMBC. The institution probably pays a fee for this and has to submit that their instructors and classroom settings meet some level of standard.

Rid is correct. Medicare does recognize a level of transport above that of your typical interfacility transport. He is also correct in calling this a "Speciality Care Transport." Maryland, as a state, recently began recognizing approved transport programs to participate (and thusly start billing) in these types of services. They also now accredit/license individuals as Speciality Care Paramedics. Part of this process requires having taken UMBC's course. This has no applicability to the 9-1-1 setting. Simply putting a speciality care paramedic on your ambulance will not allow you to bill Medicare for this service. A) The level of service provided would have to be more technical/difficult AND SCT requires a nurse to be part of the team, which is not common in the 9-1-1 setting.

Personally I would probably not place "CCEMTP" behind my name. It is not a board certification/registration in the same way that being a NREMT-P is. It would be more akin to a emergency physician in a trauma center placing ATLS (advanced trauma life support) behind his name. Postnominals are generally limited to the most advanced degree you hold and any relevant board/registrations.

I feel that the registry should move as soon as possible to establishing a level of criteria for certification of such paramedics, but feel that there is greater need in studying the efficacy of an advanced-level paramedic practitioner.

[Ridryder 911]

Personally I would probably not place "CCEMTP" behind my name. It is not a board certification/registration in the same way that being a NREMT-P is. It would be more akin to a emergency physician in a trauma center placing ATLS (advanced trauma life support) behind his name. Postnominals are generally limited to the most advanced degree you hold and any relevant board/registrations.

I feel that the registry should move as soon as possible to establishing a level of criteria for certification of such paramedics, but feel that there is greater need in studying the efficacy of an advanced-level paramedic practitioner.

Very good points. As well, NREMT is NOT a formal board either nor represent having formal education, rather a private testing firm; but people continue to place their titles as such.

Ironically, I find Bledsoe's post confusing. It was not not very long ago we had discussed the possibility of having a Critical Care Paramedic level and in fact he had discussed with me (per e-mail) that the Registry had been contacted but the costs for it were astronomical. Thus, the decision to possibly link to the FP-C for credentialing.

Again, Dr. Bledsoe is one of EMS best representatives in the business, and honestly a mentor for me and others. I can not speak enough and give enough praises of how his involvement has changed EMS. I do however; find the timing of this article strange when he has a new text "Success for the Critical Care Paramedic" coming out in a few weeks. I do wonder if this was a publisher timing.

R/r 911

[firedoc5]

I know several places that on your name tag you are limited to only your name and highest cert. or license. Any additional initials can go on your name badge. Then that can be limited to your main specialty and/ or dept. you work in.

[UMSTUDENT]

Again, Dr. Bledsoe is one of EMS best representatives in the business, and honestly a mentor for me and others. I can not speak enough and give enough praises of how his involvement has changed EMS. I do however; find the timing of this article strange when he has a new text "Success for the Critical Care Paramedic" coming out in a few weeks. I do wonder if this was a publisher timing.

R/r 911

Dr. Bledsoe doesn't really seem to like Maryland. He's written articles against more things that have originated (or found their home) here than anything else. I've read through parts of his critical care book and CCEMTP isn't mentioned once (if I remember correctly).

I think that this is unfortunately due to a clash of egos. A lot of people outside of the academic community are probably not aware of the galactic clash of minds that has occurred on things like SSM, PUM, Maryland's flight system, and CISM. I've actually learned a lot from articles on both sides, and yes, to some extent Bledsoe has always raised interesting points regarding all of these practices. Unfortunately, I feel as though he fails to recognize the important place some of these practices have in our field. PUM for instance may be impractical for the responding paramedic, but embraces principles that if used correctly can really equate to a quality EMS service.

[saboats]

If you look at the current CMS Fee Schedule Rules Specialty care transport (SCT) means;

interfacility transportation of a critically injured or ill beneficiary by a ground ambulance vehicle, including medically necessary supplies and services, at a level of service beyond the scope of the EMT–Paramedic. SCT is necessary when a beneficiary’s condition requires ongoing care that must

be furnished by one or more health professionals in an appropriate specialty area, for example, nursing, emergency medicine, respiratory care, cardiovascular care, or a paramedic with additional

training.

The SCT rate is intended for Transport, not 911 care. Those who have stated that the CCEMTP/ CICP does nothing to increase how you treat patients, in actuality this is true if you are providing 911 services only. The field of CCT is an arm of EMS, but knowing about ECMO or balloon pumps or VADS probably will not change your treatment of a 911 patient. These again, or specialty care transports, and a standard 911 ambulance is not staffed or equipped to make these runs.

Now, as far as people using NREMTP vs CCEMTP after there names; really what's the big deal. The NREMT is not a LICENSING BOARD, or ACCREDITING AGENCY nor does it grant you permission to do anything anywhere. It is a TESTING AGENCY that certifies a CANDIDATE has met MINIMUM COMPETENCY in their field. It is up to individual states to Certify / License providers to render care. True many states have direct licensure with the NREMT; (eg. all you need is the gold patch and the state gives you a license to practice), some have their own test, whatever. But if you look at the basics of the argument here about using CCEMTP, then that argument would hold about NREMTP. I hold an NREMTP card, and 3 different State EMT-P Licenses / Certifications. If I would hold to this argument, then I should use NH EMT-P, or MA-EMT-P, or simply EMT-P, and withhold the NREMTP because it means nothing! Obviously I don't agree with this interpretation; and truly don't we have bigger fish to fry?!?

But I digress, the real point of this post was SCT Rates; they are for transport, you should not bundle ALS2 with SCT as they are different rates, you can still use mileage, your GAF or RAF if applicable.