As EMS/PHC Providers; Are We That Lazy?

[NYCEMS9115]

Your assuming insurance is going to continue to pay for in many cases is a fx awfully expensive taxi. If you'll notice I mentioned changes to the reimbursement model in another post. Our current model is unsustainable. We need to get it changed before it collapses.

Your right but its not reducing or eliminating Medicare and Medicaid. Its holding patients accountable. In reality I'm for educating the patient; redirecting them to proper resources. However, it must be done professionally but it can't be done in NYS; its not in Protocol. I've sent letters to HHS regarding copays for Ambulance Transports; Emergency and Non-Emergency. Also, I've suggested premiums for Medicaid and Medicare Part A recipients. In addition, I've proposed that the current Medicare Tax should be renamed the HHS tax 1% added to it... This is probably the only way to sustain the MC/MK programs...

Thanks...

[NYCEMS9115]

Then there's the other path. The path where we stop holding ourselves back, we stop insisting that we can't and we won't, and we man up, grow some, get our educational standards where they ought to be, and start implementing these practices which have been shown in other EMS systems across the world to not only improve the cost-benefit ratio of EMS, but also elevate our profession and provide the best possible and the most competent care for our patients.

And you all may think I get ahead of myself at times, and maybe I do, but you know what? If come tomorrow, it became national mandate for paramedics to have a Bachelor's degree, what would most paramedics say? "Fuck that, they're not paying me enough and it's not going to change what I do, anyway." So why in the hell is anyone going to further their education, when it's not going to do anything for them? You HAVE to have some sort of goals in mind, some sort of changes in care that having a higher education is going to grant people. Right now, people do it to get into admin. That's the incentive to get the degree. Until we start advocating a system that permits paramedics who have achieved higher degrees to expand their clinical skills, there is absolutely NO incentive for people to get that degree. A paramedic with a B.S., M.S., and PhD. is still just as restricted and paid just the same as the certificate mill paramedic.

You have to have some bait to dangle in front of them to get them to jump. I'm not saying we should be doing these kinds of practices without degrees, I'm saying, "Hey, everyone, here are some things where we in EMS could do better, some things we could do that will really help our patients. But here's the catch... you gotta get your big boy degree first." I'm sorry, but the average paramedic in this country is not so enlightened that they're simply going to go out and get their four year degree out of the goodness in their heart and out of their deep, overwhelming desire to have more clinical knowledge. That's the reality of it. We have to not only advocate higher educational standards, but have some rewards waiting at the finish line for those who jump on board the boat. It's the same with changing medicare, you want to be paid like a healthcare professional, you've got to become a healthcare professional first.

You can't assume the average Paramedic will be against having a Degree.

Ex. Someone wants to be a Respiratory Therapist; you need a degree. An Occupational or Physical Therapist; you need a degree. A Registered Nurse; you need a degree. A Physician Assistant; you need a degree. A Social Worker; you need a degree. A Radiologist Technologist; you need a degree. Where talking about an Associates Degree; its like people complaining about getting a HS/GED Diploma. If we want progress in EMS or progress in this world you need a degree. Standards must be set.

We need to look at the future; not now. Disgruntled people will always be disgruntled, regardless. What's wrong with some College Anatomy & Physiology I/II, Microbiology, Mathematics for Healthcare, English I/II, General Chemistry, Introduction to Psychology, Developmental Psychology, Introduction to Sociology, and an Elective? This is how the Prerequisites for the A.A.S. in Paramedics look like. The Bachelors and Masters are not required but many employers who are hiring for EMS Director positions are asking for it. What's the big deal if the Colleges/Universities come up with a B.S. and/or M.S.? They've come up with Bachelors and Masters in Emergency Management and Preparedness. Education only helps; it never hurts. But you're right an AEMT-P, AS or AEMT-P, BS or AEMT-P, MS or AEMT-P, PhD is still just an AEMT-P...

However, you're right that people need the money factor to do things.

[usalsfyre]

Your right but its not reducing or eliminating Medicare and Medicaid. Its holding patients accountable. In reality I'm for educating the patient; redirecting them to proper resources. However, it must be done professionally but it can't be done in NYS; its not in Protocol. I've sent letters to HHS regarding copays for Ambulance Transports; Emergency and Non-Emergency. Also, I've suggested premiums for Medicaid and Medicare Part A recipients. In addition, I've proposed that the current Medicare Tax should be renamed the HHS tax 1% added to it... This is probably the only way to sustain the MC/MK programs...

Thanks...

I think we're arguing for the same thing...

I don't refuse transport now even when I know for a fact I'm dealing with a minor complaint. I'm not able to, I HAVE to offer transport no matter what.

My argument is, currently Medicare pays roughly $400 for an ALS 1 TRANSPORT. Doesn't matter if it's an IV "just because" or a sick CHF patient getting ready to die, as long as it fits in the ALS 1 category. What if we switched and payed $200 for an ALS RESPONSE and assessment, plus appropriate billing for procedures (x amount for an EKG, x for an IV, ect) and then bill only for your transport mileage. This way you get reimbursed not for your truck, but rather the important part of the response, your knowledge. Plus, the more you do, the more your reimbursement is. Your assessment shows it can stay home? Congratgulations, you've just saved the system a $1k plus ED bill, which helps prove your worth. So how to keep services from doing inappropriate procedures and running up charges? On chart review if a procedure is not indicated it's not reimbursed. In addition, if service "A" has better outcomes than service "B", service "A" can negotiate for higher reimbursement.

The part that most don't like about this plan? Paramedics now have to be VERY accountable for their decisions. The "I'm not a doctor" BS no longer flies under this model.

Yes, it's a drastic change. Current providers at all levels are lined up against it, as it requires more education, shifts responsibility back on to them, may actually increase "EMS abuse", ect. However, I feel this is the direction we need to go for the good of healthcare and EMS. It's time to join the healthcare community and drop the "public safety" charade.

Edited April 18, 2011 by usalsfyre

[NYCEMS9115]

Okay. You're a Paramedic who wants to progress further in the field. Here are current job postings. Hopefully, its in your area or an area you can relocate to.

Fernandina Beach, FL; Division Chief of EMS and Training

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site_id=12090&jb=7837254

Glenwood Springs, CO; EMS Program Faculty

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site_id=12090&jb=7807047

Bend, OR; Director of EMS and Structual Fire

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site%5Fid=12090&jb=7865967

North Syracuse, NY; EMS Executive Director

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site%5Fid=12090&jb=7807058

Roanoke, VA; EMS Program Faculty

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site%5Fid=12090&jb=7807069

Cincinnati, OH; EMS Program Faculty; Visiting Professor

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site%5Fid=12090&jb=7807062

Greenville, SC; Marketing Director

http://www.emsjobcenter.com/c/job.cfm?vnet=0&site%5Fid=12090&jb=7819831

Sumpter County, FL; Chief of Fire and EMS

http://www.emsjobcenter.com/c/job.cfm?vnet=0&str=26&site%5Fid=12090&jb=7708371

Chester, VA; EMS Faculty

http://www.emsjobcenter.com/c/job.cfm?vnet=0&str=26&site%5Fid=12090&jb=7794119

These are some great positions outside the Ambulance but you need a Degree. Good Luck...

[usalsfyre]

Working on a bachelor's degree right now, not sure if I'm going to stay in EMS or go a different direction (very early stages). So, I'm trying to change what I can from inside the system right now.

[NYCEMS9115]

I think we're arguing for the same thing...

I don't refuse transport now even when I know for a fact I'm dealing with a minor complaint. I'm not able to, I HAVE to offer transport no matter what.

My argument is, currently Medicare pays roughly $400 for an ALS 1 TRANSPORT. Doesn't matter if it's an IV "just because" or a sick CHF patient getting ready to die, as long as it fits in the ALS 1 category. What if we switched and payed $200 for an ALS RESPONSE and assessment, plus appropriate billing for procedures (x amount for an EKG, x for an IV, ect) and then bill only for your transport mileage. This way you get reimbursed not for your truck, but rather the important part of the response, your knowledge. Plus, the more you do, the more your reimbursement is. Your assessment shows it can stay home? Congratulations, you've just saved the system a $1k plus ED bill, which helps prove your worth. So how to keep services from doing inappropriate procedures and running up charges? On chart review if a procedure is not indicated it's not reimbursed. In addition, if service "A" has better outcomes than service "B", service "A" can negotiate for higher reimbursement.

The part that most don't like about this plan? Paramedics now have to be VERY accountable for their decisions. The "I'm not a doctor" BS no longer flies under this model.

Yes, it's a drastic change. Current providers at all levels are lined up against it, as it requires more education, shifts responsibility back on to them, may actually increase "EMS abuse", etc. However, I feel this is the direction we need to go for the good of healthcare and EMS. It's time to join the healthcare community and drop the "public safety" charade.

I fully agree with you. I am on board. Too bad the people who can do something about it won't because they will lose votes in their bid for re-election. So how the Republicans took the House in 2010. See how, Pres. Obama is changing his strategy as he seeks re-election. The Directors of HHS in the Federal and Regional Levels are appointed and expendable. You want to keep the job; do as what the Politicians say....

[Just Plain Ruff]

.

We need to look at the future; not now. Disgruntled people will always be disgruntled, regardless. What's wrong with some College Anatomy & Physiology I/II, Microbiology, Mathematics for Healthcare, English I/II, General Chemistry, Introduction to Psychology, Developmental Psychology, Introduction to Sociology, and an Elective? This is how the Prerequisites for the A.A.S. in Paramedics look like. The Bachelors and Masters are not required but many employers who are hiring for EMS Director positions are asking for it. What's the big deal if the Colleges/Universities come up with a B.S. and/or M.S.? They've come up with Bachelors and Masters in Emergency Management and Preparedness. Education only helps; it never hurts. But you're right an AEMT-P, AS or AEMT-P, BS or AEMT-P, MS or AEMT-P, PhD is still just an AEMT-P...

However, you're right that people need the money factor to do things.

What's wrong with a little A&P or Chemistry? For most of the EMT's and paramedics to be out there, they want it fast and easy. If they didn't we wouldn't be seeing these 12 week courses, or these fly by night get-ups that promise zero to hero in as short a time as possible.

I propose that the first thing we do to increase our educational standards is to preclude these types of companies from letting their students sit for the national registry or the state exams. If you get rid of the zero to hero puppy mills, then you increase the standards 10 fold if you ask me.

I then propose a national standard of an AS at least in paramedicine. If you want to work the streets as a paramedic then you get your AS or higher degree. Simple as that. If it's a national standard then there is no place to go bitch and moan about it.

I would also require at least 2000 hours in hospital clinical work and then another 2000 hours of ambulance ride-time. Lofty numbers I know but the more exposure you get to the system and patient care the better you will be. Maybe 4000 hours total is too high a number but it should not be less than 1000 in each.

Broken down that should be 500 ER hours, 250 hours in ICU/PICU/MICU etc etc. and then 250 hours divided by the other notable hospital departments.

Break down for ambulance would be 750 hours in an urban system and 250 hours in a rural system. With a minimum of 250 ambulance calls and if you don't get the 250 then you have to keep in clinicals until you do get them.

Continuing education is another sad sticking point. I relicensed in Missouri last time by taking all the credits from CE Solutions. I got over 150 hours of continuing education completed in less than 1 month. Did I learn anything, NOPE, it was all computer based and it was easy to skirt the system. Did I cheat, no, I just didn't put the most I could have put into it that I should have.

Continuing education, 30 hours a year or 150 hours in 5 years. This includes 2 full refresher classes (total hours 80) and those can be done online. The rest should be done in a classroom setting or classes like PALS, ACLS, PHTLS/BTLS/ITLS, ABLS, NRP, Extrication - you get the picture. For a maximum of 80 hours online and 70 hours actually attending a class.

Before anyone goes off to complain "whaaa it takes too much money to go to a class and I would have to drive a long way to get to the class" buck up and take responsibility for your job and licensure. ACLS/PALS often are taught inhouse or at the nearest hospital. I travelled 1200 miles to take ITLS. It's offered by PHI International for free if you know who to talk to.

Once we take responsibility for our own education and stop expecting it to be given to us, we can begin to take ownership of our collective profeesions future and make changes that will really impact our profession.

To continue to do nothing is tantamount to saying "I don't give a shit"

I'm not ready to say that, are you?

Bieber, since when is leaving patients home to die a sign of clinical excellance ? Thats the problem with this generation, you are too concerned about the procedures and treatments you can do to a patient, versus good old fashion assessment. As long as you can do RSI or use a drill to IO someone, you think you have accomplished something. Be a patient advocate first, a paramedic practicum advocate second.

So Crotchity, how bout the 78 year old completely lucid male patient, in profound respiratory distress, purple to all get out, who knows who he is, where he is, what is going on and knows that today is the day he is going to die. I had that patient about 2 years ago.

He adamantly refused to go to the hospital despite his daughters pleas, the phone call to his doctor that I made for him to try to convnice him to go- didn't work, the call from his son in california and the statement from me that said "if you do not go, you will be dead in less than an hour".

Not one of those worked.

I made him write out "I know I am going to die today if I don't go to the hospital but I refuse to go" and he signed it.

I then told him that I was going to drive up the street, get a soda at the convenience store and wait for the call to go back to his residence. I told him that I would be back within 20 minutes to work his cardiac arrest and he said "get the hell out, I'm ready"

30 minutes later I was back and I coded him.

Was I lazy or imcompetent in this call?

I think not. I will also add that I did talk to medical control and they agreed no transport because the patient was completely lucid.

You should have seen my run report. It was 3 pages long in the narrative.

Some patients just want to be left and to die at home. WE cannot force them unless you have the protocols and medical control to back you up. It's still the patients right to refuse no matter how much like god some of our illustrious paragods think they are.

Ruff

[NYCEMS9115]

Working on a bachelor's degree right now, not sure if I'm going to stay in EMS or go a different direction (very early stages). So, I'm trying to change what I can from inside the system right now.

I wish you all the best. Its good to see people progress; stagnation is such a waste. The way you debate and make an argument shows the confidence you have. You have a pure quality to succeed.

I'm just catching up. I became an EMT in 1995 and a Paramedic in 1998. It took me a decade and a half, after HS to figure out that education is important and necessary. I've applied to numerous EMS and Executive Director Positions. All told me the same thing; my resume is impressive but I lack the Educational Experience they were looking for. Could they all be wrong? No they are right. That's why I've been going to College PT since 2005. I received my AAS in Paramedics in 2008. I am pursing my ASN for Summer of 2012; then my RN/NCLEX. I am set to go for my BPS in Fall 2012. I'm 35 now; so I will be 40 when I get my Bachelors but you have to work until your 67; if the govt has its way; 69.

All the best...

[NYCEMS9115]

What's wrong with a little A&P or Chemistry? For most of the EMT's and paramedics to be out there, they want it fast and easy. If they didn't we wouldn't be seeing these 12 week courses, or these fly by night get-ups that promise zero to hero in as short a time as possible.

I propose that the first thing we do to increase our educational standards is to preclude these types of companies from letting their students sit for the national registry or the state exams. If you get rid of the zero to hero puppy mills, then you increase the standards 10 fold if you ask me.

I then propose a national standard of an AS at least in paramedicine. If you want to work the streets as a paramedic then you get your AS or higher degree. Simple as that. If it's a national standard then there is no place to go bitch and moan about it.

I would also require at least 2000 hours in hospital clinical work and then another 2000 hours of ambulance ride-time. Lofty numbers I know but the more exposure you get to the system and patient care the better you will be. Maybe 4000 hours total is too high a number but it should not be less than 1000 in each.

Broken down that should be 500 ER hours, 250 hours in ICU/PICU/MICU etc etc. and then 250 hours divided by the other notable hospital departments.

Break down for ambulance would be 750 hours in an urban system and 250 hours in a rural system. With a minimum of 250 ambulance calls and if you don't get the 250 then you have to keep in clinicals until you do get them.

Continuing education is another sad sticking point. I relicensed in Missouri last time by taking all the credits from CE Solutions. I got over 150 hours of continuing education completed in less than 1 month. Did I learn anything, NOPE, it was all computer based and it was easy to skirt the system. Did I cheat, no, I just didn't put the most I could have put into it that I should have.

Continuing education, 30 hours a year or 150 hours in 5 years. This includes 2 full refresher classes (total hours 80) and those can be done online. The rest should be done in a classroom setting or classes like PALS, ACLS, PHTLS/BTLS/ITLS, ABLS, NRP, Extrication - you get the picture. For a maximum of 80 hours online and 70 hours actually attending a class.

Before anyone goes off to complain "whaaa it takes too much money to go to a class and I would have to drive a long way to get to the class" buck up and take responsibility for your job and licensure. ACLS/PALS often are taught inhouse or at the nearest hospital. I travelled 1200 miles to take ITLS. It's offered by PHI International for free if you know who to talk to.

Once we take responsibility for our own education and stop expecting it to be given to us, we can begin to take ownership of our collective profeesions future and make changes that will really impact our profession.

To continue to do nothing is tantamount to saying "I don't give a shit"

I'm not ready to say that, are you?

Well put. I agree with the principle of your statement. I totally agree but like you said; most will belly ache. No one, who can do something about this will do anything. Not the NHTSA, DOT, NAEMT NREMT NAEMSE, NASEMSO, and the rest of the Alphabet Clans; they will let EMS remain stagnant. Its up to the individual to just do it on their own. Many people don't need extrinsic factors to make them get an education. Its survival of the fittest; I guess.

[crotchitymedic1986]

We are not talking aboout Patient Refusals, we are talking about Lazy EMS people refusing patient transport. Big difference. No one is going to argue that patients refuse AMA, although I will contend there was rarely a patient I could not talk into going if I tried for more than 2 minutes.