EMS or taxi service?

[tniuqs]

I find there are two types of B.S. patients medics: Lazy ones and ignorant ones.

The <snip for sanity> "ambulance driver", which pisses me off.

Agreed, I prefer life saving hero myself

cheers

Edited July 30, 2011 by tniuqs

[andrean678]

I find it easier to just do the call than bitch at the pt. You end up doing it anyway, so what is the point of pissing them off?

Our service has 3 distinct frequent fliers that use their serious medical conditions to find a ride to the hospital for different reasons. One is a straight up drug seeker, another signs out AMA and hits the streets to hook and the last cuts her cab fare in half when she has to return her daughter to the father.

[Just Plain Ruff]

Actually those BS patients usually have medicaid or no insurance so they are NOT paying our bills. The people who actually pay your bills are the ones who can pay for your services, hence the ones who have insurance. My insurance is pretty damn good and we called 911 for my wifes first pregnancy and we were billed 930.00 of which insurance paid only 360 of it because we had not met our deductible yet.

So I suspect that us paying almost 600.00 of that bill, which we did promptly paid for one medic and one EMT's salary for the day and the gas for the fire truck and ambulance. What a banner day for the service who transported us.

We ended up using this particular cities ambulance service twice during the pregnancy and our the second trip was completely free to us because we had met our out of pocket maximum deductible.

so honestly, most of the BS calls that you get are from uninsured/medicaid patients and do you honestly think that most of those people are going to pay the bill they get? I think now.

I think the ambulance service I worked at last had a collection rate of about 38% or so based on the large numbers of uninsured/medicaid/medicare patients in our district.

[PCP]

I run every call as if it was an " Emergency " I might not think it is an emergency but the person who called does. Yes, I will explain to them if they ask about getting in to see a Dr. faster because they called for an ambulance. I tell them " No" everybody who comes into the ER gets triaged even the patient's that come by ambulance so they may have to wait a while to see a Dr. depending on their complaint.

I feel that getting mad is not going to help the situation and explaining to them that we are not a taxi does not go very far besides maybe a 1104 or a 1105 depending on if the patient complains to the Unit Chief about me or my partner telling them that we are not a taxi service.

I know we all want to do nothing but exciting calls but we all no that is not how it works. So I do my best to have fun, treat my patient, and not worry about if I feel that the patient should have called for a taxi or for an ambulance.

Brian

[ERDoc]

PCP, that is very altruistic (and there is nothing wrong with that). Unfortunetly there are always people who will abuse the system and this includes EMS and the ER. It's great that, as a provider, you don't let it bother you and make you jaded. As a society however, it is a huge drain. Think of the resources that are being wasted and the resulting costs to society. As a member of ACEP, I have to disagree with their statement that most of the pts in the ER need to be there. In my practice at a total of 5 different hospitals, I would say less than 50% of the people that are there need to be there. That 50%+ have complaints that could be cared for by their PMDs or don't need a doctor and just need time. Let's say in an average day I see 22 pts. So we are looking at 11 pts that don't need to be there. Let's assume the average PMD visit costs $100 and ER $500. That is $400X11=$4400 just in the pts I see in one day, now spread that across the country. I realize this is very oversimplified but it makes the point. Now let's add into that the number of unnecessary ambulance rides. The numbers start to add up. I could go on but there are whole debates about this on other websites. I'll step off my soapbox now.

[Happiness]

One of the problems we have had here is that getting a Dr's app. Honestly you could wait for months (I have). Comming through emergency was a way to by pass that so we would get called. What our hospital did to help correct this was, in the morning (you have to call around 8 am) you call and ask to see the Dr. on call. The days that the on-call doc is on the appointments are kept open so you can get in that day, and if not you call the next day.

As for the frequent flyiers, I know we get tired of them but there is going to be one day that they really do have an emergency and you will be caught of guard. I have a flyer and one day he was unresponsive and drunk. I did notice this time he was a bit more out of it than normal. I didnt really think he was more than drunk as all vitals were good. They did a 12 lead on him and he has a left sided bundle with bunny ears (which really dosnt mean alot as I dont read the strips) but now I will look at him alittle different.

Also with the ones that just call use them as practice. Give them a good look over pretend your back in school doing your final test and after think about what you missed. I do

[island emt]

One must always remember that even the frequent flyers are sometimes truly sick and need to be seen emergently.

If you forget this, one day it will bite you in the ass, HARD!

Every patient deserves a good head to toe assessment from us and if there is any doubt at all, transport to an appropriate medical facility.

[HERBIE1]

I'll be honest. The BS calls DO piss me off. Do I treat the patient crappy? Of course not, but I also do not pretend if it wasn't for them I wouldn't have a job. As someone mentioned, the BS calls come from folks who do NOT have to pay for the service. They are either self pay or Medicaid, which means we get nothing for the ride, or pennies on the dollar at best. They have no deductible to meet, they have no copay, they have no screening process to get an ER visit approved, much less an ambo ride. I've been in homes of our frequent flyers where they have a dozen or so unopened bills from previous rides, strewn across their table. They know they will never be forced to pay, nobody will deny them service because they do not pay, so they continue the process. There is simply no penalty for those who abuse the system.

Doc hit the nail on the head. A good portion of our patients do NOT need an ER, nor do they need an ambulance ride to get there. Yes, some folks- primarily the elderly- have mobility issues and an ambulance is the only way they can get help. That's fine- I will always go the extra mile for the seniors. I don't care why they call, but in our case, we are a 911 service, and although we have some BLS units, the system is so screwed up that calls get over or mis- triaged and too often ALS is sent for a basic call. A person has a cardiac history, but tripped, fell, and sprained an ankle. Cardiac history gets them an ALS response. It's all about liability and everyone is afraid of getting sued.

Abdicates soap box...

[Bernhard]

Here we have the possibility to refuse transport and turn the patient over to a general practioner making house calls (24/7 service available throughout the state).

Generally, a non-emergency transport has to be prescripted by a doctor anyway, so if no prescription is given we don't transport - unless it's an emergency. This is filtered by dispatch, but the EMT/medic can do it as well (and point the patient to the next general practioner service). it sometimes is a fine line, but calling a general practioner usually gets you well out of the way of beeing liable. Last year there even was a case in next big city where dispatch refused to send an ambulance to an obvious "only drunk" patient (17 year old), his father filed a law suit which resulted in a clear verdict of "not gulty" because of "EMS is no taxi service for drunkards".

There are some general practioners acting very loosely on whom to give prescriptions for an ambulance transport, so there may be the occasional patient waving with his prescription and demanding transport which could easily be done by a taxi or private/public transport - BTW, the doctor could have prescribed a taxi transport as well. That tends to be reduced, since health insurances seem to keep an eye on this.

So the real "BS" calls here are mostly reduced to "kind-of-emergency-but-not-really" types (drunks, helpless), when a certain probability exists that a medical condition could exist and/or police refuses them.

We have to live with that. But from what I read from the U.S., we seem to have a far less share of real BS calls and frequent flyers without any emergency. Wouldn't want to change this (and as well wouldn't want to decide wrong - such cases exist...).

[crotchitymedic1986]

If you are a plumber, sometimes you have to put your hands in poop, if you are a cop there are days you have to direct traffic in the rain. In our business 95% of our patients would get to the ER alive if they went by car (I didnt say in great condition, I said alive). People abuse us, it happens, get over it. But there is a big lesson here: Always treat the patient in front of you. It is not your job to worry about how many ambulances are available, how many calls or holding, or whether or not your service is profitable. It is your job to treat the patient in front of you.

The drug seekers and drunks are the two patients that will bite you in the ass. Drug seekers are not healthy, they dont eat right, and they are probably on several different drugs, and taking a dose daily that would kill an elephant. There is a reason you dont see too many 90 year old drug seekers.