EMS-Still for emergencies? (private sector EMS only)

[PRPGfirerescuetech]

*SPIN off from another thread* *private 911 EMS sector only*

It seems that EMS has gotten away from being strictly for "patients in life threatening condition". But many providers also seem to be concerned about "misuses and abuses". Should EMS be used strictly for emergencies? Or do we simply have to provide a billable service to customers who request us, regardless or malady (or lack thereof?)?

I personally believe that EMS provides a billable service to whoever needs it. If you need a taxi ride, and are willing to accept the responsibility for a 900 dollar bill, then who are we to complain?

Thoughts? Im curious...

[Dustdevil]

Interesting question.

I tend to agree with your assessment, but with some situational stipulations.

Do you have the resources to commit to these types of transports without compromising EMS coverage?

Do you have a way to ensure that you actually get paid for these? Remember, to get government or insurance reimbursement for them, there is a good chance you are going to have to commit fraud. Even then, you wait six months to receive only a fraction of what you billed. Generally speaking, this is not a smart business move.

If you're going to run a taxi service, horizontal or otherwise, you need to run it like a taxi service, not a charity. That means fee for service, not free for service. In Allah we trust. All others pay cash.

Of course, this leads to the bigger discussion of whether your personnel are capable of competently determining who is and is not a legitimate medical patient without letting people fall through the cracks, die, and/or sue your arse off. Therein lies the dilemma.

[Ridryder 911]

I have seen them usually identify themselves as EMS and ambulance service. This being, usually as they will provide EMS and then provide ambulance transport for non-emergencies. Many of these services will also provide non-emergency services as well, again to increase profit.

For as "transport" anything, I do wonder on the percentage of payment and then how much paperwork in coding is changed to be able to justify for payment?

R/r 911

[PRPGfirerescuetech]

I have seen them usually identify themselves as EMS and ambulance service. This being, usually as they will provide EMS and then provide ambulance transport for non-emergencies. Many of these services will also provide non-emergency services as well, again to increase profit.

For as "transport" anything, I do wonder on the percentage of payment and then how much paperwork in coding is changed to be able to justify for payment?

R/r 911

TONS.

The fraud in EMS is mind-boggling.

Lots of stories to support this.

Just go to a documentation class and listen. Somewhere, they will remind you to always document a non-ambulating patient who rode on the stretcher.

As if medicare cant decipher "tooth pain" shouldnt be non-ambulatory.

[katbemeEMT-B]

I think it comes down to what the people we are serving want. I do find it frustrating sometimes when you get a non-emergency call and have to transport the patient, but in the same aspect isn't that what we are getting paid to do? An example would be the patient who has a list of medical problems including asthma, COPD, diabetes, and more recently a seizure disorder. We transport this patient at least five times month. The call always comes in as SOB and chest pain. When we get to the scene, the patient is lying on his bed "gasping" for air. The odor of cigarette smoke knocks you over when you open the door. The patient refuses any treatments or interventions you attempt. Within three hours the patient is home from the hospital. Was this a true emergency? In my eyes no. This is a patient who is more than likely is looking for attention. But the one time we did not respond it very well could have been a true emergency. We transport because that is our job whether it is an emergency or not. As far as fraud, I don't know of a service in our area that falsifies their run reports. If we get paid, great. If we don't get paid, well, thats the way it goes. If it's a none emergency we explain to the patient they will be responsible for the bill and insurance may not pay for it. Haven't had very many patients refuse transport yet.

[spenac]

First will not go into rant that this is spin off of.

Fraud is playing a big part in numerous services being raided, all ambulances, equipment, and paperwork being taken this year, just watch the news or do a search. Not only are the owners in trouble, any employee that knowingly did anything to deceive on run reports can face jail. In EMS legal we are always teach "If it's not on the report it did not get done". Really need to add "Don't write that you did it if you didn't". Should not have to teach it, it should be common sense but as others have said elsewhere many lack common sense, besides the lack of education. All the bad publicity continues to rob us the chance as a group to be looked upon as professionals.

Now as far as statement if person is willing to agree to pay $900 taxi ride hall them. Most that say yes already know that there is limited collection rights of medical claims, so they just saved paying a licensed taxi $25 to get where they want. Then you also lose money with the man hours sending bill after bill. Finally you just write it off or maybe sell it to a collection agency for pennys on the dollar. In the end you have lost money even if no supplys other than fuel and time were used. Remember the charge for each transport is actually in large part paying for overhead that is the down time, the vehichle maintenance, building maintenance, insurance, etc,.

So if a service is willing to provide non emergent transport (taxi for short) they should be able to require immediate payment just like real taxis do, just my thought. I'll leave now. See no rant. Have a great day. Stay safe. Lets keep learning from each other.

[CBEMT]

If you need a taxi ride, and are willing to accept the responsibility for a 900 dollar bill, then who are we to complain?

Oh yeah. I bet the check will be in the mail as soon as they get home. :roll: :roll:

[Richard B the EMT]

FDNY EMS is supposed to be a 9-1-1 "Emergency" service, but a lot of what we transport is really a taxi service, as described. We don't do scheduled transports, as that is handled by the "private/proprietary" ambulance services like, as I name 3, MetroCare (MetroSCARE), American Medical Response, or Hunter Ambulance.

The privates do this non emergency transport work, which is usually stable patients, which do not require lights and/or siren while enroute, or when responding to make the pickups, however, if any of them find the patient to be crashing, they can request their dispatchers or managers to allow them to go L&S.

Some misuse the L&S, claiming they are paid to "get there quick", and unfortunately, these are the companies that I end up reading about, in the New York Daily News, when they have a fatal collision, or run down a pedestrian.

But, "Municipal," "Proprietary Hospital Based," or "private/proprietary" ambulance services, and recently independent Volunteer Ambulance Services, now can, and do, bill private medical insurance companies like Blue Cross, Health Insurance Plan of Greater New York, or GEICO, or programs like Medicaid, Medicare, and in California, Medi-Cal, for services rendered.

If the insurer feels that the case does not warrant they pay, the ambulance service provider won't be paid.

Now, a little free thinking on my part: If services rendered by a provider won't be paid, perhaps the insurance companies would prosecute the "free-riders" for attempting to do a "theft of services" using their (the insurers') name?

Just thinking out loud.

[JPINFV]

The privates do this non emergency transport work, which is usually stable patients, which do not require lights and/or siren while enroute, or when responding to make the pickups, however, if any of them find the patient to be crashing, they can request their dispatchers or managers to allow them to go L&S.

while a little off topic, how exactly is that supposed to work? Wouldn't the attendant know the most about the patient's condition, and thus be the attendant's decision to upgrade the transport of a critical patient?

[Richard B the EMT]

I don't have a clear picture on why, but my experiences were, if quickly told why the ambulance crew was changing to an upgraded status, usually it would not be denied.

However, back then (1975 to 1985), the various services didn't have Dr. Clawson's flip-books for assisting a dispatcher with caller Q&A, and a number of dispatchers didn't even have the equivalent of Certified First Responder training then, more just taxi fleet dispatcher experience.

Basically, unless the dispatcher told you to respond to a call L&S, you risked being fired if you took such initiative on your own.