The U.S. Bureau of Labor Statistics expects career opportunities for EMTs and Paramedics to grow another 15 percent by 2026, far outpacing most other professions… With EMS agencies hungry for skilled providers, there has never been a better time to chart your career path in mobile healthcare.
This week, an editorial from AAA President Mark Postma was featured in a special Media Planet section on healthcare careers. Read the full article►
Mark Postma, AAA President & Asbel Montes, AAA Payment Reform Chair
The recent merger of Aetna/CVS may be the catalyst that finally brings the change that the ambulance industry has been advocating for over the past several years. This new healthcare strategy supports the ambulance industry’s ideas that alternative patient destinations are needed in EMS.
To explain this better, one must understand the current state of ambulance reimbursement via the 911 system or equivalent. At this point in time most commercial payers of healthcare (Insurance) as well as Medicare will not pay for 911 ambulance transportation to any destination other than the “nearest appropriate” hospital based emergency room; arguably, the most expensive and least efficient form of healthcare. The continuation of this policy discounts the advanced capabilities of both EMS and new clinical settings and the savings that can be achieved through innovative change. In addition, at the same time that the cost of healthcare in general is increasing, reimbursement from all payers is decreasing, creating a significant challenge for providers. Medicare consistently pays providers below cost for providing life-saving services and state Medicaid agencies are consistently underfunding the critical services to the un- and under-insured populations that have allowed intermediaries to delay or not pay ambulance services.
Much of the U.S. population believes that vital 911 EMS services or the equivalent are provided free or included in their local property taxes. This is generally not the case. While EMS services must be at the ready on a 24/7/365 basis, they are not paid for being on call, but only when the service is used.
Many communities have governing rules that require 911, or the equivalent, paramedic services to arrive on-scene within 8-12 minutes of receiving the call. This cost of readiness is VERY expensive. Skyrocketing personnel costs, ambulances, equipment, and other high cost drugs only exacerbate an already fragile reimbursement structure. Although recent articles about calling Uber or Lyft sound intriguing, these drivers and cars are not prepared for any type of injury. Nor can they alert the hospital in critical situations to have the heart cath lab ready or a trauma surgeon on standby, shortening the time to definitive care when time matters most. Emergency paramedics are highly trained, are nationally and/or state certified, and provide services on state regulated ambulances equipped to manage all types of emergencies. Ambulances are also often strategically placed to arrive in that 8-12 minute response time requirement. However, there is one piece missing from the ambulance scenario that allows for Uber/Lyft to succeed; your personal credit card is on file with them. NO GUARANTEED PAYMENT, NO TRANSPORT. The cost of providing ambulance services “on call” with life-saving equipment, medications, and personnel at the ready is steep. When you consider the many regulations providers must adhere to outside of patient care, the cost increases even more. This misunderstanding of the cost often results in patients being stunned when they receive a bill for services provided and feel that it is excessive. However, comparing the cost of a life-saving ambulance transport to an Uber/Lyft ride is like comparing the cost of building a house to putting up a tent.
On the other hand, these highly trained paramedics, with vehicles that are comprehensively (medically) equipped to meet the highest safety standards, have no credit card on file. They do not treat you based on your ability to pay. In fact, approximately less than half of ambulance patients have insurance, and when commercial insurance does pay, they are increasingly paying only a percentage of the total bill, leaving their insured left to pay the balance. In a time of an emergency, insurers should not place an additional burden on their insured through underpayment or claiming out of network status. In addition, although many emergency 911 calls begin as a “frantic call for help,” not all are life threatening and require the highest level of care; however, they do need some type of a health care intervention.
It is this high volume of low acuity patients who do not have primary care physicians and who currently by law must be transported to hospitals that continue to bottleneck emergency rooms. This bottleneck then requires ambulances to be “on the wall” at local hospital emergency rooms. The cost to the 911 EMS system rapidly begins a domino effect where all the patients begin to be diverted/directed to other hospitals causing an overflow to the next hospital. In large EMS systems, this domino effect can bring emergency rooms at all available hospitals to capacity quickly. EMS units are unable to go on additional emergency calls because they are caring for a patient while waiting on hospital staff to become available to take over. They also cannot leave that hospital with the patient to go to another hospital due to federal laws that prohibit this movement.
So why does the AETNA/CVS excite the leaders of EMS organizations? Most people assume that since this acquisition just occurred, Walgreens will probably follow suit with another insurer. Other local pharmacy “CVS types” may partner with local hospitals or medical insurance cooperatives as well. This leads the ambulance industry to believe that the capacity to transport patients to alternative locations could greatly change the landscape of EMS. The idea that local CVS/Walgreens/clinics could receive low acuity patients breaks open the bottleneck and can provide several benefits for the ambulance service and patient. One benefit is that adding these stores/clinics greatly increases the resources for caring for low acuity patients and could potentially double the locations an ambulance can transport to, which will allow for quicker transport times and increase efficiencies. Lastly, and most importantly, diverting the low acuity patients to these additional community resources would reduce overflow in the emergency departments and allow true emergency patients to be transferred over more quickly to receive the higher level of care they require. This scenario is also a win for the patient. They could be transported to the most appropriate location to care for their needs and therefore can be billed more accurately for services they require rather than the emergency department fees which are usually costlier.
To make this happen, obviously the CVS system needs to evolve to receive these patients. More importantly, ambulance reimbursement by federal, state, and private payers must evolve to meet the demands of the market. Due to the complexities of how EMS services are provided because of state and local regulations, mandatory response times, service area parameters, and others, reimbursement for these services must be adequately paid for by Medicare, Medicaid, and private insurers. Today EMS agencies can only “hope” that their patients have a source of payment!
Although one would think that this state of concern for EMS services is being monitored, it currently has only a very small voice in the healthcare continuum. Federal agencies seem to want to look at what EMS will look like in 10 to 25 years rather than where EMS is today and where it can develop over the next few years. EMS reform needs to happen soon to save these systems from bankruptcy and/or the public from higher taxation.
We hope that this merger will be the beginning of alternative EMS/ambulance destinations with allocated reimbursements that meet the costs of providing high quality, efficient, and necessary 911 ambulance services.
Mark Postma, COO, Sunstar Paramedics
American Ambulance Association, President
Works for Sunstar Paramedics, Florida’s largest EMS provider
MPostma@sunstarems.com, 727-224-0295
Asbel Montes, Vice President, Acadian Ambulance Service, Inc.
American Ambulance Association, Chair-Payment Reform Committee
Works for Acadian Ambulance Service, Inc., Louisiana’s largest EMS provider
Asbel.Montes@acadian.com, 337-291-3310
Below is the American Ambulance Association’s Response to a recent Kaiser Health News article on ambulance billing. It was reprinted in several metropolitan areas on November 20, 2017.
To the Editor:
I write today in response to Melissa Bailey’s November 20 piece about ambulance balance (“surprise”) billing. While we disagree with the characterization of ambulance services in the article, we welcome the ongoing public dialogue about how unsustainable reimbursement for emergency medical services results in cost-shifting to patients.
Missing from the article is a true understanding of the sky-high cost of readiness for emergency medical services. Ambulance service providers offer their communities 24/7/365 on-demand mobile healthcare. Skilled staff and ambulances—high-tech emergency rooms on wheels—are ready to respond to a 9-1-1 call at a moment’s notice to help patients with issues ranging from stroke to heart attack to trauma to childbirth. EMS is also on the very front lines of the surge in opioid overdoses, providing naloxone (Narcan) to hundreds of patients each day. Keeping supplies, medications, equipment, and personnel at-the-ready requires a significant ongoing investment, regardless of whether or not an ambulance is out responding to a call. Cost comparisons between EMS and the rideshare app Uber may make for catchy sound bites, but they are misleading and misguided.
The piece states that our nation’s 14,000 ambulance service providers received 1,200 Better Business Bureau complaints spread over three years. While certainly not optimal, this is a tiny, unrepresentative fraction of the tens of millions of responses ambulance service providers conduct annually. In fact, BBB 2016 statistics show that ambulance services receive far fewer complaints than hospitals, physicians, dentists, and many other trusted healthcare providers.
The article also offhandedly mentions that balance billing occurs when private insurers and ambulance service providers are unable to agree about fair reimbursement rates. This glosses over the dark reality that it would be hard to categorize the process that occurs between the insurer and ambulance services as a “negotiation.” Instead, insurers often present an all-or-nothing proposition to force ambulance service providers to accept contracts at unsustainably low reimbursement rates.Unlike the multi-billion dollar insurance behemoths, most ambulance services are small and operate on razor-thin margins. In fact, 73% of ambulance services provide fewer than 1,000 Medicare transports per year—just three per day. Ambulance services do not turn down insurance network contracts out of greed, but instead out of necessity. Facing reimbursement rates below the cost of the services they provide, they must decline these agreements in order to keep their doors open and continue to provide healthcare to their communities. Unfortunately, this sometimes creates a situation where out-of-network ambulance costs are shouldered by patients via balance billing, instead of insurers.
In addition to challenges receiving fair compensation from private insurance, EMS is stretched thin by ultra-low Medicare and Medicaid reimbursement rates. In fact, in 2007 and 2012 GAO studies showed that without temporary, Congress-authorized percentage increases in EMS payments, ambulance services would receive reimbursement from government payors below the cost of operations. These are often the very same unsustainable rates that private insurers are attempting to strong-arm EMS providers into accepting for network contracts.
Finally, when someone calls 9-1-1 in need of emergency medical care, it is key to recall that, unlike in other industries, an ambulance responds regardless of the patient’s ability to pay. In many cases, the patient does not have insurance and is financially unable to reimburse the ambulance service provider. Therefore, EMS provides a significant amount of uncompensated care, the cost of which must be spread across all payors in order for them to continue their life-saving operations.
Ambulance services provide an essential, on-demand healthcare benefit to their communities. Unfortunately our current healthcare payment structure means that much of this care is not compensated equitably, resulting in the necessity of balance billing patients. While there are no quick fixes for this issue, we encourage consumers to educate themselves about their own insurance coverage. We also ask for your support of legislation that provides sustainable reimbursement for ambulance providers, including the bipartisan US Senate Bill 967. Together, we can ensure the future of mobile healthcare in our great nation.
Mark Postma President American Ambulance Association
“Representing EMS In America”
Educating your members of Congress about ambulance industry issues makes them much more likely to support your efforts. An easy and effective way to educate them is to invite them to participate in a local Ambulance Ride-Along!
Congress is scheduled to adjourn on July 28 for their August congressional recess with members of Congress returning home to their districts and states. This is the perfect opportunity for you to educate your members of Congress about those issues, in particular Medicare ambulance relief and reform, which are important to your operation. The most effective way to deliver these key messages is to host your member of Congress or their staff on a tour of your operation and an ambulance ride-along. If you cannot host a tour and ride-along, we strongly encourage you to arrange local meetings with your members of Congress during August. The AAA has made the process of arranging a ride-long or scheduling a meeting easy for you with our 2018 Congressional Ride-Along Toolkit.
Are you willing to host a Member of Congress at your service but unsure of how to set it up? Email Aidan Camas at acamas@ambulance.org and Aidan can help you set up a meeting.
Everything you need to arrange the ride-along or schedule a meeting is included in the Toolkit. Act now and invite your elected officials to join you on an Ambulance Ride-Along!
REPLICA Meets Goal, Interstate Compact Becomes Official
May 8, 2017
For Immediate Release
Contact:
Sue Prentiss
603-381-9195
prentiss@emsreplica.org
May 8, 2017 (Falls Church, VA). With the 10th member state enactment, the Recognition of
Emergency Medical Services Licensure Interstate Compact (REPLICA) has become official.
Governor Nathan Deal of Georgia signed Senate Bill 109 on today activating the nation’s first EMS
licensure compact. States that have passed REPLICA to date include: Colorado, Texas, Kansas,
Virginia, Tennessee, Idaho, Utah, Mississippi, Wyoming and Georgia.
Released in 2014, REPLICA’s model legislation creates a formal pathway for the licensed individual
to provide pre-hospital care across state lines under authorized circumstances. According to Keith
Wages, president of the National Association of State EMS Officials (NASEMSO), “REPLICA
represents a collective, nationwide effort to address the problems faced by responders when needing
to cross state borders in the line of their duties.” Wages highlighted the compact’s abilities to
“increase access to healthcare, reduce regulatory barriers for EMS responders, and place an
umbrella of quality over cross border practice not previously seen in the EMS profession.” Wages
also noted that the partnership with the National Registry of Emergency Medical Technicians
(NREMT) has been essential during the advocacy and implementation phases. “We are grateful for
their continued support and contributions.”
Through funding provided by the Department of Homeland Security (DHS), NASEMSO led 23 EMS,
fire, law enforcement organizations and associations as well as key federal partners in the design and
drafting of REPLICA. The National Registry of EMTs (NREMT) currently provides funding to finalize
the development of the Commission.
The compact calls for establishment of an Interstate Commission with each state that has passed
REPLICA holding a seat, as well as a national EMS personnel coordinated database. Member states
will be able to rapidly share personnel licensure information, develop policy focused only on cross
border EMS practice, and hold EMS personnel originating in other states accountable in an
unprecedented way. The National Registry of EMT’s (NREMT) has committed to the development
and hosting of the coordinated database.
Twelve national associations and organizations support REPLICA. Three states have REPLICA bills
under consideration in their legislative sessions. Learn more at www.emsreplica.org.
If you were asked to name the top 10 most popular websites in the United States today, I’m willing to bet that you could guess most of them: they are, in descending order of Alexa page view rankings, Google, YouTube, Facebook, Amazon, Yahoo, Wikipedia, Twitter, Reddit, Ebay, and LinkedIn.
“Wait,” you may be asking, “what is ‘Reddit,’ and how can it be in the top 10 most popular American websites if I’ve never even heard of it?”
As a self-appointed cultural ambassador for the millennial-heavy EMS workforce, I’d love to give you a basic introduction. Seasoned Redditors, feel free to skip this post. But those new to Reddit, or even social media in general, please hang in there—it is increasingly important for ambulance executives of all age groups and technology skill levels to “get” what is going on in influential online communities.
What is Reddit?
Reddit describes itself as “the front page of the internet.” What does that mean?
Reddit (usually styled lowercase as “reddit,” but I’m capping for clarity) is an online community platform allowing users to anonymously share, comment, and vote on links, images, personal stories and more in topic-specific “subreddits.” A user’s self-selected subreddits are merged into a personalized feed, which is often very different than the generic Reddit Front Page generated from the posts voted best across the whole site.
Wildly popular with millennials, Reddit is one of the most engaged and active digital communities in history. Reddit communities’ collective taste-making influence drives modern pop culture and politics in unprecedented ways, and the popularity and sway of the site is only growing.
Large swaths of your staff are routinely participating in Reddit communities, likely many times per week. For all that we hear about generational conflict in EMS organizations, wouldn’t it be great to gain some firsthand insight into the candid thoughts of EMTs and Paramedics across the country? Of course this only works if leaders approach Reddit (and the subs and threads of varying merit within) with an open mind—because of its inherently populist and anonymous nature, there is an ever-changing mix of valuable and abhorrent content that sometimes takes a little time to sort through.
Additionally, more and more people are electing to get their news, pop culture, and entertainment first through Reddit or other social media, instead of mainstream news sources. EMS leaders relying solely on information from TV newscasts or even the websites of traditional print journalism outlets are missing the backchannel dialogue and meta commentary that is shaping the way our industry is perceived.
Can Reddit participation help with EMS advocacy?
Many ambulance execs are unfamiliar with the fact that top politicians as diverse as President Obama and Gary Johnson choose to interact directly with Redditors, personally fielding user questions in the r/IamA sub. Reddit’s political commentary subs are also famed for the sometimes prescient, sometimes wacky user analysis of current affairs and election hoopla. Start with r/politics, the largest sub, to get a feel for the Reddit politosphere, then find your niche in some of the more targeted subs below. Not seeing your interest? Search the site for hundreds of other options ranging from radical to reactionary—or start your own.
We all have that kooky relative who doesn’t “get” Facebook, and so posts inappropriate rants or the equivalent of text voice mails on our walls. Don’t be “that guy” (or gal) on Reddit—although most people are nice, not everyone is patient, and some users may report your post to moderators for removal. Also, it is just good manners to follow the norms of any community in which you participate, be it face-to-face or online. Here are some easy steps to ensure that you become a valued contributor to the Reddit community.
Login to reddit, then visit your subscription page to remove yourself from any default subs that don’t interest you. For me, this meant immediately axing everything related to sports (sorry, I mean, “Go Sox!“).
Next, find and subscribe to many subs that interest you. There are thousands of subreddits for everything from r/cooking to r/gardening to r/motorcyles to r/parenting to r/books, and that is just scratching the surface. Typically large, general-interest subs will list more niche subs in their sidebars to make them easy to find.
Lurk and get used to voting. Read your feed, or peruse a specific sub in-depth, upvoting posts and comments based on quality, not your level of agreement with the poster’s opinion. Typically, it is best to lurk (read without posting) for a month or two before you leap into the fray to get a sense for how each community interacts.
Start posting and commenting. Now that you have some context for the types of conversations going on in your favorite subs, you’re ready to start submitting new posts and commenting on the posts of others, in addition to voting. It is really important to read Reddit’s content rules and Reddiquette guidelines, as well as the sidebar rules for your particular sub, before posting. Also, it is pretty much universally forbidden to share with the group any personally identifying information, even about yourself. Don’t get overwhelmed—most of the rules are common sense, and the time investment will pay off when you experience the thrill of sharing ideas and news with like-minded people from around the world.
Are there EMS-specific subs?
There are many EMS-focused subreddits, ranging from the (mostly) serious to the ridiculous. Here are just a few:
r/EMS – by far the largest, with 21k subscribers as of today. Diverse mix of jokes, personal stories, protocol questions, opinions on employers, and more.
r/911Dispatchers – (2k subscribers) – Sub targeting dispatch professionals.
r/EMScringepics, r/LookImAFireFighter, etc – smaller subreddits where some popular EMS sartorial choices are mocked. Very definitely Not Nice, but may strike your funny bone if you have a certain sense of humor.
r/firefighting (11k subscribers) – sub serving firefighters, but often touches on EMS topics
Hint: Sort by “TOP” then choose a timeframe to catch up on the best (or at least most popular) posts in a particular sub.
My service is mentioned on Reddit in a negative manner. Should I respond?
If someone posts something negative on Reddit (or Facebook, or Twitter, etc, etc) about the organization to which you’ve dedicated so much time and love, it can be very tempting to fire off your side of the story in response. However, it is almost always inadvisable to go in “guns blazing” on an anonymous message board, particularly if you aren’t very familiar with the norms for the specific sub in which you would respond.
If you really feel you must set the record straight, I suggest asking three other sensible Redditors and your attorney to review before posting, to make sure that you don’t accidentally open your organization up to a lawsuit or media nightmare. You may also want to create a separate “throwaway” username before replying, as anything you’ve previously commented or posted under your usual username is publicly visible. No matter how innocuous your past activity may be, it can and will be used against you in the court of public opinion (see: Ken Bone Reddit controversy).
My service is mentioned on Reddit in a positive manner. Should I respond?
In this case, it is a hard maybe. The tricky thing is that you want your organization to avoid being perceived as “Big Brother,” particularly in response to anything (good or bad) that might have been posted by one of your own employees. Given Reddit’s higher level focus on anonymity than, say, Facebook, even a “thanks so much, so glad to be your favorite employer!” reply can seem creepy or intrusive, depending on context. It may be best to just privately enjoy the knowledge that thousands are reading your unsolicited praises (and likely looking for job openings at your service).
If there are no HIPAA or human resources concerns involved, you can enlist the help of seasoned Redditors in crafting a response that is right in tone for your service.
Can I market my ambulance service on Reddit?
Commercial self-promotion of any kind is very much frowned upon by the Reddit community. Viral marketing, or any post planting or vote manipulation that can be perceived as viral marketing, even more so. For a glimpse at the level of energy around this issue, please see r/HailCorporate, or consider the vitriol directed at users who create alternate “sockpuppet” accounts to upvote their own posts. Any kind of advertising outside of appropriate subs that specifically allow it (or actual Reddit ads) is risky at best, and may completely backfire.
Can I post job listings to Reddit?
Read the sidebar rules of the subreddit you’re considering posting in to see if commercial offers are permitted (for example, counter-intuitively, r/jobs forbids job postings). Your may wish to consider posting to one of the subs dedicated to job seekers, including r/jobopenings, r/youngjobs, and r/jobbit, or your closest local job sub.
Another thing to consider is buying an ad on the Reddit site, then running it in EMS-specific subs, particularly if you’re open to paying relocation for medics from other areas, or if you are willing to train individuals coming from other industries.
Note: recruitment is not yet a primary Reddit focus, so you may or may not have much luck at this point. However, as more people join Reddit and rely on it new and different ways, this is likely to change.
Glossary
Default sub—Default subreddits are subs considered to have the right mix of popularity and quality to be automatically included in new users’ subreddit subscriptions. You can remove default subreddits that you are not interested in following on your subscription page after you create a login.
Karma—When a post or comment is submitted, other users can vote it up or down. “Karma,” divided into post karma and comment karma, is a loose indicator of the quality of a thread. You can track your own karma on your profile page, but it has no monetary or other value. In theory, voting is supposed to be based on the quality and relevance of the post or comment, but this doesn’t always play out perfectly. Some users have high overall karma scores because they post very relevant articles or incredibly insightful posts, others because they draw sketches or write poems related to posts, and still others because they are known for submitting posts or comments that the community finds funny.
NSFL—an initialism for “Not Safe for Life.” This is used in the title of a post to indicate offensive content that shows or makes reference to gore, death, serious injury, the abuse of animals or people, etc. I would very strongly suggest that even the most hardened EMS folks stay away from most of these posts and the comments sections about them—NSFL posts do not bring out the best in humanity.
NSFW—an initialism for “Not Safe for Work.” This is used in the title of a post to potentially sensitive content involving any kind of nudity or sex. Depending on context and the subreddit in which it is posted, this flag can be used for posts covering everything from a news photo of the Janet Jackson Super Bowl wardrobe malfunction to actual pornography. Use your best judgment.
OP—like most other internet forums, on Reddit “OP” refers to “original poster,” and is a generic term used in comments to refer to the creator of the thread you’re currently reading.
Meme—Most folks have probably heard of memes (pron. “meems”, not “meh-mehs,” “me-mes,” etc), or may even have shared some around the office or on Facebook. Reddit has a variety of inside jokes and memes specific to the community. If someone replies to a post with something that seems like a total non-sequitur, but others seem to find it funny, you may want to Google for inside jokes or check Know Your Meme for answers. Be forewarned: while some are funny or insightful, many memes and Reddit inside jokes are crass, prejudiced, or just stupid.
Sub / Subreddit—Although originally not officially recognized, “sub” or “subreddit” are now almost universally used terms refers to self-moderated community centered around a particular topic. Here are just a few examples of the tens of thousands of subs you can choose to subscribe to, depending on your interests.
Have questions about Reddiquette or other social media platforms? Please don’t hesitate to reach out at ariordan@ambulance.org. Please feel free to share your own tips in the comments section below. We would love to hear about your ambulance service’s online successes and foibles.
Press Contact
Don Johnson
Vice President Marketing
CDO Squared, Inc.
309.530.8269
Ambulance Delivery To Emergency Rooms Set To Skyrocket Putting Ambulance Company Financials On Life Support
Medicaid and Medicare Drive Reimbursements Below Cost of Service
More Boomers will visit the ER
Schaumburg, IL—September 22, 2016—The convergence of the aging baby boomer population, the projected increase of emergency room services for baby boomers, added to lower reimbursement rates for Medicaid and the increasing influence of private insurance companies with Medicare, signals a rough road ahead for ambulance companies.
In a new survey by revenue realization leader, CDO Squared, and the American Ambulance Association, 126 ambulance company executives were asked,“As a rule, the number of emergency department visits is much higher for Medicaid and Medicare recipients than for the uninsured and those with private insurance. How will this effect your profitability over the next five years?”
The survey revealed that well over 70 percent of ambulance companies saw decreased profitability over the next five years. “In an industry already hard hit by the effects of Obama Care, this is just one more pressure point put onto ambulance companies to maintain profitability.” according the William Stuckert, CEO of CDO Squared. The American Ambulance Association also weighed in on the survey results. “Ambulance services continue to struggle to do more in the way of providing high-quality medical care and improving patient outcomes with less financial resources, and from the survey it doesn’t appear it will get better.” Stated Mike Hall, AAA President. “On the Medicare payor front, H.R. 745 and S. 377 would make permanent the current temporary add-ons that have allowed ambulance services to maintain critical financial relief.”
Stuckert offered this advice for those struggling with increased pressure on their financials. “Ambulance companies must learn how to balance their payer mix. With the push by many states to move Medicaid patients into Managed Medicaid Programs, ambulance companies must choose a payer mix that provides a reasonable amount of profitability.” Stuckert stressed the importance of using cash flow analytics to take a deeper look at the profitability of an ambulance company’s location. “Once you understand the true value of your facility, you’ll be able to balance your runs for reasonable profitability” said Stuckert.
About CDO Squared
CDO Squared maximizes revenue realization for profit-minded EMS providers by connecting data, developing processes, and optimizing their ROI. CDO Squared has been helping healthcare businesses run more profitably for over two decades. Through proven financial technology and innovative workflow tracking, CDO Squared provides the medical industry advanced software and tools for analytics, visualization, and financial management along with the industry experience of seasoned revenue realization management professionals.
About AAA
The American Ambulance Association represents ambulance services across the United States that participate in serving more than 75% of the U.S. population with emergency and non-emergency care and medical transportation. The AAA was formed in response to the need for improvements in medical transportation and emergency medical services. AAA views pre-hospital care not only as a public service, but also as an essential part of the total public health care system.
The AAA is proud to announce this year’s award winners. Awards will be presented at the AAA Annual Conference and Tradeshow Awards Reception on Tuesday, November 8, 2016. Please join us in congratulating the winners.
The J. Walter Schaefer Award is given annually to an individual whose work in EMS has contributed positively to the advancement of the industry as a whole. Randy has achieved this through his tireless dedication and service to the industry and his role in elevating the association and its members to national prominence.
The Robert L. Forbuss Lifetime Achievement Award is named in honor of the first Executive Director of the American Ambulance Association. It recognizes a volunteer leader who has made a significant long-term impact on the association. Julie has held numerous leadership positions in the AAA including Membership Committee Chair, Region III Director and Alternate Director. Julie has worked tirelessly to get members of her Region to join the AAA, knowing that it is important to participate in the national organization to be part of the team finding solutions to today’s challenges in EMS.
These awards are given by the President to volunteer leaders who have shown commitment to the advancement of the AAA above and beyond the call of duty. This year the three outstanding volunteers represent tireless work on behalf of the AAA.
Jon Howell has served as the chair of the AAA’s nominating committee for 4 years and in that time has worked to grown the involvement of our members to participate in the AAA nominating and election process. Asbel Montes has worked tirelessly as Co-Chair of the Payment Reform Committee, and David Tetrault has served as a Region IV Board or Director as well as an active participant on the Membership and Education Committee. AAA President Hall was quoted as saying, “this award is given by the sole discretion of the President of the AAA and I cannot think of three more deserving individuals than Jon, Asbel and David. No matter what I have asked them to do for the AAA, they have taken on the task with determination, commitment and a level of servant leadership rarely seen anymore.”
Distinguished Service Award
Brian Choate, Solutions Group
Kathy Lester, MPH, JD, Lester Health Law & AAA Healthcare Consultant
Scott Moore, Esq., EMS Resource Advisors LLC & AAA Human Resources Consultant
Brian Werfel, Esq., Werfel & Werfel, PLLC & AAA Medicare Consultant
The American Ambulance Association (AAA) is proud to award Brian Choate, Kathy Lester, Scott Moore, and Brian Werfel with 2016 Distinguished Service Awards.
The Regional Workshop team worked countless hours to create the content for the four compliance, billing and reimbursement policy workshops that were presented throughout the country. The workshops were designed to help all types of services structure their billing departments more maximum efficiency and integrity.
It is for this dedication of the team members to the AAA that we are proud to recognize Brian Choate, Kathy Lester, Scott Moore, and Brian Werfel with the 2016 Distinguished Service Award.
The Partner of the Year Award is given to an EMS partner whose collaboration with the AAA enhances educational programs, legislative priorities and/or member benefits. This pas year the NAEMT has partnered with the AAA on numerous projects including Medicare Relief, EMS Compass and most recently issues a joint statement regarding Payment Reform Policies for EMS.
The American Ambulance Association (AAA) is proud to award Avesta with the 2016 Affiliate of the Year Award. The award is given to the vendor whose supports the programs of the association. Avesta is dedicated to solely to the practice of Human Capital Management and the development of solutions that meet the unique human resource challenges of their EMS clients. This year’s Affiliate winner has shown unconditional support of the AAA Stars of Life Program. The Stars of Life event, held annually in Washington, D.C., publically recognized and celebrates the achievements and exceptional work of EMS professionals.
Press Contact
Don Johnson
Vice President Marketing
CDO Squared, Inc.
309.530.8269
Obama Care Costs Ambulance Companies More Than $2 Billion In Lost Revenue
Schaumburg, IL—August 30, 2016—To understand the serious affect that the Affordable Care Act (Obama Care) has had on ambulance companies, CDO Squared™, the leader in revenue realization for profit-minded EMS providers, initiated a survey with the American Ambulance Association. The results were staggering when dollarized. One hundred twenty-six ambulance company executives were asked the following question: “Over the past few years, many ambulance companies have been negatively impacted by the increase in Medicare and Medicaid patients now enrolled in managed care plans run by for-profit insurance companies. What effect has this had on your operation in lost revenue since the Affordable Care Act (Obama Care) was enacted?”
The result: Overall the impact totaled $2.1 billion in lost revenue because of reduced margins due to lower fees dictated by the plan. The survey also revealed that those with revenues of $1 to $50 million (82.5% of the participants) had lost revenues between $315,000 to $730,000 with larger operations driving the averages up. According to William Stuckert, President and CEO of CDO Squared, “The results are not surprising when you consider that over 75 percent of Medicare and Medicaid patients now opt for a managed care plan. What it boils down to is that these for-profit insurance companies are driving costs down, in many cases below the actual operating costs of many ambulance companies. It’s a numbers game, as you see the larger companies with more exposure being hit the hardest.” When asked what ambulance companies can do to offset these losses, Mr. Stuckert said “Ambulance companies need to manage their commercial payers and overall costs better, and that means collecting more of the revenue they are entitled to. Since ambulance companies excel at saving lives, many lack the tools to collect revenue they are owed. In fact, on average, ambulance companies collect only 70 percent of the revenue they are due as reimbursements are lost in a sea of EMS data.”
Maria Bianchi, Executive Vice President of American Ambulance Association, echoed much the same sentiment regarding insufficient reimbursements in the industry. “The CDO Squared survey results reinforce what the American Ambulance Association has long known—ambulance services across the country are operating in a climate where reimbursement is often well below the cost of service. AAA volunteers, consultants, partners, and staff are working tirelessly across many channels to bring to ambulance services the reimbursement revenue they need to continue serving the public each and every day.”
About CDO Squared
CDO Squared maximizes revenue realization for profit-minded EMS providers by connecting data, developing processes, and optimizing their ROI. CDO Squared has been helping healthcare businesses run more profitably for over two decades. Through proven financial technology and innovative workflow tracking, CDO Squared provides the medical industry advanced software and tools for analytics, visualization, and financial management along with the industry experience of seasoned revenue realization management professionals.
About AAA
The American Ambulance Association represents ambulance services across the United States that participate in serving more than 75% of the U.S. population with emergency and non-emergency care and medical transportation. The AAA was formed in response to the need for improvements in medical transportation and emergency medical services. AAA views pre-hospital care not only as a public service, but also as an essential part of the total public health care system.
The American Ambulance Association is saddened to report that f Allan S. (“Al”) Reichle passed away on July 20. In addition to owning Springs Ambulance and other successful business ventures, Al served on AAA’s Government Affairs and AMBUPAC Committees. Our thoughts are with his family.
By Desiree LaFont, Education & Events Director, American Ambulance Association
October 2015
In a previous life I worked for a hospitality-related association. Within that industry there was something known as the “Gaylord Effect”—when Gaylord Hotels would open a property in a city, all of the other businesses in the area, including other hotel brands, benefitted. High standards, a sterling reputation, and the ultimate in customer service meant Gaylord booked convention and leisure business on a scale few could rival. Everyone from the local cab drivers to the bartenders to the surrounding hotels profited from the huge influx of travelers. Where once feared as the luxury brand that would crush the competition, they were soon seen as a desirable ally. So fast forward a few years, and I have a new life working for the American Ambulance Association (AAA), but I often think about the Gaylord brand and their ability to change a city with their commitment to their customers. If you are wondering what any of this has to do with ambulance services, I’m about to get to that.
On a recent trip to Louisiana to document the tenth anniversary of Hurricane Katrina and the role AAA members had in the recovery, the AAA’s Director of Membership, Amanda Riordan, and I had the opportunity to visit Acadian Ambulance. Armed with a local videographer, a short list of questions, and a crippling doubt in our ability to capture what is arguably the most important private EMS story in recent history, we arrived at Acadian’s Air Med Station in Lafayette, Louisiana.
Lafayette Headquarters
Our first interview was with Marc Creswell, Acadian’s Air Med Operations Manager. Marc’s story is incredible for a number of reasons, and I won’t attempt to retell all of it here, but I will tell you Marc is the kind of guy that could have inspired the phrase, “when the going gets tough, the tough get going.” This is the guy you want in your foxhole. And to be honest, we could have completed our interview with Marc, packed up, and had more than enough material to tell a great story about Acadian and Katrina, but Acadian was just getting started.
We spent the remainder of the day interviewing Dee Dee Sewell, their Critical Support Intervention Specialist; Clay Henry, Acadian’s Vice President of Operations, Communications Center; Blane Comeaux, President of Acadian Total Security; and Chairman and CEO Richard Zuschlag. Everyone, including Mr. Zuschlag, gave us more time then we could have hoped for and held nothing back. They shared a great many operational details, but always through the lens of the story of the people behind all those unseen efforts and rescues.
Downtown New Orleans
Dee Dee at work in Lafayette
The next day we visited downtown New Orleans to meet with Steven Kuiper, Regional Vice President for Acadian. Within minutes, I felt like I was hearing the story of Katrina for the first time. Steven shared facts, but, once again, it was wrapped in the story of the people around him—the suffering and the heroism he personally observed on the ground.
And, then came the big finish; Janie Fuller, Paramedic Field Supervisor and lifelong resident of St. Bernard Parish. Janie accompanied us to the Mayor’s Office to interview Deputy Mayor Andy Kopplin and New Orleans Director of EMS Dr. Jeffrey Elder. She then gave us the insiders’ tour of her parish and showed us exactly where the levees were breached. Her entire hometown was under eighteen feet of water in 15 minutes, but by nightfall Janie had commandeered an airboat and was taking a cardiac patient to I-10 and Causeway for evacuation. Needless to say, Janie is a force of nature herself, and no matter what dark alley a call takes her down, this lady is coming out alive and so is her patient.
Telling the Story
[quote_right]What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.[/quote_right]What emerged over the course of those two days of interviews was the amazing story of what Acadian, and private EMS, were able to accomplish in the midst of the hurricane’s devastation. Hospitals were shuttered, law enforcement was overrun, citizens were cut off, and conditions for everyone—including EMS—were unspeakable. Despite this, medics in the area stayed and other ambulance services rolled in.
Hundreds of ambulances with trained medics rolled in to help New Orleans and countless communities throughout Louisiana, Mississippi and Alabama. Whether or not they knew how bad the situation was, they still went in. No one can ever calculate what that response meant to the City of New Orleans and the other affected areas, but I think we all have a sense of how much worse it would have been without the timely response of private EMS. What also emerged during our visit was Acadian’s ability to tell the human side of what it means to be in EMS. They tell the Katrina story and the story of their company with humility, grace, and a deep appreciation for their colleagues and the many other services that stepped in to lend a hand.
So after an incredible 48 hours in Louisiana we had to head home, and I left with a heavy heart. I wanted to stay a little longer. No, I wanted to stay a lot longer. But why? As I sat on the plane home, it hit me. It was the Acadian Effect. Acadian is that big, shining example of what an innovative, self-determined private EMS company can mean to the population they serve. How you can put people first and come out a winner. How when you put people first everyone benefits. Telling the incredible Acadian success story benefits all of EMS because it typifies the EMS culture of going beyond what’s required and how maintaining human dignity is an essential part of patient care.
So let’s tell that story! Let’s tell the story of Acadian and Katrina. Let’s tell the story of Sandy, Joplin, the Boston Bombing, and the thousands of times a day private EMS responds to 9-1-1 with compassion and highly skilled medical knowledge because that’s your chosen profession. Let’s tell the story until the press, the public and the legislators are telling it for us.
Our heartfelt thanks to Acadian and every AAA member we have the privilege of serving.
Want More?
Watch AAA’s Katrina & Rita retrospective video that features many of the subjects of this blog post.
Press Contact
Our first interview was with Marc Creswell, Acadian’s Air Med Operations Manager. Marc’s story is incredible for a number of reasons, and I won’t attempt to retell all of it here, but I will tell you Marc is the kind of guy that could have inspired the phrase, “when the going gets tough, the tough get going.” This is the guy you want in your foxhole. And to be honest, we could have completed our interview with Marc, packed up, and had more than enough material to tell a great story about Acadian and Katrina, but Acadian was just getting started.