News & Updates

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  • 1 Dec 2021 7:00 AM | Matt Zavadsky (Administrator)

    Modern Healthcare Source Article | Comments courtesy of Matt Zavadsky

    Interesting development.  Several agencies, including ours, recently received written notice from some facilities within the past 2 weeks requiring EMS providers to be vaccinated in order to enter their facility.


    Federal judge blocks healthcare worker vaccine mandate nationwide


    November 30, 2021 08:25 PM

    President Joe Biden's bid to boost COVID-19 vaccination rates among healthcare personnel hit a roadblock when a federal judge halted its enforcement Tuesday.

    The Centers for Medicare and Medicaid Services published an interim final rule this month that effectively made COVID-19 inoculations a condition of participation in Medicare and Medicaid, meaning healthcare employers that don't comply by mandating shots risk losing reimbursements from those programs.

    Under the rule, an estimated 17 million workers at 76,000 healthcare sites needed to have received their first dose of a coronavirus vaccine by Dec. 6 and to be fully immunized by Jan. 4.

    That regulation is on hold after Judge Terry Doughty of the U.S. District Court for the Western District of Louisiana issued a preliminary injunction halting it. Republican officials from 14 states filed the lawsuit challenging the vaccine mandate. Officeholders from Alabama, Arizona, Georgia, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Montana, Ohio, Oklahoma, South Carolina, Utah and West Virginia initiated the legal challenge.

    "This matter will ultimately be decided by a higher court than this one. However, it is important to preserve the status quo in this case. The liberty interests of the unvaccinated require nothing less," Doughty wrote in his ruling.

    CMS's rule for healthcare workplaces and the Occupational Safety and Health Administration's regulation for employers with at least 100 workers are key elements of Biden's COVID-19 response, and have been subject to numerous lawsuits.

    The Louisiana federal judge's decision came a day after a federal judge in Missouri paused the CMS rule in Alaska, Arkansas, Iowa, Kansas, Missouri, Nebraska, New Hampshire, North Dakota, South Dakota and Wyoming as part of a separate lawsuit. A federal judge in Florida rejected that state government's attempt to block the healthcare worker mandate last week.

    In addition to federal rules requiring healthcare workers to be vaccinated against COVID-19, a number of states have enacted similar mandates. A dozen states mandate vaccinations and another three require that healthcare employees be inoculated or be tested weekly. Another dozen states have outlawed employer vaccine mandates. The U.S. Supreme Court denied a request by healthcare employees in Maine to stop that state's rule last month.

    In practice, vaccine mandates in healthcare settings have been effective, but the results vary by geography and provider type.

    Some hospitals and health systems that instituted vaccination requirements prior to state and federal actions saw significant successes. Overall, 70% of hospital workers had been vaccinated as of mid-September, according to the Centers for Disease Control and Prevention. But vaccination rates at rural healthcare employers, in particular, have lagged. Healthcare companies haven't been outspoken against the mandates, but many have expressed concern that these rules can worsen the ongoing staffing shortage facing hospitals, nursing homes, home health agencies and others.

  • 1 Dec 2021 6:57 AM | Matt Zavadsky (Administrator)

    Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

    The use of paramedics in health systems as a result of the nursing shortage is not ‘news’ to many of us, but here it is in ‘print’…

    Not only are health systems reconfiguring their workforce due to shortages, but it’s also resulting in many EMS systems re-evaluating their staffing and deployment models.  Well respected and innovative systems like REMSA (Reno, NV); MEMS (Little Rock, AR); MEDIC EMS (Charlotte, NC); EMSA (Tulsa, OK); and MedStar (Ft. Worth) have used patient outcomes based on EMD determinants to refine their response plans.

    Right patient, right time, right response configuration, right outcomes, right staffing!


    Health systems reconfigure workforce amid shortages


    November 30, 2021

    Hospital labor costs continue to rise as nurses seek higher pay, requiring providers to reconfigure their workforce.

    Total labor expenses rose 12.6% from October 2020 to October 2021, and 14.8% from October 2019 to October 2021, according to Kaufman Hall's analysis of around 900 hospitals. Full-time equivalents per adjusted bed decreased 4.5% year over year while labor expense per adjusted discharge increased 16.3%, suggesting higher salaries prompted by nationwide labor shortages are driving up labor expenses rather than increased staffing levels, the report concluded.

    "We continue to see labor expenses rise at a much greater rate than you'd normally imagine," said Erik Swanson, senior vice president at Kaufman Hall. "Comparing elevated labor expenses to a drop in discharge rates shows how higher acuity care, longer stays, higher wages and contract labor support are driving a really dramatic increase in labor costs."

    CommonSpirit Health's financial metrics mirrored national trends. Labor costs across the 140-hospital system were up 16.3% year over year in the quarter ended Sept. 30, primarily because of higher contract labor costs, premium pay, overtime, etc.

    CommonSpirit is reworking its staffing models as a result. It is tasking virtual registered nurses with administrative duties, like supervising non-licensed personnel, to relieve onsite RNs. CommonSpirit has used a team-based patient care model using pharmacists, licensed practical nurses, nursing assistants and paramedics in its Iowa division over the past year. It plans to roll out that model across the entire system over the next five years, the organization said in its latest earnings report.

    Contract labor rates have been out of control, said Don Lilly, chief networks and affiliates officer at University of Alabama-Birmingham Medicine.

    "If we can't find revenue stability for many of these safety-net hospitals, we are really concerned about what is going to happen in the next two to four years," he said. "CARES dollars have benefited some hospitals. But the costs associated with what we have had to pay nurses to compete with staffing agencies and other providers aren't going away once the pandemic is less than it is now."

    UPMC's labor expenses rose nearly 5% through the first nine months of 2021 compared to the same prior-year period.

    Transfer times between hospitals are going up due to staff shortages. Both COVID-19 and non-COVID-19 patients are being turned away as the labor market tightens and practitioners leave the profession, hospital executives and industry observers said.

    "Nurses are leaving rural hospitals to go to their larger urban counterparts, become travel nurses or work at brick-and-mortar retailers like Walmart for better pay. The stress of this pandemic has also caused a number of nurses and administrators to simply say enough and retire early. No one can blame them," said Michael Topchik, national leader for the Chartis Center for Rural Health, adding that some nurses are also leaving because of COVID-19 vaccine mandates. "This has led to skyrocketing costs."

    It has been even harder to find specialty nurses, like ones with expertise in neurology and critical care, health system executives said.

    Vanderbilt University Medical Center has tried to fill the gap via telehealth and advanced practice providers, but there is still a supply-demand mismatch, president and CEO Dr. Jeffrey Balser said.

    "We have to make sure we're using all practitioners at the top of their license," he said.

  • 17 Nov 2021 12:07 PM | AIMHI Admin (Administrator)

    KHN Source Article | Comments Courtesy of Matt Zavadsky

    Interesting development…  Tip of the hat to Mark Babson for assuring we saw this news report!


    Congressional Doctors Lead Bipartisan Revolt Over Policy on Surprise Medical Bills

    By Michael McAuliff

    NOVEMBER 17, 2021

    The detente that allowed Congress to pass a law curbing surprise medical bills has disintegrated, with a bipartisan group of 152 lawmakers assailing the administration’s plan to regulate the law and medical providers warning of grim consequences for underserved patients.


    For years, people have faced these massive, unexpected bills when they get treatment from hospitals or doctors outside their insurance company’s network. It often happens when patients seek care at an in-network hospital but a physician such as an emergency room doctor or anesthesiologist who treats the patient is not covered by the insurance plan. The insurer would pay only a small part of the bill, and the unsuspecting patient would be responsible for the balance.


    Congress passed the No Surprises Act last December to shield patients from that experience after long, hard-fought negotiations with providers and insurers finally yielded an agreement that lawmakers from both parties thought was fair: a 30-day negotiation period that would be followed by arbitration when agreements cannot be reached.


    The rule, which would take effect in January, effectively leaves patients out of the fight. Providers and insurers have to work it out among themselves, following the new policy.


    But now many doctors, their medical associations and members of Congress are crying foul, arguing the rule released by the Biden administration in September for implementing the law favors insurers and doesn’t follow the spirit of the legislation.


    “The Administration’s recently proposed regulation to begin implementing the law does not uphold Congressional intent and could incentivize insurance companies to set artificially low payment rates, which would narrow provider networks and potentially force small practices to close thus limiting patients access to care,” Rep. Larry Bucshon (R-Ind.), who is a doctor and helped spearhead a letter of complaint this month, said in a statement to KHN.


    Nearly half of the 152 lawmakers who signed that letter were Democrats, and many of the physicians serving in the House signed it. But the backlash has not won the support of some powerful Democrats, including Rep. Frank Pallone (N.J.), chair of the Energy and Commerce Committee, and Sen. Patty Murray (Wash.), chair of the Senate Health, Energy, Labor and Pensions Committee, who wrote to the administration urging officials to move forward with their plan.


    Some members of Congress who are also doctors held a conference call with the administration late last month to complain, according to aides to lawmakers on Capitol Hill, who could not speak on the record because they did not have authorization to do so. “The doctors in Congress are furious about this,” said one staff member familiar with the call. “They very clearly wrote the law the way that they did after a year, or two years, of debate over which way to go.”


    The controversy pertains to a section of the proposed final regulations focusing on arbitration.


    The lawmakers’ letter — organized by Reps. Thomas Suozzi (D-N.Y.), Brad Wenstrup (R-Ohio), Raul Ruiz (D-Calif.) and Bucshon — noted that the law specifically forbids arbitrators to favor a specific benchmark to determine what providers should be paid. Expressly excluded are the rates paid to Medicare and Medicaid, which tend to be lower than insurance company rates, and the average rates that doctors bill, which tend to be much higher.


    Arbitrators would be instructed to consider the median in-network rates for services as one of several factors in determining a fair payment. They would also have to consider items such as a physician’s training and quality of outcomes, local market share of the parties involved where one side may have outsize leverage, the patient’s understanding and complexity of the services, and past history, among other things.


    But the proposed rule doesn’t instruct arbiters to weigh those factors equally. It requires them to start with what’s known as the qualifying payment amount, defined as the median rate the insurer pays in-network providers for similar services in the area.


    If a physician thinks they deserve a better rate, they are then allowed to point to the other factors allowed under the law — which the medical practitioners in Congress believe is contrary to the bill they wrote.


    The provisions in the new rule “do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes,” the lawmakers told administration officials in the letter.


    The consequences, opponents of the rule argue, would be a process that favors insurers over doctors, and pushes prices too low. They also argue that it would harm networks, particularly in rural and underserved areas, because it gives insurers incentive to push down the rates they pay to in-network providers. If the in-network rates are lower, then the default rate in arbitration is also lower.


    That is the argument made specifically in a lawsuit filed last month against the Biden administration by the Texas Medical Association.


  • 15 Nov 2021 3:30 PM | AIMHI Admin (Administrator)

    Becker's Source Article | Comments Courtesy of Matt Zavadsky

    This might be something to keep in our quiver as discussions continue on surprise payments.


    Former UnitedHealth exec says company would only pay surprise bills after complaints

    November 12th, 2021

    Nick Moran

    The former head of UnitedHealthcare's Shared Savings Program alleged during testimony that the insurer was willing to pay for its members' surprise medical bills, but only if they filed a complaint to the company.


    The testimony is part of the ongoing legal battles between UnitedHealthcare and TeamHealth. John Haben, the former UnitedHealthcare executive, has been testifying in Nevada over a TeamHealth lawsuit that alleges the insurer's Shared Savings Program resulted in millions of dollars in clinician underpayments.


    During his testimony, Mr. Haben told prosecutors that UnitedHealthcare's explanation of benefits told members they could raise questions about reimbursement but did not explicitly say UnitedHealthcare would pay for surprise bills, according to a Nov. 11 news release.


    He also claimed that UnitedHealthcare undercut providers through the program, paying them as little as 20 percent of billed charges.


    A UnitedHealthcare spokesperson told Becker's that TeamHealth's lawsuit doesn't hold any weight but that it does serve as a distraction against TeamHealth's decision to leave the insurer's provider network.


    "This lawsuit is meritless and is just another example of TeamHealth’s efforts to distract from the real reason it no longer participates in our network, which is their unreasonable demands that they be paid double or even triple the median rate we pay other physicians providing the same services," the UnitedHealthcare spokesperson told Becker's. "We are committed to addressing these unreasonable and anticompetitive rates that many private equity-backed physician staffing companies charge for services, which drive up the cost of care for our customers, members and the health care system."


    TeamHealth contested the claims in UnitedHealthcare's statement, pointing to one instance mentioned in court where the insurer allegedly reimbursed $254 for a gunshot wound treatment billed at $1,428, despite Mr. Haben calling the full price tag "worth" the charge.


    “UnitedHealthcare's goal has been to reap larger profits at the expense of frontline healthcare providers and their patients," the TeamHealth spokesperson told Becker's. "In the Nevada courtroom, TeamHealth is proving that United orchestrated a scheme to artificially and fraudulently reduce payments to physicians."


  • 28 Oct 2021 7:51 AM | Matt Zavadsky (Administrator)

    We’d like to thank the 247 respondents to the AIMHI COVID Vaccine Flash Poll.  Results from the poll are summarized here.

    Our goals for the Flash Poll are to share the current state of COVID vaccine implementation across a broad section of the EMS profession, and disseminate the experience of agencies related to this important topic.

    We’d also like to thank the 85 EMS agency leaders from all provider types who indicated they are willing to share their policies and procedures!  A list of these agencies, including their provide type, can be found here.

  • 4 Oct 2021 2:11 PM | AIMHI Admin (Administrator)

    Modern Healthcare source article


    October 04, 2021

    Air ambulance utilization and charges have been steadily increasing over the past several years, according to a new study.

    The average in-network negotiated rate for emergency transport by airplane—excluding mileage charges—rose 76.4%, from $8,855 in 2017 to $15,624 in 2020, according to a FAIR Health analysis of around 35 billion healthcare claims. But most air ambulance rides are out of network, leaving consumers to pay for most of the charges.

    The average charge associated with airplane ambulances rose 27.6%, from $19,210 in 2017 to $24,507 in 2020. The average Medicare reimbursement rose 4.7% to $3,216 over that span, the same rate increase as emergency helicopter rides.

    The average charge associated with ambulance by helicopter rose 22.2%, from $24,924 in 2017 to $30,446 in 2020.


    The Biden administration published an interim surprise billing rule last week, which states that providers and payers can turn to an independent dispute resolution process if an out-of-network provider and payer can't come to an agreement over payment during a 30-day "open negotiation."

    Read full article►

  • 4 Oct 2021 2:08 PM | AIMHI Admin (Administrator)

    Modern Healthcare Source Article


    October 01, 2021

    Providers are crying foul about a regulation from the Biden administration that lays out the process they can use to settle out-of-network billing disputes with payers.

    The rule, released Thursday by the Centers for Medicare and Medicaid Services, is the next step in its implementation of the surprise billing ban passed last year by Congress.

    Payers praised the regulation as the "right approach," while providers swiftly denounced it as a "miscue" arbitrarily favoring insurers. At issue is the part of the regulation that lays out the independent dispute resolution process used when there is a disagreement between providers and payers over the fair price for an out-of-network service.

    In the IDR process, both the insurer and provider tell an arbiter what they think the appropriate rate for an out-of-network service is. CMS directs the arbiter to presume the "qualifying payment amount," which is usually an insurer's median contracted rate for the same service in a geographic area, is the "appropriate" rate and pick the offer closest to that.

    In the providers' minds, that gives insurers too much leverage.

    "It goes way beyond protecting patients. It protects insurance companies and gives primary credence to their point of view and data," said Chip Kahn, CEO of Federation of American Hospitals. FHA is a trade group that represents for-profit hospitals.

     Continue reading►

  • 30 Sep 2021 10:36 PM | Matt Zavadsky (Administrator)

    This a VERY WELL-DONE, research and evidence-based commentary on the cause, effect, and recommended SOLUTIONS to ED overcrowding.

    It’s a bit long, but well worth the read!  A PDF of the commentary is attached.

    All facets of the healthcare system, including EMS, need to work together to appropriately navigate patients, especially those who access healthcare through ‘911’, through effective integration.

    Tip of the hat to Rob Lawrence for sharing this article!


    Emergency Department Crowding: The Canary in the Health Care System

    The solution for this serious threat to ED staff and harm to patients cannot come from a single department, but through engagement of and ongoing commitment by leaders throughout the hospital and, more broadly, by those in the payer and regulatory segments of the health care system as well.

    September 28, 2021

    By: Gabor D. Kelen, MD, Richard Wolfe, MD, Gail D’Onofrio, MD, MS, Angela M. Mills, MD, Deborah Diercks, MD, Susan A. Stern, MD, Michael C. Wadman, MD & Peter E. Sokolove, MD

    The impact of ED crowding on morbidity, mortality, medical error, staff burnout, and excessive cost is well documented but remains largely underappreciated.

    Among the most notable content in the commentary:

    Emergency department crowding is a sentinel indicator of health system functioning. While often dismissed as mere inconvenience for patients, impact of ED crowding on avoidable patient morbidity and mortality is well documented but remains largely underappreciated. The physical and moral harm experienced by ED staff is also substantial. Often seen as a local ED problem, the cause of ED crowding is misaligned health care economics that pressures hospitals to maintain inefficient high inpatient census levels, often preferencing high-margin patients. The resultant back-up of admissions in the ED concentrates patient safety risks there. Few efforts (even well-meaning ones) address the economically driven root causes of ED crowding, i.e., the need to achieve minimal financial hospital margins. The key to a sustainable solution is to realign health care financing to allow hospitals to keep inpatient capacity below a critical threshold of 90%; beyond that, hospital throughput dynamics will inevitably lead to ED crowding.

    Even prior to the Covid-19 pandemic, greater than 90% of U.S. EDs found themselves stressed beyond the breaking point at least some of the time. Many remain overwhelmed daily.

    The authors provide detailed commentary on:

    • Causes of Crowding and Why ED Crowding Persists
      • Health System Incentive Structure
      • Insufficient Health Care Capacity
      • Failure of Regulatory Agencies, Payers, and Legislative Bodies
      • Misunderstanding of the Issue
    • Solutions:
      • ED Input Solutions
        • Distinct from individual hospitals placing themselves on ambulance diversion is a new voluntary 5-year payment model by the Centers for Medicare & Medicaid Services (CMS): Emergency Triage, Treat, and Transport ET3 for Medicare fee-for-service beneficiaries calling 911. In this model, CMS will pay participants to transport to an alternative destination partner, including primary care offices, UCCs, or even community mental health centers. In and of itself, ideally, only low-acuity patients would be transported to other settings and, thus, no significant impact on ED crowding from boarding is expected. Indeed, we have apprehension about Medicare patients being sent by ambulance to nonemergency care settings given the occult medical vulnerabilities of such patients and the high rates of needed hospital admission associated with ambulance transports.
    • ED Throughput Solutions
      • Hospital Solutions to Relieve Access Block (Output)

    The authors recommend five essential elements to take on overcrowding in the ED:

    1. ED crowding must be acknowledged as the serious problem to patient safety that it is — and not the “inconvenience” it is perceived to be.
    2. Most important, there are no known examples of successful amelioration of ED crowding in any institution without significant visible buy-in and action directed from senior-most institutional leadership. This commitment must be continuously evident with incentives of management at all levels throughout the institution and aligned to resolve this most important patient safety concern.
    3. Many institutions operate on razor-thin margins. Health care financing must realign reimbursement from current practices that outright promotes ED boarding.
    4. Regulators such as TJC and CMS must clearly address the impact of crowding on patient safety, its potentiation of violence, and its implications for staff well-being; likewise, the Accreditation Council for Graduate Medical Education should consider the impact of crowding on training and trainee well-being within their credentialling criteria of institutions. The regulations should include clear metrics and associated penalties/consequences.
    5. Crowding is predictive and, accordingly, enforceable preemptive surge plans must be generated and actuated. When crowding does occur, it must be considered in the same light as a disaster with the same deliberate moral response.

  • 30 Sep 2021 10:33 PM | Matt Zavadsky (Administrator)

    Rural areas suffer from ambulance shortage

    CBS News Saturday Morning

    September 25, 2021

    Another compelling news story about the rural ambulance service challenges.

    While this CBS Saturday Morning news story, which aired September 25th, highlights the report from the Rural Health Policy Institute, similar challenges exist for many ambulance providers in urban and suburban communities as well.

    • Crisis level staffing shortages
    • Inadequate reimbursement
    • Lack of designation as an ‘Essential Service’

    In the news story, Alan Morgan, the director of the National Rural Health Association, states that the failing rural ambulance system may be contributing to the falling life expectancy in rural communities.  

    Here’s a link to the RHPI Report.

  • 25 Sep 2021 11:14 AM | AIMHI Admin (Administrator)

    CBS Saturday Morning Source | Comments by Matt Zavadsky

    The latest census report finds that 60 million Americans live in rural areas. The Centers for Disease Control and Prevention reports that they tend to be older, sicker and poorer than the average American. According to a study by the Rural Policy Institute, there are not enough ambulances to help in an emergency. CBS News transportation correspondent Errol Barnett has the story. Air Date: Sep 25, 2021

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