News & Updates

Modern Healthcare Source Article | Comments Courtesy of Matt Zavadsky

Ambulance services generally do not file cost reports.  As such, it will be important for ambulance providers to assure they are accounting their 2018 ‘net revenue’ appropriately be prepared to submit this data to HHS next week.  Ambulance agencies should check with their national associations, many of whom have resources available to assist with this calculation.

Asbel Montes and Brian Choate from the Solutions Group provided an informative 10 minute video that provides insight into calculating net revenue here.

Since concern has been raised about the adequacy of the allocated funds, it will also be crucial to file this information as soon as the HRSA web link is opened on Monday.  Plan NOW!  If you outsource your billing, it is important to reach out to them TODAY to start getting this data ready for submission.  Note that the calculation of your net revenue will likely be impacted by the rates you charge.  Net revenue calculations, and therefore the amount of eligible relief funding, will be less for agencies that charge below market rates.

Also, this process will include relief funding for the cost of providing care to uninsured COVD-19 patients, actual or presumed.  This will include ambulance services.  It’s important that you begin accounting your costs and revenues for treating and transporting these patients.

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HHS formula for $20 billion in CARES Act provider grants prompts questions

RACHEL COHRS

April 23, 2010

 

https://www.modernhealthcare.com/finance/hhs-formula-20-billion-cares-act-provider-grants-prompts-questions

The formula HHS will use to distribute $20 billion in COVID-19 relief grants is unclear about how much money providers will get and if enough money will be left after the first direct deposits go out Friday.

HHS Secretary Alex Azar said Wednesday that the department will soon pay out an additional $20 billion from the Coronavirus Aid, Relief, and Economic Security Act's provider relief fund to top up providers that were disadvantaged in the department's first $30 billion round of grant funds based on Medicare fee-for-service reimbursement. The department will now use 2018 net patient revenue to decide providers' total share of the total $50 billion, and send out the second round of grants accordingly.

But cost report data is incomplete, and Azar said some of the funds will be distributed on Friday before the department begins collecting data from providers who don't already have information on file. Some are worried that they could be left out, or that funds could be delayed.

The second round of funds should benefit some providers who were largely excluded from the earlier tranche, such as children's hospitals. The first round's formula emphasized Medicare revenue. According to Azar, one large children's hospital that got $233,000 from the first round of funds will get an additional $32 million on Friday.

But a Modern Healthcare analysis found that nearly a quarter of the 82 children's hospitals that filed full-year 2018 CMS cost reports failed to fill out the net patient revenue field that will be used to distribute the funds.

Children's Hospital Association chief operating officer Amy Knight said the new distribution formula is an improvement for children's hospitals, but a lack of centralized data will complicate the effort.

"That data is hard to come by, which is a challenge for children's hospitals," Knight said.

Independent physician groups are also worried about their share of the funds, as they don't file CMS cost reports. American Academy of Family Physicians Senior Vice President Shawn Martin said he was concerned that some physician practices have additional reporting and data analysis obstacles to obtaining the funds.

With data missing, McDermott+Consulting vice president Mara McDermott said it's difficult to tell what total proportion HHS is using to send out the first wave of direct deposit payments, and how much will be left over.

"It feels like a total black box to me. How do you rebalance the funds with less than you started with?" McDermott said.

With funds going to smooth uneven grants from the first round, some providers will likely get less than they would have if the $20 billion had just been determined proportionally on cost report data. Federation of American Hospitals President and CEO Chip Kahn said he is disappointed the formula isn't focused on COVID-19 related losses, and is unsure his member hospitals will get enough support in the second round.

"I can't say until we see all of the money, but I have my doubts and I sincerely hope they find other ways to give out what's left and the new $75 billion," Kahn said, referring to Congress' passage of a bill replenishing grant funds on Thursday.

While HHS chose to distribute funds to rural hospitals and Indian Health Service providers based on operating expenses, they are allocating general funds by net patient revenue.

Health policy experts including Guidehouse healthcare partner Dave Moseley said the net patient revenue metric favors providers with more commercially insured patients, which are largely better off anyway. But Moseley also noted HHS had to make hard choices to get the grants out fast.

"When there is an expediency requirement, equitability is not as high on the priority list," Moseley said.

Many variables such as different organizational structures, market pricing, and payer mix are difficult to account for using any one metric, Knight said.

"It's messy, and people are working hard to create some sense of relief. No number is perfect," Knight said.

Modern Healthcare source article | Comments courtesy of Matt Zavadsky

Good information for providers as they evaluate the risks/benefits of accepting the initial CMS funds distribution. 

Also, in case you missed it, Kaiser Health News and NPR reported over the weekend about an ambiguous phrase in the HHS post regarding the distribution. 

Providers accepting the funds agree to not balance bill COVID-19 patients, and:

• “If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

And this provision…

“HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions”

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CARES Act grants could spark False Claims Act issues

RACHEL COHRS

April 18, 2020

https://www.modernhealthcare.com/legal/cares-act-grants-could-spark-false-claims-act-issues 

 

While CMS Administrator Seema Verma touted that Congress' COVID-19 provider grant funds would have "no strings attached," agreeing to the assistance could open providers up to False Claims Act liability risks.

 

Many providers on April 10 received part of a $30 billion fund created in the Coronavirus Aid, Relief, and Economic Security Act, as well as a list of terms and conditions from HHS for keeping the money.

 

Several of the terms and conditions have prompted providers to seek counsel from their attorneys. Even if providers aren't technically filing a claim and didn't apply for the grants, they are not allowed to keep any money they aren't legally eligible for and could be penalized for "reverse false claims."

 

"There was a very long string attached to it," said William Jordan, a former Department of Justice official and partner at Alston & Bird.

 

Under the HHS provisions, providers can only use the funds "to prevent, prepare for, and respond to coronavirus," and for "healthcare related expenses or lost revenues that are attributable to coronavirus."

 

Documenting lost revenues may be easier for providers if they can compare patient volumes from 2019 or 2020 budget projections, according to James Segroves, a partner at Reed Smith.

 

"That may be the cleanest way to try to demonstrate compliance and not have to deal with years of investigation," Segroves said.

 

If providers don't document how they are complying with any one of the terms and conditions, it could provide an opening for FCA litigation.

 

The grant conditions require providers to track how the money is spent for quarterly reporting requirements and future audits, which may be easiest if the funds are kept in a separate account. Jordan said it's still possible to use the funds without a separate account, but it's important to maintain stringent accounting practices.

 

The added requirement may force some health systems and practices to reprioritize their expenses and bulk up their compliance practices, especially if they don't have a sophisticated system in place.

 

"What your compliance plan is on January 1, 2020 is not the same plan that should be in place on May 1," King & Spalding partner Michael Paulhus said.

 

Providers could run afoul of false claims law if they use the grants to double-dip for expenses that another assistance program covers. Some of the money can be used for payroll expenses, but with limits— employees can only be paid using grant funds up to an annual rate of up to $197,300, so salaries for more highly paid workers would need to be paid at least partly using separate funds.

 

Grant recipients are also banned from billing out-of-network patients more for COVID-19 treatments than they would have otherwise paid in-network. But if contracts didn't exist previously, it could throw a wrench in calculating in-network rates, according to Hooper, Lundy & Bookman founding partner Lloyd Bookman. Insurers use a wide variety of benefit designs to determine those rates.

 

"I don't understand how providers do that in the real world," Bookman said.

 

Providers have 30 days to either agree to HHS' terms and conditions or return the grant money. Since some of the regulatory terms are ambiguous, some lawyers suggested their clients should keep a paper trail of how they interpreted HHS' requirements or reach out to the agency for clarification.

 

If any FCA issues arise in the future, having record of interpretations can help establish whether a provider intentionally tried to defraud the government.

 

"The regulations may change and the interpretations may change, and you have to be willing to repay the funds if that happens. But with the benefit of hindsight, this will be an important step," said Crowell & Moring partner David Robbins.

 

The regulatory system is moving at warp speed, and it's possible that more clarity on providers' obligations could come later. Bookman said he is currently advising clients to hold off on agreeing to the grant terms until later in the 30-day window to make sure they have as much information as possible. If providers don't agree to or reject the terms by the HHS deadline, they are automatically considered as agreeing to them.

 

The coronavirus pandemic has caused providers to scramble as they brace for a surge of sick patients or try to pay bills as their revenue shrinks without elective procedures. The federal government may consider those extenuating circumstances as they're considering bringing a false claims case.

 

"Everybody is human. They have compassion. But they will bring cases," Robbins said.

NPR Source Article | Comments Courtesy of Matt Zavadsky

Very interesting article from Kaiser Health News and replicated by NPR - the implications could be very significant, and depending on the pending HHS clarification, may give those who received round 1 stimulus payments reasons to re-consider accepting those payments.  Providers may generate more revenue by balance billing, than they receive in stimulus payments.

 

It’s not referenced in the article, but here is the actual language in the HHS guidance regarding the stimulus payments:

 

• “If you ceased operation as a result of the COVID-19 pandemic, you are still eligible to receive funds so long as you provided diagnoses, testing, or care for individuals with possible or actual cases of COVID-19. Care does not have to be specific to treating COVID-19. HHS broadly views every patient as a possible case of COVID-19.”

 

Also, we have talked with many ambulance providers who are/were unaware they received this payment.  Typically, those have been providers who outsource their billing, and funds go into a general revenue or other account they do not monitor closely.  The CARES Act public notice contains language states that if you keep the payment, it is presumed you agree with all the provisions of accepting the fund – including the balanced billing provision.

 

“HHS' payment of this initial tranche of funds is conditioned on the healthcare provider's acceptance of the Terms and Conditions, which acceptance must occur within 30 days of receipt of payment. Not returning the payment within 30 days of receipt will be viewed as acceptance of the Terms and Conditions”

• 2020.04 CARES Act Provider Relief Fund.pdf
  
• 2020.04.13 Highlights - HHS Relief Fund Payment Terms and Conditions.pdf
  

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In Fine Print, HHS Seems To Have Banned Surprise Medical Bills During The Pandemic

April 17, 20208:25 PM

EMMARIE HUETTEMAN

 

https://www.npr.org/sections/health-shots/2020/04/17/837749925/in-fine-print-hhs-seems-to-have-banned-surprise-medical-bills-during-the-pandemi

 

U.S. officials offering emergency funding to hospitals, clinics and doctors' practices during the coronavirus pandemic have included this stipulation: They are not permitted to foist surprise medical bills on COVID-19 patients.

 

But buried in the Department of Health and Human Services' terms and conditions for eligibility is language that could carry much broader implications. "HHS broadly views every patient as a possible case of COVID-19," the guidance states.

 

Some health care analysts say that line could disrupt a longtime health care industry practice of balance billing, in which a patient is billed for the difference between what a provider charges and what the insurer pays.

 

Such charges are a major source of surprise bills, and can be financially devastating for patients. The practice of balance billing is banned in several states, though not federally.

 

The possibility that HHS might have done with fine print what Congress and the White House could not do — despite bipartisan support and public outrage — caught some who have been immersed in the issue off guard, and raised questions about what exactly HHS meant.

 

As the first wave of $30 billion in payouts began to hit bank accounts last week, health care providers were asked to sign an online form agreeing to the government's terms. Among those terms is this stipulation: "For all care for a possible or actual case of COVID-19," the provider will not charge patients any more in out-of-pocket costs than they would have if the provider were in-network, or contracted with the patient's insurance company to provide care.

 

The agreement is posted on the HHS.gov page.

 

"The intent of the terms and conditions was to bar balance billing for actual or presumptive COVID-19," an HHS spokesperson said late Friday. "We are clarifying this in the terms and conditions."

 

Lobbyists, advocates and health policy scholars say the ambiguity could be enough to mandate that providers who accept federal funds not send surprise medical bills to patients — whether or not they test positive for COVID-19.

 

"If you took the broadest interpretation, any of us could be a potential patient," says Jack Hoadley, a professor emeritus of health policy at Georgetown University and former commissioner of the Medicare Payment Advisory Commission.

 

Last week, as HHS released an initial draft of its terms and conditions for the emergency funds allocated by Congress in the CARES Act, the Trump administration startled many in health care by declaring that providers would have to agree not to send surprise bills to COVID-19 patients for treatment. A White House spokesperson declined to comment. HHS did not immediately comment.

 

But the blanket assertion by health officials that "every patient" is considered a COVID-19 patient, offered without further clarification, seems to go beyond the administration's announcement and open the door to lawsuits over whether HHS intended to ban balance billing entirely.

 

"Because the terms and conditions do not appear to be sufficiently clarified, there is a concern that there will be legal challenges around the balance-billing provision," says Rodney Whitlock, a health policy consultant and former staffer for Republicans in the Senate.

 

Some health care providers and others in the industry have fought tooth and nail to safeguard their control over what they can bill patients for care. Certain lobbying groups later revealed to be connected to physician staffing firms owned by profit-driven private equity companies, spent millions last summer to buy political ads that targeted members of Congress who were working on legislation to end surprise billing.

 

Congress has yet to pass any legislation on surprise billing, but debate over the practice continues behind the scenes. Lawmakers did include modest provisions in relief legislation that prevent people from having to pay out of pocket for COVID-19 tests.

 

Hoadley of Georgetown says HHS' guidance should have addressed some of the problems that Congress did not explicitly account for in its relief legislation.

 

"The providers, the insurers, everybody else is going to need clarification, as well as, of course, all of us as potential patients," Hoadley says. "That's going to affect our willingness to" seek testing or treatment.

 

Frederick Isasi, executive director of Families USA, a nonprofit that advocates for health care consumers, says the group supports the administration's guidance "wholeheartedly" but has urged lawmakers to enshrine broad protections against surprise billing into law.

 

"It's time to just ban them permanently, not just related to COVID," Isasi says.

 

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.

 

Local Gov Life Source Podcast

The Center for Public Safety Management (CPSM) and the Academy of International Mobile Healthcare Integration (AIMHI) teamed up to bring insights into how the COVID-19 pandemic is affecting EMS delivery, and some of the top challenges facing local EMS agencies as they try to meet this crisis head-on.

Listen to the episode now►

HealthAffairs Source Article | Comments Courtesy of Matt Zavadsky

The conversation still references surprise bills, when it should focus on surprise coverage…

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Most Patients Undergoing Ground And Air Ambulance Transportation Receive Sizable Out-Of-Network Bills

Karan R. Chhabra, Keegan McGuire, Kyle H. Sheetz, John W. Scott, Ushapoorna Nuliyalu, and Andrew M. Ryan

PUBLISHED: APRIL 15, 2020

 

https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2019.01484

 

ABSTRACT

“Surprise” out-of-network bills have come under close scrutiny, and while ambulance transportation is known to be a large component of the problem, its impact is poorly understood. We measured the prevalence and financial impact of out-of-network billing in ground and air ambulance transportation. For members of a large national insurance plan in 2013–17, 71 percent of all ambulance rides involved potential surprise bills. For both ground and air ambulances, out-of-network charges were substantially greater than in-network prices, resulting in median potential surprise bills of $450 for ground transportation and $21,698 for air transportation. Though out-of-network air ambulance bills were larger, out-of-network ground ambulance bills were more common, with an aggregate impact of $129 million per year. Out-of-network air ambulance bills averaged $91 million per year, rising from $41 million in 2013 to $143 million in 2017. Federal proposals to limit surprise out-of-network billing should incorporate protections for patients undergoing ground or air ambulance transportation.

 

CONCLUSION

Among commercially insured patients, the vast majority of emergency medical transportation occurs out of network, with charges exceeding plan payments by hundreds to thousands of dollars. Despite the financial burden of ground and air ambulance transportation, both have largely evaded state and federal legislation. Federal proposals to limit surprise out-of-network billing should incorporate protections for patients who receive ground or air ambulance transportation.

ABC News Source Article | Comments Courtesy of Matt Zavadsky

ABC News tonight profiled EMS On the Front Lines - a stark reality of what EMS teams in NYC are battling! This battle is being fought in communities all across America, and EMS professionals are on the front line!

Communications, Fleet, Logistics, Billing, Admin, EVERYONE is effected by this scourge... This story is one of many being retold in cities and towns across our country - even in ours!

Please keep all EMS providers in your thoughts and prayers, and even more importantly, HELP them - talk to your elected officials, push for the proper PPE to help them remain safe,

AND, when you see a firefighter, police officer, EMS worker, THANK THEM for putting themselves on the line (but keep at least a 6 foot buffer )

Do everything you can to keep them safe, as they work to save others.  The life they save, might be yours, or one of your loved ones!

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EMS on the front lines dealing with 'madness,' sleeping in their cars to avoid infecting their families

The FDNY said that about 20% of members were out sick with symptoms of COVID-19.

By Eva Pilgrim, Katie O'Brien, Josh Margolin, Enjoli Francis

March 31, 2020

 

 

Emergency medical service workers in Queens, New York, described living and working in what amounts to a "war zone" as they seek to help residents during the COVID-19 pandemic.

 

"We have thousands of people that are sick. Thousands that are dying," Oren Barzilay, president of FDNY-EMS Local 2507, told ABC News on Tuesday. "It's all over our city. It's not just an isolated case. It's all around us."

 

Barzilay said that the city had even broken a record for 911 calls Monday -- 7,200 calls -- passing Friday's record of 7,100.

 

John Rugen, a 16-year veteran with the fire department, described the situation for EMS workers as "madness."

 

He said that while his workers were "still holding the line" and doing what was necessary to save lives, they were short on personal protective equipment and needed a lot of supplies.

 

"We want people to be mindful when they call 911. ... We're dealing with severely ill people at the moment that need our attention," he said. "The hospitals are overwhelmed as we are overwhelmed."

 

 

ABC News followed EMS at a safe distance in Queens on four calls on Tuesday, including two reports of fever and cough, a COVID-19 patient and a person who had died. As they arrived for each call, EMS workers wore thin, blue gowns, gloves and masks.

 

During one call that ABC News witnessed, Tracy Sims stood outside as EMS workers entered the home of her aunt who'd been diagnosed with COVID-19 the previous week.

 

Sims told ABC News that her aunt's doctor had sent her home so she could self-quarantine but that the aunt, who's in her 60s, also had a touch of pneumonia and was feeling winded and short of energy.

 

"If you're having trouble breathing and, you know, you're an older person, you're by yourself, who's going to go inside to help her?" Sims said to ABC News. "Nobody can go inside to help her."

 

Barzilay said that Local 2507 had roughly 4,500 EMTs/paramedics with the New York Fire Department, including officers. Of those, he said more than 500 were showing signs and symptoms of COVID-19 and more than 50 members had tested positive for the virus.

 

The FDNY confirmed to ABC News that more than 20% of the EMS workforce was out sick. The Federal Emergency Management Agency was sending a contingent of paramedics and ambulances to help backfill.

 

Rugen said that when EMS workers arrived at a call, they went in suspecting that everyone in the home or at the scene had COVID-19 in order to protect themselves.

 

He said that while his station had gloves and N95 masks, it was running short. He told ABC News that he'd even called some stations last week and learned that they didn't have any masks left.

 

For Rugen, going out every shift puts him at risk. He said he had stage 4 lung cancer from Sept. 11 and that even cigarette smoke could close his lungs.

 

"This could attack me and kill me because I have shortage [of] lung capacity," he said of COVID-19.

 

Yet, he said, he worked because he liked taking care of people and had been working with the department since he was 16 years old.

 

Tracy Sims told ABC News that her aunt's doctor had sent her home so she could self-quarantine but that the aunt, who's in her 60s, also had a touch of pneumonia and was feeling winded and short of energy.

 

Rugen said he'd even decided to stop seeing his son, who has an underlying medical condition, to prevent him from possibly catching the virus. Rugen said he still Skyped with his young son whom he had not seen for a week.

 

"It's hard," he said. "Very hard."

 

Barzilay said that Rugen's decision was a common one among city EMTs. Barzilay said that other members of the service were afraid to go home and chance putting their family members at risk.

 

"They're sleeping in their cars. We have dozens and dozens and dozens of members who are sleeping in their cars.

They rather stay here, sleep in the car, wash up and go do it again," he said about working their shifts, which ranged from 16 hours to 20 hours long.

 

Sims, whose aunt had been diagnosed with COVID-19 and got assistance from EMS Tuesday, told ABC News that she was terrified.

 

"I'm scared for her. ... I'm scared for me. For everybody. ... It's emotionally taxing," Sims said. "I want this thing to be over."

COVID-19 EMS Patient Management: Myth vs. Reality
Free Webinar Recorded March 13, 2020
Watch On-Demand Now► | Download Slides

Medic Ambulance Service and Solano County Public Health in Solano County, CA are on the front-line of managing COVID-19 confirmed and persons under investigation (PUI) patients at Travis AFB in Northern California. More than 40 patients have been transported to area hospitals for further treatment. 

Hear first-hand from Jimmy Pierson, President/COO Medic Ambulance;  Dr. Bela Matyas, Solano County Public Health Director; and Ted Selby, Solano County EMS Administrator, how they planned for and executed the management of these patients and the impacts from a public health and EMS perspective. This valuable webinar will give attendees the ‘ground level truth’ about things like:

• Myth vs. Reality of PPE
• Crew preparation and communication
• Ambulance decon
• Crew member quarantine
• Public Health Information 

The presenters will plan 30 minutes of content so that there will be significant time to answer participant questions.

Presenters

• Bela T. Matyas, MD, MPH, Health Officer / Deputy Director, Solano County Public Health
• James Pierson, President / COO, Medic Ambulance Service, Vice President, California Ambulance Association
• Ted Selby, Agency Administrator, Solano County Emergency Medical Services

Hosting Organizations

• Academy of International Mobile Healthcare Integration
• National Association of Emergency Medical Technicians (NAEMT)
• International Academies of Emergency Dispatch (IAED)
• FirstWatch Solutions
• California Ambulance Association
• Paramedic Chiefs of Canada

Roll Call Source Article | Comments Courtesy of Matt Zavadsky

There is $10 million in the bill for training for First Responders….

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House OKs $8.3 billion coronavirus aid package with little debate

Trump has said he would accept a higher spending level than the original $2.5 billion White House request

By Jennifer Shutt

March 4, 2020

 The House approved an $8.3 billion emergency spending package to help contain the rapidly spreading COVID-19 illness on Wednesday after about 15 minutes of debate, as the death toll continued to mount in the United States and worldwide.

The vote was 415-2, easily eclipsing the two-thirds threshold necessary for passage under suspension of the rules. The two 'no' votes were Republicans Andy Biggs of Arizona and Ken Buck of Colorado. In a statement after the vote, Biggs called it a "larded-up bill" that wouldn't solve the problem and wastes taxpayer dollars.

The Senate is expected to quickly send the legislation to President Donald Trump, who said last week he would accept a higher spending level than the $2.5 billion the White House originally requested. Only half of that amount was new funding, with the rest pulled from existing programs that lawmakers said would shortchange other priorities.

"We worked together to craft an aggressive and comprehensive response that provides the resources the experts say they need to combat this crisis," Senate Appropriations Chairman Richard C. Shelby, R-Ala., said in a statement. "I thank my colleagues for their cooperation and appreciate President Trump’s eagerness to sign this legislation and get the funding out the door without delay.”

Trump's legislative director, Eric Ueland, confirmed after the House vote that the president "looks forward to signing" the bill.

Only hours earlier, Shelby said negotiators were "at a standstill" over Democratic demands to maintain drug and vaccine affordability provisions that GOP lawmakers said would stifle innovation. Asked what triggered quick turnaround in sentiment, House Appropriations Chairwoman Nita M. Lowey, D-N.Y., said: "Just a willingness on the part of both sides to have a deal."

The measure includes $300 million for the federal government to buy drug treatments, tests and eventually vaccines for the coronavirus-caused illness when those are developed.

The package would maintain standard procurement requirements for federal contracts requiring a "fair and reasonable" price for those supplies. It would also provide the Department of Health and Human Services with authority to ensure that they are "affordable in the commercial market" as long as product development isn't delayed as a result.

Keep reading>

AJC Source Article | Comments Courtesy of Matt Zavadsky

Interesting article that depicts additional activity toward evaluating EMS performance for the privilege of serving a community!

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State demands more accountability on EMS selection

AJC EXCLUSIVE: EMERGENCY MEDICAL SERVICES

By Yamil Berard, The Atlanta Journal-Constitution

Feb 21, 2020

 

 

State officials are about to assert unprecedented control over how emergency medical service providers are selected, with reforms they say will wring out politics and conflicts of interest while saving lives.

 

Under new rules expected to take effect this spring, regional EMS councils will have to give the state detailed performance data on ambulance service before even considering a change of providers. Those performance measures will drill into how quickly and how well ambulances help infants and children in respiratory distress, victims of gunshots, stroke sufferers and people in cardiac arrest.

 

If the councils fail to provide data or to adhere to specific rules that will govern their selection processes, the state will likely reject any changes, said David Newton, director of EMS and Trauma in the Georgia Department of Public Health.

 

“If you didn’t follow the procedure, guess what, you’ve got to start over,’’ Newton on Thursday told a room of a few dozen EMS leaders who serve on the state’s Emergency Medical Services Advisory Council. “And that’s obviously not what anyone wants.”

 

The moves are the latest in a series of reforms Newton has been firing off in his first year as the state’s top EMS leader.

 

His goal has been to bring more accountability to EMS providers in Georgia, following criticisms of gaps in state oversight.

 

Among the critics, the Atlanta-based Georgia Ambulance Transparency Project raised questions about potential conflicts-of-interests by ambulance executives and EMS operators on the regional councils. Fire chiefs in the Atlanta metro area also have raised concerns that regional council decisions don’t reflect community needs.

 

What’s more, an Atlanta Journal-Constitution investigation last June found that state has failed in its duty to ensure the quality and reliability of Georgia’ emergency medical services system. State standards are vague and oversight weak, leaving the system vulnerable to breakdowns and political pressures, the AJC reported.

 

At Thursday’s address to EMSAC leaders, Newton made it clear that the state would no longer tolerate arbitrary decision-making by the councils.

 

“So, if someone says, in a written form, I would like the X-Y-Z emergency response zone examined because they were mean to my grandmother, that’s probably not a good thing to do,” Newton said.

 

Major overhaul

In moves late last year to reform the selection process, Newton announced that the state planned to implement a rule limiting the number of representatives from any one organization on the regional councils.

 

Yet another reform will require each council member to complete a conflict-of-interest statement that discloses personal affiliations and financial interests. Leaders of the Ambulance Transparency Project had urged the state to require the disclosures, concerned that ambulance executives were able to sway decisions that may not be in the public’s best interest.

To improve transparency, the state also made it clear that regional councils must comply with the state’s open meetings law. A pending goal will require council members to undergo training on open meeting requirements.

 

But the most profound change is a requirement that regional councils conduct uniform assessments of the existing level of service in each geographical zone, even before anyone vies for a contract.

 

To conduct the assessments, agencies would have to submit data from patient trip reports to Newton’s office, which they are already required to do but sometimes don’t.

 

Newton also would like agencies to report performance data established under the National Highway Traffic Safety Administration’s EMS Compass initiative. The initiative depends on standardized measures of performance to improve the quality of care to patients.

 

For example, the state wants providers to show the councils that they are transporting patients to the hospitals that are equipped to meet their needs, Newton said.

 

If a patient has experienced severe burns in a car fire after an accident, the state would want to know if the EMS agency transported the victim to a Level One Trauma Center, which can provide the highest level of care.

Continue reading►

Source Article | Comments courtesy of Matt Zavadsky

Bente Bouthier did a nice job reporting on a complex topic…

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Senate Bill Would Set Universal Rate For EMS Transport, Providers Say It's A Bad Idea

By BENTE BOUTHIER

February 18, 2020

 

https://indianapublicmedia.org/news/senate-considering-bill-to-set-universal-rate-for-ems-transport,-providers-say-its-a-bad-idea.php

 

Indiana lawmakers are considering legislation that would peg all of the state’s ambulance and transportation costs to in-network rates.

The Senate’s Insurance and Financial Institutions Committee will decide by the end of February whether to pass the bill with its current language.

House Bill 1372 attempts to eliminate instances of patients getting surprise bills after receiving emergency medical services that weren’t covered by insurance.   

Many EMS providers lobbied against the bill, saying setting costs at in-network rates will dramatically cut the industry’s already low revenue.

Matt Zavadsky is the president of the National Association of Emergency Medical Technicians. He says EMS providers don’t reap the same benefits of in-network rates as regular healthcare providers. Primary care physicians who go with in network rates usually get more patients, which usually compensates for reduced fees.

“People aren’t going to call 9-1-1 more just because we’re now in-network with any of their insurance payers,” he says.  "The concept of accepting an additional rate without having an additional volume to help cover the lost revenue per call doesn't work in the emergency medical services industry setting."

In-network rates would lock in the universal rate for transportation costs.

Zavadsky says this means Indiana EMS services could receive less compensation than what it costs to operate.

He also says tax payers will either have to make up for the revenue loss or accept a decrease in services in their community if the bill’s language remains unchanged.

Before any laws are passed changing reimbursement rates for EMS providers, Zavadsky says lawmakers should examine how much healthcare costs more carefully. 

He suggests using the FAIR database which looks at costs of all healthcare by region, rather than setting a statewide average.

"Instead of going right to, setting a statewide, in-network rate for ambulance services, maybe the first step is finding out what it really costs to provide ambulance services in the communities across the state of Indiana."

He says under HB 1372's current language, insurance companies would be the primary beneficiary. 

"If the insurance companies have to pay less, they benefit financially," Zavadsky says. "The patient is going to get a higher bill from the ambulance provider. The ambulance providers are going to have a reduced reimbursement, which means they're going to suffer."

The Senate committee is considering two amendments to the bill, one of which would remove the in-network rates for providers that are owned by or have a contract with a municipality.

The other would allow ambulance providers and insurance companies negotiate prices of transportation costs.