Re: The Galveston County Daily News

March 21, 2000

Interestingly enough, the new medicare reimbursement plan actually looks like it'll HELP those agencies which are all ALS and emergency-response only. Payments for emergency ALS transports will actually be going UP, it looks like. Non emergency transfers will be going DOWN, most likely.

Who's to benefit? Fire departments running ALS EMS services, and municipal and private emergency-only EMS services. All of these should see an increase in revenues from medicare, not a decline.

The difference? Medicare allows for a "multiplying factor" for certain calls, so emergency ALS transports get 1.9 times the normal rate. Interesting stuff...

Mike

-----Original Message-----From: Sent: Saturday, March 18, 2000 8:06 PMTo: emsat; egroupsSubject: The Galveston County Daily News

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Cutbacks in EMS possible

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By Neal Falgoust The Daily News Published March 17, 2000 12:03 AM CST

GALVESTON -- Cuts in federally funded Medicare and Medicaid programs likely will leave city officials holding a bill for nearly $200,000 in emergency medical response costs this year. And unless the city can find alternative sources of revenue, council members might be faced with the prospect of having to cut back EMS services.

"It's to the point right now where we're going to have to find other ways to fund the service," said city spokesman Wes Swift. "We're not sure where that money's going to come from."

Part of the problem also can be attributed to a lack of money generated by donations from city water bills.

Each month, islanders have the option to donate $2 to city medical services. But in the first five months of this fiscal year, the city has collected less than $10,000 from those donations.

"That's a lot less than the $200,000 projected for the shortfall," Swift said.

The problem the city faces has its foundation in the large number of poor people the county's health district serves. Because EMS paramedics respond to emergencies regardless of a person's insurance coverage, the city-supported program is left holding the bill for people who have no medical insurance and can't afford to pay.

In the past, federal programs have reimbursed the county and city for the costs, but because of cuts in federal funds, local governments now are left holding the bill.

Last year, Galveston officials helped to cover the shortfall by dipping into the city's reserve account, which typically has a balance of about $1 million.

But city officials are reluctant to dip into that account again this year because nearly a third of it has been earmarked for a local match to accompany a federal beach erosion grant.

Drawing an additional $200,000 to cover EMS services would leave the city in a bad situation going into this year's hurricane season.

"We're really not where we should be on the reserves anyway," Swift said. "We're trying to build it up, not take away."

City manager Steve LeBlanc is scheduled to present the dilemma to city council members next week. He said the city could not afford to keep covering the deficits and must find alternative sources of revenue.

"I'm not sure right now what our options are, but we may have to cut back EMS services," LeBlanc said.

"I don't want to do that, and the best way to keep that from happening is for citizens to check that donation box on their water bills."

Neal Falgoust can be reached at or neal.falgoust@....

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March 24, 2000

Jessie,

Ask Royal about this; I'm sure he's an expert. It's been alot of

years, but I think this is one of the things he went to jail for. If you

can't find him around downtown Baptist, driving a " medical taxi, " then call

RLH. It is owned by his son-in-law.

Steve Pike

The Galveston County Daily News

>

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> Cutbacks in EMS possible

>

> .

> By Neal Falgoust

> The Daily News

>

> Published March 17, 2000 12:03 AM CST

>

> GALVESTON -- Cuts in federally funded Medicare and Medicaid

>programs likely will leave city officials holding a bill for nearly

>$200,000

>in emergency medical response costs this year.

> And unless the city can find alternative sources of revenue,

>council members might be faced with the prospect of having to cut back EMS

>services.

>

> " It's to the point right now where we're going to have to

>find

>other ways to fund the service, " said city spokesman Wes Swift. " We're not

>sure where that money's going to come from. "

>

> Part of the problem also can be attributed to a lack of

>money

>generated by donations from city water bills.

>

> Each month, islanders have the option to donate $2 to city

>medical services. But in the first five months of this fiscal year, the

>city

>has collected less than $10,000 from those donations.

>

> " That's a lot less than the $200,000 projected for the

>shortfall, " Swift said.

>

> The problem the city faces has its foundation in the large

>number of poor people the county's health district serves. Because EMS

>paramedics respond to emergencies regardless of a person's insurance

>coverage, the city-supported program is left holding the bill for people

>who

>have no medical insurance and can't afford to pay.

>

> In the past, federal programs have reimbursed the county and

>city for the costs, but because of cuts in federal funds, local governments

>now are left holding the bill.

>

> Last year, Galveston officials helped to cover the shortfall

>by dipping into the city's reserve account, which typically has a balance

>of

>about $1 million.

>

> But city officials are reluctant to dip into that account

>again this year because nearly a third of it has been earmarked for a local

>match to accompany a federal beach erosion grant.

>

> Drawing an additional $200,000 to cover EMS services would

>leave the city in a bad situation going into this year's hurricane season.

>

> " We're really not where we should be on the reserves

>anyway, "

>Swift said. " We're trying to build it up, not take away. "

>

> City manager Steve LeBlanc is scheduled to present the

>dilemma

>to city council members next week. He said the city could not afford to

>keep

>covering the deficits and must find alternative sources of revenue.

>

> " I'm not sure right now what our options are, but we may

>have

>to cut back EMS services, " LeBlanc said.

>

> " I don't want to do that, and the best way to keep that from

>happening is for citizens to check that donation box on their water bills. "

>

> Neal Falgoust can be reached at or

>neal.falgoust@....

>

> Email this story to a friend.

> Fax this story from your computer for free.

> Printing? Use this version.

>

> SOUND OFF

> Sound off on this article in The Daily News forums,

>plus

>see what other readers have to say:

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> b.. Read comments

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> CONTACT US

> Letters: Send your commentary to The Daily News.

>

> News tips: Have a story or tip for our staff?

>

> Subscribe: Get The Daily News delivered to your door

>or

>mailbox.

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> ..

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March 27, 2000

My understanding of the issue from discussions I'm having with folks

involved is that medicare will pay based on care initiated to the patient.

On our run forms, we document the level of care provided on the call, as do

most if not all other services I've dealt with. The general consensus is

that medicare will pay per patient, not per system type.

I'm glad you brought up the definitions. Everyone should be aware that IV

catherterization is NOT grounds for ALS'ing a call... medicare identifies

simple placement of IV's as a BLS skill. It comes down to procedure vs.

intervention. If you just place the line as a precaution, it's a procedure.

If you place the line and run fluids to correct a problem, it's an

intervention and an ALS call.

ALS wise, however, things get interesting. ALS trained personnel (I and P

in Texas) will *always* perform an ALS assessment, regardless of ALS

interventions used, however, treatment at a BLS level may occur, so it

appears that medicare will line-item charges outside of simple transport.

What does this mean? The ALS service that responds to an MVA and transports

BLS will get the BLS transport reimbursement from medicare along with the

ALS assessment reimbursement. That's what everyone thinks will be

happening. Where is this important?

Fire departments. ALS fire departments who contract with other services for

transport should be able to bill for ALS assessment seperate from actual

transport of the patient. Interesting how this is going, eh?

Mike

The Galveston County Daily News

>

>Forums

>| Subscribe

>

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>

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> Search

> About Us

>

> Job Openings

>

> Local Returns

>

> Audio Updates

>

> Cutbacks in EMS possible

>

> .

> By Neal Falgoust

> The Daily News

>

> Published March 17, 2000 12:03 AM CST

>

> GALVESTON -- Cuts in federally funded Medicare and Medicaid

>programs likely will leave city officials holding a bill for nearly

>$200,000

>in emergency medical response costs this year.

> And unless the city can find alternative sources of revenue,

>council members might be faced with the prospect of having to cut back EMS

>services.

>

> " It's to the point right now where we're going to have to

>find

>other ways to fund the service, " said city spokesman Wes Swift. " We're not

>sure where that money's going to come from. "

>

> Part of the problem also can be attributed to a lack of

>money

>generated by donations from city water bills.

>

> Each month, islanders have the option to donate $2 to city

>medical services. But in the first five months of this fiscal year, the

>city

>has collected less than $10,000 from those donations.

>

> " That's a lot less than the $200,000 projected for the

>shortfall, " Swift said.

>

> The problem the city faces has its foundation in the large

>number of poor people the county's health district serves. Because EMS

>paramedics respond to emergencies regardless of a person's insurance

>coverage, the city-supported program is left holding the bill for people

>who

>have no medical insurance and can't afford to pay.

>

> In the past, federal programs have reimbursed the county and

>city for the costs, but because of cuts in federal funds, local governments

>now are left holding the bill.

>

> Last year, Galveston officials helped to cover the shortfall

>by dipping into the city's reserve account, which typically has a balance

>of

>about $1 million.

>

> But city officials are reluctant to dip into that account

>again this year because nearly a third of it has been earmarked for a local

>match to accompany a federal beach erosion grant.

>

> Drawing an additional $200,000 to cover EMS services would

>leave the city in a bad situation going into this year's hurricane season.

>

> " We're really not where we should be on the reserves

>anyway, "

>Swift said. " We're trying to build it up, not take away. "

>

> City manager Steve LeBlanc is scheduled to present the

>dilemma

>to city council members next week. He said the city could not afford to

>keep

>covering the deficits and must find alternative sources of revenue.

>

> " I'm not sure right now what our options are, but we may

>have

>to cut back EMS services, " LeBlanc said.

>

> " I don't want to do that, and the best way to keep that from

>happening is for citizens to check that donation box on their water bills. "

>

> Neal Falgoust can be reached at or

>neal.falgoust@....

>

> Email this story to a friend.

> Fax this story from your computer for free.

> Printing? Use this version.

>

> SOUND OFF

> Sound off on this article in The Daily News forums,

>plus

>see what other readers have to say:

>

> a.. Post a comment

>

> b.. Read comments

>

> CONTACT US

> Letters: Send your commentary to The Daily News.

>

> News tips: Have a story or tip for our staff?

>

> Subscribe: Get The Daily News delivered to your door

>or

>mailbox.

>

> .. ..

>

> ..

>

> ...

>

>---------------------------------------------------------------------------

-

>--

>

> FindLawLegal NewsLaw ReviewsAll Legal Web SitesUS Government

>SitesMailing List ArchivesU.S. ConstitutionU.S. CodeUS Supreme Court

>OpinionsAll Federal Circuits

>

> eGroups.com Home: /group/

> www. - Simplifying group communications

>

>------------------------------------------------------------------------

>Go to Findlaw.com and get your FREE FLEECE from FindLaw.

>FindLaw is the Internet's best destination for free legal

>information! Take advantage of this offer and go to

>Findlaw.com now!

>http://click./1/1827/4/_/4981/_/953625919/

>

>-- 20 megs of disk space in your group's Document Vault

>-- /docvault//?m=1

>

______________________________________________________

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April 3, 2000

OK I fell out of the chair reading this Steve.

April 3, 2000

Steve,

Thanks, I'm very familiar with superior ambulance and reliable ambulance and

their brush with the law. But their committing fraud was obvious.

Ambulatory patients, multiple ambulatory patients, false documentation as to

the patients actual condition, billing ambulance transports while

transporting in a wheelchair van, etc.

Also, where Reliable ambulance got away with it because he bought excellent

representation, they lost their right to bill medicare in SA, but his family

member can still participate with medicare in corpus, and the valley. He did

not serve any jail time and may be still running the same kind of service.

I dont know.

Superior ambulance owner may have gotten the same deal if he had better

lawyers???

I'm really not talking about fraud. Whats unclear is how the ALS or BLS

rate will be determined. Is it by staffing, equipment, and unit

certification, or by the level of treatment a patient receives.

Currently medicare pays according to staffing and certificton. They do

realize the extra cost of having available these types of services. Its

just unclear if they are going to continue along that thought process?

It is obvious that MICU equiped and staffed ambulance cost more in equipment

and in payroll than a BLS equiped and staffed ambulance. If medicare pays

according to treatment, then I venture to perdict an increase in the need of

the basic emt and a more minor role of the paramedic in the private

ambulance sector that, " just provide services to contracted facilities " .

All I want is to provide a future for my employees and ensure our

continuation of being an employer.

I know that the information will eventually be addressed, but I was hoping

to get a leg up from some of these interesting fellows on this egroup. Some

do have prvy to good information.

thanks for responding.

jessie

>Jessie,

>

>Ask Royal about this; I'm sure he's an expert. It's been alot of

>years, but I think this is one of the things he went to jail for. If you

>can't find him around downtown Baptist, driving a " medical taxi, " then call

>RLH. It is owned by his son-in-law.

>

>Steve Pike

>

______________________________________________________

Get Your Private, Free Email at http://www.hotmail.com

April 3, 2000

Very good, thanks.

jessie

>

>Reply-To: egroups

>To: <egroups>

>Subject: RE: Re: The Galveston County Daily News

>Date: Mon, 3 Apr 2000 19:04:22 -0500

>

>Under current Medicare practices... EMS providers who are mandated by

>local/county ordinance to provide ALS or MICU only service are allowed to

>file for Medicare benefits using the ALS rates.

>

>Under the new guidelines, Medicare reimbursement will be based upon the

>interventions provided to the patient in several catagories. Your example

>of the dialysis patient should be eligible for the BLS rate reimbursement,

>if all other qualifiers are met.

>

>Jack Pitcock, EMT-P

>EMS Division Manager

>Baytown Health Dept

>Baytown, Texas

>

> > Re: The Galveston County Daily News

> >

> > I'm still unclear if medicare will be paying for level of

> > service provided

> > by the provider or by the treatment initiated to the patient.

> >

> > i.e. will an micu or als unit transporting a non emergency

> > to a dialysis be

> > paid at the als non-emergency rate even if no treatment was

> > initiated or

> > will it be paid at the bls rate.

> >

>

______________________________________________________

Get Your Private, Free Email at http://www.hotmail.com

April 3, 2000

Under current Medicare practices... EMS providers who are mandated by

local/county ordinance to provide ALS or MICU only service are allowed to

file for Medicare benefits using the ALS rates.

Under the new guidelines, Medicare reimbursement will be based upon the

interventions provided to the patient in several catagories. Your example

of the dialysis patient should be eligible for the BLS rate reimbursement,

if all other qualifiers are met.

Jack Pitcock, EMT-P

EMS Division Manager

Baytown Health Dept

Baytown, Texas

> Re: The Galveston County Daily News

>

> I'm still unclear if medicare will be paying for level of

> service provided

> by the provider or by the treatment initiated to the patient.

>

> i.e. will an micu or als unit transporting a non emergency

> to a dialysis be

> paid at the als non-emergency rate even if no treatment was

> initiated or

> will it be paid at the bls rate.

>

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