Ambulances and Wreckers

[Guest guest]

It's been an interesting week. After talking with several friends in

and around Houston, I really have to wonder what it's going to take to

get some accountability among EMS providers, particularly private

providers...

Example: Provider in east texas area receives call for non-emergency

transfer. They (not a service with any 911 responsibility) do not

have a local unit available. Rather than refer the call to another

local company with a local unit available and serve the patient and

facility, they call another unit from a sister operation that's

somewhere in the area of 2.5 - 3 hours away. That unit responds

(leaving their " area " uncovered, though no 911 service is being

provided - transfer only), drives 3 hours to pick up the patient, then

takes them to DALLAS. Why on earth the service didn't refer it to a

local provider, or even a provider IN DALLAS (who would come get the

patient then return to their home service area) is beyond me unless we

just want to agree that greed, not the patient's best interest, rules.

Based on a discussion about this scenario and several other things,

I'd like to wonder aloud about the following: why don't we treat

non-emergency ambulances like wreckers?

Most large municipal or county police departments have wrecker

rotations. They need a wrecker, the one on top of the list is sent

(and their service drops to the bottom of the list). Wreckers that

want to be on the list have to meet a basic set of requirements, and

have to be willing to accept what call volume they're given on

rotation.

At a high level, why couldn't RAC's serve the same function? Give

every facility in that RAC a single phone number to call for

transfers, and utilize a rotation list for non-emergency transfers?

Companies would no longer fight for contracts with facilities, there

would be no incentive to lie, cheat and steal for business, and it

would be a step more regulated as the RAC's could handle " enforcement "

of the terms of being on the non-emergency transfer list. For the

sake of argument, assume that enabling legislation is in place that

would allow RAC's to regulate non-emergency transfers and perform

inspections to ensure compliance with rotation listing requirements.

Why wouldn't this work (or some other form of this)?

Yes, it's not possible now with what we have today. There's a lot of

work to be done, a lot of arguments to be had, etc... but given the

sad state of greed-based competition that overrides patient-based

care, isn't now the right time to start asking, again, " What next? "

So, I ask this: bat this around in your head. Feel free to disagree,

but if you disagree, you must ALSO post YOUR change or solution to fix

this thought or the overall problem. Create discussion and see where

it goes...

Mike

[Guest guest]

http://www.ghemsc.org/

Ambulances and Wreckers

It's been an interesting week. After talking with several friends in

and around Houston, I really have to wonder what it's going to take to

get some accountability among EMS providers, particularly private

providers...

Example: Provider in east texas area receives call for non-emergency

transfer. They (not a service with any 911 responsibility) do not

have a local unit available. Rather than refer the call to another

local company with a local unit available and serve the patient and

facility, they call another unit from a sister operation that's

somewhere in the area of 2.5 - 3 hours away. That unit responds

(leaving their " area " uncovered, though no 911 service is being

provided - transfer only), drives 3 hours to pick up the patient, then

takes them to DALLAS. Why on earth the service didn't refer it to a

local provider, or even a provider IN DALLAS (who would come get the

patient then return to their home service area) is beyond me unless we

just want to agree that greed, not the patient's best interest, rules.

Based on a discussion about this scenario and several other things,

I'd like to wonder aloud about the following: why don't we treat

non-emergency ambulances like wreckers?

Most large municipal or county police departments have wrecker

rotations. They need a wrecker, the one on top of the list is sent

(and their service drops to the bottom of the list). Wreckers that

want to be on the list have to meet a basic set of requirements, and

have to be willing to accept what call volume they're given on

rotation.

At a high level, why couldn't RAC's serve the same function? Give

every facility in that RAC a single phone number to call for

transfers, and utilize a rotation list for non-emergency transfers?

Companies would no longer fight for contracts with facilities, there

would be no incentive to lie, cheat and steal for business, and it

would be a step more regulated as the RAC's could handle " enforcement "

of the terms of being on the non-emergency transfer list. For the

sake of argument, assume that enabling legislation is in place that

would allow RAC's to regulate non-emergency transfers and perform

inspections to ensure compliance with rotation listing requirements.

Why wouldn't this work (or some other form of this)?

Yes, it's not possible now with what we have today. There's a lot of

work to be done, a lot of arguments to be had, etc... but given the

sad state of greed-based competition that overrides patient-based

care, isn't now the right time to start asking, again, " What next? "

So, I ask this: bat this around in your head. Feel free to disagree,

but if you disagree, you must ALSO post YOUR change or solution to fix

this thought or the overall problem. Create discussion and see where

it goes...

Mike

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[Guest guest]

???

>

> http://www.ghemsc.org/

>

[Guest guest]

Our RAC runs from Jasper, Texas to Lake . Maybe your RAC is better

bunched together. By the way, who says they will call this number and what is

the RAC gonna do if they don't? I hope it is not the same thing that DSHS

does to them.

Andy

[Guest guest]

I am an active participant in the RAC. We have a good number of people who

make RAC-R work, but we are strecthed from one end of deep East Texas to past

Galveston. Now with the Cardiac and Stroke committees going full force,

those that do not have a big RAC will either suffer or have 4 or 5 people doing

everything and cutting their regular jobs short. Either the RAC's are going

to run EMS in Texas or DSHS has seemingly given them that job without a

fight. I see what the possibilities are, but some of this is coming faster

than

we expected. Please do not give us an ambulance response policing job.

Andy

[Guest guest]

What are the punishments for non-compliance and how are they enforced?

[Guest guest]

Mike: I agree that this is a viable option. Most of us have worked for

non-emergency providers and have seen some of the unscrupulous practices

that some go to get the transfer at all cost. One of the worst is taking

emergency units out of service or out of coverage areas to provide a

non-emergency transport because it is " guaranteed " money as opposed to

potential non-payment by emergency patients.

The North Central Texas RAC (NCTTRAC)has a system in place called the

Regional Communication Center that is set up to handle transferring

patients between hospital facilities. Basically, it's " one stop

shopping. " I spoke with someone at the Conference and they are only

handling about 30 calls per month. It is underutilized. I believe that

non-emergency transports for a region could be handled in a similar

manner. Ensure that the services meet at least minimum standards, QI/QA

the system to make sure estimated times aren't fudged, and be placed in

the rotation. This would do away with some of the undercutting and

preferential treatment.

To take this another step, I believe that air medical transport could be

handled in a similar manner. Your crew would basically call for " air

medical " and be assigned the closest available aircraft to your scene.

We have seen a great increase in the number of services come available;

some over utilized, some underutilized.

These requests could be handled by an independent third party at the

oversight of the RAC. More funding is coming available that DSHS is

tying into participation in the RAC. Demonstration of participation in

using the RCC could be required for funding, as opposed to going it

alone and calling one preferred service.

Thoughts are my own....

Steve

Ambulances and Wreckers

It's been an interesting week. After talking with several

friends in

and around Houston, I really have to wonder what it's going to

take to

get some accountability among EMS providers, particularly

private

providers...

Example: Provider in east texas area receives call for

non-emergency

transfer. They (not a service with any 911 responsibility) do

not

have a local unit available. Rather than refer the call to

another

local company with a local unit available and serve the patient

and

facility, they call another unit from a sister operation that's

somewhere in the area of 2.5 - 3 hours away. That unit responds

(leaving their " area " uncovered, though no 911 service is being

provided - transfer only), drives 3 hours to pick up the

patient, then

takes them to DALLAS. Why on earth the service didn't refer it

to a

local provider, or even a provider IN DALLAS (who would come get

the

patient then return to their home service area) is beyond me

unless we

just want to agree that greed, not the patient's best interest,

rules.

Based on a discussion about this scenario and several other

things,

I'd like to wonder aloud about the following: why don't we treat

non-emergency ambulances like wreckers?

Most large municipal or county police departments have wrecker

rotations. They need a wrecker, the one on top of the list is

sent

(and their service drops to the bottom of the list). Wreckers

that

want to be on the list have to meet a basic set of requirements,

and

have to be willing to accept what call volume they're given on

rotation.

At a high level, why couldn't RAC's serve the same function?

Give

every facility in that RAC a single phone number to call for

transfers, and utilize a rotation list for non-emergency

transfers?

Companies would no longer fight for contracts with facilities,

there

would be no incentive to lie, cheat and steal for business, and

it

would be a step more regulated as the RAC's could handle

" enforcement "

of the terms of being on the non-emergency transfer list. For

the

sake of argument, assume that enabling legislation is in place

that

would allow RAC's to regulate non-emergency transfers and

perform

inspections to ensure compliance with rotation listing

requirements.

Why wouldn't this work (or some other form of this)?

Yes, it's not possible now with what we have today. There's a

lot of

work to be done, a lot of arguments to be had, etc... but given

the

sad state of greed-based competition that overrides

patient-based

care, isn't now the right time to start asking, again, " What

next? "

So, I ask this: bat this around in your head. Feel free to

disagree,

but if you disagree, you must ALSO post YOUR change or solution

to fix

this thought or the overall problem. Create discussion and see

where

it goes...

Mike

[Guest guest]

>

> The North Central Texas RAC (NCTTRAC)has a system in place called the

> Regional Communication Center that is set up to handle transferring

> patients between hospital facilities. Basically, it's " one stop

> shopping. " I spoke with someone at the Conference and they are only

> handling about 30 calls per month. It is underutilized.

Wow! So this is already being done? Apparently someone is not only

as smart as me, but faster <grin>!

In all seriousness I'm glad to hear that folks are trying something

like this. And like I said, I'm well aware that it would likely take

legislative changes to make it mandatory (although I hadn't thought

about tying grant funding to participation and crediting those

agencies involved with participation, that's an interesting thought).

Does anyone on the list know why this was started, how it works, etc.?

If not, I'll try to find out (but I'm going to be away in classes for

the next two weeks, then it's Christmas/New Year's/etc.).

Mike

[Guest guest]

Hey Mike,

I think the central dispatch is a great idea, all around promo for better

time service. However, 2 things -

1. Quality of the other provider called

2. Right now we can't even get the helo service the RAC has placed responsible

for getting the closest helo to do just that.... It is all about the money I

guess. 3 services in an area and there is a wait for one from the originating

service to send a helo from 30+ miles away...

Makes great theory but not practical since the patients are not the center or

focus....

Chris

Mike wrote:

It's been an interesting week. After talking with several friends in

and around Houston, I really have to wonder what it's going to take to

get some accountability among EMS providers, particularly private

providers...

Example: Provider in east texas area receives call for non-emergency

transfer. They (not a service with any 911 responsibility) do not

have a local unit available. Rather than refer the call to another

local company with a local unit available and serve the patient and

facility, they call another unit from a sister operation that's

somewhere in the area of 2.5 - 3 hours away. That unit responds

(leaving their " area " uncovered, though no 911 service is being

provided - transfer only), drives 3 hours to pick up the patient, then

takes them to DALLAS. Why on earth the service didn't refer it to a

local provider, or even a provider IN DALLAS (who would come get the

patient then return to their home service area) is beyond me unless we

just want to agree that greed, not the patient's best interest, rules.

Based on a discussion about this scenario and several other things,

I'd like to wonder aloud about the following: why don't we treat

non-emergency ambulances like wreckers?

Most large municipal or county police departments have wrecker

rotations. They need a wrecker, the one on top of the list is sent

(and their service drops to the bottom of the list). Wreckers that

want to be on the list have to meet a basic set of requirements, and

have to be willing to accept what call volume they're given on

rotation.

At a high level, why couldn't RAC's serve the same function? Give

every facility in that RAC a single phone number to call for

transfers, and utilize a rotation list for non-emergency transfers?

Companies would no longer fight for contracts with facilities, there

would be no incentive to lie, cheat and steal for business, and it

would be a step more regulated as the RAC's could handle " enforcement "

of the terms of being on the non-emergency transfer list. For the

sake of argument, assume that enabling legislation is in place that

would allow RAC's to regulate non-emergency transfers and perform

inspections to ensure compliance with rotation listing requirements.

Why wouldn't this work (or some other form of this)?

Yes, it's not possible now with what we have today. There's a lot of

work to be done, a lot of arguments to be had, etc... but given the

sad state of greed-based competition that overrides patient-based

care, isn't now the right time to start asking, again, " What next? "

So, I ask this: bat this around in your head. Feel free to disagree,

but if you disagree, you must ALSO post YOUR change or solution to fix

this thought or the overall problem. Create discussion and see where

it goes...

Mike

---------------------------------

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[Guest guest]

Mike: I didn't make it clear enough probably, but the system is only

used for interhospital transfers by the hospitals themselves. EMS and

air medical are not the focus of the system.

Steve

Re: Ambulances and Wreckers

On 12/2/06, Lemming, Steve <slemming@...

<mailto:slemming%40ci.azle.tx.us> > wrote:

>

> The North Central Texas RAC (NCTTRAC)has a system in place

called the

> Regional Communication Center that is set up to handle

transferring

> patients between hospital facilities. Basically, it's " one

stop

> shopping. " I spoke with someone at the Conference and they are

only

> handling about 30 calls per month. It is underutilized.

Wow! So this is already being done? Apparently someone is not

only

as smart as me, but faster <grin>!

In all seriousness I'm glad to hear that folks are trying

something

like this. And like I said, I'm well aware that it would likely

take

legislative changes to make it mandatory (although I hadn't

thought

about tying grant funding to participation and crediting those

agencies involved with participation, that's an interesting

thought).

Does anyone on the list know why this was started, how it works,

etc.?

If not, I'll try to find out (but I'm going to be away in

classes for

the next two weeks, then it's Christmas/New Year's/etc.).

Mike