IS IT PROPER OR ETHICAL ?

[Guest guest]

Mike, if the transfer is medically necessary and an inter-hospital

transfer, I would not ask my crews to collect payment in advance. That sounds

like a

" bill-facility " situation or even " medicaid pending " situation.

If it was an elective transport (like patient preference), then yes, the

patient would be advised of what the cost is and attempt to secure payment with

a credit card or have a payment waiting. With very, very few exceptions, I

am not a big fan of field collections. The field crews main responsibility is

to the patient. It is not that it is wrong or immoral, it is just that I

have been placed in that situation before in the field and was never

comfortable asking for payment.

Except as outlined above, it is my opinion that any field collections need

to be limited to 1) a non-emergency, non-qualifying pre-scheduled transport

and 2) a special event where it is customary to collect payment at the end of

the event. Even with the prescheduled transport in # 1, every attempt to

secure payment should be made by the billing department prior to dispatching a

unit on the call.

Just my 2 cents.

[Guest guest]

Simple question:

Is it proper, or even ,ethical to have the EMS crew doing

the transfer to ask for

payment up front from a patient or their family going from hospital to

hospital for treatment

not available at the origin facility? The pt. in question needs an emergency

procedure at a

higher level of care. E-mail me off list if you'd like.

Thank

you in advance

[Guest guest]

Better yet - can you refuse this transfer if the patient can't pay?

For an " elective " transfer I could see ways to say yes. For a medically

necessary transport, I'm not sure you can legally refuse.

Mike

>

> Simple question:

>

> Is it proper, or even ,ethical to have the EMS crew doing the transfer to

> ask for

>

> payment up front from a patient or their family going from hospital to

> hospital for treatment

>

> not available at the origin facility? The pt. in question needs an

> emergency procedure at a

>

> higher level of care. E-mail me off list if you'd like.

>

> Thank you in advance

>

>

>

[Guest guest]

Mike,

As a medic, I would not have refused-

>

> Simple question:

>

> Is it proper, or even ,ethical to have the EMS crew doing the transfer to

> ask for

>

> payment up front from a patient or their family going from hospital to

> hospital for treatment

>

> not available at the origin facility? The pt. in question needs an

> emergency procedure at a

>

> higher level of care. E-mail me off list if you'd like.

>

> Thank you in advance

>

>

>

[Guest guest]

I have always thought that medical staff should not be involved in

collections. This makes your service look greedy and unprofessional. I think

that all this should be completed prior to getting the medical crew

involved. If a med crew comes in and request money prior to transport, the

pt. will be hesitant to seek treatment for something due to fear that they

will say, well if you want me to fix that you will have to give me more

money. We are here to do patient care, not bill collect.

Ruhnke, NREMT-P/CCEMT-P

Flight Paramedic

Spirit Medical Transportation Services

>

>Reply-To: texasems-l

>To: paramedicop@..., texasems-l

>Subject: Re: IS IT PROPER OR ETHICAL ?

>Date: Mon, 11 Dec 2006 20:18:16 -0800 (PST)

>

>Mike,

>

> As a medic, I would not have refused-

> >

> > Simple question:

> >

> > Is it proper, or even ,ethical to have the EMS crew doing the transfer

>to

> > ask for

> >

> > payment up front from a patient or their family going from hospital to

> > hospital for treatment

> >

> > not available at the origin facility? The pt. in question needs an

> > emergency procedure at a

> >

> > higher level of care. E-mail me off list if you'd like.

> >

> > Thank you in advance

> >

> >

> >

[Guest guest]

Ok, let's say the service was contacted by the

hospital on behalf of the patient and a price was

agreed upon, then I see nothing wrong. Now if nosuch

thing occured, then hmmm. I have been asked to

collect money for transfers between hospitals, but the

sending facility calls all the local ems services and

then goes with the lowest bidder. Is it wrong of

immoral, no. How else are we going to get paid? The

company needs to make ends meet too. In this day and

age of uninsured patients, I see this as becoming more

frequent. Now if the situation in question was an

emergency transfer, e.g., angioplasty, open heart,

etc., then I would have to say that someone dropped

the ball. Hospitals usually use their contracted

provider, if they have one. If not, and they have a

rotation list, then what now? Anyone. And by the

way, when I have collected money, yes I felt bad, but

I usually ask at the destination, I never heard one

derogatory comment from family or patient. It is all

in how you approach the patient.

Salvador Capuchino Jr

EMT-Paramedic

--- Ruhnke

wrote:

> I have always thought that medical staff should not

> be involved in

> collections. This makes your service look greedy and

> unprofessional. I think

> that all this should be completed prior to getting

> the medical crew

> involved. If a med crew comes in and request money

> prior to transport, the

> pt. will be hesitant to seek treatment for something

> due to fear that they

> will say, well if you want me to fix that you will

> have to give me more

> money. We are here to do patient care, not bill

> collect.

>

>

>

> Ruhnke, NREMT-P/CCEMT-P

> Flight Paramedic

> Spirit Medical Transportation Services

>

>

>

>

> >

> >Reply-To: texasems-l

> >To: paramedicop@...,

> texasems-l

> >Subject: Re: IS IT PROPER OR ETHICAL ?

> >Date: Mon, 11 Dec 2006 20:18:16 -0800 (PST)

> >

> >Mike,

> >

> > As a medic, I would not have

> refused-

> > >

> > > Simple question:

> > >

> > > Is it proper, or even ,ethical to have the EMS

> crew doing the transfer

> >to

> > > ask for

> > >

> > > payment up front from a patient or their family

> going from hospital to

> > > hospital for treatment

> > >

> > > not available at the origin facility? The pt. in

> question needs an

> > > emergency procedure at a

> > >

> > > higher level of care. E-mail me off list if

> you'd like.

> > >

> > > Thank you in advance

> > >

> > >

> > > [Non-text portions of this message have been

> removed]

> > >

> > >

> > >

> >

> >[Non-text portions of this message have been

> removed]

> >

> >

> >

> >

> >

> >

> >[Non-text portions of this message have been

> removed]

> >

>

>

>

>

>

>

[Guest guest]

I didn't ask the original question - I just replied. Basically, however, I

agree with you. Aside from special events (which I work routinely), I've

only had one field collection - and that was set up by management long

before my arrival and secured upon arrival at our destination, not at the

onset of transport.

Mike

>

> Mike, if the transfer is medically necessary and an inter-hospital

> transfer, I would not ask my crews to collect payment in advance. That

> sounds like a

> " bill-facility " situation or even " medicaid pending " situation.

>

> If it was an elective transport (like patient preference), then yes, the

> patient would be advised of what the cost is and attempt to secure payment

> with

> a credit card or have a payment waiting. With very, very few exceptions, I

>

> am not a big fan of field collections. The field crews main responsibility

> is

> to the patient. It is not that it is wrong or immoral, it is just that I

> have been placed in that situation before in the field and was never

> comfortable asking for payment.

>

> Except as outlined above, it is my opinion that any field collections need

>

> to be limited to 1) a non-emergency, non-qualifying pre-scheduled

> transport

> and 2) a special event where it is customary to collect payment at the end

> of

> the event. Even with the prescheduled transport in # 1, every attempt to

> secure payment should be made by the billing department prior to

> dispatching a

> unit on the call.

>

> Just my 2 cents.

>

>

>

>

[Guest guest]

The mixing of ethical and legal issues here is what gets to me.

As far as ethics goes, if I'm a 9-1-1 Provider I feel that any medically

emergent, as in life and death or limb and sight type of transfer needs to be

done now and sorted out later in the best interest of the patient. In any case

where it's those circumstances I can't sleep at night or look myself in the

mirror if any other measures are used. If I was the street Supervisor and a

" gray " call came in like this I'd use that as my guide 100% of the time and

deal with any heat later on. In some services I work for I'd expect not to get

any heat if it was this way in others I'd expect to be fired and everywhere in

between.

However, I'm also a business person by my nature. I know I can't do charity

work for long with no source of income so if this is likely to be a recurring

thing I'm expecting the guys in the front office to figure this out and give

me better guidance for the calls that are not truly life and death or limb

and sight.

In the case of my last 9-1-1 service, we also had a transport division so

this would be less problematic for me as I could tap their resources and I also

know that in the case of that service I'd be backed by the 2 guys above me

(I was # 3 in that organization) who were more or less of the same mind set as

I when it came to stuff like this. I can see Barry (the Chief) telling jimmy

to " figure this out " since Jimmy was the brains on this kind of stuff

business wise.

Louis N. Molino, Sr., CET

FF/NREMT-B/FSI/EMSI

Freelance Consultant/Trainer/Author/Journalist/Fire Protection Consultant

LNMolino@...

(Cell Phone)

(Home Phone)

(IFW/TFW/FSS Office)

(IFW/TFW/FSS Fax)

" A Texan with a Jersey Attitude "

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discuss people " Eleanor Roosevelt - US diplomat & reformer (1884 - 1962)

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[Guest guest]

I have never been put in this situation but many patients I have dealt with in

the past have asked how much a transport would cost them before deciding to go

the the emergency room. I have always said the same thing to each one. That is

not my department. Our main concern in the field is patient care and not are we

gonna get paid for this or not. We have enough to think about without having to

consider that as well. Just my two cents.

Ray

[Guest guest]

Ones insurance to take care of this. If they don't have insurance then the

sending facility is, or should be, responsible since they can not provide the

service.

learningmedic wrote: Simple question:

Is it proper, or even ,ethical to have the EMS crew doing the transfer to ask

for

payment up front from a patient or their family going from hospital to hospital

for treatment

not available at the origin facility? The pt. in question needs an emergency

procedure at a

higher level of care. E-mail me off list if you'd like.

Thank you in advance