Re: Paramedics Cannot Determine Which Patients Require Transport

[Guest guest]

Renny,

I want to make sure I'm hearing you correctly because if I am then I'm not going

to argue against what you wanting to see happen but I'm questioning the

methodology for making it happen. What I'm hearing is that you want to ensure

the patient/client/taxpayer is directed to the appropriate level and location to

meet their needs irregardless of whether it's a hospital and their ability to

pay. If so, I'm with you. It sounds like you envision a system of care where EMS

is linked to not only the hospital ED, but also to the local minor emergency

centers, primary care clinics, substance abuse treatment, mental health

treatment, public health and social services so that clients can be directed to

the proper provider to meet their needs. While that system is ideal, I'm not

sure that it truly exists in most places on this planet. I think you are

envisioning the role of EMS to be more than a treat and transport function to

being a hub to access multiple levels of the health system. I'm thinking this

would be a cross between patient assessment and social worker. On one hand, I

think this is a great function that is probably more desperately needed than

anyone wants to admit since each of those elements are distinct agencies which

only see their piece of the elephant.

My concerns are: 1) If we have those in our midst who do EMS because they have

to rather than they want to (such as has been alluded to in the FF/medic

discussion) then how open will they be to playing with social services and

non-medical agencies? That's getting into the warm and fuzzy part of health and

farther from the adrenaline fed trauma/rescue. 2) Are these services already

being done within the current community settings, such as the hospital or public

health social worker? Perhaps we need to deliver patients to a different part of

the hospital than the ED or to a different place altogether. 3) Social services

offered at the community level is a very fluid environment that is heavily

impacted by the availability of local/state/federal funding. Someone needs to be

able to keep track of who is and isn't in business. (This may not need to be an

EMS function, but EMS needs to know someone who does this.) 4) Unfortunately

money is what keeps the wheels running, so there would be a need to find funding

for this activity. While I doubt it would be from traditional EMS funding

sources, there may be some other funding streams that can be tapped into or

created since in the long run this may actually save those who fund indigent

care dollars by not having people show up at the ER. 5) Even if those receiving

this help don't need transport to the ED, they probably will need assistance in

getting transported where they need to go. Should EMS provide transport to a

site for non-emergency medical treatment or arrange to have a lower level of

care (basic or non-certified) provide transportation using an ambulance, van or

sedan?

These are some very philosophical questions about how EMS is going to function

and/or reinvent itself in the years to come if I understand your basic premise

correctly. It's a far cry from the " you call, we haul " mentality and the public

safety model that we've traditionally rallied our flags around. It's very

holistic and would require an additional set of skills to what we traditionally

train on. It would also require that we look past the immediacy of the incident,

limitations on scene time and rushing to get back in service. Some of these

calls may require extensive clock time with the patient in order to understand

what they need, connecting them with that resource and getting them there. That

may mean we look at non-traditional staffing - perhaps a single person (social

worker perhaps?) in a non-transport vehicle who can spend the time in order to

free up the transport vehicle.

While this is a true paradigm shift, it's not necessarily a bad thing. This is

far beyond the issue of paramedic refusals. You are looking outside the EMS box

into a much larger box of addressing community needs to ensure everyone has

access to appropriate care. The question is what role will EMS play?

Barry

Barry Sharp, MSHP, CHES

Tobacco Prevention & Control Program Coordinator

Mental Health and Substance Abuse Division

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of spenair

Sent: Wednesday, September 09, 2009 9:49 AM

To: texasems-l

Subject: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am confused. My wanting to get a patient that tells you they need to talk to

someone actually turned over to the services they need is arrogant/hubris? How?

I do not see doing what is best for the patient is wrong. I have had many

patients tell me they asked for the ambulance because they did not know what

they need. If I am aware of a service that takes care of their need and get the

process started for them how is that wrong? If I take them to the ER is that a

benefit to them? No as they now have a huge transport bill, an even larger ER

bill and sadly may be discharged w/o ever being put in touch with the agency

they needed.

As I stated earlier I am not saying deny chest, abd, or head.

Oh and why have we chosen to use two words with the same meaning like they are

two separate things. Hubris basically means arrogant so using them in the same

sentence/question seems to be improper based on my uneducated understanding. But

maybe I misunderstand as I am not an English major.

As to reimbursement. I am sorry when did money start coming before being a

patient advocate? If I cause more harm by transporting a patient that does not

need transport should I justify it by saying oh well that will make sure the

service has enough money to keep an ambulance staffed so if there is ever a real

emergency? I am well aware it takes money to function but disagree with making

my patients suffer undue hardship because the current reimbursement system is

flawed. Based on Medicare/Medicaid rules I do not see how many of those that do

not need an ambulance transport are getting reimbursed anyway? Which means you

are transporting for free so why not just do whats right instead?

Again I know the medical education we as Paramedics get is seriously lacking. I

know even if we do add education w/o all sorts of lab, cat scans, etc that we

still would just have to transport the callers with chest, head, abd problems as

there are way to many variables.

I mean no disrespect but I just can not wrap my brain around what you and Wes

are saying.

Renny Spencer

The Idealistic Paramedic

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

Renny,

I want to make sure I'm hearing you correctly because if I am then I'm not going

to argue against what you wanting to see happen but I'm questioning the

methodology for making it happen. What I'm hearing is that you want to ensure

the patient/client/taxpayer is directed to the appropriate level and location to

meet their needs irregardless of whether it's a hospital and their ability to

pay. If so, I'm with you. It sounds like you envision a system of care where EMS

is linked to not only the hospital ED, but also to the local minor emergency

centers, primary care clinics, substance abuse treatment, mental health

treatment, public health and social services so that clients can be directed to

the proper provider to meet their needs. While that system is ideal, I'm not

sure that it truly exists in most places on this planet. I think you are

envisioning the role of EMS to be more than a treat and transport function to

being a hub to access multiple levels of the health system. I'm thinking this

would be a cross between patient assessment and social worker. On one hand, I

think this is a great function that is probably more desperately needed than

anyone wants to admit since each of those elements are distinct agencies which

only see their piece of the elephant.

My concerns are: 1) If we have those in our midst who do EMS because they have

to rather than they want to (such as has been alluded to in the FF/medic

discussion) then how open will they be to playing with social services and

non-medical agencies? That's getting into the warm and fuzzy part of health and

farther from the adrenaline fed trauma/rescue. 2) Are these services already

being done within the current community settings, such as the hospital or public

health social worker? Perhaps we need to deliver patients to a different part of

the hospital than the ED or to a different place altogether. 3) Social services

offered at the community level is a very fluid environment that is heavily

impacted by the availability of local/state/federal funding. Someone needs to be

able to keep track of who is and isn't in business. (This may not need to be an

EMS function, but EMS needs to know someone who does this.) 4) Unfortunately

money is what keeps the wheels running, so there would be a need to find funding

for this activity. While I doubt it would be from traditional EMS funding

sources, there may be some other funding streams that can be tapped into or

created since in the long run this may actually save those who fund indigent

care dollars by not having people show up at the ER. 5) Even if those receiving

this help don't need transport to the ED, they probably will need assistance in

getting transported where they need to go. Should EMS provide transport to a

site for non-emergency medical treatment or arrange to have a lower level of

care (basic or non-certified) provide transportation using an ambulance, van or

sedan?

These are some very philosophical questions about how EMS is going to function

and/or reinvent itself in the years to come if I understand your basic premise

correctly. It's a far cry from the " you call, we haul " mentality and the public

safety model that we've traditionally rallied our flags around. It's very

holistic and would require an additional set of skills to what we traditionally

train on. It would also require that we look past the immediacy of the incident,

limitations on scene time and rushing to get back in service. Some of these

calls may require extensive clock time with the patient in order to understand

what they need, connecting them with that resource and getting them there. That

may mean we look at non-traditional staffing - perhaps a single person (social

worker perhaps?) in a non-transport vehicle who can spend the time in order to

free up the transport vehicle.

While this is a true paradigm shift, it's not necessarily a bad thing. This is

far beyond the issue of paramedic refusals. You are looking outside the EMS box

into a much larger box of addressing community needs to ensure everyone has

access to appropriate care. The question is what role will EMS play?

Barry

Barry Sharp, MSHP, CHES

Tobacco Prevention & Control Program Coordinator

Mental Health and Substance Abuse Division

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of spenair

Sent: Wednesday, September 09, 2009 9:49 AM

To: texasems-l

Subject: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am confused. My wanting to get a patient that tells you they need to talk to

someone actually turned over to the services they need is arrogant/hubris? How?

I do not see doing what is best for the patient is wrong. I have had many

patients tell me they asked for the ambulance because they did not know what

they need. If I am aware of a service that takes care of their need and get the

process started for them how is that wrong? If I take them to the ER is that a

benefit to them? No as they now have a huge transport bill, an even larger ER

bill and sadly may be discharged w/o ever being put in touch with the agency

they needed.

As I stated earlier I am not saying deny chest, abd, or head.

Oh and why have we chosen to use two words with the same meaning like they are

two separate things. Hubris basically means arrogant so using them in the same

sentence/question seems to be improper based on my uneducated understanding. But

maybe I misunderstand as I am not an English major.

As to reimbursement. I am sorry when did money start coming before being a

patient advocate? If I cause more harm by transporting a patient that does not

need transport should I justify it by saying oh well that will make sure the

service has enough money to keep an ambulance staffed so if there is ever a real

emergency? I am well aware it takes money to function but disagree with making

my patients suffer undue hardship because the current reimbursement system is

flawed. Based on Medicare/Medicaid rules I do not see how many of those that do

not need an ambulance transport are getting reimbursed anyway? Which means you

are transporting for free so why not just do whats right instead?

Again I know the medical education we as Paramedics get is seriously lacking. I

know even if we do add education w/o all sorts of lab, cat scans, etc that we

still would just have to transport the callers with chest, head, abd problems as

there are way to many variables.

I mean no disrespect but I just can not wrap my brain around what you and Wes

are saying.

Renny Spencer

The Idealistic Paramedic

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

Renny,

I want to make sure I'm hearing you correctly because if I am then I'm not going

to argue against what you wanting to see happen but I'm questioning the

methodology for making it happen. What I'm hearing is that you want to ensure

the patient/client/taxpayer is directed to the appropriate level and location to

meet their needs irregardless of whether it's a hospital and their ability to

pay. If so, I'm with you. It sounds like you envision a system of care where EMS

is linked to not only the hospital ED, but also to the local minor emergency

centers, primary care clinics, substance abuse treatment, mental health

treatment, public health and social services so that clients can be directed to

the proper provider to meet their needs. While that system is ideal, I'm not

sure that it truly exists in most places on this planet. I think you are

envisioning the role of EMS to be more than a treat and transport function to

being a hub to access multiple levels of the health system. I'm thinking this

would be a cross between patient assessment and social worker. On one hand, I

think this is a great function that is probably more desperately needed than

anyone wants to admit since each of those elements are distinct agencies which

only see their piece of the elephant.

My concerns are: 1) If we have those in our midst who do EMS because they have

to rather than they want to (such as has been alluded to in the FF/medic

discussion) then how open will they be to playing with social services and

non-medical agencies? That's getting into the warm and fuzzy part of health and

farther from the adrenaline fed trauma/rescue. 2) Are these services already

being done within the current community settings, such as the hospital or public

health social worker? Perhaps we need to deliver patients to a different part of

the hospital than the ED or to a different place altogether. 3) Social services

offered at the community level is a very fluid environment that is heavily

impacted by the availability of local/state/federal funding. Someone needs to be

able to keep track of who is and isn't in business. (This may not need to be an

EMS function, but EMS needs to know someone who does this.) 4) Unfortunately

money is what keeps the wheels running, so there would be a need to find funding

for this activity. While I doubt it would be from traditional EMS funding

sources, there may be some other funding streams that can be tapped into or

created since in the long run this may actually save those who fund indigent

care dollars by not having people show up at the ER. 5) Even if those receiving

this help don't need transport to the ED, they probably will need assistance in

getting transported where they need to go. Should EMS provide transport to a

site for non-emergency medical treatment or arrange to have a lower level of

care (basic or non-certified) provide transportation using an ambulance, van or

sedan?

These are some very philosophical questions about how EMS is going to function

and/or reinvent itself in the years to come if I understand your basic premise

correctly. It's a far cry from the " you call, we haul " mentality and the public

safety model that we've traditionally rallied our flags around. It's very

holistic and would require an additional set of skills to what we traditionally

train on. It would also require that we look past the immediacy of the incident,

limitations on scene time and rushing to get back in service. Some of these

calls may require extensive clock time with the patient in order to understand

what they need, connecting them with that resource and getting them there. That

may mean we look at non-traditional staffing - perhaps a single person (social

worker perhaps?) in a non-transport vehicle who can spend the time in order to

free up the transport vehicle.

While this is a true paradigm shift, it's not necessarily a bad thing. This is

far beyond the issue of paramedic refusals. You are looking outside the EMS box

into a much larger box of addressing community needs to ensure everyone has

access to appropriate care. The question is what role will EMS play?

Barry

Barry Sharp, MSHP, CHES

Tobacco Prevention & Control Program Coordinator

Mental Health and Substance Abuse Division

________________________________

From: texasems-l [mailto:texasems-l ] On Behalf

Of spenair

Sent: Wednesday, September 09, 2009 9:49 AM

To: texasems-l

Subject: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am confused. My wanting to get a patient that tells you they need to talk to

someone actually turned over to the services they need is arrogant/hubris? How?

I do not see doing what is best for the patient is wrong. I have had many

patients tell me they asked for the ambulance because they did not know what

they need. If I am aware of a service that takes care of their need and get the

process started for them how is that wrong? If I take them to the ER is that a

benefit to them? No as they now have a huge transport bill, an even larger ER

bill and sadly may be discharged w/o ever being put in touch with the agency

they needed.

As I stated earlier I am not saying deny chest, abd, or head.

Oh and why have we chosen to use two words with the same meaning like they are

two separate things. Hubris basically means arrogant so using them in the same

sentence/question seems to be improper based on my uneducated understanding. But

maybe I misunderstand as I am not an English major.

As to reimbursement. I am sorry when did money start coming before being a

patient advocate? If I cause more harm by transporting a patient that does not

need transport should I justify it by saying oh well that will make sure the

service has enough money to keep an ambulance staffed so if there is ever a real

emergency? I am well aware it takes money to function but disagree with making

my patients suffer undue hardship because the current reimbursement system is

flawed. Based on Medicare/Medicaid rules I do not see how many of those that do

not need an ambulance transport are getting reimbursed anyway? Which means you

are transporting for free so why not just do whats right instead?

Again I know the medical education we as Paramedics get is seriously lacking. I

know even if we do add education w/o all sorts of lab, cat scans, etc that we

still would just have to transport the callers with chest, head, abd problems as

there are way to many variables.

I mean no disrespect but I just can not wrap my brain around what you and Wes

are saying.

Renny Spencer

The Idealistic Paramedic

> > >

> > >

> > > The one thing I find the longer I have my paramedic patch is that I

> > know less than I thought I did.Â

> > >

> > >

> > >

> > > At this point, EMS has a hard enough time mastering our core skills,

> > as the Wang study and several others have indicated. I'm not sure

> > that we're anywhere near ready to assume a role as the gatekeepers to

> > the healthcare system, determining who is worthy of our time. That to

> > me is the height of arrogance, especially considering that we want to

> > be considered a profession. It smacks of hubris at the least.

> > >

> > >

> > >

> > > I realize that we've come a long ways from high-top Cadillac

> > hearse/ambulances, but the reality is that we're still in the business

> > of medical transportation. Ultimately, that means we give people

> > rides to the hospital. Having said that, though, part of informed

> > consent means giving patients a realistic expectation of our

> > capabilities and treatment. I have told a patient with minor

> > complaints that it's unlikely that I could provide any treatment

> > beyond assessment and transport.  If I've informed the patient as to

> > their options and they still choose to ride in an ambulance, I'm not

> > in a position to deny them that option.

> > >

> > >

> > >

> > > And can we please kill this damned thread?

> > >

> > >

> > >

> > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > >

> > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > >

> > > -Austin, Texas

> > >

> > >

> > >

> > >

> > >

> > >

> > > Re: Paramedics Cannot Determine Wh

> > > ich Patients Require Transport

> > >

> > >

> > >

> > >

> > >

> > >

> > > As a person in favor of denying transport I do feel that we should

> > not deny chest, abd, or head related calls. Even Doctors with all

> > their equipment have trouble making accurate diagnosis. The calls that

> > would be allowed denial would be the minor trauma such as stubbed toe,

> > the sneezed once and want to make sure its not swine flu, the I just

> > need a ride to the hospital so I can get to my doctors appointment,

> > the I really just need someone to talk to to help cope ( this one only

> > if you have resources that can come there while you wait ).

> > >

> > > The denial process would also involve as much if not more effort

> > than just load and go so would discourage abuse by that one lazy

> > Paramedic that everyone seems to know since he is mentioned often.

> > >

> > > I would like to see a study on EMS denials based on a system as

> > described above. If allowed denial of the items even Doctors have

> > trouble with then it is doomed to show we can not do it. It would also

> > need a better criteria for mistake than admission to the hospital. For

> > example the stubbed toe might end up needing surgery, yet nothing

> > about the call required EMS, so admission was not a failure in this case.

> > >

> > > Well just my worthless idealistic thoughts.

> > >

> > > Renny Spencer

> > > The Idealistic Paramedic

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

In defense of Gene (he doesn't need it), many of the " Dinosaurs " on this

list have fought these battles for decades, and have opinions based on

facts, which are often considered by the younger EMS types to be anecdotal.

Gene is absolutely correct in framing the discussion on reimbursement, but

that seems to be obscured in the rhetoric of commitment, idealism, provider

types, expanded scope of practice, etc., etc., etc.

To that end, I would like to provide some selective and meaningful reading

for the younger ones to digest and incorporate into their belief systems. We

have fought these battles before and it behooves no one to suffer convenient

amnesia or derive opinions in the absence of facts. So, please read these

opinions and documents, then report your opinions in the context of these

historical events. It's all about the funding. To wit:

Medicare Part B Ambulance Services, OAI-03-86-00012, March 1987.

Project HOPE Report, Study of Payments for Ambulance Services under

Medicare, Final Report, Project HOPE, October 21, 1991.

Review of Medical Necessity for Ambulance Services, A-01-91-00513, October

1993.

Ambulance Services for Medicare End-Stage Renal Disease Beneficiaries:

Payment Practices, OEI-03-90-02131, March 1991.

Donna E. Shalala, A Report to Congress, Project HOPE, Center for Health

Affairs, Bethesda, land, 1994.

Follow-Up to Review of Medical Necessity for Ambulance Services,

A-01-94-00528.

Medicare Ambulance Payments, OEI 05-95-00300, November 1997.

State Ambulance Services and Policies, OEI 09-95-00410, February 1998.

Medical Necessity of Medicare Ambulance Services, OEI 09-95-00412, December

1998.

Medicare Payments for Ambulance Services: Comparisons to Non-Medicare

Payers, OEI 09-95-00411.

Medicare Ambulance Payments: A Framework for Change, Department of Health

and Human Services, Office of Inspector General, OEI 12-99-00280, April

1999.

These references serve as the entry point for all of the revenue issues

currently facing the EMS industry, and thus, all the other issues that that

have a direct or indirect basis in said revenues.

Bob

>

>

>

> I for one am done with this discussion. Let's move on to another dead horse

> -- like the semi-regular fire versus other providers discussion or a rant

> about Christmas.

>

> -Wes

>

> Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EM

> S, so admission was not a failure in this case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

>

>

[Guest guest]

In defense of Gene (he doesn't need it), many of the " Dinosaurs " on this

list have fought these battles for decades, and have opinions based on

facts, which are often considered by the younger EMS types to be anecdotal.

Gene is absolutely correct in framing the discussion on reimbursement, but

that seems to be obscured in the rhetoric of commitment, idealism, provider

types, expanded scope of practice, etc., etc., etc.

To that end, I would like to provide some selective and meaningful reading

for the younger ones to digest and incorporate into their belief systems. We

have fought these battles before and it behooves no one to suffer convenient

amnesia or derive opinions in the absence of facts. So, please read these

opinions and documents, then report your opinions in the context of these

historical events. It's all about the funding. To wit:

Medicare Part B Ambulance Services, OAI-03-86-00012, March 1987.

Project HOPE Report, Study of Payments for Ambulance Services under

Medicare, Final Report, Project HOPE, October 21, 1991.

Review of Medical Necessity for Ambulance Services, A-01-91-00513, October

1993.

Ambulance Services for Medicare End-Stage Renal Disease Beneficiaries:

Payment Practices, OEI-03-90-02131, March 1991.

Donna E. Shalala, A Report to Congress, Project HOPE, Center for Health

Affairs, Bethesda, land, 1994.

Follow-Up to Review of Medical Necessity for Ambulance Services,

A-01-94-00528.

Medicare Ambulance Payments, OEI 05-95-00300, November 1997.

State Ambulance Services and Policies, OEI 09-95-00410, February 1998.

Medical Necessity of Medicare Ambulance Services, OEI 09-95-00412, December

1998.

Medicare Payments for Ambulance Services: Comparisons to Non-Medicare

Payers, OEI 09-95-00411.

Medicare Ambulance Payments: A Framework for Change, Department of Health

and Human Services, Office of Inspector General, OEI 12-99-00280, April

1999.

These references serve as the entry point for all of the revenue issues

currently facing the EMS industry, and thus, all the other issues that that

have a direct or indirect basis in said revenues.

Bob

>

>

>

> I for one am done with this discussion. Let's move on to another dead horse

> -- like the semi-regular fire versus other providers discussion or a rant

> about Christmas.

>

> -Wes

>

> Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls that

> > > would be allowed denial would be the minor trauma such as stubbed toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would also

> > > need a better criteria for mistake than admission to the hospital. For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EM

> S, so admission was not a failure in this case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

>

>

[Guest guest]

I am not sure where your thought on education comes from. Here in the panhandle

it is becoming the norm for a paramedic to get an associate degree. Speaking

from a Private EMS standpoint I am not sure either from whence you speak of

monetary reimbursement being unable to meet personnel pay.  Private mangaers see

the profit margin go down as the pay for personnel goes up. I can assure you it

is not the volume of the loss that keeps them in business. Perhaps we need a

stronger voice. That only comes with willlingness to sacrifice,(something that

our whole society lacks in these days.)

  I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

  As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

No data, just personal observation.

GG

>  

> Okay, I will get off my soap box now, but I would like to see your data

> to support the statement:

>

> The fire service medics are typically IAFF or some other union members,

> but

> their interests are in their fire service jobs, not in EMS. So they

> typically do not involve themselves in lists like this and the others, do

> not

> come to conferences, and are not interested in improving EMS as a whole in

> terms of what you are talking about. I realize that's a broad

> generalization,

> and I recognize that there are exceptions, but they are few and far

> between.

> The man who we honored last week on the 5th anniversary of his death, Jim

> Page, knew that better than anybody. The facts are that fire service

> medics see themselves as public safety and fire professionals, not medical

> professionals. We have had discussions here about whether or not one can

> serve

> two masters. Can one be both a crackerjack fire suppression expert and a

> prehospital medicine expert? I don't think so. Some will disagree, and

> there are always exceptions, but that's my take. And will fire service

> medics make any more than their non-medic coworkers if they are required

> to have

> bachelors degrees? Of course not.

>

> For fire service agencies providing EMS, EMS is just as important as fire

> suppression, as just as important as fire AND injury prevention.. For fire

> service agencies providing EMS, EMS is just as important as fire

> suppression, as

>

> Generalizations such as this contribute to lack of unity and distance the

> fire service from other providers. I am a fire service professional active

> in EMS since 1981. I have also worked for private EMS providers for a

> number of years. Maxie Bishop came from Dallas Fire Rescue. I can think of

fire

> based EMS providers from all across this great State who would argue with

> you about your comments. Have you vetted this group list to know there are

> few fire based medics included? Have you reviewed the attendee lists from

> the Texas EMS conference or others to quantify your statements?

>

> There are good fire based EMS providers, good third City providers, and

> good private providers. There are also bad in each category. I find it

> incredibly frustrating when generalizations are made without supporting

evidence.

> This debate has been going on since I joined the profession in 1981.

>

> Your arguments perpetuate the separation. How about we put differences

> aside and work together?

>

> I agree with several of your comments on education. Gradual change rather

> than radical will likely gain wider support.

>

> Danny Kistner

>

> ____________ ________ ________ _

>

> From: texasems-l@yahoogrotexasem on behalf of wegandy1938@wegandy

> Sent: Wed 9/9/2009 1:11 AM

> To: texasems-l@yahoogrotexasem

> Subject: Re: Re: Paramedics Cannot Determine Which Patients

> Require Transport

>

> Danny, I am with you. But it's going to take some real wrenching changes

> before things will be where you and I would like them to be.

>

> 500 hour paramedic courses won't cut it. And unless we somehow get

> funding for services other than transport, we'll never be able to pay

> people for

> doing a bachelor's degree in EMS. Which comes first? The chicken or the

> egg?

>

> And bachelor degreed medics won't cut it either without extensive clinical

> experience and improved diagnostic tools available in the ambulance. Even

> then, we're rolling the dice when we try to make field determinations

> about

> who needs a ride and who doesn't. It's not simple. It cannot be made

> simple. We are nowhere close to being able to do that reliably, and I see

> no

> prospects for change in an upward direction. I see lots of factors that

> indicate going to a lessor level of care and decision making.

>

> We have so much potential power. If we had ONE VOICE in this country as

> medics, from EMT-B to Paramedic, we could do great things. But we have NO

> VOICE because we cannot even muster 1% of the Texas certificants to join

> the

> one organization that's dedicated to their interests. NAEMT only has less

> percent than that of the medics in the country. We have no voice, no

> presence, no political clout, and we have nobody to blame but ourselves.

>

> The fire service medics are typically IAFF or some other union members,

> but

> their interests are in their fire service jobs, not in EMS. So they

> typically do not involve themselves in lists like this and the others, do

> not

> come to conferences, and are not interested in improving EMS as a whole in

> terms of what you are talking about. I realize that's a broad

> generalization,

> and I recognize that there are exceptions, but they are few and far

> between.

> The man who we honored last week on the 5th anniversary of his death, Jim

> Page, knew that better than anybody. The facts are that fire service

> medics see themselves as public safety and fire professionals, not medical

> professionals. We have had discussions here about whether or not one can

> serve

> two masters. Can one be both a crackerjack fire suppression expert and a

> prehospital medicine expert? I don't think so. Some will disagree, and

> there are always exceptions, but that's my take. And will fire service

> medics make any more than their non-medic coworkers if they are required

> to have

> bachelors degrees? Of course not.

>

> How do we come together as medics and promote improved education standards

> and scope of practice? As long as fire chiefs and private service

> managers veto any effort to improve standards, we'll never see

> improvement. And

> where is the groundswell of support for a more strict education and

> training

> system? It's just not there. Right now, paramedicine is the best deal

> imaginable. Where else can you spend as little time in class as we do and

> earn the kind of salaries and benefits that most fire service medics do?

> What percentage of EMS is run by fire departments? Figure it out for

> yourselves. What percentage of all certified medics work for private

> services?

> What do you get for having an associate's degree or a bachelor's degree in

> either of them? Maybe a little, but not enough to pay for a 4 year

> bachelor's degree when you can be a nurse and make at least three to four

> times what

> a medic does. A respiratory therapist makes twice what a paramedic does.

> A radiology tech the same. Who will pay us for the expanded education?

> Some services do pay a premium for a degree, but out of all the medics

> working in the U.S., I'll wager that most of them have minimum education

> and

> would be paid no more if they had a college degree in EMS. Prove me wrong.

> I

> hope you can.

>

> Certainly the rank and file have never demonstrated that as a group

> they're

> in favor of anything other than less CE and maintaining the status quo.

> Sorry if I offend, but that's my experience.

>

> And unless the folks who pay for care recognize us as doing something

> that's reimbursable and decide to pay us for non-transport care, nothing

> will

> happen. That means primarily that Medicare and Medicaid must change their

> reimbursement rules. Anybody think that's going to happen?

>

> I do not see that happening. In all the discussion about " Healthcare

> Reform " there is not one word that I have heard about EMS. It's as though

> we

> didn't exist.

>

> There are many more forces arguing for the status quo or less than there

> are for improvements. Start talking about making a bachelor degree

> requirement for paramedics and you'll see some fire chiefs and private

> service

> managers with their hair on fire.

>

> And when there is no medical evidence to support much of what we do now,

> where would the evidence be for an expanded scope of practice and

> responsibility? Doesn't exist. And it's damn near impossible to construct

> research

> studies that will prove that anything we do actually helps, because you

> cannot do a double blind study because of ethics.

>

> I wish it were otherwise, but it's not. It seems that we're stuck in a

> niche that we'll always have, but it won't expand or improve because the

> politics and the economics are just not there.

>

> GG

> In a message dated 9/8/09 10:34:33 PM, petsardlj@sbcglobalpets <

> mailto:petsardlj%mailto:petsamai> writes:

>

> >

> > But that is the point, If you do a proper assessment things like an

> > atypical chest pain or even a typical chest pain would not be an issue.

> There

> > are several things that diagonses do not do. I believe that as a

> profession

> > the Standard of Care for the future can include refusals and other

> avenues

> > of treatment not currently offered today. I do not see us that far off

> from

> > this picture.

> > I do see many at the top of our ranks and even within the ranks that

> > would rather not see it get that far. Why? God only knows. We are tasked

> with

> > doing the best for our patients from point A to point B and anywhere

> > in-between. Education has come up from what it was even 4 years ago.

> What do we

> > need to continue to do that will make this discussion history in the

> > making?

> > I for one am in it for the long haul. Who's with me?

> >

> >

> >

> >

> >

> >

> > Danny L.

> > Owner/NREMT-

> > PETSAR INC.

> > (Panhandle Emergency Training Services And Response)

> > Office

> > Fax

> >

> >

> > > >

> > > >

> > > > Why is it arrogant to actually try and get the patient the care they

> > > > need while saving them money? Honestly it seems much more

> professional

> > > > to get patients the help they need rather than just treating them as

> > > > not worthy of our time which is what is being said by just

> > > > transporting them all if better options of help are available. And

> > > > even in the way under educated state we find ourselves being in we

> > > > should still strive for what is best for our patients rather than to

> > > > just be a taxi service.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > > >

> > > >

> > > > >

> > > > >

> > > > > The one thing I find the longer I have my paramedic patch is that

> I

> > > > know less than I thought I did.Â

> > > > >

> > > > >

> > > > >

> > > > > At this point, EMS has a hard enough time mastering our core

> skills,

> > > > as the Wang study and several others have indicated. I'm not sure

> > > > that we're anywhere near ready to assume a role as the gatekeepers

> to

> > > > the healthcare system, determining who is worthy of our time. That

> to

> > > > me is the height of arrogance, especially considering that we want

> to

> > > > be considered a profession. It smacks of hubris at the least.

> > > > >

> > > > >

> > > > >

> > > > > I realize that we've come a long ways from high-top Cadillac

> > > > hearse/ambulances, but the reality is that we're still in the

> business

> > > > of medical transportation. Ultimately, that means we give people

> > > > rides to the hospital. Having said that, though, part of informed

> > > > consent means giving patients a realistic expectation of our

> > > > capabilities and treatment. I have told a patient with minor

> > > > complaints that it's unlikely that I could provide any treatment

> > > > beyond assessment and transport.  If I've informed the patient as

> to

> > > > their options and they still choose to ride in an ambulance, I'm not

> > > > in a position to deny them that option.

> > > > >

> > > > >

> > > > >

> > > > > And can we please kill this damned thread?

> > > > >

> > > > >

> > > > >

> > > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> > > > >

> > > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > > >

> > > > > -Austin, Texas

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > Re: Paramedics Cannot Determine Wh

> > > > > ich Patients Require Transport

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > As a person in favor of denying transport I do feel that we should

> > > > not deny chest, abd, or head related calls. Even Doctors with all

> > > > their equipment have trouble making accurate diagnosis. The calls

> that

> > > > would be allowed denial would be the minor trauma such as stubbed

> toe,

> > > > the sneezed once and want to make sure its not swine flu, the I just

> > > > need a ride to the hospital so I can get to my doctors appointment,

> > > > the I really just need someone to talk to to help cope ( this one

> only

> > > > if you have resources that can come there while you wait ).

> > > > >

> > > > > The denial process would also involve as much if not more effort

> > > > than just load and go so would discourage abuse by that one lazy

> > > > Paramedic that everyone seems to know since he is mentioned often.

>

> > > > >

> > > > > I would like to see a study on EMS denials based on a system as

> > > > described above. If allowed denial of the items even Doctors have

> > > > trouble with then it is doomed to show we can not do it. It would

> also

> > > > need a better criteria for mistake than admission to the hospital.

> For

> > > > example the stubbed toe might end up needing surgery, yet nothing

> > > > about the call required EMS, so admission was not a failure in this

> > > case.

> > > > >

> > > > > Well just my worthless idealistic thoughts.

> > > > >

> > > > > Renny Spencer

> > > > > The Idealistic Paramedic

> > > >

> > > >

> > >

> > > --

> > > Grayson

> > > www.kellygrayson. ww

> > >

> > >

> > >

> > >

> >

> >

[Guest guest]

 

I know arrogant. I'm capable of being the most arrogant paragod bastard

you will ever meet.

 

Remember , don't let your humility get in the way of your ego.,,,,,,

 

You're right though, and others have said, and I concur, that there is a place

for initiated refusals, WITH the proper training, that's really the only

argument left.

 

Hatfield

" The main part of intellectual education is not the acquisition of facts but

learning how to make facts live. " - Oliver Wendell Holmes

www.michaelwhatfield.net

>

>

> I am confused. My wanting to get a patient that tells you they need to

> talk to someone actually turned over to the services they need is

> arrogant/hubris? How? I do not see doing what is best for the patient

> is wrong. I have had many patients tell me they asked for the

> ambulance because they did not know what they need. If I am aware of a

> service that takes care of their need and get the process started for

> them how is that wrong? If I take them to the ER is that a benefit to

> them? No as they now have a huge transport bill, an even larger ER

> bill and sadly may be discharged w/o ever being put in touch with the

> agency they needed.

>

> As I stated earlier I am not saying deny chest, abd, or head.

>

> Oh and why have we chosen to use two words with the same meaning like

> they are two separate things. Hubris basically means arrogant so using

> them in the same sentence/question seems to be improper based on my

> uneducated understanding. But maybe I misunderstand as I am not an

> English major.

>

> As to reimbursement. I am sorry when did money start coming before

> being a patient advocate? If I cause more harm by transporting a

> patient that does not need transport should I justify it by saying oh

> well that will make sure the service has enough money to keep an

> ambulance staffed so if there is ever a real emergency? I am well

> aware it takes money to function but disagree with making my patients

> suffer undue hardship because the current reimbursement system is

> flawed. Based on Medicare/Medicaid rules I do not see how many of

> those that do not need an ambulance transport are getting reimbursed

> anyway? Which means you are transporting for free so why not just do

> whats right instead?

>

> Again I know the medical education we as Paramedics get is seriously

> lacking. I know even if we do add education w/o all sorts of lab, cat

> scans, etc that we still would just have to transport the callers with

> chest, head, abd problems as there are way to many variables.

>

> I mean no disrespect but I just can not wrap my brain around what you

> and Wes are saying.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> > > >

> > > >

> > > > The one thing I find the longer I have my paramedic patch is that I

> > > know less than I thought I did.Â

> > > >

> > > >

> > > >

> > > > At this point, EMS has a hard enough time mastering our core

> skills,

> > > as the Wang study and several others have indicated. I'm not sure

> > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > the healthcare system, determining who is worthy of our time. That to

> > > me is the height of arrogance, especially considering that we want to

> > > be considered a profession. It smacks of hubris at the least.

> > > >

> > > >

> > > >

> > > > I realize that we've come a long ways from high-top Cadillac

> > > hearse/ambulances, but the reality is that we're still in the

> business

> > > of medical transportation. Ultimately, that means we give people

> > > rides to the hospital. Having said that, though, part of informed

> > > consent means giving patients a realistic expectation of our

> > > capabilities and treatment. I have told a patient with minor

> > > complaints that it's unlikely that I could provide any treatment

> > > beyond assessment and transport.  If I've informed the patient

> as to

> > > their options and they still choose to ride in an ambulance, I'm not

> > > in a position to deny them that option.

> > > >

> > > >

> > > >

> > > > And can we please kill this damned thread?

> > > >

> > > >

> > > >

> > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT- P

> > > >

> > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > >

> > > > -Austin, Texas

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > Re: Paramedics Cannot Determine Wh

> > > > ich Patients Require Transport

> > > >

> > > >

> > > >

> > > >

> > > >

> > > >

> > > > As a person in favor of denying transport I do feel that we should

> > > not deny chest, abd, or head related calls. Even Doctors with all

> > > their equipment have trouble making accurate diagnosis. The calls

> that

> > > would be allowed denial would be the minor trauma such as stubbed

> toe,

> > > the sneezed once and want to make sure its not swine flu, the I just

> > > need a ride to the hospital so I can get to my doctors appointment,

> > > the I really just need someone to talk to to help cope ( this one

> only

> > > if you have resources that can come there while you wait ).

> > > >

> > > > The denial process would also involve as much if not more effort

> > > than just load and go so would discourage abuse by that one lazy

> > > Paramedic that everyone seems to know since he is mentioned often.

> > > >

> > > > I would like to see a study on EMS denials based on a system as

> > > described above. If allowed denial of the items even Doctors have

> > > trouble with then it is doomed to show we can not do it. It would

> also

> > > need a better criteria for mistake than admission to the hospital.

> For

> > > example the stubbed toe might end up needing surgery, yet nothing

> > > about the call required EMS, so admission was not a failure in

> this case.

> > > >

> > > > Well just my worthless idealistic thoughts.

> > > >

> > > > Renny Spencer

> > > > The Idealistic Paramedic

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson. com

> >

>

>

--

Grayson

www.kellygrayson. com

[Guest guest]

I haven't practiced law in 21 years. I would not want to do both fulltime.

A private law practice is extremely demanding. So I chose to become an

EMS educator and provider and gave up law as a profession. Could I do both

effectively? Perhaps. It would be extremely difficult to work as a

private attorney and do it just because of the time private law practice

requires. You cannot try cases and do a good job at it and be running off on

EMS

calls. I tried it for a while, and it just didn't work. I left

plenty of room for exceptions in my post, and I realize that there are

always exceptions. I did not mean to be insulting, just reflecting what my

observations over the years have been. I stand by them. And you're right,

it's not that it's impossible, it's just that most lack the will to do it or,

as you say, don't want to.

And it also depends a lot on how one defines excellence. My current job

as an educator requires me to spend 16 hours a week in the classroom, and

that's what I get paid for. However, I spend over 40 hours in preparation,

review, and writing outside of class. I could not do that and practice law

at the same time.

GG

In a message dated 9/9/09 7:40:37 AM, abaustin+yahoogroups@...

writes:

>  

>

> Are you a good attorney or a good paramedic, Gene? You can't be good

> at two things, right?

>

> The implication is just as insulting to a fire/medic as it would be to

> you, I'd assume. I understand -why- you'd feel that way, but you're

> just wrong. The problem isn't that you CAN'T be good at more then one

> thing, it's that many people don't WANT to, particularly when it comes

> to a firefighter being told that he's going to be required to get his

> EMT or 'Medic.

>

> Austin

>

>

>

> > Danny, I am with you. But it's going to take some real wrenching

> > changes

> > before things will be where you and I would like them to be.

> >

> > 500 hour paramedic courses won't cut it. And unless we somehow get

> > funding for services other than transport, we'll never be able to

> > pay people for

> > doing a bachelor's degree in EMS. Which comes first? The chicken

> > or the

> > egg?

> >

> > And bachelor degreed medics won't cut it either without extensive

> > clinical

> > experience and improved diagnostic tools available in the

> > ambulance. Even

> > then, we're rolling the dice when we try to make field

> > determinations about

> > who needs a ride and who doesn't. It's not simple. It cannot be

> > made

> > simple. We are nowhere close to being able to do that reliably,

> > and I see no

> > prospects for change in an upward direction. I see lots of factors

> > that

> > indicate going to a lessor level of care and decision making.

> >

> > We have so much potential power. If we had ONE VOICE in this

> > country as

> > medics, from EMT-B to Paramedic, we could do great things. But we

> > have NO

> > VOICE because we cannot even muster 1% of the Texas certificants to

> > join the

> > one organization that's dedicated to their interests. NAEMT only

> > has less

> > percent than that of the medics in the country. We have no voice, no

> > presence, no political clout, and we have nobody to blame but

> > ourselves.

> >

> > The fire service medics are typically IAFF or some other union

> > members, but

> > their interests are in their fire service jobs, not in EMS. So they

> > typically do not involve themselves in lists like this and the

> > others, do not

> > come to conferences, and are not interested in improving EMS as a

> > whole in

> > terms of what you are talking about. I realize that's a broad

> > generalization,

> > and I recognize that there are exceptions, but they are few and far

> > between.

> > The man who we honored last week on the 5th anniversary of his

> > death, Jim

> > Page, knew that better than anybody. The facts are that fire service

> > medics see themselves as public safety and fire professionals, not

> > medical

> > professionals. We have had discussions here about whether or not

> > one can serve

> > two masters. Can one be both a crackerjack fire suppression expert

> > and a

> > prehospital medicine expert? I don't think so. Some will

> > disagree, and

> > there are always exceptions, but that's my take. And will fire

> > service

> > medics make any more than their non-medic coworkers if they are

> > required to have

> > bachelors degrees? Of course not.

> >

> > How do we come together as medics and promote improved education

> > standards

> > and scope of practice? As long as fire chiefs and private service

> > managers veto any effort to improve standards, we'll never see

> > improvement. And

> > where is the groundswell of support for a more strict education and

> > training

> > system? It's just not there. Right now, paramedicine is the best

> > deal

> > imaginable. Where else can you spend as little time in class as we

> > do and

> > earn the kind of salaries and benefits that most fire service medics

> > do?

> > What percentage of EMS is run by fire departments? Figure it out for

> > yourselves. What percentage of all certified medics work for

> > private services?

> > What do you get for having an associate's degree or a bachelor's

> > degree in

> > either of them? Maybe a little, but not enough to pay for a 4 year

> > bachelor's degree when you can be a nurse and make at least three to

> > four times what

> > a medic does. A respiratory therapist makes twice what a paramedic

> > does.

> > A radiology tech the same. Who will pay us for the expanded

> > education?

> > Some services do pay a premium for a degree, but out of all the medics

> > working in the U.S., I'll wager that most of them have minimum

> > education and

> > would be paid no more if they had a college degree in EMS. Prove

> > me wrong. I

> > hope you can.

> >

> > Certainly the rank and file have never demonstrated that as a group

> > they're

> > in favor of anything other than less CE and maintaining the status

> > quo.

> > Sorry if I offend, but that's my experience.

> >

> > And unless the folks who pay for care recognize us as doing something

> > that's reimbursable and decide to pay us for non-transport care,

> > nothing will

> > happen. That means primarily that Medicare and Medicaid must

> > change their

> > reimbursement rules. Anybody think that's going to happen?

> >

> > I do not see that happening. In all the discussion about " Healthcare

> > Reform " there is not one word that I have heard about EMS. It's as

> > though we

> > didn't exist.

> >

> > There are many more forces arguing for the status quo or less than

> > there

> > are for improvements. Start talking about making a bachelor degree

> > requirement for paramedics and you'll see some fire chiefs and

> > private service

> > managers with their hair on fire.

> >

> > And when there is no medical evidence to support much of what we do

> > now,

> > where would the evidence be for an expanded scope of practice and

> > responsibility? Doesn't exist. And it's damn near impossible to

> > construct research

> > studies that will prove that anything we do actually helps, because

> > you

> > cannot do a double blind study because of ethics.

> >

> > I wish it were otherwise, but it's not. It seems that we're stuck

> > in a

> > niche that we'll always have, but it won't expand or improve because

> > the

> > politics and the economics are just not there.

> >

> > GG

> > In a message dated 9/8/09 10:34:33 PM, petsardlj@sbcglobalpets writes:

> >

> >

> >>

> >> But that is the point, If you do a proper assessment things like an

> >> atypical chest pain or even a typical chest pain would not be an

> >> issue. There

> >> are several things that diagonses do not do. I believe that as a

> >> profession

> >> the Standard of Care for the future can include refusals and other

> >> avenues

> >> of treatment not currently offered today. I do not see us that far

> >> off from

> >> this picture.

> >> I do see many at the top of our ranks and even within the ranks

> >> that

> >> would rather not see it get that far. Why? God only knows. We are

> >> tasked with

> >> doing the best for our patients from point A to point B and anywhere

> >> in-between. Education has come up from what it was even 4 years

> >> ago. What do we

> >> need to continue to do that will make this discussion history in the

> >> making?

> >> I for one am in it for the long haul. Who's with me?

> >>

> >>

> >>

> >>

> >>

> >>

> >> Danny L.

> >> Owner/NREMT-

> >> PETSAR INC.

> >> (Panhandle Emergency Training Services And Response)

> >> Office

> >> Fax

> >>

> >>

> >>>>

> >>>>

> >>>> Why is it arrogant to actually try and get the patient the care

> >>>> they

> >>>> need while saving them money? Honestly it seems much more

> >>>> professional

> >>>> to get patients the help they need rather than just treating them

> >>>> as

> >>>> not worthy of our time which is what is being said by just

> >>>> transporting them all if better options of help are available. And

> >>>> even in the way under educated state we find ourselves being in we

> >>>> should still strive for what is best for our patients rather than

> >>>> to

> >>>> just be a taxi service.

> >>>>

> >>>> Renny Spencer

> >>>> The Idealistic Paramedic

> >>>>

> >>>>

> >>>>>

> >>>>>

> >>>>> The one thing I find the longer I have my paramedic patch is

> >>>>> that I

> >>>> know less than I thought I did.Â

> >>>>>

> >>>>>

> >>>>>

> >>>>> At this point, EMS has a hard enough time mastering our core

> >>>>> skills,

> >>>> as the Wang study and several others have indicated. I'm not sure

> >>>> that we're anywhere near ready to assume a role as the

> >>>> gatekeepers to

> >>>> the healthcare system, determining who is worthy of our time.

> >>>> That to

> >>>> me is the height of arrogance, especially considering that we

> >>>> want to

> >>>> be considered a profession. It smacks of hubris at the least.

> >>>>>

> >>>>>

> >>>>>

> >>>>> I realize that we've come a long ways from high-top Cadillac

> >>>> hearse/ambulances, but the reality is that we're still in the

> >>>> business

> >>>> of medical transportation. Ultimately, that means we give people

> >>>> rides to the hospital. Having said that, though, part of informed

> >>>> consent means giving patients a realistic expectation of our

> >>>> capabilities and treatment. I have told a patient with minor

> >>>> complaints that it's unlikely that I could provide any treatment

> >>>> beyond assessment and transport.  If I've informed the patient

> >>>> as to

> >>>> their options and they still choose to ride in an ambulance, I'm

> >>>> not

> >>>> in a position to deny them that option.

> >>>>>

> >>>>>

> >>>>>

> >>>>> And can we please kill this damned thread?

> >>>>>

> >>>>>

> >>>>>

> >>>>> -Wes Ogilvie, MPA, JD, Lic.P./NREMT-

> >>>>>

> >>>>> -Attorney at Law/Licensed Paramedic/EMS Instructor

> >>>>>

> >>>>> -Austin, Texas

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> Re: Paramedics Cannot Determine Wh

> >>>>> ich Patients Require Transport

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> As a person in favor of denying transport I do feel that we should

> >>>> not deny chest, abd, or head related calls. Even Doctors with all

> >>>> their equipment have trouble making accurate diagnosis. The calls

> >>>> that

> >>>> would be allowed denial would be the minor trauma such as stubbed

> >>>> toe,

> >>>> the sneezed once and want to make sure its not swine flu, the I

> >>>> just

> >>>> need a ride to the hospital so I can get to my doctors appointment,

> >>>> the I really just need someone to talk to to help cope ( this one

> >>>> only

> >>>> if you have resources that can come there while you wait ).

> >>>>>

> >>>>> The denial process would also involve as much if not more effort

> >>>> than just load and go so would discourage abuse by that one lazy

> >>>> Paramedic that everyone seems to know since he is mentioned

> >>>> often.

> >>>>>

> >>>>> I would like to see a study on EMS denials based on a system as

> >>>> described above. If allowed denial of the items even Doctors have

> >>>> trouble with then it is doomed to show we can not do it. It would

> >>>> also

> >>>> need a better criteria for mistake than admission to the

> >>>> hospital. For

> >>>> example the stubbed toe might end up needing surgery, yet nothing

> >>>> about the call required EMS, so admission was not a failure in this

> >>> case.

> >>>>>

> >>>>> Well just my worthless idealistic thoughts.

> >>>>>

> >>>>> Renny Spencer

> >>>>> The Idealistic Paramedic

> >>>>

> >>>>

> >>>

> >>> --

> >>> Grayson

> >>> www.kellygrayson. ww

> >>>

> >>>

> >>>

> >>>

> >>

> >>

[Guest guest]

,

I guess not listening is a two way street. So I will drop out of this part of

discussion rather than retyping same points of what would be allowed to be

denied which are not any of the items doctors have trouble with, in fact even

most basics would not have trouble with so actually education is not really a

factor on the items I am suggesting not transporting.

But as to not working under current reimbursement system. Again based on

Medicaid/Medicare rules many if not all of the types of problems I have been

saying no to transporting are not being paid anyway so you are getting $0 if you

transport and $0 if you don't. Now if you bill non transports the patient might

actually decide hey I can afford the $100 especially because that crew of

Professionals worked hard to get me the help I actually needed rather than

costing me thousands by taking me to the hospital. But if you just load and go

they get that $1000 bill from EMS then the $5000 ER bill and they are

overwhelmed and just file them in the round file. So now you have $0 from the

patient compared with maybe getting paid the $100.

Yes we need Medicaid/Medicare to start paying for non transports but

realistically that is not going to happen. In fact I would not be shocked if

EMS is eventually not reimbursed at all thinks to all the FRAUD. The government

may just say easier to punish everyone rather than spending all that money

investigating.

Again just my worthless opinion.

Renny Spencer

The Idealistic Paramedic

> > > > >

> > > > >

> > > > > The one thing I find the longer I have my paramedic patch is that I

> > > > know less than I thought I did.Â

> > > > >

> > > > >

> > > > >

> > > > > At this point, EMS has a hard enough time mastering our core

> > skills,

> > > > as the Wang study and several others have indicated. I'm not sure

> > > > that we're anywhere near ready to assume a role as the gatekeepers to

> > > > the healthcare system, determining who is worthy of our time. That to

> > > > me is the height of arrogance, especially considering that we want to

> > > > be considered a profession. It smacks of hubris at the least.

> > > > >

> > > > >

> > > > >

> > > > > I realize that we've come a long ways from high-top Cadillac

> > > > hearse/ambulances, but the reality is that we're still in the

> > business

> > > > of medical transportation. Ultimately, that means we give people

> > > > rides to the hospital. Having said that, though, part of informed

> > > > consent means giving patients a realistic expectation of our

> > > > capabilities and treatment. I have told a patient with minor

> > > > complaints that it's unlikely that I could provide any treatment

> > > > beyond assessment and transport.  If I've informed the patient

> > as to

> > > > their options and they still choose to ride in an ambulance, I'm not

> > > > in a position to deny them that option.

> > > > >

> > > > >

> > > > >

> > > > > And can we please kill this damned thread?

> > > > >

> > > > >

> > > > >

> > > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > > > >

> > > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > > >

> > > > > -Austin, Texas

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > Re: Paramedics Cannot Determine Wh

> > > > > ich Patients Require Transport

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > >

> > > > > As a person in favor of denying transport I do feel that we should

> > > > not deny chest, abd, or head related calls. Even Doctors with all

> > > > their equipment have trouble making accurate diagnosis. The calls

> > that

> > > > would be allowed denial would be the minor trauma such as stubbed

> > toe,

> > > > the sneezed once and want to make sure its not swine flu, the I just

> > > > need a ride to the hospital so I can get to my doctors appointment,

> > > > the I really just need someone to talk to to help cope ( this one

> > only

> > > > if you have resources that can come there while you wait ).

> > > > >

> > > > > The denial process would also involve as much if not more effort

> > > > than just load and go so would discourage abuse by that one lazy

> > > > Paramedic that everyone seems to know since he is mentioned often.

> > > > >

> > > > > I would like to see a study on EMS denials based on a system as

> > > > described above. If allowed denial of the items even Doctors have

> > > > trouble with then it is doomed to show we can not do it. It would

> > also

> > > > need a better criteria for mistake than admission to the hospital.

> > For

> > > > example the stubbed toe might end up needing surgery, yet nothing

> > > > about the call required EMS, so admission was not a failure in

> > this case.

> > > > >

> > > > > Well just my worthless idealistic thoughts.

> > > > >

> > > > > Renny Spencer

> > > > > The Idealistic Paramedic

> > > >

> > > >

> > >

> > >

> > > --

> > > Grayson

> > > www.kellygrayson.com

> > >

> >

> >

>

>

> --

> Grayson

> www.kellygrayson.com

>

[Guest guest]

No comment here from the guy who's doing both.  LOL

-Wes

Re: Paramedics20Cannot Determine Wh

> >>>>> ich Patients Require Transport

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> As a person in favor of denying transport I do feel that we should

> >>>> not deny chest, abd, or head related calls. Even Doctors with all

> >>>> their equipment have trouble making accurate diagnosis. The calls

> >>>> that

> >>>> would be allowed denial would be the minor trauma such as stubbed

> >>>> toe,

> >>>> the sneezed once and want to make sure its not swine flu, the I

> >>>> just

> >>>> need a ride to the hospital so I can get to my doctors appointment,

> >>>> the I really just need someone to talk to to help cope ( this one

> >>>> only

> >>>> if you have resources that can come there while you wait ).

> >>>>>

> >>>>> The denial process would also involve as much if not more effort

> >>>> than just load and go so would discourage abuse by that one lazy

> >>>> Paramedic that everyone seems to know since he is mentioned

> >>>> often.

> >>>>>

> >>>>> I would like to see a study on EMS denials based on a system as

> >>>> described above. If allowed denial of the items even Doctors have

> >>>> trouble with then it is doomed to show we can not do it. It would

> >>>> also

> >>>> need a better criteria for mistake than admission to the

> >>>> hospital. For

> >>>> example the stubbed toe might end up needing surgery, yet nothing

> >>>> about the call required EMS, so admission was not a failure in this

> >>> case

..

> >>>>>

> >>>>> Well just my worthless idealistic thoughts.

> >>>>>

> >>>>> Renny Spencer

> >>>>> The Idealistic Paramedic

> >>>>

> >>>>

> >>>

> >>> --

> >>> Grayson

> >>> www.kellygrayson. ww

> >>>

> >>>

> >>>

> >>>

> >>

> >>

[Guest guest]

No comment here from the guy who's doing both.  LOL

-Wes

Re: Paramedics20Cannot Determine Wh

> >>>>> ich Patients Require Transport

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> As a person in favor of denying transport I do feel that we should

> >>>> not deny chest, abd, or head related calls. Even Doctors with all

> >>>> their equipment have trouble making accurate diagnosis. The calls

> >>>> that

> >>>> would be allowed denial would be the minor trauma such as stubbed

> >>>> toe,

> >>>> the sneezed once and want to make sure its not swine flu, the I

> >>>> just

> >>>> need a ride to the hospital so I can get to my doctors appointment,

> >>>> the I really just need someone to talk to to help cope ( this one

> >>>> only

> >>>> if you have resources that can come there while you wait ).

> >>>>>

> >>>>> The denial process would also involve as much if not more effort

> >>>> than just load and go so would discourage abuse by that one lazy

> >>>> Paramedic that everyone seems to know since he is mentioned

> >>>> often.

> >>>>>

> >>>>> I would like to see a study on EMS denials based on a system as

> >>>> described above. If allowed denial of the items even Doctors have

> >>>> trouble with then it is doomed to show we can not do it. It would

> >>>> also

> >>>> need a better criteria for mistake than admission to the

> >>>> hospital. For

> >>>> example the stubbed toe might end up needing surgery, yet nothing

> >>>> about the call required EMS, so admission was not a failure in this

> >>> case

..

> >>>>>

> >>>>> Well just my worthless idealistic thoughts.

> >>>>>

> >>>>> Renny Spencer

> >>>>> The Idealistic Paramedic

> >>>>

> >>>>

> >>>

> >>> --

> >>> Grayson

> >>> www.kellygrayson. ww

> >>>

> >>>

> >>>

> >>>

> >>

> >>

[Guest guest]

No comment here from the guy who's doing both.  LOL

-Wes

Re: Paramedics20Cannot Determine Wh

> >>>>> ich Patients Require Transport

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>>

> >>>>> As a person in favor of denying transport I do feel that we should

> >>>> not deny chest, abd, or head related calls. Even Doctors with all

> >>>> their equipment have trouble making accurate diagnosis. The calls

> >>>> that

> >>>> would be allowed denial would be the minor trauma such as stubbed

> >>>> toe,

> >>>> the sneezed once and want to make sure its not swine flu, the I

> >>>> just

> >>>> need a ride to the hospital so I can get to my doctors appointment,

> >>>> the I really just need someone to talk to to help cope ( this one

> >>>> only

> >>>> if you have resources that can come there while you wait ).

> >>>>>

> >>>>> The denial process would also involve as much if not more effort

> >>>> than just load and go so would discourage abuse by that one lazy

> >>>> Paramedic that everyone seems to know since he is mentioned

> >>>> often.

> >>>>>

> >>>>> I would like to see a study on EMS denials based on a system as

> >>>> described above. If allowed denial of the items even Doctors have

> >>>> trouble with then it is doomed to show we can not do it. It would

> >>>> also

> >>>> need a better criteria for mistake than admission to the

> >>>> hospital. For

> >>>> example the stubbed toe might end up needing surgery, yet nothing

> >>>> about the call required EMS, so admission was not a failure in this

> >>> case

..

> >>>>>

> >>>>> Well just my worthless idealistic thoughts.

> >>>>>

> >>>>> Renny Spencer

> >>>>> The Idealistic Paramedic

> >>>>

> >>>>

> >>>

> >>> --

> >>> Grayson

> >>> www.kellygrayson. ww

> >>>

> >>>

> >>>

> >>>

> >>

> >>

[Guest guest]

Renny,

What percentage of overall Medicare fraud would you say is EMS related?

I don't know but I can't buy it being the bulk of the overall fraud

problem on the forefront of the Feds.

ly wheni see over $ 500.00 in bandages on a charge sheet for a

fairly minor operation where I'd estimate about a true cost at Wal-

Mart of about $ 100.00 assuming no sales that week. That is what I

call fraud.

Does anyone have any idea as to what the percentage of overall

Medicare fraud is?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

> ,

>

> I guess not listening is a two way street. So I will drop out of

> this part of discussion rather than retyping same points of what

> would be allowed to be denied which are not any of the items doctors

> have trouble with, in fact even most basics would not have trouble

> with so actually education is not really a factor on the items I am

> suggesting not transporting.

>

> But as to not working under current reimbursement system. Again

> based on Medicaid/Medicare rules many if not all of the types of

> problems I have been saying no to transporting are not being paid

> anyway so you are getting $0 if you transport and $0 if you don't.

> Now if you bill non transports the patient might actually decide hey

> I can afford the $100 especially because that crew of Professionals

> worked hard to get me the help I actually needed rather than costing

> me thousands by taking me to the hospital. But if you just load and

> go they get that $1000 bill from EMS then the $5000 ER bill and they

> are overwhelmed and just file them in the round file. So now you

> have $0 from the patient compared with maybe getting paid the $100.

>

> Yes we need Medicaid/Medicare to start paying for non transports but

> realistically that is not going to happen. In fact I would not be

> shocked if EMS is eventually not reimbursed at all thinks to all the

> FRAUD. The government may just say easier to punish everyone rather

> than spending all that money investigating.

>

> Again just my worthless opinion.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> > > > > >

> > > > > >

> > > > > > The one thing I find the longer I have my paramedic patch

> is that I

> > > > > know less than I thought I did.Â

> > > > > >

> > > > > >

> > > > > >

> > > > > > At this point, EMS has a hard enough time mastering our core

> > > skills,

> > > > > as the Wang study and several others have indicated. I'm no

> t sure

> > > > > that we're anywhere near ready to assume a role as the

> gatekeepers to

> > > > > the healthcare system, determining who is worthy of our

> time. That to

> > > > > me is the height of arrogance, especially considering that

> we want to

> > > > > be considered a profession. It smacks of hubris at the leas

> t.

> > > > > >

> > > > > >

> > > > > >

> > > > > > I realize that we've come a long ways from high-top Cadillac

> > > > > hearse/ambulances, but the reality is that we're still in the

> > > business

> > > > > of medical transportation. Ultimately, that means we give p

> eople

> > > > > rides to the hospital. Having said that, though, part of in

> formed

> > > > > consent means giving patients a realistic expectation of our

> > > > > capabilities and treatment. I have told a patient with minor

> > > > > complaints that it's unlikely that I could provide any

> treatment

> > > > > beyond assessment and transport.  If I've informed the pat

> ient

> > > as to

> > > > > their options and they still choose to ride in an ambulance,

> I'm not

> > > > > in a position to deny them that option.

> > > > > >

> > > > > >

> > > > > >

> > > > > > And can we please kill this damned thread?

> > > > > >

> > > > > >

> > > > > >

> > > > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > > > > >

> > > > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > > > >

> > > > > > -Austin, Texas

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > > Re: Paramedics Cannot Determine Wh

> > > > > > ich Patients Require Transport

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > > As a person in favor of denying transport I do feel that

> we should

> > > > > not deny chest, abd, or head related calls. Even Doctors

> with all

> > > > > their equipment have trouble making accurate diagnosis. The

> calls

> > > that

> > > > > would be allowed denial would be the minor trauma such as

> stubbed

> > > toe,

> > > > > the sneezed once and want to make sure its not swine flu,

> the I just

> > > > > need a ride to the hospital so I can get to my doctors

> appointment,

> > > > > the I really just need someone to talk to to help cope

> ( this one

> > > only

> > > > > if you have resources that can come there while you wait ).

> > > > > >

> > > > > > The denial process would also involve as much if not more

> effort

> > > > > than just load and go so would discourage abuse by that one

> lazy

> > > > > Paramedic that everyone seems to know since he is mentioned

> often.

> > > > > >

> > > > > > I would like to see a study on EMS denials based on a

> system as

> > > > > described above. If allowed denial of the items even Doctors

> have

> > > > > trouble with then it is doomed to show we can not do it. It

> would

> > > also

> > > > > need a better criteria for mistake than admission to the

> hospital.

> > > For

> > > > > example the stubbed toe might end up needing surgery, yet

> nothing

> > > > > about the call required EMS, so admission was not a failure in

> > > this case.

> > > > > >

> > > > > > Well just my worthless idealistic thoughts.

> > > > > >

> > > > > > Renny Spencer

> > > > > > The Idealistic Paramedic

> > > > >

> > > > >

> > > >

> > > >

> > > > --

> > > > Grayson

> > > > www.kellygrayson.com

> > > >

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

>

>

> Messages in this topic (50)

[Guest guest]

Renny,

What percentage of overall Medicare fraud would you say is EMS related?

I don't know but I can't buy it being the bulk of the overall fraud

problem on the forefront of the Feds.

ly wheni see over $ 500.00 in bandages on a charge sheet for a

fairly minor operation where I'd estimate about a true cost at Wal-

Mart of about $ 100.00 assuming no sales that week. That is what I

call fraud.

Does anyone have any idea as to what the percentage of overall

Medicare fraud is?

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

> ,

>

> I guess not listening is a two way street. So I will drop out of

> this part of discussion rather than retyping same points of what

> would be allowed to be denied which are not any of the items doctors

> have trouble with, in fact even most basics would not have trouble

> with so actually education is not really a factor on the items I am

> suggesting not transporting.

>

> But as to not working under current reimbursement system. Again

> based on Medicaid/Medicare rules many if not all of the types of

> problems I have been saying no to transporting are not being paid

> anyway so you are getting $0 if you transport and $0 if you don't.

> Now if you bill non transports the patient might actually decide hey

> I can afford the $100 especially because that crew of Professionals

> worked hard to get me the help I actually needed rather than costing

> me thousands by taking me to the hospital. But if you just load and

> go they get that $1000 bill from EMS then the $5000 ER bill and they

> are overwhelmed and just file them in the round file. So now you

> have $0 from the patient compared with maybe getting paid the $100.

>

> Yes we need Medicaid/Medicare to start paying for non transports but

> realistically that is not going to happen. In fact I would not be

> shocked if EMS is eventually not reimbursed at all thinks to all the

> FRAUD. The government may just say easier to punish everyone rather

> than spending all that money investigating.

>

> Again just my worthless opinion.

>

> Renny Spencer

> The Idealistic Paramedic

>

>

> > > > > >

> > > > > >

> > > > > > The one thing I find the longer I have my paramedic patch

> is that I

> > > > > know less than I thought I did.Â

> > > > > >

> > > > > >

> > > > > >

> > > > > > At this point, EMS has a hard enough time mastering our core

> > > skills,

> > > > > as the Wang study and several others have indicated. I'm no

> t sure

> > > > > that we're anywhere near ready to assume a role as the

> gatekeepers to

> > > > > the healthcare system, determining who is worthy of our

> time. That to

> > > > > me is the height of arrogance, especially considering that

> we want to

> > > > > be considered a profession. It smacks of hubris at the leas

> t.

> > > > > >

> > > > > >

> > > > > >

> > > > > > I realize that we've come a long ways from high-top Cadillac

> > > > > hearse/ambulances, but the reality is that we're still in the

> > > business

> > > > > of medical transportation. Ultimately, that means we give p

> eople

> > > > > rides to the hospital. Having said that, though, part of in

> formed

> > > > > consent means giving patients a realistic expectation of our

> > > > > capabilities and treatment. I have told a patient with minor

> > > > > complaints that it's unlikely that I could provide any

> treatment

> > > > > beyond assessment and transport.  If I've informed the pat

> ient

> > > as to

> > > > > their options and they still choose to ride in an ambulance,

> I'm not

> > > > > in a position to deny them that option.

> > > > > >

> > > > > >

> > > > > >

> > > > > > And can we please kill this damned thread?

> > > > > >

> > > > > >

> > > > > >

> > > > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > > > > >

> > > > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > > > >

> > > > > > -Austin, Texas

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > > Re: Paramedics Cannot Determine Wh

> > > > > > ich Patients Require Transport

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > >

> > > > > > As a person in favor of denying transport I do feel that

> we should

> > > > > not deny chest, abd, or head related calls. Even Doctors

> with all

> > > > > their equipment have trouble making accurate diagnosis. The

> calls

> > > that

> > > > > would be allowed denial would be the minor trauma such as

> stubbed

> > > toe,

> > > > > the sneezed once and want to make sure its not swine flu,

> the I just

> > > > > need a ride to the hospital so I can get to my doctors

> appointment,

> > > > > the I really just need someone to talk to to help cope

> ( this one

> > > only

> > > > > if you have resources that can come there while you wait ).

> > > > > >

> > > > > > The denial process would also involve as much if not more

> effort

> > > > > than just load and go so would discourage abuse by that one

> lazy

> > > > > Paramedic that everyone seems to know since he is mentioned

> often.

> > > > > >

> > > > > > I would like to see a study on EMS denials based on a

> system as

> > > > > described above. If allowed denial of the items even Doctors

> have

> > > > > trouble with then it is doomed to show we can not do it. It

> would

> > > also

> > > > > need a better criteria for mistake than admission to the

> hospital.

> > > For

> > > > > example the stubbed toe might end up needing surgery, yet

> nothing

> > > > > about the call required EMS, so admission was not a failure in

> > > this case.

> > > > > >

> > > > > > Well just my worthless idealistic thoughts.

> > > > > >

> > > > > > Renny Spencer

> > > > > > The Idealistic Paramedic

> > > > >

> > > > >

> > > >

> > > >

> > > > --

> > > > Grayson

> > > > www.kellygrayson.com

> > > >

> > >

> > >

> >

> >

> > --

> > Grayson

> > www.kellygrayson.com

> >

>

>

> Messages in this topic (50)

[Guest guest]

But Wes if your Mom would let you you'd volunteer as a. Attorney.

Louis N. Molino, Sr. CET

FF/NREMT/FSI/EMSI

Typed by my fingers on my iPhone.

Please excuse any typos

(Cell)

LNMolino@...

>

> No comment here from the guy who's doing both. LOL

>

> -Wes

>

> Re: Paramedics20Cannot Determine Wh

> > >>>>> ich Patients Require Transport

> > >>>>>

> > >>>>>

> > >>>>>

> > >>>>>

> > >>>>>

> > >>>>>

> > >>>>> As a person in favor of denying transport I do feel that we

> should

> > >>>> not deny chest, abd, or head related calls. Even Doctors with

> all

> > >>>> their equipment have trouble making accurate diagnosis. The

> calls

> > >>>> that

> > >>>> would be allowed denial would be the minor trauma such as

> stubbed

> > >>>> toe,

> > >>>> the sneezed once and want to make sure its not swine flu, the I

> > >>>> just

> > >>>> need a ride to the hospital so I can get to my doctors

> appointment,

> > >>>> the I really just need someone to talk to to help cope ( this

> one

> > >>>> only

> > >>>> if you have resources that can come there while you wait ).

> > >>>>>

> > >>>>> The denial process would also involve as much if not more

> effort

> > >>>> than just load and go so would discourage abuse by that one

> lazy

> > >>>> Paramedic that everyone seems to know since he is mentioned

> > >>>> often.

> > >>>>>

> > >>>>> I would like to see a study on EMS denials based on a system

> as

> > >>>> described above. If allowed denial of the items even Doctors

> have

> > >>>> trouble with then it is doomed to show we can not do it. It

> would

> > >>>> also

> > >>>> need a better criteria for mistake than admission to the

> > >>>> hospital. For

> > >>>> example the stubbed toe might end up needing surgery, yet

> nothing

> > >>>> about the call required EMS, so admission was not a failure

> in this

> > >>> case

> .

> > >>>>>

> > >>>>> Well just my worthless idealistic thoughts.

> > >>>>>

> > >>>>> Renny Spencer

> > >>>>> The Idealistic Paramedic

> > >>>>

> > >>>>

> > >>>

> > >>> --

> > >>> Grayson

> > >>> www.kellygrayson. ww

> > >>>

> > >>>

> > >>>

> > >>>

> > >>

> > >>

[Guest guest]

So, Danny...

For whatever you teach and train people to do, you now need to spend 3 times as

long providing the training...but you cannot charge one penny more, and you will

need to do 50% of the training to people without any reimbursement for the

training that you provide.?

Don't worry...you can just cut into your profit margin to make it all work out.?

I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

Dudley

Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am not sure where your thought on education comes from. Here in the panhandle

it is becoming the norm for a paramedic to get an associate degree.?Speaking

from a Private EMS standpoint I am not sure either from whence you speak of

monetary reimbursement being unable to meet personnel pay.? Private mangaers see

the profit margin go down as the pay for personnel goes up. I can assure you it

is not the volume of the loss that keeps them in business. Perhaps we need a

stronger voice. That only comes with willlingness to sacrifice,(something that

our whole society lacks in these days.)

? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

So, Danny...

For whatever you teach and train people to do, you now need to spend 3 times as

long providing the training...but you cannot charge one penny more, and you will

need to do 50% of the training to people without any reimbursement for the

training that you provide.?

Don't worry...you can just cut into your profit margin to make it all work out.?

I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

Dudley

Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am not sure where your thought on education comes from. Here in the panhandle

it is becoming the norm for a paramedic to get an associate degree.?Speaking

from a Private EMS standpoint I am not sure either from whence you speak of

monetary reimbursement being unable to meet personnel pay.? Private mangaers see

the profit margin go down as the pay for personnel goes up. I can assure you it

is not the volume of the loss that keeps them in business. Perhaps we need a

stronger voice. That only comes with willlingness to sacrifice,(something that

our whole society lacks in these days.)

? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

So, Danny...

For whatever you teach and train people to do, you now need to spend 3 times as

long providing the training...but you cannot charge one penny more, and you will

need to do 50% of the training to people without any reimbursement for the

training that you provide.?

Don't worry...you can just cut into your profit margin to make it all work out.?

I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

Dudley

Re: Re: Paramedics Cannot Determine Which Patients Require

Transport

I am not sure where your thought on education comes from. Here in the panhandle

it is becoming the norm for a paramedic to get an associate degree.?Speaking

from a Private EMS standpoint I am not sure either from whence you speak of

monetary reimbursement being unable to meet personnel pay.? Private mangaers see

the profit margin go down as the pay for personnel goes up. I can assure you it

is not the volume of the loss that keeps them in business. Perhaps we need a

stronger voice. That only comes with willlingness to sacrifice,(something that

our whole society lacks in these days.)

? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

Danny L.

Owner/NREMT-P

PETSAR INC.

(Panhandle Emergency Training Services And Response)

[Guest guest]

EMS may only be a small percentage of the fraud but it is so disorganized so

would be the easiest to just drop.

> > > > > > >

> > > > > > >

> > > > > > > The one thing I find the longer I have my paramedic patch

> > is that I

> > > > > > know less than I thought I did.Â

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > At this point, EMS has a hard enough time mastering our core

> > > > skills,

> > > > > > as the Wang study and several others have indicated. I'm no

> > t sure

> > > > > > that we're anywhere near ready to assume a role as the

> > gatekeepers to

> > > > > > the healthcare system, determining who is worthy of our

> > time. That to

> > > > > > me is the height of arrogance, especially considering that

> > we want to

> > > > > > be considered a profession. It smacks of hubris at the leas

> > t.

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > I realize that we've come a long ways from high-top Cadillac

> > > > > > hearse/ambulances, but the reality is that we're still in the

> > > > business

> > > > > > of medical transportation. Ultimately, that means we give p

> > eople

> > > > > > rides to the hospital. Having said that, though, part of in

> > formed

> > > > > > consent means giving patients a realistic expectation of our

> > > > > > capabilities and treatment. I have told a patient with minor

> > > > > > complaints that it's unlikely that I could provide any

> > treatment

> > > > > > beyond assessment and transport.  If I've informed the pat

> > ient

> > > > as to

> > > > > > their options and they still choose to ride in an ambulance,

> > I'm not

> > > > > > in a position to deny them that option.

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > And can we please kill this damned thread?

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > -Wes Ogilvie, MPA, JD, Lic.P./NREMT-P

> > > > > > >

> > > > > > > -Attorney at Law/Licensed Paramedic/EMS Instructor

> > > > > > >

> > > > > > > -Austin, Texas

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > Re: Paramedics Cannot Determine Wh

> > > > > > > ich Patients Require Transport

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > >

> > > > > > > As a person in favor of denying transport I do feel that

> > we should

> > > > > > not deny chest, abd, or head related calls. Even Doctors

> > with all

> > > > > > their equipment have trouble making accurate diagnosis. The

> > calls

> > > > that

> > > > > > would be allowed denial would be the minor trauma such as

> > stubbed

> > > > toe,

> > > > > > the sneezed once and want to make sure its not swine flu,

> > the I just

> > > > > > need a ride to the hospital so I can get to my doctors

> > appointment,

> > > > > > the I really just need someone to talk to to help cope

> > ( this one

> > > > only

> > > > > > if you have resources that can come there while you wait ).

> > > > > > >

> > > > > > > The denial process would also involve as much if not more

> > effort

> > > > > > than just load and go so would discourage abuse by that one

> > lazy

> > > > > > Paramedic that everyone seems to know since he is mentioned

> > often.

> > > > > > >

> > > > > > > I would like to see a study on EMS denials based on a

> > system as

> > > > > > described above. If allowed denial of the items even Doctors

> > have

> > > > > > trouble with then it is doomed to show we can not do it. It

> > would

> > > > also

> > > > > > need a better criteria for mistake than admission to the

> > hospital.

> > > > For

> > > > > > example the stubbed toe might end up needing surgery, yet

> > nothing

> > > > > > about the call required EMS, so admission was not a failure in

> > > > this case.

> > > > > > >

> > > > > > > Well just my worthless idealistic thoughts.

> > > > > > >

> > > > > > > Renny Spencer

> > > > > > > The Idealistic Paramedic

> > > > > >

> > > > > >

> > > > >

> > > > >

> > > > > --

> > > > > Grayson

> > > > > www.kellygrayson.com

> > > > >

> > > >

> > > >

> > >

> > >

> > > --

> > > Grayson

> > > www.kellygrayson.com

> > >

> >

> >

> > Messages in this topic (50)

>

>

>

[Guest guest]

Dudley I fully agree we need to charge for what we do and that includes the no

transports.

Renny

>

>

> So, Danny...

>

>

>

> For whatever you teach and train people to do, you now need to spend 3 times

as long providing the training...but you cannot charge one penny more, and you

will need to do 50% of the training to people without any reimbursement for the

training that you provide.?

>

>

>

> Don't worry...you can just cut into your profit margin to make it all work

out.?

>

>

>

> I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

>

>

>

> Dudley

>

>

> Re: Re: Paramedics Cannot Determine Which Patients

Require Transport

>

>

>

>

>

>

>

> I am not sure where your thought on education comes from. Here in the

panhandle it is becoming the norm for a paramedic to get an associate

degree.?Speaking from a Private EMS standpoint I am not sure either from whence

you speak of monetary reimbursement being unable to meet personnel pay.? Private

mangaers see the profit margin go down as the pay for personnel goes up. I can

assure you it is not the volume of the loss that keeps them in business. Perhaps

we need a stronger voice. That only comes with willlingness to

sacrifice,(something that our whole society lacks in these days.)

> ? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

> ? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

Dudley I fully agree we need to charge for what we do and that includes the no

transports.

Renny

>

>

> So, Danny...

>

>

>

> For whatever you teach and train people to do, you now need to spend 3 times

as long providing the training...but you cannot charge one penny more, and you

will need to do 50% of the training to people without any reimbursement for the

training that you provide.?

>

>

>

> Don't worry...you can just cut into your profit margin to make it all work

out.?

>

>

>

> I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

>

>

>

> Dudley

>

>

> Re: Re: Paramedics Cannot Determine Which Patients

Require Transport

>

>

>

>

>

>

>

> I am not sure where your thought on education comes from. Here in the

panhandle it is becoming the norm for a paramedic to get an associate

degree.?Speaking from a Private EMS standpoint I am not sure either from whence

you speak of monetary reimbursement being unable to meet personnel pay.? Private

mangaers see the profit margin go down as the pay for personnel goes up. I can

assure you it is not the volume of the loss that keeps them in business. Perhaps

we need a stronger voice. That only comes with willlingness to

sacrifice,(something that our whole society lacks in these days.)

> ? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

> ? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>

[Guest guest]

Dudley I fully agree we need to charge for what we do and that includes the no

transports.

Renny

>

>

> So, Danny...

>

>

>

> For whatever you teach and train people to do, you now need to spend 3 times

as long providing the training...but you cannot charge one penny more, and you

will need to do 50% of the training to people without any reimbursement for the

training that you provide.?

>

>

>

> Don't worry...you can just cut into your profit margin to make it all work

out.?

>

>

>

> I continually find it odd that everyone can make money except the EMS

Provider...how odd...? I have said it before and I will say it again, our

industry is where it is in the healthcare world because for TOO long, we have

been the only ones?who somehow feel it is wrong to make money off providing

health care.? Doctors, nurses, hospital administrators, EMS educators,

respiratory therapists, lab techs and paramedics on ambulances...they all see it

as important.? But, someone making 5 or 6 cents on the dollar providing

ambulance transport (any type provider...BTW, they all try to make money...us

government guys just hide it by calling it " reserves " ) and it is just?a horrible

dis-service to society.? By gosh...this isn't about money...it is about patient

care!!!!!? But like Louis so eloquently said, no money...no one to advocate for

the patient.

>

>

>

> Dudley

>

>

> Re: Re: Paramedics Cannot Determine Which Patients

Require Transport

>

>

>

>

>

>

>

> I am not sure where your thought on education comes from. Here in the

panhandle it is becoming the norm for a paramedic to get an associate

degree.?Speaking from a Private EMS standpoint I am not sure either from whence

you speak of monetary reimbursement being unable to meet personnel pay.? Private

mangaers see the profit margin go down as the pay for personnel goes up. I can

assure you it is not the volume of the loss that keeps them in business. Perhaps

we need a stronger voice. That only comes with willlingness to

sacrifice,(something that our whole society lacks in these days.)

> ? I beleive that somewhere the CE has to change. We learn nothing new after

having graduated from either a college course or a vocational course. That is

where the educators need to?make the change happen. The rank and file do not

know any better when they are not guided better or educated more on the subject.

> ? As for the " OLD TIMERS " , of which I now find myself looking at inclusion.

Perhaps if change is not what you are about, bow out gracefully. I don't know

how many times in the past I have become so infuriated with the " norm " . You

either want change for the better or you do not. Lead, Follow, or get the hell

out of the way!

>

> Danny L.

> Owner/NREMT-P

> PETSAR INC.

> (Panhandle Emergency Training Services And Response)

>

>