For anyone interested, Anna Maria College has just started a fully-online degree completion program for working Paramedics.
The program leads to a Bachelor of Science in EMS Administration degree and is 100 % online. The program also has no clinical requirements.
For more information, follow the link to Anna Maria's BSEMSA Web page.
Monday, November 12, 2012
Wednesday, February 1, 2012
Just in case anyone missed it, I've pasted below an excellent article that appeared in a recent edition of the Worcester Telegram & Gazette, written by reporter Brad Miner. In an era dominated by a healthcare reform debate that couldn't care less about prehospital medicine, it's nice to see someone write thoughtfully -- and accurately, in my opinion -- about the state of affairs:
Central Mass. EMS Struggles to Make Ends Meet
Bradford L. Miner, TELEGRAM & GAZETTE
Tuesday, January 31, 2012
NORTH BROOKFIELD, Mass. -- It's been some time since the North Brookfield Emergency Medical Service has been on sound financial footing, and its future is uncertain at best.
And among private, nonprofit ambulance services in Central Massachusetts, that is more and more the norm, rather than the exception.
In a league of their own, the nonprofits don't have the revenue stream of private "for-profit" ambulance services that do more patient transports than emergency runs, nor do they have the access of municipal ambulance services to taxpayer dollars.
Rather, they survive on subscriptions, donations, grants and careful management of resources to continue to answer 911 calls.
Patrick Kiritsy, director of North Brookfield EMS, cited a litany of changes at the local, state, and federal level that could guarantee service from one year to the next, but for now almost $100,000 in billed ambulance service is outstanding, and that worries Selectman Jason Petraitis, among others.
Mr. Kiritsy can understand the selectman's concern.
"Come the day that we can't meet payroll, we close the door, turn off the lights and then it's up to the town to contract for emergency service elsewhere," he said.
Mike Emerson, billing coordinator for the Barre Rescue Squad and other ambulance services using the parent company Action Ambulance of Wilmington, said, "This is a huge, huge issue across the board affecting not just small towns like North Brookfield, but all public and private ambulance services, profit and nonprofit."
Among the issues affecting emergency medical services, a major one is patients without health insurance, said Mr. Emerson. Another factor, he said, is the steady decline in Medicare and Medicaid reimbursement rates, which are based on "fair market value."
He said Medicare pays something in the vicinity of $400 for a 911 ambulance call. Only a base rate and mileage can be charged. Medicare doesn't pay for supplies. Some cost $70 or $80 for a one-time use, and the service is left picking up the tab to replenish them, he said.
Mr. Emerson said he spends about 20 hours a month reviewing accounts, forwarding them to a collection agency.
"On average, 10 to 15 percent of everything I bill each month is going to a collection agency. Take Barre, for instance, I think I sent two months' worth of overdue accounts to collection and that represents about $30,000. For a smaller ambulance service that's a significant amount of cash - and there's no guarantee it will ever be collected," he said.
He said the greatest challenge he faces are patients who receive "free care," which covers hospitalization, but not ambulance service.
"If you're a patient receiving free care at a hospital, what are the chances of us ever recovering the cost of that ambulance ride?" he asked.
Mr. Emerson said the economy is driving up the volume of ambulance calls across Massachusetts.
"People can't afford to go to the doctor so they wait until they are so sick they have to go to the hospital, and end up calling for an ambulance to get them there," he said.
"This is not a providers' market. There is no picking or choosing whom you transport. When a 911 call comes in, some EMS crew is obligated to provide the service," he said.
Given the trends he's seen over the past decade, Mr. Emerson predicted that many of the marginal private nonprofit ambulance services will either be incorporated into town government or cease to exist.
Paul Lupacchino, president of the West Brookfield Rescue Squad, said allowing insurance companies to pay patients for ambulance services and make the patient responsible for paying the ambulance service is counterproductive at best.
"Given the state of the economy, we have reason to be concerned. That check might just as easily go toward paying the heating bill, rent or groceries," he said.
"What is even more troubling is the potential for abuse where an individual calls 911 for ambulance for a non-emergency transport to a local health facility with the expectation of receiving a check in the mail in a couple of months to support an addiction or buy a nice dinner at a restaurant - at the expense of the rescue squad," he added.
"Without the continued support of the community through subscriptions and donations, I don't know where we'd be," he said.
He said a $35 family ambulance subscription more than pays for itself, with the rescue squad offsetting the patient's copay or deductible by $250 for each call.
Brendan McCarthy, manager of the Brimfield Ambulance Service, said he's had to make significant administrative cuts to keep that nonprofit service afloat.
Mr. McCarthy said Brimfield uses Comstar for its billing and expects a return of about 45 to 50 cents for each dollar billed. The Brimfield service covers calls from Holland and Wales as well.
"I'd like to see both state and federal legislators take a look at what we do, the services we offer, the costs we incur. They'd see that reimbursement rates don't come close. Most of the 911 patients are transported to Wing Memorial in Palmer or Harrington in Southbridge."
Gary Milliard Jr., chief of Webster Emergency Medical Services, said that aside from unrealistic reimbursement rates, major insurers are pushing ambulance services into signing a contract at reduced rates in order to receive direct payment for patient services. Otherwise, he said, the patient is sent the check.
One of the larger private nonprofits in the region, Webster Emergency Medical Services has volume of more than 6,700 calls a year, said Mr. Milliard,
"The ambulance business of the 1980s was a good revenue generator. I could send out a bill for $5,000 and expect to get paid ... every nickel, but that just doesn't happen anymore. Everyone is trying to cut back on the rising costs of health care, except in this case the cuts are jeopardizing our ability to provide the service."
Mr. Milliard said Webster does not have subscribers but accepts donations and is successful to the degree that the service lives within available resources.
Bert DuVernay, New Braintree police chief and former coordinator for the Hardwick Rescue & Emergency Squad, said that at one time the merger of the Hardwick and North Brookfield squads had been proposed because Hardwick's 200 calls a year and New Braintree's 50 calls a year were not enough to keep skills sharp. At the time, he said, Hardwick was truly a "volunteer" service.
"It wasn't a question of money then, which it is now, because Hardwick's EMTs weren't paid for their time or services," Mr. DuVernay said.
"When Medicare, Medicaid and MassHealth pay about a third of what's billed, and the major insurance companies pay what they please when they get around to it, then something has to be done or services like ours won't survive. I still think regionalization is one part of the equation," the chief said.
Mr. Kiritsy was the one who advised selectmen in 2010 that the cost of maintaining an around-the-clock advanced life support service at $540,000 had become an albatross. Rather than ending the service, it was decided to downgrade it to a basic life support squad.
Now even that is a challenge, he said, citing what he called "absurdly low reimbursements" from Medicare, Medicaid and MassHealth for ambulance transport.
"As of today, we're fully staffed; operational 24-7; and we run an on-call service. Our EMTs are paid for the eight-hour shift that they are on call as well as a stipend if they get called out," Mr. Kiritsy said.
NORTH BROOKFIELD, Mass. -- It's been some time since the North Brookfield Emergency Medical Service has been on sound financial footing, and its future is uncertain at best.
And among private, nonprofit ambulance services in Central Massachusetts, that is more and more the norm, rather than the exception.
In a league of their own, the nonprofits don't have the revenue stream of private "for-profit" ambulance services that do more patient transports than emergency runs, nor do they have the access of municipal ambulance services to taxpayer dollars.
Rather, they survive on subscriptions, donations, grants and careful management of resources to continue to answer 911 calls.
Patrick Kiritsy, director of North Brookfield EMS, cited a litany of changes at the local, state, and federal level that could guarantee service from one year to the next, but for now almost $100,000 in billed ambulance service is outstanding, and that worries Selectman Jason Petraitis, among others.
Mr. Kiritsy can understand the selectman's concern.
"Come the day that we can't meet payroll, we close the door, turn off the lights and then it's up to the town to contract for emergency service elsewhere," he said.
Mike Emerson, billing coordinator for the Barre Rescue Squad and other ambulance services using the parent company Action Ambulance of Wilmington, said, "This is a huge, huge issue across the board affecting not just small towns like North Brookfield, but all public and private ambulance services, profit and nonprofit."
Among the issues affecting emergency medical services, a major one is patients without health insurance, said Mr. Emerson. Another factor, he said, is the steady decline in Medicare and Medicaid reimbursement rates, which are based on "fair market value."
He said Medicare pays something in the vicinity of $400 for a 911 ambulance call. Only a base rate and mileage can be charged. Medicare doesn't pay for supplies. Some cost $70 or $80 for a one-time use, and the service is left picking up the tab to replenish them, he said.
Mr. Emerson said he spends about 20 hours a month reviewing accounts, forwarding them to a collection agency.
"On average, 10 to 15 percent of everything I bill each month is going to a collection agency. Take Barre, for instance, I think I sent two months' worth of overdue accounts to collection and that represents about $30,000. For a smaller ambulance service that's a significant amount of cash - and there's no guarantee it will ever be collected," he said.
He said the greatest challenge he faces are patients who receive "free care," which covers hospitalization, but not ambulance service.
"If you're a patient receiving free care at a hospital, what are the chances of us ever recovering the cost of that ambulance ride?" he asked.
Mr. Emerson said the economy is driving up the volume of ambulance calls across Massachusetts.
"People can't afford to go to the doctor so they wait until they are so sick they have to go to the hospital, and end up calling for an ambulance to get them there," he said.
"This is not a providers' market. There is no picking or choosing whom you transport. When a 911 call comes in, some EMS crew is obligated to provide the service," he said.
Given the trends he's seen over the past decade, Mr. Emerson predicted that many of the marginal private nonprofit ambulance services will either be incorporated into town government or cease to exist.
Paul Lupacchino, president of the West Brookfield Rescue Squad, said allowing insurance companies to pay patients for ambulance services and make the patient responsible for paying the ambulance service is counterproductive at best.
"Given the state of the economy, we have reason to be concerned. That check might just as easily go toward paying the heating bill, rent or groceries," he said.
"What is even more troubling is the potential for abuse where an individual calls 911 for ambulance for a non-emergency transport to a local health facility with the expectation of receiving a check in the mail in a couple of months to support an addiction or buy a nice dinner at a restaurant - at the expense of the rescue squad," he added.
"Without the continued support of the community through subscriptions and donations, I don't know where we'd be," he said.
He said a $35 family ambulance subscription more than pays for itself, with the rescue squad offsetting the patient's copay or deductible by $250 for each call.
Brendan McCarthy, manager of the Brimfield Ambulance Service, said he's had to make significant administrative cuts to keep that nonprofit service afloat.
Mr. McCarthy said Brimfield uses Comstar for its billing and expects a return of about 45 to 50 cents for each dollar billed. The Brimfield service covers calls from Holland and Wales as well.
"I'd like to see both state and federal legislators take a look at what we do, the services we offer, the costs we incur. They'd see that reimbursement rates don't come close. Most of the 911 patients are transported to Wing Memorial in Palmer or Harrington in Southbridge."
Gary Milliard Jr., chief of Webster Emergency Medical Services, said that aside from unrealistic reimbursement rates, major insurers are pushing ambulance services into signing a contract at reduced rates in order to receive direct payment for patient services. Otherwise, he said, the patient is sent the check.
One of the larger private nonprofits in the region, Webster Emergency Medical Services has volume of more than 6,700 calls a year, said Mr. Milliard,
"The ambulance business of the 1980s was a good revenue generator. I could send out a bill for $5,000 and expect to get paid ... every nickel, but that just doesn't happen anymore. Everyone is trying to cut back on the rising costs of health care, except in this case the cuts are jeopardizing our ability to provide the service."
Mr. Milliard said Webster does not have subscribers but accepts donations and is successful to the degree that the service lives within available resources.
Bert DuVernay, New Braintree police chief and former coordinator for the Hardwick Rescue & Emergency Squad, said that at one time the merger of the Hardwick and North Brookfield squads had been proposed because Hardwick's 200 calls a year and New Braintree's 50 calls a year were not enough to keep skills sharp. At the time, he said, Hardwick was truly a "volunteer" service.
"It wasn't a question of money then, which it is now, because Hardwick's EMTs weren't paid for their time or services," Mr. DuVernay said.
"When Medicare, Medicaid and MassHealth pay about a third of what's billed, and the major insurance companies pay what they please when they get around to it, then something has to be done or services like ours won't survive. I still think regionalization is one part of the equation," the chief said.
Mr. Kiritsy was the one who advised selectmen in 2010 that the cost of maintaining an around-the-clock advanced life support service at $540,000 had become an albatross. Rather than ending the service, it was decided to downgrade it to a basic life support squad.
Now even that is a challenge, he said, citing what he called "absurdly low reimbursements" from Medicare, Medicaid and MassHealth for ambulance transport.
"As of today, we're fully staffed; operational 24-7; and we run an on-call service. Our EMTs are paid for the eight-hour shift that they are on call as well as a stipend if they get called out," Mr. Kiritsy said.
Friday, September 2, 2011
Stop The Presses (Yet Again)
Ok, remember how in cardiac arrests we used to do CPR until you had the pads on, and then we would stop to analyze the rhythm?
And then remember a few years ago we were told that we needed to do uninterrupted CPR for two minutes before we did ANYTHING?
Well, now it turns out that, at the least, the latter is no more beneficial than the former, and at worst, may be hurting our patients.
Evidence-based medicine is only as good as the evidence that begets it.
Now someone bring me MAST trousers and an amp of Bretylium....
http://www.jems.com/article/news/prolonging-cpr-doesnt-help?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+jems%2Fthelatest+%28JEMS.com%3A+The+Latest+EMS+News+%26+Features%29
And then remember a few years ago we were told that we needed to do uninterrupted CPR for two minutes before we did ANYTHING?
Well, now it turns out that, at the least, the latter is no more beneficial than the former, and at worst, may be hurting our patients.
Evidence-based medicine is only as good as the evidence that begets it.
Now someone bring me MAST trousers and an amp of Bretylium....
http://www.jems.com/article/news/prolonging-cpr-doesnt-help?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+jems%2Fthelatest+%28JEMS.com%3A+The+Latest+EMS+News+%26+Features%29
Monday, July 11, 2011
EMS's Own Silent Epidemic
A simple question from the "Why Do We Do This?" File:
Why do 911 ambulances transport stable, uninjured psych patients who have no medical or toxicological complaints?
It's never made any sense, and recent injuries to good friends of mine in the field have only highlighted my disdain for the practice.
A friend of mine just learned today that he's out of work for another week, making four total, due to a back injury incurred lifting a stretcher on which was loaded an angry psych patient -- who had no medical complaint, other than being angry. This patient decided to lunge, without warning and at the exact perfect moment during my friend's lift, and now he's been off the job for a month. He has a mortgage and several small children to feed on a Paramedic's salary, so you can imagine what this is doing to his financial security.
And for what?
FOR NOTHING.
There was no compelling reason for this patient to go anywhere in an ambulance. Indeed, given the patient's state of mind, she would have been far safer in the back of a police cruiser, in handcuffs if need be, applied by a law enforcement officer with the authority and training to restrain this person.
For EMS personnel, psychs represent nothing but risk.
We aren't allowed by law to restrain them, but they turn violent so often that we are often left with no alternative.
There is no medical problem for us to attend to, and the minimal training we get in EMS for responding to psychiatric emergencies is laughably inadequate.
In my opinion, the number of EMS providers significantly injured on the job by psych patients is a silent epidemic that for some reason is talked about only on ambulance docks, or in crew quarters, or on the bus.
I have yet to work for an EMS agency that really addressed the issue, or even mentioned it in passing.
In the 17 years I've been in EMS, I've been injured exactly once -- by a psych patient who, for no reason and completely out of the blue, scissor kicked me in the chest as I was getting her settled on our ambulance stretcher.
I suffered an agonizing month with costochondritis, a painful injury that made attempts at sleep excrutiating and deep breaths impossible.
And because I couldn't afford to take the time off from work (due to my own mortgage and legion of mouths to feed), I kept the pain to myself and suffered in silence until the injury healed itself.
How many millions of dollars a year are wasted in EMS on time lost to injury due to violent psychiatric patients?
These patients rightly belong to the police.
They have the authority and the means to safely restrain these patients, and the backseat of a police cruiser is a far more secure environment -- with its cages, Lexan glass and doors without handles -- than the patient care compartment of an ambulance, with its myriad of options for escape and self-injury.
I understand completely that most police officers are going to be resistant to the idea.
And while I respect those folks and have many friends in law enforcement, I say it's time for that particular branch of public safety to step up and assume this role that so clearly belongs to them.
Saturday, April 30, 2011
Suffer A Child
We decided she was about 8-months-old, and that seemed in line with the Broselow Tape, which put her weight at around 10 kg.
Her injuries weren't horrific, although the skull-deep laceration that ran from the top of her head to just between her eyes looked pretty dramatic.
But her loud wailing and vigorous movement led us to believe that our inability to find any other injuries was probably the right assessment.
Even if we could have found a broken bone or more cuts, it's most likely that the worst injuries are ones she won't know for a few years at least.
Because while my partner and I tended to this pretty little girl in the back of some random roadside ambulance, a couple hundred yards away her mother had died in an accident that left the first-arriving EMS crews so unnerved that their hands still shook.
I don't know what other family will be there for our patient -- hopefully a large and loving clan that will give her a chance at some semblance of a normal life.
When we got to our destination -- one which I'd love to name, but can't due to privacy laws -- I was impressed at the compassion of the trauma team.
They moved with the usual sense of purpose, but it seemed like each member who came into contact with the little girl took a moment to coo at her, or tell her how pretty she was, or cover her with a warm blanket, even if for just a moment.
And it gave me hope.
This job can make you cynical and hardened. It can take away your humanity, if you let it.
But at other times, you can see how it brings the best out in people, and give you hope even for the smallest and weakest among us.
I witnessed a tragedy today, and I witnessed sublime compassion.
I am going to go home after this shift, and I am going to thank God for what I am privileged to do for a living.
Her injuries weren't horrific, although the skull-deep laceration that ran from the top of her head to just between her eyes looked pretty dramatic.
But her loud wailing and vigorous movement led us to believe that our inability to find any other injuries was probably the right assessment.
Even if we could have found a broken bone or more cuts, it's most likely that the worst injuries are ones she won't know for a few years at least.
Because while my partner and I tended to this pretty little girl in the back of some random roadside ambulance, a couple hundred yards away her mother had died in an accident that left the first-arriving EMS crews so unnerved that their hands still shook.
I don't know what other family will be there for our patient -- hopefully a large and loving clan that will give her a chance at some semblance of a normal life.
When we got to our destination -- one which I'd love to name, but can't due to privacy laws -- I was impressed at the compassion of the trauma team.
They moved with the usual sense of purpose, but it seemed like each member who came into contact with the little girl took a moment to coo at her, or tell her how pretty she was, or cover her with a warm blanket, even if for just a moment.
And it gave me hope.
This job can make you cynical and hardened. It can take away your humanity, if you let it.
But at other times, you can see how it brings the best out in people, and give you hope even for the smallest and weakest among us.
I witnessed a tragedy today, and I witnessed sublime compassion.
I am going to go home after this shift, and I am going to thank God for what I am privileged to do for a living.
Tuesday, April 19, 2011
A Challenge Bigger Than A Marathon
Marathon Monday was yesterday.
That's the Monday each May where more than 30,000 aspirants gather on Hopkinton's town common hoping to join the hundreds of thousands of runners through history who have earned the title of "Finisher" of the Boston Marathon, the world's greatest road race.
Yesterday my buddy Pat Purcell, of Westborough Fire Department and Worcester EMS, once again successfully navigated the 26.2 miles from Hopkinton to Boston.
I've run Boston with Pat five times, although I took this year off.
Before that, the last year I didn't run was 2005.
Pat finished that year, though.
After trekking from Hopkinton to Boston in a sun that beat down with an ungodly heat that turned the final 1/4-mile slog to the finish line into a concrete oven, Pat received his medal and continued running to Children's Hospital, where he visited me and my son Brendan in Brendan's room on the hospital's 9th floor.
Pat had run the marathon that day in honor of Brendan, and presented him with a Dana-Farber Marathon Challenge medal in his hospital bed.
Brendan was suffering from a malignant brain tumor known as medulloblastoma, and at the time was in the middle of a grueling run of chemotherapy treatments. In the preceding days he had done little more than lay in bed and struggle to breathe.
But when Pat arrived to visit, Brendan stirred and accepted the gift with the closest thing to excitement his broken and battered body could muster. If you didn't know Brendan, you wouldn't realize how much Pat's gift meant to him, but my wife and I did, and we've never forgotten.
I don't know how many years now in a row Pat Purcell has labored to complete the 26.2 mile Boston Marathon on behalf of the Dana-Farber Cancer Institute, or how much money he has raised ($50,000? $100,000?)
I DO know that because of the money raised each year by Pat and hundreds of people like him, the scientists and clinicians at Dana-Farber are making incredible gains in the fight against cancer.
And I know that those gains are the reason I was able to play catch with Brendan and his brother Kevan today, and why Brendan is a happy, healthy 8-year-old 3rd-grader.
I also know that there are still far too many kids who won't have success against cancer, and that the battle goes on.
So while I didn't raise money this year, I figured I'd take an opportunity to appeal to readers of this blog to perhaps consider a donation to Pat Purcell's Dana-Farber fundraising page.
Simply follow the link, and click on "Support A Runner" on the right hand side of the page. Enter "Pat Purcell" for the name, and it will bring you to his page.
I thank from the bottom of my heart anyone who is able to donate. The battle is a long way from over, but every dollar brings us a little closer to victory.
That's the Monday each May where more than 30,000 aspirants gather on Hopkinton's town common hoping to join the hundreds of thousands of runners through history who have earned the title of "Finisher" of the Boston Marathon, the world's greatest road race.
Yesterday my buddy Pat Purcell, of Westborough Fire Department and Worcester EMS, once again successfully navigated the 26.2 miles from Hopkinton to Boston.
I've run Boston with Pat five times, although I took this year off.
Before that, the last year I didn't run was 2005.
Pat finished that year, though.
After trekking from Hopkinton to Boston in a sun that beat down with an ungodly heat that turned the final 1/4-mile slog to the finish line into a concrete oven, Pat received his medal and continued running to Children's Hospital, where he visited me and my son Brendan in Brendan's room on the hospital's 9th floor.
Pat had run the marathon that day in honor of Brendan, and presented him with a Dana-Farber Marathon Challenge medal in his hospital bed.
Brendan was suffering from a malignant brain tumor known as medulloblastoma, and at the time was in the middle of a grueling run of chemotherapy treatments. In the preceding days he had done little more than lay in bed and struggle to breathe.
But when Pat arrived to visit, Brendan stirred and accepted the gift with the closest thing to excitement his broken and battered body could muster. If you didn't know Brendan, you wouldn't realize how much Pat's gift meant to him, but my wife and I did, and we've never forgotten.
I don't know how many years now in a row Pat Purcell has labored to complete the 26.2 mile Boston Marathon on behalf of the Dana-Farber Cancer Institute, or how much money he has raised ($50,000? $100,000?)
I DO know that because of the money raised each year by Pat and hundreds of people like him, the scientists and clinicians at Dana-Farber are making incredible gains in the fight against cancer.
And I know that those gains are the reason I was able to play catch with Brendan and his brother Kevan today, and why Brendan is a happy, healthy 8-year-old 3rd-grader.
I also know that there are still far too many kids who won't have success against cancer, and that the battle goes on.
So while I didn't raise money this year, I figured I'd take an opportunity to appeal to readers of this blog to perhaps consider a donation to Pat Purcell's Dana-Farber fundraising page.
Simply follow the link, and click on "Support A Runner" on the right hand side of the page. Enter "Pat Purcell" for the name, and it will bring you to his page.
I thank from the bottom of my heart anyone who is able to donate. The battle is a long way from over, but every dollar brings us a little closer to victory.
Saturday, April 2, 2011
Is CPR As Effective As We Thought?
Dr. Bryan Bledsoe has made a career of challenging assumptions with the pesky tag team of facts and the scientific method. I found this article about another Sacred Cow -- in this case, the foundational belief that it is CPR alone that saves lives in cardiac arrest -- very interesting reading.
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