EMS Unions in So cal

SkiMaskWay · Aug 30, 2014

DieselBolus said:
I can see past the lack of communication skills, but.....wtf?

I have never met a medic who felt pushing a gurney was below them. Even flight medics who scored jobs with 500 applicants for a single opening. I have also never met a medic who failed to understand that the tools we have for moving people around are central in PREhospital care.

I suppose that could be hard to understand if you got into EMS to run around intubating patients and letting other people deal with the paltry transportation to definitive care.

What I mean by " Pushing a gurney" is that's all you do, no patient care...ya know "slinging Gomers" its a joke for an ems worker doing bottom of the barrel type calls Dialysis, Doctors visits wait and returns hospital discharges.

gonefishing · Aug 30, 2014

SkiMaskWay said:
What I mean by " Pushing a gurney" is that's all you do, no patient care...ya know "slinging Gomers" its a joke for an ems worker doing bottom of the barrel type calls Dialysis, Doctors visits wait and returns hospital discharges.

LOL welcome to a part of ems. Just like somebody has to fry the french frys. I can get the point of some of those calls, not all the time do those patients have to go by Ambulance. I've all seen people that seriously need an ambulance to dialysis and things go bad. BP drops dramatically, shortness of breath. Sorry its not all action and adventure.

terrible one · Aug 30, 2014

I'm not found of the saying "you don't like it pick another career". This implies one should simply be grateful of the fact that have a job at all. Nothing will change when the brightest of EMS keep leaving because they fail to follow the status quo.
It's obvious why so few EMS professionals retire as EMTs / paramedics. I for one would like to see changes and a push for making this a career instead of a stepping stone to a real career.

SkiMaskWay · Aug 30, 2014

gonefishing said:
LOL welcome to a part of ems. Just like somebody has to fry the french frys. I can get the point of some of those calls, not all the time do those patients have to go by Ambulance. I've all seen people that seriously need an ambulance to dialysis and things go bad. BP drops dramatically, shortness of breath. Sorry its not all action and adventure.

I'm in no way implying that by not doing 911 calls, dropping tubes, popping lines, pushing meds.. Etc, I'm not happy being a Paramedic, but what I'm saying is that just because we do calls that maybe warrant a wheelchair van... You cant say companies don't charge an arm and a leg for those transports because they do. And the fact that they require a trained professional they should pay accordingly despite training involved ....they sure as hell charge accordingly. And the biggest problem is that EMTs are willing to work for so little and don't give themselves any value and buy in to the notion that its OK to put up with poor wages , bad working conditions, be treated like crap by their employers. And if it is a stepping stone fine you still should not allow an employer to mistreat you. I mean who does that? I started this discussion because I was wondering why EMS union were not as effective as other union in other industries... I've her of even our movie set medics consisting of EMTs and Paramedics those guys make great money and have bennies and even retirement...how are they different ? How come the over saturated EMT market doesn't effect them??

SkiMaskWay · Aug 30, 2014

SkiMaskWay said:
I'm in no way implying that by not doing 911 calls, dropping tubes, popping lines, pushing meds.. Etc, I'm not happy being a Paramedic, but what I'm saying is that just because we do calls that maybe warrant a wheelchair van... You cant say companies don't charge an arm and a leg for those transports because they do. And the fact that they require a trained professional they should pay accordingly despite training involved ....they sure as hell charge accordingly. And the biggest problem is that EMTs are willing to work for so little and don't give themselves any value and buy in to the notion that its OK to put up with poor wages , bad working conditions, be treated like crap by their employers. And if it is a stepping stone fine you still should not allow an employer to mistreat you. I mean who does that? I started this discussion because I was wondering why EMS union were not as effective as other union in other industries... I've her of even our movie set medics consisting of EMTs and Paramedics those guys make great money and have bennies and even retirement...how are they different ? How come the over saturated EMT market doesn't effect them??

Its like the Matrix, The status Quo, it's a system ...it shouldn't be that way. What LA county needs is a really good Union a legitimate one, One that can actually make a change and attempt to unionize all the private sector EMS workers and there is such a market for it.. That it would work, in fact that would really shake the tree for all the Ambulance companies that are under the impression they could exploit these young EMTs and make it quick buck. There is absolutely no representation for these workers. On the flip side any of the older ones do move on to either Fire were they become members of the Firefighters Association or Nursing were they have a Nurses association or union at the hospitals they work at or any other industry that pays better and once again most likely has better pay due to some sort of represtation...

gonefishing · Aug 30, 2014

SkiMaskWay said:
Its like the Matrix, The status Quo, it's a system ...it shouldn't be that way. What LA county needs is a really good Union a legitimate one, One that can actually make a change and attempt to unionize all the private sector EMS workers and there is such a market for it.. That it would work, in fact that would really shake the tree for all the Ambulance companies that are under the impression they could exploit these young EMTs and make it quick buck. There is absolutely no representation for these workers. On the flip side any of the older ones do move on to either Fire were they become members of the Firefighters Association or Nursing were they have a Nurses association or union at the hospitals they work at or any other industry that pays better and once again most likely has better pay due to some sort of represtation...

And as I said before it was attempted and the only people that didn't let it happen were the few that didn't care. It all has to do with your peers.

SkiMaskWay · Aug 30, 2014

MrJones said:
Sounds to me like you picked the wrong profession.

Bro.

Nope your wrong.... I still recall my transcripts from RCC its ses the Units I got were all EMS and the title was Paramedic...so no your mistaken I did intend to be a Pre-hospital medical professional back in 2002 class 2...You mis perceived what I do.

SkiMaskWay · Aug 30, 2014

gonefishing said:
And as I said before it was attempted and the only people that didn't let it happen were the few that didn't care. It all has to do with your peers.

That's true...I agree with you on that...

DieselBolus · Aug 30, 2014

SkiMaskWay said:
I'm in no way implying that by not doing 911 calls, dropping tubes, popping lines, pushing meds.. Etc, I'm not happy being a Paramedic, but what I'm saying is that just because we do calls that maybe warrant a wheelchair van... You cant say companies don't charge an arm and a leg for those transports because they do. And the fact that they require a trained professional they should pay accordingly despite training involved ....they sure as hell charge accordingly.

If you're running transports of dubious medical necessity, I hope you're delivering Advanced Beneficiary Notices and notifying the sending staff and your supervisor that you have a call you suspect Medicare will kick back on a technical denial. Otherwise you're not being an advocate for your patient, your employer, or your healthcare system.

Technical denials that get billed directly to the patient put a massive strain on private companies because the collection rate is horrible.
For the small number of IFT patients that could go by chair van or car and have insurance preauthorization for the Tx, I do agree its frustrating, but its job security.

I think the extra dollar an hour you'd get from unionizing will land in your lap anyway if you show your employer that you've done your homework in all aspects of patient advocacy. I'm not antiunion by any stretch of the imagination, but I think if we want to be treated and paid as professionals, we have much bigger fish to fry. Sorry to stray off topic..[/QUOTE]

gonefishing · Aug 30, 2014

DieselBolus said:
If you're running transports of dubious medical necessity, I hope you're delivering Advanced Beneficiary Notices and notifying the sending staff and your supervisor that you have a call you suspect Medicare will kick back on a technical denial. Otherwise you're not being an advocate for your patient, your employer, or your healthcare system.

Technical denials that get billed directly to the patient put a massive strain on private companies because the collection rate is horrible.
For the small number of IFT patients that could go by chair van or car and have insurance preauthorization for the Tx, I do agree its frustrating, but its job security.

I think the extra dollar an hour you'd get from unionizing will land in your lap anyway if you show your employer that you've done your homework in all aspects of patient advocacy. I'm not antiunion by any stretch of the imagination, but I think if we want to be treated and paid as professionals, we have much bigger fish to fry. Sorry to stray off topic..

[/QUOTE]
EXACTLY.

SkiMaskWay · Aug 30, 2014

DieselBolus said:
If you're running transports of dubious medical necessity, I hope you're delivering Advanced Beneficiary Notices and notifying the sending staff and your supervisor that you have a call you suspect Medicare will kick back on a technical denial. Otherwise you're not being an advocate for your patient, your employer, or your healthcare system.

Technical denials that get billed directly to the patient put a massive strain on private companies because the collection rate is horrible.
For the small number of IFT patients that could go by chair van or car and have insurance preauthorization for the Tx, I do agree its frustrating, but its job security.

I think the extra dollar an hour you'd get from unionizing will land in your lap anyway if you show your employer that you've done your homework in all aspects of patient advocacy. I'm not antiunion by any stretch of the imagination, but I think if we want to be treated and paid as professionals, we have much bigger fish to fry. Sorry to stray off topic..

[/QUOTE]
Billing is not my area of expertise... Sorry.. Patient care is. Also a dollar more?? That's not the kinda union I'm talking about .. How about medical, Dental , Vision, maybe retirement or some sort of 401k. Adherence to disciplinary policies, real job security, progressive pay scale,protection from termination for unjust causes simply because they can pay less to a new guy.etc....the fact that an ambulance company is slinging lots of Gs doesn't give me job security...then not being able to be reimbursed 100% of the time is also not my problem that's the way the business works. And most importantly providing good patient care for a pat in the back from my employer is definitely not why I would do it... In this business EMS workers are very expendable and one thing is for sure even the company men or brown nosers aren't immune to being canned....Work Union Live better ...
I come from a family of skilled trades men( from Iron workers to Plumbers) and they all make a descent living and all make over 100k a year always worked Union. And some 15 years ago I had the opportunity to get into the Union after the military since I have alot of connections and family but instead I chose to be an EMT and later a Paramedic because this is what I enjoyed doing and still do....but never expected it to have such a dark side, And be so degrading at times.

avdrummerboy · Aug 30, 2014

Be careful what you wish for, very few unions that I know of that people actually like working under. Aside from the vast majority not caring (and wanting to just fly under the radar and not make waves), if you managed to band enough people together in the LA/ OC area who demand unionization and it comes off as desperate as it now feels, chances are you're going to get some shady union that will only be the slightest bit better than any given company down there.

As to a high profit/ big return company, you might want to talk to a few financial managers of companies. Even the unethical owners (and boy are there a lot down there) are going to have to play the same games with medicare/ medical/ other insurances. A good company is one that gets 30+% return on billed runs. 20-25% is common, if you've got a company making 35% or more, count your blessings as that is a rarity.

SkiMaskWay · Aug 30, 2014

Billing is not my area of expertise... Sorry.. Patient care is. Also a dollar more?? That's not the kinda union I'm talking about .. How about medical, Dental , Vision, maybe retirement or some sort of 401k. Adherence to disciplinary policies, real job security, progressive pay scale,protection from termination for unjust causes simply because they can pay less to a new guy.etc....the fact that an ambulance company is slinging lots of Gs doesn't give me job security...then not being able to be reimbursed 100% of the time is also not my problem that's the way the business works. And most importantly providing good patient care for a pat in the back from my employer is definitely not why I would do it... In this business EMS workers are very expendable and one thing is for sure even the company men or brown nosers aren't immune to being canned....Work Union Live better ...
I come from a family of skilled trades men( from Iron workers to Plumbers) and they all make a descent living and all make over 100k a year always worked Union. And some 15 years ago I had the opportunity to get into the Union after the military since I have alot of connections and family but instead I chose to be an EMT and later a Paramedic because this is what I enjoyed doing and still do....but never expected it to have such a dark side, And be so degrading at times.[/QUOTE]
Maybe I will just hang up the driving gloves and just leave the industry and go work a Union job and lay pipe and make better wages instantly with no experience, And play paramedic for an operation like morongo or baker ambulance maybe as a flight medic just part time for the love of the job.

drl · Aug 30, 2014

SkiMaskWay said:
Billing is not my area of expertise... Sorry.. Patient care is. Also a dollar more?? That's not the kinda union I'm talking about .. How about medical, Dental , Vision, maybe retirement or some sort of 401k. Adherence to disciplinary policies, real job security, progressive pay scale,protection from termination for unjust causes simply because they can pay less to a new guy.etc....the fact that an ambulance company is slinging lots of Gs doesn't give me job security...then not being able to be reimbursed 100% of the time is also not my problem that's the way the business works. And most importantly providing good patient care for a pat in the back from my employer is definitely not why I would do it... In this business EMS workers are very expendable and one thing is for sure even the company men or brown nosers aren't immune to being canned....Work Union Live better ...

At least from what I've seen, unions in the EMS industry often don't provide huge wage increases. I have a friend who works in a unionized ambulance service in the same region as me, and the starting wage is less than a dollar more per hour, before union fee deductions. The benefits that my company provides are also on par with his, and begin after a shorter period of full-time employment.

One major area that his union does protect is job security; on the flip side, however, you get burned-out EMTs/medics who deliver sub-par care that the company can't easily let go. Bottom line, be careful what you wish for.

I agree with one of the earlier posters: if this EMS environment is to change, it needs to begin with raising the education, training, and certification bar. Once EMTs/medics are not so easily replaceable, like RNs, compensation will improve with or without unions.

And on the earlier note re. ambulatory patients who really don't need an ambulance: it's definitely in everyone's best interest to communicate that to the higher-ups. My company makes it pretty clear that they'll discontinue service for patients who don't need it, since insurance won't cover it.

DieselBolus · Aug 30, 2014

SkiMaskWay said:
Billing is not my area of expertise... Sorry.. Patient care is. Also a dollar more?? That's not the kinda union I'm talking about .. How about medical, Dental , Vision, maybe retirement or some sort of 401k. Adherence to disciplinary policies, real job security, progressive pay scale,protection from termination for unjust causes simply because they can pay less to a new guy.etc....the fact that an ambulance company is slinging lots of Gs doesn't give me job security...then not being able to be reimbursed 100% of the time is also not my problem that's the way the business works. And most importantly providing good patient care for a pat in the back from my employer is definitely not why I would do it... In this business EMS workers are very expendable and one thing is for sure even the company men or brown nosers aren't immune to being canned....Work Union Live better ...
I come from a family of skilled trades men( from Iron workers to Plumbers) and they all make a descent living and all make over 100k a year always worked Union. And some 15 years ago I had the opportunity to get into the Union after the military since I have alot of connections and family but instead I chose to be an EMT and later a Paramedic because this is what I enjoyed doing and still do....but never expected it to have such a dark side, And be so degrading at times.

As an IFT EMT it is absolutely integral to patient care to understand how Medicare patients (your biggest demographic) are affected by your documentation and interaction with all parties involved.

For example, ERs want to clear out beds, and if an ambulance ETA beats a wheelchair van by a number of hours, you can bet your *** an MD will sign a bull **** Physician's Certification Statement for Medical Necessity form in a heartbeat. I had that happen last night, and I'm sure it'll happen again within a week. If there's no supporting evidence in the chart or your PCR, that's a technical denial on a Tx granny didn't need. Without your advocacy, she may never be told it won't be covered. Read: a surprise bill for thousands of dollars for someone's elderly family member because you didn't act as a patient advocate. Again, as an IFT EMT, preventing unnecessary financial hardship is absolutely patient care.

As for your employer not getting paid for a Tx, do you think that could possibly have an effect on your wages? It is absolutely your problem. That's the way business works.

EMS personnel not understanding the long term implications of their actions doesn't just apply to clinical decisions. You can screw up a patient medically and financially.

Remember those bigger fish to fry before worrying about unions?

I would hope anyone proclaiming to be a professional and discussing the financial aspects of EMS would have at least a working knowledge of how Medicare affects their industry and their patients.

By the way, as a data point, I'm a Basic at an IFT only company and have the option of medical, vision, dental with decent premiums and 401(k) without a union. Also, I would say that for the 160 hours of education I have, as well as how easy, enjoyable, and low stress IFT is, and the glut of unemployed EMTs in my area, I have absolutely no gripes with being paid minimum wage. I'd pay me minimum wage too.

SkiMaskWay · Aug 30, 2014

DieselBolus said:
As an IFT EMT it is absolutely integral to patient care to understand how Medicare patients (your biggest demographic) are affected by your documentation and interaction with all parties involved.

For example, ERs want to clear out beds, and if an ambulance ETA beats a wheelchair van by a number of hours, you can bet your *** an MD will sign a bull **** Physician's Certification Statement for Medical Necessity form in a heartbeat. I had that happen last night, and I'm sure it'll happen again within a week. If there's no supporting evidence in the chart or your PCR, that's a technical denial on a Tx granny didn't need. Without your advocacy, she may never be told it won't be covered. Read: a surprise bill for thousands of dollars for someone's elderly family member because you didn't act as a patient advocate. Again, as an IFT EMT, preventing unnecessary financial hardship is absolutely patient care.

As for your employer not getting paid for a Tx, do you think that could possibly have an effect on your wages? It is absolutely your problem. That's the way business works.

EMS personnel not understanding the long term implications of their actions doesn't just apply to clinical decisions. You can screw up a patient medically and financially.

Remember those bigger fish to fry before worrying about unions?

I would hope anyone proclaiming to be a professional and discussing the financial aspects of EMS would have at least a working knowledge of how Medicare affects their industry and their patients.

By the way, as a data point, I'm a Basic at an IFT only company and have the option of medical, vision, dental with decent premiums and 401(k) without a union. Also, I would say that for the 160 hours of education I have, as well as how easy, enjoyable, and low stress IFT is, and the glut of unemployed EMTs in my area, I have absolutely no gripes with being paid minimum wage. I'd pay me minimum wage too.

We'll maybe they should include all of that good billing info in the next revision of the Brady's Paramedic and EMT textbook since according to you its patient care... Once again I'm a Paramedic with 12 years experience in the field and my expertise is on patient care not billing ....I formulate my treatment plan based on me exercising clinical judgment in the capacity of a Paramedic... I don't know about reimbursement or medical or medicare billing nor do I care, what I do care is that I provide the best possible care for the patient in my truck in the few minutes they will spend with me....as far as you being content with your pay thats your problem and the life style you want, but the fact that EMTs only have a 160 hours of training there is no excuse for low ball wages. There is a lot of other industries that an abundance of workers exists due to absolutely no training needed yet they make substantially better salaries with frindge benefits... So don't throw that myth about x amount of hours of schooling that's just a bs line ...in this day and age employers want specialized training ...a worker that can work. A skilled and experienced person
At a job or trade. and good wages equals good moral and productivity and longevity. Cheap labor is cheap, poor quality , high turnaround. That's why most construction firms hire union workers because things are done right the first no needed for second inspection.
Go to home depot and hire an illegal to build you a house good luck passing inspection. Same idea. Cheap labor you pay for what you get...

SkiMaskWay · Aug 30, 2014

DieselBolus said:
As an IFT EMT it is absolutely integral to patient care to understand how Medicare patients (your biggest demographic) are affected by your documentation and interaction with all parties involved.

For example, ERs want to clear out beds, and if an ambulance ETA beats a wheelchair van by a number of hours, you can bet your *** an MD will sign a bull **** Physician's Certification Statement for Medical Necessity form in a heartbeat. I had that happen last night, and I'm sure it'll happen again within a week. If there's no supporting evidence in the chart or your PCR, that's a technical denial on a Tx granny didn't need. Without your advocacy, she may never be told it won't be covered. Read: a surprise bill for thousands of dollars for someone's elderly family member because you didn't act as a patient advocate. Again, as an IFT EMT, preventing unnecessary financial hardship is absolutely patient care.

As for your employer not getting paid for a Tx, do you think that could possibly have an effect on your wages? It is absolutely your problem. That's the way business works.

EMS personnel not understanding the long term implications of their actions doesn't just apply to clinical decisions. You can screw up a patient medically and financially.

Remember those bigger fish to fry before worrying about unions?

I would hope anyone proclaiming to be a professional and discussing the financial aspects of EMS would have at least a working knowledge of how Medicare affects their industry and their patients.

By the way, as a data point, I'm a Basic at an IFT only company and have the option of medical, vision, dental with decent premiums and 401(k) without a union. Also, I would say that for the 160 hours of education I have, as well as how easy, enjoyable, and low stress IFT is, and the glut of unemployed EMTs in my area, I have absolutely no gripes with being paid minimum wage. I'd pay me minimum wage too.

Also as far as pay being impacted by non reimbursement?? No I'm an hourly employee...I don't work on commission... I don't get paid anymore or less if xyz Ambulance reimburses..in fact if I was making minimum wage I treat that job as such: A minimum wage job!!!

SkiMaskWay · Aug 30, 2014

DieselBolus said:
As an IFT EMT it is absolutely integral to patient care to understand how Medicare patients (your biggest demographic) are affected by your documentation and interaction with all parties involved.

For example, ERs want to clear out beds, and if an ambulance ETA beats a wheelchair van by a number of hours, you can bet your *** an MD will sign a bull **** Physician's Certification Statement for Medical Necessity form in a heartbeat. I had that happen last night, and I'm sure it'll happen again within a week. If there's no supporting evidence in the chart or your PCR, that's a technical denial on a Tx granny didn't need. Without your advocacy, she may never be told it won't be covered. Read: a surprise bill for thousands of dollars for someone's elderly family member because you didn't act as a patient advocate. Again, as an IFT EMT, preventing unnecessary financial hardship is absolutely patient care.

As for your employer not getting paid for a Tx, do you think that could possibly have an effect on your wages? It is absolutely your problem. That's the way business works.

EMS personnel not understanding the long term implications of their actions doesn't just apply to clinical decisions. You can screw up a patient medically and financially.

Remember those bigger fish to fry before worrying about unions?

I would hope anyone proclaiming to be a professional and discussing the financial aspects of EMS would have at least a working knowledge of how Medicare affects their industry and their patients.

By the way, as a data point, I'm a Basic at an IFT only company and have the option of medical, vision, dental with decent premiums and 401(k) without a union. Also, I would say that for the 160 hours of education I have, as well as how easy, enjoyable, and low stress IFT is, and the glut of unemployed EMTs in my area, I have absolutely no gripes with being paid minimum wage. I'd pay me minimum wage too.

I would hope that any Ambulance service proclaiming to be a Professional Ambulance service that may be serving my community would atleast have the descentsie to provide their medical professionals with livable wages and access to healthcare in the form of medical insurance and benefits. I could I expect good patient care if you don't even take care of your own. And as far as being a Billing advocate for the patient??? Your delusional! You really are!

DieselBolus · Aug 30, 2014

If the Brady book has every aspect of patient care covered, then why did you feel the need to post how long you've been in the field?

The fact of the matter is people are more than willing to work for the market rate. Most people dont intend on, or want to be "lifers" in private EMS. They move to fire, or move up from their vocational position as a medic to a professional position with more education.

I'm happy with my minimum wage because I need the hours for medic school. Its like a paid internship. It's also a hell of a lot more intellectually stimulating than my previous job doing drywall.

As far as me being delusional, probably. But CMS states that for a Medicare patient where the transporting staff suspects that there will be a technical denial, a good faith effort to deliver an Advanced Beneficiary Notice must be attempted. The patient, now informed that they will likely be fully responsible for the transport vs. the 20% copay they pay for a covered ride, then has the opportunity to refuse the transport and wait for the wheelchair van for ~$50+$5/mile vs thousands for an ambulance. The wheelchair van is usually the more popular choice for those who dont need an ambulance.

By the way, pay is usually impacted when your company has nothing to pay you with.

drl · Aug 30, 2014

In the modern health care system, everyone has to deal with billing. Even a large part of doctors' work is dealing with insurance companies and MediCare. Like it or not, the days where healthcare providers could focus on just patient care are over.

EMS Unions in So cal

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