Medi-care will never let the cut go through. It just will not happen.
Advocacy
- Thread starter Sasha
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Medi-care will never let the cut go through. It just will not happen.
To anyone from other states, does it work differently from the way it works in California? Unfortunately what you say is 100% the fact, if we piss them off, we get nothing. It's the reality of the business. Some companys actually "pay" to get patients, i refuse but as result taking much longer to get more and more patients.
JPINFV
Gadfly
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No, it works like that everywhere. When I was in MA, I heard first hand accounts of employees making facilities so mad that the service was essentially told to never set foot on the property again.
Edit:
As a side note, since the concept of mandated reporter came up, if you do fulfill your legal duty, make sure you have your ducks in a row. As someone who has sent in a report and received an interrogation by phone with the GM when the poop finally hit the fan, need to be able to answer the following:
1. Why did you report? (here's what happened, here was what my concern was, etc).
2. Why didn't you let the company handle it? (I am legally required to. In fact, [at least in CA] "EMTs" are named specifically and do not fall under the "not limited to" clause. I. Have. No. Other. Legal. Choice.)
3. Why didn't you let the company know? (In my case, "You got my incident report, right?" For everyone else, submit an incident report).
Edit:
As a side note, since the concept of mandated reporter came up, if you do fulfill your legal duty, make sure you have your ducks in a row. As someone who has sent in a report and received an interrogation by phone with the GM when the poop finally hit the fan, need to be able to answer the following:
1. Why did you report? (here's what happened, here was what my concern was, etc).
2. Why didn't you let the company handle it? (I am legally required to. In fact, [at least in CA] "EMTs" are named specifically and do not fall under the "not limited to" clause. I. Have. No. Other. Legal. Choice.)
3. Why didn't you let the company know? (In my case, "You got my incident report, right?" For everyone else, submit an incident report).
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Nurses...?
it ain't the nurses making the decisions about which ambulance company to call, it's the people paying the nurses, same ones that people who own private ambulance companies bribe to get the calls from.
As for not filing Medicare claims, given that an average IFT ambulance EMT can write up a PCR that makes it sound like the EMT is Johnny Gage, Roy Desoto and the entire cast of "Trauma" and that the patient was on death's door til the EMT arrived to save the day, I'd spend my time billing private medical insurance companies too. Far less chance of getting indicted for fraud that way, as I'm sure our resident ambulance company owner could attest too if he/she was honest.
I'm shocked at the naivete around here at times.
it ain't the nurses making the decisions about which ambulance company to call, it's the people paying the nurses, same ones that people who own private ambulance companies bribe to get the calls from.
As for not filing Medicare claims, given that an average IFT ambulance EMT can write up a PCR that makes it sound like the EMT is Johnny Gage, Roy Desoto and the entire cast of "Trauma" and that the patient was on death's door til the EMT arrived to save the day, I'd spend my time billing private medical insurance companies too. Far less chance of getting indicted for fraud that way, as I'm sure our resident ambulance company owner could attest too if he/she was honest.
I'm shocked at the naivete around here at times.
redcrossemt
Forum Asst. Chief
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Unfortunately, about 90% of our rescue payors and I would guess over 60% of our IFT payors are Medicare and Medicaid. My company spends our time enforcing the rules and making sure we have our ducks in a row, as another poster said, so we can get paid. If we gave up care/caid payments, we'd be out of business.
mycrofft
Still crazy but elsewhere
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OP, know your state laws, and the County Ombudsman's number.
IF a facility is dirty, unsafe, and objectively objectionable, then turn the whole place in.
(Don't you hate being called OP?)
IF a facility is dirty, unsafe, and objectively objectionable, then turn the whole place in.
(Don't you hate being called OP?)
JPINFV
Gadfly
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Unless your chain of command is in direct violation of the law. If you suspect abuse while working as a medical provider or non-volunteer fire fighter, you are required to report, regardless of what your chain of command says.
Child abuse: CA Penal Code
Elder and dependent adult abuse: CA Health and Welfare Code:
LACo LEMSA protocol on child abuse reporting
http://ems.dhs.lacounty.gov/policies/Ref800/822.pdf
LACo LEMSA protocol on elder/dependent adult abuse reporting
http://ems.dhs.lacounty.gov/policies/Ref800/823.pdf
Sorry, but if you so much as suspect that child or elder abuse occurred, then your patient care team are legally required to report it. If more than one mandated reporter is present, then the report can be done as a group, however if you become aware that your designated person (i.e. the officer you're trying to pawn it off on) doesn't report it, then you are required to make the report. Failure to report suspected abuse is 6 months in jail and/or up to $1,000 fine.
Edit: LA Co LEMSA represents the top of the EMS chain of command in LA County. As such, their rules, regulations, and protocols override what anyone in your service says while working as an EMT. Similarly, California state law over rides anything your service says. Finally, I have one word, just one word. Nuremberg.
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ummm, that defense didn't work for the soldiers at Abu Ghraib.
Having said that civilian side EMS is a different animal. So is civilian firefighting.
Just a couple of quick points.
If an online medical control physician gives you an order for an improper medication or an excessive dose, if you follow that order without question and the patient comes to harm, you are responsible.
If you do not question an order or do not refuse to carry out an order for a procedure you have not been trained to do and/or is outside your scope of practice, you are responsible. (with both criminal and civil liability)
If you are ordered to perform some operational task which will result in harm to others, you are responsible.
Now there is a proper and professional way to question orders just as there are laws that compel a provider to report certain events. (like gunshot wounds, child/elder abuse, etc.)
In my original response to this post I tried to point out some system issues that may come up that have to be dealt with in a professional manner.
Just as there is a proper way to address problems there are also several not very conventional ways in handling potential issues. (which I will not detail here) There is definately a few wrong ways to handle these situations.
Not everyone in healthcare knows all about the details of what is happening to patients down the pipe. When I am an attending physician I would certainly want to know and be thankful for a paramedic who brings to my attention a circumstance which may put my patient at risk or cause outright harm so that I can address it. Like a nursing home without the ability to take fall precautions or that does not have a specific piece of equipment that my patient absolutely needs immediately.(I tried to demonstrate that not all equipment is immediately required for life or health, but some things are.)
In the IFT world, if an ALS ambulance is sent to pick up my patient for transfer and they do not have the knowledge, skills, or equipment to care for my patient I want to know before the patient is loaded so I can get somebody who can. I don't want them to take the patient because they were ordered to by a dispatcher or anyone else "in their chain of command."
If an IFT unit goes to a facility with a patient that has indwelling medical devices or is immuno compromised and that facility is a cesspool, I want them keep the patient and bring them right back to the hospital. Sepsis like trauma is easier and cheaper to prevent than it is to treat.
Being a healthcare provider of any title requires independant thought and the ability to take action. There are many providers in the continuity of patient care, questions and problems need to flow both ways in order to help the patient. Haelthcare is about helping people, not achieving a mission.
Either in the military or the fire service, do not mistake a higher ranking officer for a superior one.
Just to be clear - are you suggesting that you have no moral obligation to report child or elder abuse?
Sandog
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We as human beings have a moral obligation. Even the military observes a protocol such as a lawful order.
The wallet be damned. Right is right, wrong is wrong, to ignore this basic premise questions ones moral compass.
How would...
doing what you're legally mandated to do, which is to report any signs of sexual or physical abuse, violate anyone's "protocols"?
Atropine, I like a good intellectual argument as much or more than the next guy, but you seem to be going out of your way to make a really baseless point. Please explain what the hell you're talking about.
doing what you're legally mandated to do, which is to report any signs of sexual or physical abuse, violate anyone's "protocols"?
Atropine, I like a good intellectual argument as much or more than the next guy, but you seem to be going out of your way to make a really baseless point. Please explain what the hell you're talking about.
Sandog
Forum Asst. Chief
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I am gobsmacked (as the brits would say). Please tell me that you missed a noun and adjective somewhere in this statement. I wish to give you the benefit of doubt. As a human Gosh dern being you have a darn gosh obligation to help those that cannot help themselves. If you think otherwise and only of your wallet, then I pity you. I am sorry for being so blunt but you just made me so gosh darn mad. I am more probie than probie can get, I just hope I never have a partner that thinks this way.
8jimi8
CFRN
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quoted and bolded the theory,
quoted the evidence that the theory is wrong.
and a follow-up question, what protocol tells you not to report inadequate care?
You have a DUTY to deliver your patient to EQUAL or HIGHER level of care. Leaving your patient in an unsafe situation is not EQUAL OR HIGHER
Get it, Atropine?
btw, please don't take my bolding, quoting, italicizing, or underlining as a personal attack.
Sandog
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Just to be clear. I used words like darn and gosh, as not to swear...
All right let me giva an example, of what Iam talking about. Say you have a STEMI pt. and your first in hospital is closer than the other hospital with a cath lab, I would take my pt. to the closedt, one I have an obligation to my community to get back in service right away, and two the pt. is going to recieve way more advanced care than i can give them as far as treatment and continuous Dx specific care, and third depending on the time of day with traffic and all they would benifit from all the specific medications involving the STEMI Dx than waisting time in the back of the ambulance fighting traffic. The er is going to get them to the cath lab anyways maybe by CCT transport or some other means, so thats my example. However where I work most places do have a cath lab so this is kinda of a far streched example, except for the traffic part sometime it's almost impossible just to get down the street in our first in.
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No offense man, but I really wouldn't want to go to court with that.
Yeah I agree, lucky this can't happen where I work, but i imagine it could somewhere else around the country that doesn't have too many hospitals to choose from let alone any with specific capabilities. Again this is just an example of what i was talking about.
Your obligation to your current patient is to take them to the closest appropriate facility. In the case of a STEMI, that means a facility that has catheterization ability. If your concern is cross-town traffic, well, then a CCT truck is going to have the same problem.
I will admit, the calculus might change if the closest appropriate facility is far away, or the patient is so unstable they need a hospital right now. But isn't that supposed to be what paramedics are for? Bringing advanced emergency room techniques to the back of an ambulance?
If you have a patient who has a need for specialized care, and a reasonable paramedic would have taken the extra time to transport them to the specialized facility, and the patient suffered additional harm (further heart tissue necrosis in the STEMI case we're discussing), then you could certainly be legally liable. And I'm pretty sure, from my trial experience, that a jury isn't going to want to hear that you needed to get back into service a little more quickly.
If you /know/ the hospital isn't equipped to deal with the patient you're bringing them, then you have an obligation not to bring them there. Your protocols shouldn't require you to, and the protocols aren't going to be much of a fig leaf when someone dies (or, worse yet from a liability standpoint, becomes permanently disabled and in need of lifetime medical care) because you needed to get back to the station faster to wax the engine and hit the recliner in time for The View.