Billing and 911

[Shishkabob]

The challenge with EMS is that the bill is so astronomically high compared to the level of service the public perceives we provide.

Because those who actually pay are subsidizing the vast majority of those that don't. (I know you know, just saying)


My new agency actually sends all new hires through the billing department AND actually has provided EACH new employee the entire company's itemized budget for the year so we see where money comes in and where it gets spent.



I'm going to be honest here: The vast majority of the time I tell someone who's giving me a 'refusal' that they should 'be checked out by a doctor because as a Paramedic I can only do so much', it's mainly just so if asked, I can honestly say I told them to.

 

[the_negro_puppy]

In a paying system if people call for an Ambulance and refuse transport they should be billed. Otherwise there is no disincentive for them to stop abusing Ambulances for free 'check ups" instead of seeing their doctor or going to a pharmacy and taking Tylenol for their fever.

Unfortunately or fortunately? :glare: all Ambulances and transport in my state are free to due our socialised healthcare. People can call an ambulance for anything they want (and they will get one eventually) and get transported to hospital for anything. Any overseas or out of state residents get charged $1000 for an Ambulance trip.

 

[mycrofft]

$400 is helping defray the tons of deadbeats

Hence $25 tylenols in the hospital and $600 toilet seats in the USAF.

You average your number of dispatches per month versus your amortization and outstanding debt service then add profit and come up with a "per dispatch" charge.

Personally, I think the overhead is greatly exaggerated. The local hospital crying "poor" all the time are quietly buying up their surrounding properties and becoming amongst the largest property owners in town...and all nonprofit.

 

[Luno]

The real scam

Unfortunately, people perceive that their taxes and the property levies that they approve every year for the fire department are paying for their medical emergencies. Just look at how much EMS and call response is pushed whenever the fire departments are asking for money. Now the dirty secret is that the fire departments really don't do much with regards to treating and transporting the people who contribute to them, but rather sell them out to private companies. Now I'm sure somebody is going to get their panties in a bunch, and whine that "my department always transports our residents where ever they want to go, no charge." However that is in the minority, and unfortunately that money that is wasted on non-transporting fire departments that provide the illusion of EMS is just that a scam. Money is wasted by sending someone to help that can't get you to a hospital if you need to go. Response times and the golden hour have already been shown to be mountains created out of mole hills. If I called 911 in my city, I would not go with a private ambulance, because I've already paid to be served by local department. That's not saying anything bad about private ambulance, I've worked with some of the best providers on the private side, however, I will not pay twice for a service that I've already been taxed for.

 

[JPINFV]

^
So the best solution is to simply not automatically dispatch the fire department to EMS calls.

 

[the_negro_puppy]

^
So the best solution is to simply not automatically dispatch the fire department to EMS calls.

Do any other countries besides the US use Fire Departments as part of EMS?

 

[Tigger]

Devils advocate time (even if it should be it's own subject), how much time is spent in paramedic school determining who needs to be hospitalized and who doesn't? Needing to go to the hospital and needing to go to the hospital via ambulance should be two different topics entirely. However, often a "you need to see a doctor, but don't need an ambulance" is often going to be interpreted as "you don't need a doctor."

I'll agree that more education is needed, but that doesn't change the current system. Our patients aren't aware that EMS might not be the people who are most qualified to decide whether they need to go the hospital or not, but we get there a lot quicker than the visiting nurse. Like many other aspects of EMS, we sometimes fill a role that our jobs were not quite designed for.

I agree that patients shouldn't be forced to go to the hospital just for the ability to bill. However...

1. Refusing to force transport is not the same as providers more often being willfully ignorant of what, how much, and when bills are sent (and yes, I spent the majority of my time being willfully ignorant).

The willful ignorance is an unfortunate byproduct of the current transport based billing system. In the short-term, it does no one any good to not be willfully ignorant. My bosses want all the transports as possible, and the average EMT is happy to transport everyone too, either because of an unwarranted fear of litigation or the misguided notion that the hospital helps all step through its doors.

2. Ambulance services should bill for services provided. Treat and release is a service. Assessment is a service. Unless the patient says, "No, I'm fine, I didn't call an ambulance," then a billable service has been completed.

No doubt.

 

[looker]

^
So the best solution is to simply not automatically dispatch the fire department to EMS calls.

I would support that but it is not going to happen. If there is no fire, no need for heaving lifting etc then there is no need for fire.

 

[Sandog]

^
So the best solution is to simply not automatically dispatch the fire department to EMS calls.

When I crashed my motorcycle in San Diego, was treated by the FD, I still got a transport bill, not sure where this free stuff comes from.

 

[JPINFV]

When I crashed my motorcycle in San Diego, was treated by the FD, I still got a transport bill, not sure where this free stuff comes from.

Were you transported? Follow up: You do realize that Rural/Metro provides transport services in the City of San Diego?

 

[exodus]

Yup, SD county is provided by SDMSE a private company. They just partner with the FD to provide stations. Certain cities, such as Santee, lakeside, El Cajon, Barona, and a few others are all FD transport so the taxes pay for them.

 

[Bosco836]

San Francisco, California. Patient requests for an ambulance via 911, Engine and Private company arrives. Walks down stairs and into ambulance, gets blood pressure, blood glucose, and 4 lead. Patient feels significantly better, and signs an 'against medical advice', and walks back home. No transport was done.

Patient was billed 400 dollars 2 days later by private company. Patient was unaware they would be billed, refused transport and believed they should not have been billed.
Comments?

Thank you,
Alas

Obviously things are a little different here in Ontario, Canada - but - over here, no pt. receives a bill unless they were transported to a hospital. If a refusal is obtained, no bill is issued.

 

[medicdan]

Obviously things are a little different here in Ontario, Canada - but - over here, no pt. receives a bill unless they were transported to a hospital. If a refusal is obtained, no bill is issued.

How does that impact your practice? Do you find patients "abuse" this-- and expect on scene-treatment then release? How often do you get refusals, or not transport?

 

[Bosco836]

How does that impact your practice? Do you find patients "abuse" this-- and expect on scene-treatment then release? How often do you get refusals, or not transport?

Things obviously differ among the various paramedic services across the province. Obviously, some pt.'s are content with an assessment/on-scene treatment and then signing a refusal; however, I wouldn't say that's the norm.

Even pt's who go to the hospital via ambulance are usually only billed 45 dollars per transport - regardless of the treatment rendered (the exception of course is if its deemed a 'non-emergent transfer - then the bill is for 240. However, in practice, this rarely happens). Moreover, many private insurance plans will even reimburse transport fees. With that said, I would suggest that there isn't much of an incentive to call 911 to have paramedics attend, only to sign a refusal - as there might be if a similar practice were adopted in the USA (whereby if a refusal was free relative to a transport that may cost 1000's of dollars).

With respect to the number of refusals vs. transports, I suppose that really depends on the paramedic service. In my area, I would suggest that most calls do result in transports, but with that said - refusal's aren't unheard of either - especially with (minor) car accidents where 911's been called by bystanders - or perceived medical emergencies in public (i.e. a person fainting at a wedding who regains consciousness within a few seconds, is CAOx3 following the incident, has stable v/s, etc.)

More info re: billing practices can be found here - http://www.health.gov.on.ca/english/public/program/ehs/land/service_qa.html