I think a lot of Looker's issues are a non-issue if (when) non-emergent transport was completely disassociated with the emergency medical system outside of an MCI/disaster surge capacity role.
If people can't make much money why would they stay in this business? At the end of the day it's about profit.
The question isn't whether a profit is being made or not, but what is done with the profit. How much is being reinvested into the company vs going into the owners pocket, especially for something that should, at worst, be treated like a natural monopoly like water service or power (prior to deregulation in California).
Something tells me city would object to this
Depends. Plenty of cities run great non-fire EMS systems, and a lot of the recent mergers aren't going well. Ultimately, the success of fire based EMS revolves around the attitude involved. Is fire suppression and EMS equals? Is EMS just something that the fire department has to do during their down time? Is it more of a behind the scenes ("fire department administered EMS), which can go either good (Seattle) or bad (New York City)?
Couple of issue with this. 1) Will all current emt/medic be grandfathered? Also how much more would it cost to become emt/medic, how long etc? That would make big difference if people would go in to this field or not. Especially if all ambulance company become non profit.
I have no problem with grandfathered status provided that the grandfathered applicants can meet the new standards (i.e. can they at least pass the test). There will always be a transition period. As a perfect example, when Emergency Medicine became a medical specialty, there was a practice track to essentially grandfather emergency physicians into board certification without going through a residency. That track has been closed for a while and the only way to become a board certified (through ABEM and AOBEM) is by completing a residency. However, the practice track wasn't a simple, "Oh, you worked in an emergency room? Here's your card."
As far as cost, what about it? Ideally, as education level increases, so does usefulness and scope of practice (including things like community paramedicine, research, etc), which will ultimately lead to increased reimbursement. The current path, however, is not sustainable especially as Medicare continues to cut reimbursement.
Big problem if current emt/medic are not grandfathered in to this plan. Pay will also be bigi problem. Everything cost money to run ambulance company, lets not forget that.
Where's the problem? If EMS providers were reimbursed for providing care besides transport, then reimbursement will go up, even as transports go down. The problem is that currently it's fee for service, and the only service recognized by Medicare is transport. Is the only potential value for EMS is as a glorified taxi driver?
This would eliminate big pool of people being how low emt are being paid. If you need to get bs to be a medic you might as well get some good bs degree and work in that field.
1. I don't think the assumption that reimbursement would not increase when EMS can begin to do something other than transport every patient to the ED is not a valid assumption.
2. Why can't paramedicine be good work? Work worthy of requiring a proper education?
extra cost that is just not needed.
Yet having a bajillion and a half paramedics sitting around fire stations is a justified extra cost?
Why not make gurney vehicle paid by medicare and eliminate majority of the industry which is what will happened eitherway.
For non-emergent medical transport? Sure. For pre-hospital emergency medicine? The better path is to integrate it better into the health care system as something other than a medical taxi service.
Looker, how do you ultimately view your company? Is it a medical taxi company? Is it, in any part, providing prehospital emergency medicine? Do you provide, in some fashion health care?
If you're ultimately coming from a medical taxi service view point, I can understand your argument completely. That portion of "EMS" (it should have never been a part of EMS due to different demands and different needs, not a "one side is better than the other" view) has a legitimate stake at keeping the trade as it currently is. Unfortunately, the demands of the 911 service is moving towards being able to do more than be a medical taxi service. Ultimately how do we ensure that paramedics are capable of taking on the roles that the health care system needs them to take on?
