IFT companies

[njff/emt]

Is anyone else besides myself getting really sick(more than usual) of the IFT company their working for?

 

[Shishkabob]

They're



And yes, only because it's IFT and not because of the company.

 

[DrParasite]

most IFT companies (at least in NJ) are :censored::censored::censored::censored:ty for-profit companies, where profits are more important that the employees, working conditions, or anything else.

I worked for an IFT company for 3 months..... I can honestly say if I never do another IFT, I will be a happy man.

Many in EMS start out in IFT, with a goal of getting hired by a 911 service. Some hospital based services have an IFT division and 911 division, and in order to get into the 911 division, you have to do your time in the IFT section.

Do your time, make some money, but if you can, be on the lookout to get a real job doing 911 EMS

 

[AnthonyTheEmt]

absolutely, I hate the company I work for. They care more about profit than patient care and have proven that time and time again. Last week we did a transport from San Francisco to Eureka (about 250 miles, 6 hours) and they wouldnt let us take the big box because it was not gas efficient. Not to mention, a coworker was written up because a SNF was offended by him asking for history, meds, allergies.

 

[Flight-LP]

absolutely, I hate the company I work for. They care more about profit than patient care and have proven that time and time again. Last week we did a transport from San Francisco to Eureka (about 250 miles, 6 hours) and they wouldnt let us take the big box because it was not gas efficient. Not to mention, a coworker was written up because a SNF was offended by him asking for history, meds, allergies.

Why does that transport necessitate a type III ambulance? Personally, I agree with their decision. Why take a more costly and non efficient unit, if their is alternative that is perfectly adequate? Did your patients equipment needs require the additional room?

I have to laugh at many of these IFT posts. Yes, these companies are profit driven, after all they are a BUSINESS. Not all place money before the advocacy of their patients though, there are, believe it or not, those running IFT companies that do respect and appreciate the individual needs of their clients. On the other hand, there are a lot of crap operators.....

I believe many of these frustrations stem from a complete lack of understanding the business side of EMS. Regardless of your clientele or the type of business model your agency has, all must be financially judicious if they wish to survive in todays economy. All too often, ignorant EMT's who have no concept of anything EMS other than the "cool stuff", are the one's doing the complaining. Their expectations are highly unrealistic.

Since we like to eat our own and always place blame, we should start with the EMT schools that provide ZERO instruction into the business of our industry. Hell, even most Paramedic programs fail to educate on this aspect. That has got to change! (Of course, so does the unneeded supply of minimally trained technicians being pumped out of schools every month, but I digress.........)

 

[Aidey]

While I mostly agree with you, there is a difference between business and borderline defrauding insurance companies. I don't blame people when they get frustrated at the latter.

Grandma has a broken hip and needs to go from her SNF to the ER? Ok, valid.

Grandma's son drove her to the hospital for foot pain, and forgot to grab her O2 tank when he left. Even though he drove her to the hospital without it ok, the hospital won't let him take her home without it. Son refuses to go get one, so the hospital calls an ambulance.

I know in that case it is the hospital initiating the transport, but the company, knowing full well that it will be rejected as not medically necessary should have a obligation to make sure the hospital and pt/family know that instead of doing the transport and then surprising them with a bill in 6 weeks.


Or even better, the medical director for a private company is also a practicing family practice MD that has a large number of patients in SNFs and such. No matter what the doctor ALWAYS orders transport for those patients when staff call him with some concern. Even if they are hospice or comfort care or whatever you want to call it. Questionable much?

 

[Flight-LP]

You are correct, there is a huge difference. However, that was not the complaint presented.

 

[46Young]

There are a few legitimate issues with some IFT companies. Bouncing paychecks. Inaccurate hours. Sending someone home after a few hours w/LWOP if their partner bangs in. Pt steering to the hospital that benefits the sending MD instead of the closest appropriate in the emergent situation. Encouraging fraudulent billing to show medical necessity when there is none. Punitive measures toward employees that refuse to steer pts and or refuse to be pressured into fraudulent billing practices, such as write ups, LWOP, reduction of hours, schedule changes, termination. Punitive measures towards those who use sick time. Inadequate supplies and equipment. Failure to back their employees during a dispute with a contract facility when they're in the right. Poor or no pay progression. A lower rate of pay than was agreed upon during the interview, when you get your check. Mandated working holidays with little to no additional pay, certainly not 1 1/2 to double time, as is the industry standard. No uniform allowance. No deferred comp. No medical insurance (yes, there are a few that give no benefits whatsoever).

Many IFT companies are guilty of at least a few of these examples, and some are guilty of a good many of them.

 

[JPINFV]

Grandma's son drove her to the hospital for foot pain, and forgot to grab her O2 tank when he left. Even though he drove her to the hospital without it ok, the hospital won't let him take her home without it. Son refuses to go get one, so the hospital calls an ambulance.

I know in that case it is the hospital initiating the transport, but the company, knowing full well that it will be rejected as not medically necessary should have a obligation to make sure the hospital and pt/family know that instead of doing the transport and then surprising them with a bill in 6 weeks.

I would agree that it's fraud, if the dispatcher or crew knew the background. However, I'm pretty sure that most of the information gleaned from the call taker is along the lines of pick up, drop off, insurance, C/C, and medical necessity (in this case oxygen use). The nurse is going to sign the declaration of medical necessity, which will appease the crew. Patient gets transported. If no one knows that the patient is safe to go the short time without oxygen, then it's hard to say that it's fraud.

Or even better, the medical director for a private company is also a practicing family practice MD that has a large number of patients in SNFs and such. No matter what the doctor ALWAYS orders transport for those patients when staff call him with some concern. Even if they are hospice or comfort care or whatever you want to call it. Questionable much?

So the EMT, dispatcher, or the call taker are supposed to second guess the physician's transport order? Also, what happens if there is something going on with a hospice patient that warrants treatment, but needs to be hospitalized for a few days? This seems to be more of a problem with SNFs than with ambulance companies.

 

[Aidey]

In the first example you're forgetting that both the patient and son are (and did) able to say "we don't need the ambulance." In my reports I always say "The patient is being transported by ambulance because _____________", and I'm not about to lie or leave out info.

As for the second example, I could get into it more, because the situation truly was wrong in a number of ways. It wasn't about all SNFs, it was about the fact that the Medical Director of a private ambulance was ordering multiple questionable transports for his patients. It is hard to explain without getting way more into it than I want to. But in the long run it was the ER docs complaining that ended the situation.

 

[Sassafras]

Hmmm, I'm still new at my IFT so I can't complain yet LOL. Really though they do seem to care about their employees, and they really push positive customer relations which is right up my alley being in retail as long as I was.

 

[ochacon80]

I'm at the brink of frustration with my IFT company. I enjoy most of the people I work with and I have developed a good relationship with some of the ER staffs in Long Beach, but my company is starting to feel like a sinking ship. I think the two things that piss me off the most are Marketing department and the loss of seniority.

We are a small company so we only have, or HAD two marketers. One would get us legit calls with patients who needed an actual ambulance. The other marketer is ridiculous! she has turned us into a taxi service giving us patients with no complaints whats so ever, most of them damn near jog to my rig.

The second is the worse of all, seniority has been taken aways due to our companies new recruiting strategy. Promising new people flexible scheduling, while the established EMT's work the weekends and nights.

 

[firetender]

IFT; the grease that turns the wheels

Guaranteed payment. That is what allows many private ambulance services to respond to emergencies. IFT as a stand-alone business is subject to all of the "cut-corners" and minimization of employees as exists wherever the management are hacks. Some actually pride themselves on doing good work.

But as has already been pointed out, IFT is VERY much a part of what we do and it's more than just hauling around flesh and bones. I think a lot of us are guilty (I certainly was, far too often!) of looking at IFTs as "have-tos" just UNTIL that "real" emergency comes up. It's an integral part of the job and deserves more attention because, believe it or not, those are times when we get to act as healers.

Do you understand the power of connection as a tool of healing? It's as important as anything in your drug box. It is so important it can determine the positive course of a call and favorably affect the rest of the patient's life. IFTs are where you get to practice the art, and see results immediately.

Why would you choose not to grow in ALL aspects of the "care and transportation of the sick and injured"? If I remember correctly, that's what the whole EMT program was about; pre-paramedic, but it has always been the foundation of the biz.

 

[ochacon80]

Even though I am IFT I take pride in my patient care, I assess patients and look for signs of seriously potential problems, my patients are in good hands, it's just the management side of things that has be burnt on my company.

I have a question of ethics though. According to my training a chief complaint is defined as the reason we (EMS) were called, or what is wrong with the pt. Now I have been given a couple of warning because on my PCR I wrote Pt has no medical cc. The pt is one of our regular dialysis pts and there seriously is never anything wrong with him, he has htn, DM, and anemia, but whenever I see him he is alert, orientated, and all signs point to him being in no distress, yet I am told to find a reason!!!

 

[JPINFV]

Dialysis patient going to/from dialysis? C/C is often renal failure and the reason for transport is dialysis.

Technically speaking, the "chief complaint" is what ever the patient says it is. However I agree that it is also often acceptable to list the working diagnosis, especially when the staff given CC doesn't match up at all with patient presentation.

 

[ochacon80]

Yeah but Renal Faliure is a dx and I have been told that can't be used as a cc so I refuse to make one up or go with the "general weakness"

 

[Aidey]

That is where "presenting problem" works better than "chief complaint".

Example

Presenting problem: Renal Failure needing dialysis.

HX: The patient is a 40 year old male with ESRD who is being transported to his dialysis appointment. The pt is being transported via ambulance because he had recent back surgery and needs to lay flat.

 

[Shishkabob]

C/C of "can't pee".

 

[firetender]

A Humanistic Outlook

I have a question of ethics...He has htn, DM, and anemia, but whenever I see him he is alert, orientated, and all signs point to him being in no distress, yet I am told to find a reason!!!

ETHICALLY there's nothing wrong with offering recumbent transport to an individual with a multiplicity of medical problems to assure his comfort while going to and returning from a medically prescribed PROCEDURE.

Of course he's in no distress, he's with YOU! Betcha a buck it'd be a whole lot different cramming him into Sister's Toyota where he'd then have to worry about Spontaneous Acceleration!

 

[ochacon80]

ETHICALLY there's nothing wrong with offering recumbent transport to an individual with a multiplicity of medical problems to assure his comfort while going to and returning from a medically prescribed PROCEDURE.

Of course he's in no distress, he's with YOU! Betcha a buck it'd be a whole lot different cramming him into Sister's Toyota where he'd then have to worry about Spontaneous Acceleration!

Depending on who the driver is, spontaneous acceleration in the ambulance is always possible lol.