NYT Article on EMS Billing

usalsfyre

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The comments of that article are exactly why we need to be better at public relations...
 

EMDispatch

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The comments of that article are exactly why we need to be better at public relations...

Reading the comments was pretty shocking. Especially the guy complaining about his bill for the MI.

I understand people feeling pressured to be transported. Is it deliberate? No, but they get caught up in the moment, and they don't necessarily think logically. I just find it fascinating how many are saying they were bullied into it... Then again family members often comeback after a cardiac arrest, and claim they weren't provided CPR instructions or asked if they wanted to attempt.

The comments are definitely worth the read.
 

Christopher

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The comments of that article are exactly why we need to be better at public relations...

I mean sure, the comments are misguided, but reading the lead-in...

Kira Milas has no idea who called 911, summoning an ambulance filled with emergency medical technicians. Ms. Milas, 23, was working as a swim instructor for the summer and had swum into the side of the pool, breaking three teeth.

Shaken, she accepted the ambulance ride to Scripps Memorial Hospital in La Jolla, Calif. The paramedics applied a neck brace as a precaution.

A week later she received a bill for the 15-minute trip: $1,772.42.

Holy rip up those paramedic's cards Batman. A C-collar for messed up teeth while swimming?! Outrageous. And a nearly $2k bill for a BLS ride?

They don't have a public relation problem if that's what's getting billed.

They have a system problem.
 

Wheel

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EMS billing is really screwed up as a whole. Perhaps this will spark a conversation about changing how we bill, so that perhaps there can be some standardization.
 

unleashedfury

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People fail to realize one of the biggest reasons for rising health care costs and even ambulance trips

1) back in the hey day ambulance services were a volunteer corps. So they didn't have to pay a crew, municipalities covered minimal operating expenses through tax dollars and donations provided to the services low operating costs meant charges weren't required

2) EMT and paramedic training has advanced and became more costly that few people choose to do extensive training and continuous training to work for free so this money to pay for training has to come from somewhere?

3) the insured end up paying for the uninsured and underinsured Our biggest payor Medicare limits funding to EMS.

When you take those facts into play, the losses can't continue to stack up in order to remain in business someone has to absorb the costs thus the well insured and those who choose to pay their bills suffer
 

Christopher

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2) EMT and paramedic training has advanced and became more costly that few people choose to do extensive training and continuous training to work for free so this money to pay for training has to come from somewhere?

I'm not sure where this is coming from, but there is an overabundance of EMS providers because the barriers to entry are so low, both educationally and financially.
 

DrParasite

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Today, like the rest of the health care system in the United States, most ambulance services operate as businesses and contribute to America’s escalating medical bills.
compared to
Thirty years ago ambulance rides were generally provided free of charge, underwritten by taxpayers as a municipal service or provided by volunteers.
So 30 years ago, ambulance rides were covered by volunteers (who were doing it out of the goodness of their heart, and often begging for money by asking for donations to cover expenses) or by taxpayers (ie, your taxes pay for the services ahead of time, everyone pays the same, so the overall bill is less). I am failing to see the problem, only that the author is trying to pull at the emotional outrage of people for a service they are utilizing, often after they have already used it.

You ask for a service, expect to pay for it. I am sick of people expecting something for nothing. If you don't want the service, feel free to take a cab to where you want to go (oh wait, they expect you to pay for services too.... hmmmm). I might try to convince you to go to the ER in an ambulance if you are sick, but if you want to roll the dice, and think your life isn't worth the service you will be paying for, hey, that's your choice. But we provide a service, and whether you like it or not, we have expenses, and I don't work for free.

BTW, I am 100% against ambulance billing; I think all EMS should be tax payer funded, so if your taxes pay for my salaries, you shouldn't get a bill. but if your taxes aren't paying my salary (ie, you are a non-tax paying resident and you require EMS), than you should be expected to pay for the services that are being provided to you. It's also much easier to budget for stuff based on tax funds, than hoping you reach a goal of billing revenue.

It's like going to a fancy restaurant (based on someone's recommendation) because you are hungry, eating a good meal, enjoying a few drinks, and then when the bill comes, expressing outrage that you have to pay such a large bill. Sorry, you received a service (and maybe a product too), expect to pay for it!!!
 

mycrofft

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compared to So 30 years ago, ambulance rides were covered by volunteers (who were doing it out of the goodness of their heart, and often begging for money by asking for donations to cover expenses) or by taxpayers (ie, your taxes pay for the services ahead of time, everyone pays the same, so the overall bill is less). I am failing to see the problem, only that the author is trying to pull at the emotional outrage of people for a service they are utilizing, often after they have already used it.

You ask for a service, expect to pay for it. I am sick of people expecting something for nothing. If you don't want the service, feel free to take a cab to where you want to go (oh wait, they expect you to pay for services too.... hmmmm). I might try to convince you to go to the ER in an ambulance if you are sick, but if you want to roll the dice, and think your life isn't worth the service you will be paying for, hey, that's your choice. But we provide a service, and whether you like it or not, we have expenses, and I don't work for free.

BTW, I am 100% against ambulance billing; I think all EMS should be tax payer funded, so if your taxes pay for my salaries, you shouldn't get a bill. but if your taxes aren't paying my salary (ie, you are a non-tax paying resident and you require EMS), than you should be expected to pay for the services that are being provided to you. It's also much easier to budget for stuff based on tax funds, than hoping you reach a goal of billing revenue.

It's like going to a fancy restaurant (based on someone's recommendation) because you are hungry, eating a good meal, enjoying a few drinks, and then when the bill comes, expressing outrage that you have to pay such a large bill. Sorry, you received a service (and maybe a product too), expect to pay for it!!!

Paragraph two: I also don't like going into Denny's then getting a bill sent to my home for $1,000 for two burgers and an a'la carte order of chicken bits.
Para 3: YES!!!


http://en.wikipedia.org/wiki/Chargemaster
 

unleashedfury

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I'm not sure where this is coming from, but there is an overabundance of EMS providers because the barriers to entry are so low, both educationally and financially.

I was referring to the Volunteer side of things.

As it stands right now EMT School here in PA Avg cost about 600 dollars. 6 months of 2 nights a week tied up into training.

Paramedic school Avg. Cost 10 Grand. 1 year to complete. 1200 hrs didactic, 1200 hrs. Clinical/Field time.

I got 10 grand from my estimate of expenses. My core program is 8K. But I have to pay all my own fees for Fisdap, Uniforms, Textbooks, Liability Insurance that the school requires you to have, And you must buy the insurance through the provider they have hand picked for you, Guy looks Like Jerry Garcia. Add in the physical costs, Health Insurance requirements, all your shots, 2 Step PPD, I think it cost me almost 1k, to prepare for the program, and it wasn't a guraunteed seat.

So the idea of shelling out so much cash and dedicating this much time to a profession to do it for free, its just not feasible for the company to absorb the cost, or the individual to absorb the cost without a return on investment
 
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SandpitMedic

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Good points all around. However, I'm pretty sure the largest private EMS provider net profited like 5-6 billion dollars last year, and the employees make exactly bull:censored::censored::censored::censored:t... So the monies gained from those who pay the bill certainly is t all going to salaries, nor is the increase in call volume helping anyone's checks save for a "do 10 a day get an extra $50" type of thing.

I like the points about being a service and expecting to pay, but I also agree the prices of Ambulance transports and ER fees are incredibly blown out of proportion. They're all making money, large sums of money.
 

SandpitMedic

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Also, after reviewing the comments, what can you really expect of the general public/lay person? They have no idea what the operating costs are, nor any idea what they're even talking about. It's like me speaking to the type of warp drive they're using on the next Mars rover mission or what have you over at NASA or Space X; I have no clue about any of that. Some argue its a waste, some say its necessary, yet I wouldn't be belittling that lowly analyst for it regardless. That's my analogy: lay person is to EMS/medical billing as Paramedic is to Astronaut. No freaking clue.
 

usalsfyre

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I was referring to the Volunteer side of things.

As it stands right now EMT School here in PA Avg cost about 600 dollars. 6 months of 2 nights a week tied up into training.

Paramedic school Avg. Cost 10 Grand. 1 year to complete. 1200 hrs didactic, 1200 hrs. Clinical/Field time.

I got 10 grand from my estimate of expenses. My core program is 8K. But I have to pay all my own fees for Fisdap, Uniforms, Textbooks, Liability Insurance that the school requires you to have, And you must buy the insurance through the provider they have hand picked for you, Guy looks Like Jerry Garcia. Add in the physical costs, Health Insurance requirements, all your shots, 2 Step PPD, I think it cost me almost 1k, to prepare for the program, and it wasn't a guraunteed seat.

So the idea of shelling out so much cash and dedicating this much time to a profession to do it for free, its just not feasible for the company to absorb the cost, or the individual to absorb the cost without a return on investment

I understand looking at it as a student it's expensive. It's also extraordinarily cheap compared to other healthcare professions. Especially when you consider the academics involved aren't all that strenuous.
 

Kevinf

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In PA they upped the price and class time last year. It's a little north of a grand now and the class is longer (it's pretty much national registry).
 
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Christopher

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I was referring to the Volunteer side of things.

As it stands right now EMT School here in PA Avg cost about 600 dollars. 6 months of 2 nights a week tied up into training.

Paramedic school Avg. Cost 10 Grand. 1 year to complete. 1200 hrs didactic, 1200 hrs. Clinical/Field time.

Medic school in NC is subsidized. If you volunteer or work for a service somewhere you'll only pay for insurance and maybe books. Probably <$400 total, including EMT school.
 
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rescue1

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In Maryland everything but medic school is subsidized (free), and many volunteer organizations will fund medic school in exchange for X years of active service.

Still basically 0 volunteer medics though. It's just too long to do something for volunteering only, even if it is short compared to PA school or nursing. If you want guaranteed ALS service, you have to pay for it the old (new?) fashioned way, with paid workers.
And unfortunately, since tax money usually doesn't cover it, that means billing for service. I think in a perfect world EMS would be tax funded, perhaps with a small ($100-500) transport fee, but right now we have to make do with what we have.
 

CFal

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In Maryland everything but medic school is subsidized (free), and many volunteer organizations will fund medic school in exchange for X years of active service.

Still basically 0 volunteer medics though. It's just too long to do something for volunteering only, even if it is short compared to PA school or nursing. If you want guaranteed ALS service, you have to pay for it the old (new?) fashioned way, with paid workers.
And unfortunately, since tax money usually doesn't cover it, that means billing for service. I think in a perfect world EMS would be tax funded, perhaps with a small ($100-500) transport fee, but right now we have to make do with what we have.

In RI we have the "EMT-Cardiac" level that most department use in leu of medics, even most paid departments, some good things about it some not so good parts of it but it works pretty well for the most part. 90% of what a medic can do.
 

EpiEMS

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In RI we have the "EMT-Cardiac" level that most department use in leu of medics, even most paid departments, some good things about it some not so good parts of it but it works pretty well for the most part. 90% of what a medic can do.

NYS has AEMT-CC ("Critical Care"), it's a similar sort of thing that I find to be potentially suspect. It's about 300 hours of training (versus ~1000 for medics) and easily 75% of scope as AEMT-P (i.e. Paramedic).

If EMT-Cardiac has 90% of the skills of a paramedic but only a fifth of the training, it strikes me as potentially risky, especially given the concerns over the depth of training at the paramedic level.
 

usalsfyre

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In RI we have the "EMT-Cardiac" level that most department use in leu of medics, even most paid departments, some good things about it some not so good parts of it but it works pretty well for the most part. 90% of what a medic can do.

We had these in Virginia and its no bueno....
 

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