Out to get....

[E tank]

There seems to be a vibe among providers (RN, medic, EMT, even docs) that gives the impression that the powers that be, whether private company, pharmaceutical company, bosses, are out to get patients to save or make a buck. That vibe conveniently leaves out us, the boots on the ground, out from the desire to make bank... we're just there for the patient, a la "Mother Theresa".

The realities of running a business in the 21st century are what they are. Not to kick a hornet's nest, but are we really that different than the powers that be?

 

[GMCmedic]

No, we just make our buck from "the man" so that is supposed to make it ok.

Sent from my SAMSUNG-SM-G920A using Tapatalk

 

[EpiEMS]

are we really that different than the powers that be?

We can't afford to be, can we? We (care providers) are agnostic to ability to pay because we are required to be...but should we be? (e.g. Is it in the patient's best interest to transport somebody who is not in extremis if they can't afford what we cost?)

The tough part of a technical field is that (in many cases), the business management is actually just a group of "technicians" (clinicians) who have no formal training in business (or management, for that matter). So is it the blind leading the blind? Maybe so.

The healthcare "system", if you can call it that, is so full of perverse incentives that it makes my head spin. What is the role of a provider, other than to provide competent care? To look out for the patient's best interest, holistically - should that involve some element of saying "Do you really need this procedure? Do you really need an ambulance ride? Wouldn't you be better off going to the urgent care?". Unfortunately, EMS often cannot make these recommendations - for a number of reasons, some of which are good - but it'd be awfully nice to get to a point where we can.

 

[NomadicMedic]

To look out for the patient's best interest, holistically - should that involve some element of saying "Do you really need this procedure? Do you really need an ambulance ride? Wouldn't you be better off going to the urgent care?". Unfortunately, EMS often cannot make these recommendations - for a number of reasons, some of which are good - but it'd be awfully nice to get to a point where we can.

Wait... don't you do this now? Do you not have these discussions with patients before you transport them?

I mean, look... not everyone is reasonable, and sometime you have to default to the "you call, we haul" mentality, but I try to have a real discussion with anyone who will listen.

I understand that if we don't transport, we don't get paid and I want to make money for the system, but I know that the EDs are overwhelmed with minor issues and our reimbursement rates are low. In many cases it makes sense to take a step back and say, "I know you've had this cough for a week, but the urgent care is right down the street, they'll see you quickly and you'll be home in an hour. They accept cash and your insurance. And honestly, you don't need an ambulance."

Maybe I'm trying to bail out the flood with a teaspoon, but every time I am successful, I feel a small victory. Advocating for the patient and helping to reduce the stress on the system makes it worth while for me.

 

[DrParasite]

Wait... don't you do this now? Do you not have these discussions with patients before you transport them?

I mean, look... not everyone is reasonable, and sometime you have to default to the "you call, we haul" mentality, but I try to have a real discussion with anyone who will listen.

I understand that if we don't transport, we don't get paid and I want to make money for the system, but I know that the EDs are overwhelmed with minor issues and our reimbursement rates are low. In many cases it makes sense to take a step back and say, "I know you've had this cough for a week, but the urgent care is right down the street, they'll see you quickly and you'll be home in an hour. They accept cash and your insurance. And honestly, you don't need an ambulance."

Maybe I'm trying to bail out the flood with a teaspoon, but every time I am successful, I feel a small victory. Advocating for the patient and helping to reduce the stress on the system makes it worth while for me.

I know of one EMS agency where crews would have a nightly competition for who would get the most non-transports...... regardless of if they were in the patient's best interest or not.....

I used to discuss this with the patient; however, the longer I spent in EMS, the less I did it, as in the end, it didn't benefit me at all. The risk for provider liability is higher with an RMA vs a transport. If the patient wants to go, even for a sniffle, I can't deny them transport, and trying to talk them out of it might result in a complaint (where you are guilty until proven innocent). my boss wants me to take them to the hospital. and when I worked in they city, I can spend 20 minutes working out a patient refusal, or spend 10 minutes transporting the ambulatory patient to the hospital.

As for the original question, some people are different, but many are not. Too many bosses run their crews into the ground (an ambulance that isn't on a run isn't making any money), and equip their ambulances with the bare minimum level of supplies; if the state doesn't require it, even if it will help the patient (or the provider) you won't see it on the ambulance. Too many employees don't learn more than the bare minimum to maintain their certs, and won't (or can't) think outside the box. Too many bosses see their employees as just warm bodies, so they don't invest in them at all; likewise many employees will jump ship to a new agency that pays them better.

If my superiors supported me referring people to an alternative destination, I would do it every time. "Sir, you don't need an ER, you need to go to your PMD or the urgent care. you will be seen quicker, be discharged quicker, and it will be cheaper for all involved." or "sir, you aren't dying, why do you want to go to the ER we a urgent care or your PMD?" and of course, I would take sick people to the ER. But until I get the support from above, it's "you call, we haul." At the end of the day, it wasn't worth losing my job over.

 

[EpiEMS]

Wait... don't you do this now? Do you not have these discussions with patients before you transport them?

I mean, look... not everyone is reasonable, and sometime you have to default to the "you call, we haul" mentality, but I try to have a real discussion with anyone who will listen.

I understand that if we don't transport, we don't get paid and I want to make money for the system, but I know that the EDs are overwhelmed with minor issues and our reimbursement rates are low. In many cases it makes sense to take a step back and say, "I know you've had this cough for a week, but the urgent care is right down the street, they'll see you quickly and you'll be home in an hour. They accept cash and your insurance. And honestly, you don't need an ambulance."

I think I was a bit ambiguous - sorry! I certainly do discuss alternatives with patients ("Well, we can take you to the ED, but there is also an urgent care nearby that will see you faster.") - but the problem is, I have no state protocol or organizational procedure in place that expressly permits me to do so, and I think that in the absence of this (plus the evidence - here's an example - out there that EMS isn't exactly great at determining transport need), it is hard for many providers (including myself) to get comfortable with encouraging non-transport.

If my superiors supported me referring people to an alternative destination, I would do it every time. "Sir, you don't need an ER, you need to go to your PMD or the urgent care. you will be seen quicker, be discharged quicker, and it will be cheaper for all involved." or "sir, you aren't dying, why do you want to go to the ER we a urgent care or your PMD?" and of course, I would take sick people to the ER. But until I get the support from above, it's "you call, we haul." At the end of the day, it wasn't worth losing my job over.

I'm pretty sympathetic to this POV.

 

[Bullets]

i dont think its that any of the above are "Out to get" anyone. Its just a fundamental misunderstanding of the roles of corporations.

They have no job other than to make money for their shareholders.

Due to the field that we are in, people ascribe a higher morality to the functions of the company. But this is a product of the overall shifting societal view of healthcare and not the true obligation of a company. Now in healthcare, the things we want to do generally lead to better patient satisfaction, and thus increased business and therefore increased profits.