Patient Choice

[Sasha]

Linuss' quick guide to medical necessity:

If they can walk to your ambulance, and all you do is a staring contest for the duration of the ride, they don't meet criteria for an ambulance transport.

Iso precautions. Psych transfers.

 

[bigbaldguy]

So every patient gets punished because a few abuse the system? That's slippery slope reasoning. The problem is not your departments policy regarding patient choice the problem is the patients who abuse the system.

 

[DrParasite]

Linuss' quick guide to medical necessity:

If they can walk to your ambulance, and all you do is a staring contest for the duration of the ride, they don't meet criteria for an ambulance transport.

While I happen to agree with you (with very few exceptions, EDPs and people who are bleeding but ambulatory), I will say that I still want to get paid for the transport, even if it isn't medically necessary.

 

[epipusher]

It seems as though the ts needs to find a new career.

 

[frdude1000]

We usually give patients the option of the closest two hospitals. The exceptions to this are when the pt. needs a specialty center, a hospital is on divert status, or there is an extenuating circumstance. If there is a problem on hospital destination, we can radio our county wide EMS supervisor to remedy the situation.

 

[johnrsemt]

Two problems about the OP: one was already mentioned; if the patients long term care is at a particular hospital then take them there.

The other is insurance: if you have multiple hospitals in the area; alot of insurances will NOT pay the normal amount for an out of network hospital. Even for things like Cardiac cath: we had a patient get transported to a hospital the EMS crew wanted to take him to instead of the in network one the same distance, but the other direction: it ended up costing the patient almost $25,000 more for the Cath and post care: out of pocket. His insurance paid 50% instead of 95%. Patient sued the EMS provider, I haven't heard how that has turned out

Insurances have to and will pay the in network fees for out of network if it is the difference of a large difference in time, or a Level I over a Level III, etc; but they shouldn't have to pay when there is no difference except ambulance crew desire.

 

[Shishkabob]

: it ended up costing the patient almost $25,000 moror the Cath and post care: out of pocket. His insurance paid 50% instead of 95%. Patient sued the EMS provider, I haven't heard how that has turned out

Hopefully the judge threw it out as a frivolous lawsuit, as that is what it is. No one forced him to get treatment at that facility, he signed the forms.


Anyhow I know some insurance agencies are starting to not pay for "out of network" ambulances.

 

[phideux]

Two problems about the OP: one was already mentioned; if the patients long term care is at a particular hospital then take them there.

The other is insurance: if you have multiple hospitals in the area; alot of insurances will NOT pay the normal amount for an out of network hospital. Even for things like Cardiac cath: we had a patient get transported to a hospital the EMS crew wanted to take him to instead of the in network one the same distance, but the other direction: it ended up costing the patient almost $25,000 more for the Cath and post care: out of pocket. His insurance paid 50% instead of 95%. Patient sued the EMS provider, I haven't heard how that has turned out

Insurances have to and will pay the in network fees for out of network if it is the difference of a large difference in time, or a Level I over a Level III, etc; but they shouldn't have to pay when there is no difference except ambulance crew desire.

The patients long term care is not at a hospital. It is at a clinic. We are a 911 based ambulance and cannot transport to the clinic. We can only take patients to the hospitals with an ER. When this patients monthly check-up appointment/prescription refill time rolls around he calls 911 with a minor complaint and wants to be taken to the ER around the corner from the clinic he goes to. After we take him there he will sign out, and walk around the corner to the clinic.
There are 4 transport companies in the area, plus it is a VA clinic and they have their own van, plus he has family that drives.
I don't care about the insurance or billing end of things, that is someone else's problem.
I'm all about patient care. My problem is this is a very rural station. While we take him for his non emergency call, passing 3 hospitals on the way, the rest of our area is uncovered. The next due ambulance has anywhere from a 30-90 minute response time depending on where a call comes in at.
The higher ups answer is we transport anyone and everyone with a complaint, to the hospital of their choice. No ifs, ands or buts about it.

 

[johnrsemt]

Yea there are people who abuse the system; I think it is Memphis that is giving out cab vouchers, paid for by the city; for people who have no need for an ambulance. Works great for them, wouldn't work in a rural setting due to no cabs.

We had problems (and they still have them) where I used to work in Indy; both 911 and private service. They are working on them; but I don't know if they got any further along than taking care of one person/abuser at a time still.
There was a city next to Indianapolis that there EMS would transport only to the hospital in that city; unless the patient needed Level I type treatment; (I remember going into their city on our private service and taking patients that were in care of their crews and taking them to the hospital of their choice; {on patient waited for 45 minutes till the city dispatcher found a private service with a truck in service to come get the patient; the EMS crew stayed with the patient, even though if they would have transport to her hospital of choice they would have been back to their city in less than 20 minutes}). They ran into too many lawsuits due to it; and put more units in service and started transporting to other hospitals.