The 10 commandments of ems

[bstone]

I don't think he's asking you to withhold treatment, rather to see the bigger picture. You need to be aware of the consequences of your interventions.

Consequences- patient lives or patient dies. Sans DNR, DNI, Advanced Orders, family request it doesn't really matter.

 

[Veneficus]

There simply is no way she got a $6000 bill from a hospital even if she only has Original Medicare. The 2011 deductible is only $1100ish.

The bills are not EOB, there are 2 one for roughly 6K and another for 5K from 2 different hospitalizations at the same facility.

I should hope dialysis, pain control, and cellulitis are covered.

 

[truetiger]

It's not that black and white. There's always more than one way to solve a problem.

 

[AndyK]

Excuse the lack of apprehension here as i'm not a US resident so have little experience of your healthcare system but am I right in thinking that a healthcare professional would knowingly withhold treatment for lack of means of payment from a patient?

 

[Veneficus]

Excuse the lack of apprehension here as i'm not a US resident so have little experience of your healthcare system but am I right in thinking that a healthcare professional would knowingly withhold treatment for lack of means of payment from a patient?

It is not as simple as the patient not being able to pay.

It is a question of whether or not performing the treatment ultimatley causes more harm than good from the financial ramifications.

Part of medical treatment is to inform the patient of all of their options. I think it is absolutely wrong not to discuss the potential costs of those treatments with them when making the decisions about what they want. Especially since there could be lasting consequences on others.

I also think it is important not to throw every treatment possible at patients who are responsible for paying the bill for it when they place trust in a healthcare provider to do what is best for their presentation.

Running every test on every patient is not good medicine. It is waste at the least and potentially incompetence.

In the US, many patients are responsible for part or all of their bill. Some agencies are more aggresive than others in collecting.

It is only responsible to be aware that costs are a concern, should be addressed openly, and do play a significant factor in the lives of not only the patients but of the relatives as well.

 

[jgmedic]

Excuse the lack of apprehension here as i'm not a US resident so have little experience of your healthcare system but am I right in thinking that a healthcare professional would knowingly withhold treatment for lack of means of payment from a patient?

No It's that we should take into consideration a pt's ability to pay if we are doing interventions "just to be sure". If it's a life or death situation, that's different. But things like prophylactic IV's, maybe not.

 

[bstone]

Excuse the lack of apprehension here as i'm not a US resident so have little experience of your healthcare system but am I right in thinking that a healthcare professional would knowingly withhold treatment for lack of means of payment from a patient?

No, they should never take it into consideration.

 

[AndyK]

ok guys, thanks for the replies... certainly an interesting concept and differs considerably to here. Ambulance & Paramedic services are generally free to anybody who needs it and interventions based purely on patient needs rather than wants.. I think that's what you are alluding to aswell JGMedic?

BStone.. I suspect you and I are of similar breed, Pro Utilitate Hominum and all that... it certainly raises an interesting question about prehospital ethics if immediate care interventions are based on social and economic considerations of an individual by some providers.

That, for the sake of Veneficus, is not meant as provocation - merely a wish to understand the system out of interest as an outsider, I hope no offence is taken by ignorance on my part!

 

[certguy]

I certainly didn't mean to start a firestorm here.The commandments are meant as hand me down wisdom from 1 generation of EMT to the next.The commandment in question came about from me having to report a facility our company cotracts to for elder abuse,putting me square in my manager's crosshairs over lost business. Sometimes you have to take a stand for your pts.

 

[usalsfyre]

No, they should never take it into consideration.

You are very, very naive in how medical care is paid for, and how you draw a salary.

Suffice to say, there's a large segment of the population that's one EMS trip away from finical ruin. "But at least your alive" can be little comfort when staring down the barrel of the long-term consequences of this. I'm not advocating withholding care by any means. However it's important to understand the money aspect of our job isn't all rainbows and unicorns either.

 

[lampnyter]

I wouldnt have a problem not treating because they couldnt afford. Ive never had to deal with it because my agency doesnt get any insurance info or anything.

 

[bstone]

You are very, very naive in how medical care is paid for, and how you draw a salary.

Except for the part in which I wrote extensively about Medicare reimbursement. Care to amend your accusation?

 

[usalsfyre]

Except for the part in which I wrote extensively about Medicare reimbursement. Care to amend your accusation?

Just because you can read the CMS guide doesn't mean you understand the end user consequences for the un/underinsured when non-payment is the issue. CMS, as slimy as it is, is the CLEAN side of reimbursement.

 

[bstone]

Just because you can read the CMS guide doesn't mean you understand the end user consequences of the un/underinsured and non-payment. CMS, as slimy as it is, is the CLEAN side of reimbursement.

Still not seeing you prove your accusation that I am "very, very naive" about reimbursement and salary. The same can be said for you as you haven't demonstrated any specific knowledge on this topic, while I have written rather extensively about it. Would you like a copy of my 30 page report for a graduate-level public health class I took?

 

[certguy]

With my son about to start EMT academy,I figured I'd share some dad wisdom;
THE 10 COMMAMDMENTS OF EMS
1.THOU SHALT CONSIDER THE SAFETY OF YOURSELF&YOUR CREW OF UTMOST IMPORTANCE.
2.THOU SHALT HOLD THE SAFETY OF ALL OTHERS SECONDARY.
3.THOU SHALT PROVIDE THE BEST CARE POSSIBLE.
4.THOU SHALT NOT PUT BILLING COMSIERATIONS OVER PT CARE.
5.THOU SHALT,TO THE EXTENT POSSIBLE,BE COURTEOUS,KIND&SYMPETHETIC TO PTS,FAMILY&THE PUBLIC.
6.THOU SHALT KEEP A PROFESSIONAL ATTITUDE&APPEARANCE AT ALL TIMES.
7.THOU SHALT KEEP A CLEAN,WELL STOCKED UNIT.
8.THOU SHALT KNOW YOUR RESPONSE AREA.
9,THOU SHALT WORK WELL WITH OTHER AGENCIES.
10.THOU SHALT,IF PERSONALLY AFFECTED BY A CALL,GET ASSISTANCE WHEN NEEDED.REMEMBER,YOU'RE JUST AS HUMAN AS YOUR PTS.

Sorry,I'm a lousy speller.That's supposed to be considerations.

 

[usalsfyre]

Still not seeing you prove your accusation that I am "very, very naive" about reimbursement and salary. The same can be said for you as you haven't demonstrated any specific knowledge on this topic, while I have written rather extensively about it. Would you like a copy of my 30 page report for a graduate-level public health class I took?

How about this. I'll retract my statement that you don't understand how salaries are derived. If you have the education you claim, it's likely you understand the mechanics if this better than I do.

I will not, however, retract what I said about your understanding of reimbursement, collections and it's effect on the end user. How does transporting an indigent or nearly indigent patient for a relatively minor complaint that didn't require emergency care and leading to defaulting on the bill improve overall health status? Very likely this will cause the patient to hesitate in seeking care when it IS an emergent complaint. This is not to mention the health effects of increased stress levels, and the generally poor health of the economically disadvantaged anyway.

Again, I'm not saying to withhold care, but not being honest with yourself or patients about the finical aspects of transport is like I said, very, very naive.

 

[bstone]

How about this. I'll retract my statement that you don't understand how salaries are derived. If you have the education you claim, it's likely you understand the mechanics if this better than I do.

I appreciate that.

I will not, however, retract what I said about your understanding of reimbursement, collections and it's effect on the end user. How does transporting a patient for a relatively minor complaint, thereby causing increased stress levels, possibly causing the patient to hesitate

I never said this is a good thing. I said cost should not be a consideration when treating a patient with severe and life-threatening injuries. The examples I gave were severe trauma and an MI in progress. That is certainly not minor. Right?

 

[usalsfyre]

I appreciate that.

When your wrong your wrong. I do appolgize, I'm used to dealing with my coworkers who fail to understand that doing you paperwork correctly and transporting patients is directly tied to them getting paid.

I never said this is a good thing. I said cost should not be a consideration when treating a patient with severe and life-threatening injuries. The examples I gave were severe trauma and an MI in progress. That is certainly not minor. Right?

Sorry, didn't finish my post, Tappatalk defeats me sometimes.

Severe trauma and evolving MI are one thing. I don't think anyone will argue about transport. It's the minor complaints that keep people from seeking medical care for the MI I'm worried about.

As a side note this is why community paramedicine needs to evolve from where we're currently at. A $50 home visit with instructions for symptom management looks after the patient far more "holistically" than a $300-1000 transport and several thousand dollar ED bill.

 

[bstone]

When your wrong your wrong. I do appolgize, I'm used to dealing with my coworkers who fail to understand that doing you paperwork correctly and transporting patients is directly tied to them getting paid.

I understand. All is forgiven.

Sorry, didn't finish my post, Tappatalk defeats me sometimes.

Severe trauma and evolving MI are one thing. I don't think anyone will argue about transport. It's the minor complaints that keep people from seeking medical care for the MI I'm worried about.

As a side note this is why community paramedicine needs to evolve from where we're currently at. A $50 home visit with instructions for symptom management looks after the patient far more "holistically" than a $300-1000 transport and several thousand dollar ED bill.

I agree. We need to educate paramedics to a BS level and let them treat and release on scene, or make arrangements for primary care services, not ED services.

 

[firetender]

Just like the Ten Commandments ain't it?

Come off the Mountain with a couple tabs of wisdom and what are the damn people doing? Arguing over whose Golden Calf is cooler!