Doug

As a follow up...Can I assume then, Dust, you turn down your insurance and pay full boat out of pocket for your medical expenses at time of use? At the risk of incuring the wrath of Dust it seems a bit hypocritical for you to point out that someone would complain about the cost of healthcare while you enjoy said compensation.

Ok...without insurance my bill for routine check up would be $225. Now add in my wife and 2 kids...so right there you are talking $900. I don't know about where you are but to walk into an ER here is $425...not including anything beyond a consult. I don't abuse the ER but I have been a few times for things that couldn't wait till Monday. let's say average once a year. And we are the proverbial "healthy ones." Now, god forbid you had anything moderately serious, that required repeated follow ups, under the AMR plan as explained to us EACH FOLLOW UP visit is billed to you up to $300 whereas most insurance has a deductable PER incident. I had a partial tear in one of my calves a couple years ago that required 4 follow up visits and 1 surgical consult...lets see 1 ER visit $300 to me, 4 follow ups $225, and one surgical consult $160 (i have no idea why) My insurance considered that all one incidnet and my co-pay was $100..under the AMR plan I would have had to pay for all but $125 of the ER visit. Dust, where do you get the idea that I want something for nothing and/or think that I don't think the value is there?

Nobody is questioning that the care they get is worth more than $300...but most insurance you pay a co-pay when you go for a visit...AMR wanted us to pay a "co-pay" of up to $300 per visit...I assume you have insurance Dust you know how it works, nice try though.

That insurance provision is HUGE...that was offered to us. It's AMR's attempt to "self-insure" they pay 90% of the "premium" (meaning you pay 10% to the insurer..oh wait that's AMR). The deductable is HUGE something in the area of $300/ visit...yes VISIT not month or year. And around $10,000 for major procedures. To quote the corporate guy trying to push it on us "It's a pretty good deal if you don't get sick." (Note: that is an actual quote, he was trying to say if you don't get sick and are on the "real" insurance plan you are throwing away an add'l 15%, but we took it as "If you have this plan, you better not get sick..")

I agrre with sommers this doesn't seem legal. msShow00 i understand you get $8/hour yes? And you have the ability to bump your pay up per week based on performance. What I understood was happening was that you have your $8/hour and they can TAKE some of that from you based on performance. so if your base pay is $320/week for 40 hours "oops, sorry dear you missed 3 signatures thats $25 deducted." Or am I misunderstanding this whole thing?

God forbid we lay any blame on those that overuse the 911 system and take trucks out of service in an area....

Sorry, Dust but you're talking out your arse there....AMR in Massachusetts was the one that petitioned the state for the first Paramedic/Basic waiver, before that ALS ambulances in Massachusetts were required to be Medic/Medic or Medic/Intermediate crew. The claim was because they couldn't find enough ALS providers, as part of that waiver they were supposed to "promote and recruit" ALS providers, which they did not do becasue in the words of D.B and A.G. "Why should we pay for a medic when we can get 2 Basics?" They also successfully delayed the use of 12 lead ekgs in the field due to the "financial burdon." Regional Optional Meds were also left off the truck because of the added cost of provideing training and in some case special handleing. We lost out field vent for transfers because they refused to have the one we had inspected and serviced while not purchaseing a new one. Training was non-existant, I take that back..we did recieve yearly training on proper BILLING. They also tried to consolidate dispatch here to a location 60 miles away on outdated and unpredictable equipment, resulting in significant delays in care, I was dispatched to the wrong TOWN on a few of occasions. They also had a poor supply chain with routine supplies running out. In one case they purposely ordered the wrong sharps containers for the trucks because they were cheaper and we were told to "just tape it to the wall." When I raised a concern over this I was told to "F'ing quit then!!" These are concrete complaints against the company itself and not the "whineings" of a disgruntled employee, though the way were treated did suck, as I said before in another post being called "Owned" and "Property" by the national VP of labor relations tends to be a poor motivator. Dust is right, I should have quit but, no excuse, I didn't know better, I just assumed that this was how EMS was.

I have nothing good to say about them. Honestly, I worked for them for 10 years (my own fault, this was my first EMS job and i assumed they all were like this) they pulled out of my town after loseing contract after contract, they also pulled out of another western massachusetts town. They refused to listen to us when we said we were losing busines. I've said all this before in other posts so let me summerize. When I started we had 4 trucks during day and 2 scheduled 1 reserve (call in) at night that usually wound up getting called in, the competator had 2 trucks day and night...by the time they left AMR had TOPS 2 trucks during the day and TOPS 2 trucks at night (usually 1) and the competition had 5 day trucks and 3 night trucks...even with that the AMR crews often just sat on our asses as no one wanted to call us any more, we lost major hosp contract (no no we didn't management said) we lost 75% of our NH contracts (no no we didn't what is this guy talking about) virtually no intercepts unless other company was completely out (so what those don't make us money anyway) yes well those intercepts oftewn wound up being transfered out and the company that brought the pt in got first dibs on transfer out (our records show this never happened, besides we weren't getting proper reimbursement from insurance/medicare/caid). Suffise to say I now work for the competition, who, despite covering the EXACT same area had enough in cash reserves to hire all the AMR employees who wanted jobs (95% of us) plus BUY 2 new trucks, convert a used truck to a bari unit AND buy a whole garage, and after 2 months was turning a profit again. Side note: the one AMR left in Western Mass (springfield/holyoke) was the only show in town until 3 years ago...since then 3 companies have moved in and Baystate Medical has begun doing their own transfers again (AMR had the contract but my understanding is that they were unrelyable). If you really want to read something amazing google AMR and Richmond, VA.

Time to show my ignorance...what's the difference between BDU and EMS pants? The drawstring at the cuff?

I'm in Massachusetts and I know that Southern Vt. routinely uses Massachusetts based Medic services for PRIMARY response. I think there is 1 Paramedic level ambulance in Bennington, and it is not uncommon for Southern Vt Hosp. to call my service (about an hour away) to arrange ALS transfers. Vermont also allows for direct reciprocity for any equivalent level from Massachusetts.

I considered it a personal choice until I read Richard B's response. I'm sorry Richard but since you did not earn that piece you should not wear it even if it is to honor those who died. Would you be ok with somebody wearing a paramedic rocker in honor of those who have gone before? Or an RN pin? You are wearing an insignia that is stateing you have recieved specific training possibly above the level you are practiceing, never mind the emotional reaction that some may feel for the service those men provided. In the interest of full disclosure a was a Corpsman (HM3/8404 4th MarDiv, Fox Company) and I do not wear any designation on my uniform.

Different view....You can bet your life that had that light going out resulted in the crew hitting a bump and spilling the pt. the family would have sued the company, crew AND if it wasn't their house (apt./condo/business) the property owner. I would also like to point out in some cases workman's comp can sue to recoup loses associated with an employees injury on the job if it could have been preventable by a third party. I don't know what the rules are over there is it possible he was told he would need to seek damages first from the property owner? I know here in the states if you are the owner/partner/ or family employee of a business you have to file a lawsuit against your company to recieve compensation. Both my sister and I had to file letters of intent to sue to our Dad, our boss, AKA The MAN, following injuries on the construction site. Not to wuss out here but I have to say, not enough information to make a definative judgement.

My ADD kicked in...couldn't get through it all...36 pages sorry... Here the city had a zero bid contract with a private service to provide ambulance transport, that is the private service covered 911 at no cost to city just what they could bill pt's for. There have been whispers however of makeing the private company PAY for the privalige of coverage...at first it was bill percentage, then later a flat yearly fee...mind you this company owns the property it's on (property tax) and excise taxes for each of the 30+ company vehicles...this was a year ago...and as i said only whispers...are there any other cities out there that run something like this?

I guess we do flat rate...pulse ox is part of BLS assesment...part of vital signs...do they itemize BP's too? oh yeah...it's too bad that lady died....

They charge for Pulse Ox?

60 calls a year for FT 24/7 365? ok, minimum staffing would be 5 (crew of 2 day and night, plus one to cover sick time, PTO, and rotateing shifts) at 30,000/year salery you'd have to charge all 60 calls $2500 AND get 100% billage paid. Now that doesn't include SS contribution, workmans comp insurance, any health benefit plan etc. So you're really talking closer to $300,000 (average costs to employ someone usually runs double the "seen" pay.) So each run needs to go about $5000. Unless you have some sort of subcontract or sub-station deal with a larger service that provides coverage in addition to it's regular service area, which would also aleviate the worry of low call volume leading to lower skill usage.

I just thought of something...by the standards that LFD is setting, ambulance services should be able to bill more for it's frequent flyers, because they use the ambulance proportionatly more than most people, we have a few that MUST make up 2-3% of our call volume by itself. LOL Also, if it weren't for the mall these people wouldn't have been in Lanesboro in the first place having whatever emergency they were having, thus reducing the billing by $1600 (4 mall emergencies times $400 apiece)

Ok, everyone, for once I actually have first hand knowledge of whats going on here. I live in the next town over from Lanesboro (local spelling.) And I used to work for the AMR that was mentioned and I currently work for County Ambulance that is also mentioned. First, Ruff, try not to jump to conclusions. AMR was not located in this town, it was located in Pittsfield MA (pop. @45,000) and along with County was the primary 911 coverage for Pittsfield. In addition to these services we did (and with County we still do) provide ALS intercept and mutual aide services for @2/3 of Berkshire county as well as bordering NY towns. We also do transfers but that's besides the point. There are no NH in Lanesboro so your point there is moot. I will agree however that management at AMR Pittsfield/Western MA ran the place into the ground and ignored warnings of lowering call volumes for us and increased business to our direct competator. I am willing to bet that that call volume of 16 calls since Jan. 1 they are counting calls which they had no response and County covered the call by provideing mutual aide (I did one call that they toned out 3 times, to the mall of all places, that 1 person of unknown level from LFD showed up in POV) so their claims of 16 may even be exagerated. I would also like to note that the trucks they are buying and tradeing are the diesel guzzleing monstrousities that look like they should be towing a trailer on a cross country haul, god forbid these small towns buy something more reasonable. Sadly Massachusetts seems to be leading the way in it attempts to lower minimum staffing standards for ambulances. Deerfield MA, has attempted several times to reduce their staffing to 1 emt 1 cpr (no i didn't mean to type CFR i meant CPR) because of claims that they just can't get the crews. I do find it funny as well that on another post people complain about vollys, yet to paraphrase CBEMT...he wouldn't want to work in such a low call volume area. AK where did you find the article...there is no Lanesboro Newspaper. AGAIN NO NURSING HOMES IN LANESBORO.

In this instance the Rx stands for treatment...not enough space in subject line to write "treatment." On another point...some of you seem o be directing anger toward me when in fact we may agree...i would never, in fact HAVE never refused treatment for a patient for any reason, I have treated HIV pts. I have started lines, bandaged wounds etc. I find that the people who know they have HIV are forthcoming with their status the only time I've done anything out of the ordinary is by their request (one HIV pt asked me to pull over to the side of the road to start an IV, because "If we hit a bump and you stick yourself I could never forgive myself") Again my point was certainly not to advocate this practice but suggest a new angle to the arguement that HIV+ healthcare workers be kept from practice, I apologize if I didn't make that clear in my initial post.

Ruff, this was not meant to be inflammatory, to me it seems to be a logical conclusion to the idea posted in the other forum, it was meant to provoke thought not anger. Dust's response was logical and well thought out and like many he is unable to come to a conclusion. I will tell you of one incident early in my career where I went to start an IV on a man who was having chest pain. The senior medic grabbed my arm and shook his head...not being well seasoned I just accepted it and since it was his turn to tech went to drive. He came to me later and said "I never start IV's on him he has HIV." So, Ruff, your suggestion that this is ludicrous is wrong...in fact i assure you it happens.

wow...no response...now i'm scared.

This is a separate "response" to another topic about healthcare workers being banned for their HIV/HEP status. Some argue that healthcare workers with HIV/HEP (in some cases even cold/flu) should no longer be allowed contact with patients. It seems to me that the logical extension of this argument would be that if the HIV/HEP status of a pt is known that the healthcare provider should be allowed to refuse treatment. I mean if one is so concerned that an HIV/HEP infected healthcare worker with no open wounds and taking proper precautions is kept from practicing then certainly we can't ask EMS personnel to enter into a car with open wounds/sharp edges and bone fragments, you can't ask a nurse/paramedic to intentionally pierce the skin of such a pt. by starting an IV and cause potential exposure, you can't ask a surgeon to possible expose themselves and end their career by coming in contact with a pt. who needs emergency trauma surgery.

paid service for less then 100 calls a year...well, then you run into the other end of the spectrum...how skilled can a service be at less then 100 calls a year? I'm pretty sure in some states you would not be allowed to run ALS on less then 100 calls. And I assume you mean the service has less then 100 calls a year...which means unless you are the sole EMS provider you are actually doing less then half of those calls...of which national polls have shown that only approx 15% of EMS calls are actually ALS...wel you see where I am going...

For those of you who think that even the most remote areas with a call volume of 100 calls a year should dump the volenteers and go for a full time ALS service because "We all want and deserve the best", I expect you to be the first ones to pony up the cash when your local clinic wants $$$ for an MRI/CT/or neurosurgeon on staff....Let's face it evetthing runs on $$$, and yes human life sometime comes down to a cost/benefit analysis. Not every area warrents ALS or even a paid BLS service.

I would use the money to pay the health insurence and severence for the next year for all the AMR employees in my division that are losing thier jobs at the end of the year.