EMT's Performing Selected ALS?

[Asysin2leads]

Okay, now that EMTwannabe has had his little bitch fest, back to intelligent discussion. Ah, how sweet it is. All right NREMT, you asked how EMT's doing ALS skills takes money away from paramedics, and then said that it saves the community money. I'll answer the last part first. Having two paramedics on an ambulance only costs the company or city more than running, not the patients. You see, when a patient recieves a bill, it looks something like this:

ALS Assessment (me saying hiya): $500

Oxygen: $100

Transport: $200

Cardiac Monitoring: $400

Etc.

To the best of my knowledge you can't bill for having two seperate paramedics. You can basically bill for ALS treatment and assessment, but it doesn't matter if you use 1, 2, or 3 paramedics, you can only bill once. Some Fire Departments have all of their firefighters as medics. I'm sure you don't get billed five times if one of their engines shows up. Now, if it is a municipal based service, yes the increased salary of a paramedic does cost the community a bit more, but seriously, in a reasonable sized city, how much of the budget would really be eaten up by shelling out an extra $10,000 a year for a medic over an EMT? Secondly, I'm not saying your department in particular, but if you can afford the $70,000 Freightliner ambulance with the airshocks and thrust vector engines that people are so fond of, you can afford to pay the extra to have another medic on your staff.

Now as to how this decreases the salaries of paramedics. As Dust said, its economic theory of supply and demand. My good friend Frank Slaughtery played by Barry Pepper in "The 25th Hour" explains it thusly in relating unemployment figures to inflation.

"Look... More jobs means fewer people looking for work. Means it's harder to find good people to fill those jobs. Means you gotta raise wages to get them. Means inflation goes up. You got it?"

However, I don't think raising the wages of paramedics would have a dramatic effect on inflation anytime soon. I hope this answers your questions.

[whit72]

So does that mean everyone is charged an ALS assessment fee, even though the call could BLS?

[Ridryder 911]

The problem is most EMS does not charge per line item rather they charge captivated rates either Emergency or Non Emergency and ALS or BLS. Now to aggravate the matter it does not matter if it is a Paramedic or an EMT Advanced that is on that unit. Hence, the problem. The reimbursement pay is the same, there is not differential.

Want to know how it affects Paramedics pay ? Simple.. Since EMS administrators will receive the same amount of reimbursement as not having Paramedics it is much cheaper to have placebo Paramedics than to offer the real thing. Why would EMS administrators want to have to pay for the 'real thing" if insurance and medicare does not differentiate? There is no incentive to have the "real deal". They much rather be able to bill and provide inferior care and lower levels. We need a regulatory commission similar to hospitals have (JCAHO) to enforce and oversee that standards are adhered to.

What I don't understand is why we Paramedic continue to allow states to continue to have inferior levels ? Compare this with other medical professions that have abolished or limited lower levels. Physicians in my state immidiately had legislation drafted when optometrist wanted to perform minor surgical procedures. Citing .."inadequate education levels and not in the best interest of the patient'... the same could be true in EMS.

The problem again lies in EMS administration not wanting or having to provide what is best for the patient. This also includes cities and communities that rather provide lower levels in lieu of the real thing. Again all other levels are in comparison or judged against what a Paramedic (gold standard) can do or perform.

Part of the problem is we (Paramedics) are apathetic. As long as the check clears, majority do not care whom or what occurs in EMS. Whenever we can get payment to EMS dependent on the level of care they pay, then we will see EMS administrators change whom they will support and we will see the removal of multiple EMT levels.

R/r 911

[Niftymedi911]

That's a relief to hear, because in the other topic, you stated that you started 2 IVs in each AC, which sounded a little extreme to me.

I just figured it was another case of an EMT taking advantage of a situation to practise outside of his education by overdoing it.

But Wouldn't that lead to vein influtration Dust? Big no no

LOL yea I kinda worded that alittle odd, my mistake.

[Niftymedi911]

So does that mean everyone is charged an ALS assessment fee, even though the call could BLS?

EMS billing companies can bill ALS if the call came in as an ALS call, even if the call, by the time you transport is a BLS pri 3 call.

Now if the call came in BLS its has to be upgraded to ALS by the medic on scene to be able to bill.

Our agency utilizes this loophole every well, we still respond L&S to everything.

And Asysin, the Frieghtliner Ambulances nowadays are running us $174,000/per truck from American LaFrance MedicMaster, which comes with all the bells and whistles. ( Air Shocks, LED lighting Package, Extended Cab, etc.)

[Niftymedi911]

tttt

[Dustdevil]

:?

[Niftymedi911]

Other then the national shortage of medics everywhere probably is due to growth,I really don't.

I'm sorry bout that Dust I was just hot and venting.

If ya read my post , you'll get the info.

[Dustdevil]

:?

[Niftymedi911]

That's why I retracked what I said and edited my post I couldn't either but I was hot about something before the. Sorry.