When you dial 911 in Thurston County for a medical issue, you’re going to get a response of at least a local fire department member who is trained in some form of emergency medicine (EMS) to your assistance. But after the initial examination, if you require further care than the field EMS provider can give you then the majority of the time it means a date at the local hospital emergency department. Lately, many a customer or 911 caller has told Lacey EMT’s that they’re hesitant in going to the hospital for a variety of reasons which can include concerns about cost of the ER exam, private ambulance transportation, getting home from the hospital, emergency room wait times, and more. It’s our observation that sometimes 911 is being called because the fire department EMS providers is perceived as the most viable option for care for the individual.
If you read the Olympian, you may have caught where St. Peters is expanding its emergency room again even though it had a massive construction project less than 4 years ago that more than tripled its capacity. What we should note is that the business decision makers believe that emergency medicine is going to be a growth industry and thus have decided to invest millions in advance of a predicted wave of patients. Further, it’s also been in the paper about the difficulty at times local citizens have in finding out of hospital care such as a general practitioner and even specialists.
A few months ago, I asked the general manager of Olympic Ambulance, Mary Gregory, what she made on Medicare patient and she said it’s about $.18 on the dollar. So every dollar that is charged means that 82 cents are frequently not collected. I’ve also talked to a doctor in the community on the same subject and he told me typically can’t accept Medicaid because that he only collected less than 50 cents on every dollar which didn’t even cover overhead and insurance. So that every patient on government healthcare that he saw was a loss to his practice; he said he must limit Medicaid/Medicare patients because they ‘can take over your practice’ with my assumption in the statement is that it would kill his business/practice.
So what does this mean with health care reform for pre-hospital medicine specifically during that time a perspective patient arrives at the emergency room? The final answer is yet to be unveiled as bills are yet to be combined, and the new administrative rules adopted and implemented. But some bets are that the very methods in which people are treated may put new emphasis on how the system functions. That is to say that you may call 911 and you may not go to the hospital. Or you may not want to call 911 seeking other more affordable alternatives that involve not going to the emergency room. For agencies that charge patient transports to the hospital (such as some county fire departments and private ambulances but note Lacey Fire District does not charge for service) the impact of health care reform could be huge on their business and operations!
In the short term, Medicare rules set reimbursement rates at an apparent flat reimbursement rate, but Medicare rates are reported to be likely falling again in Washington State as the budget crisis continues. In the long term, it could mean a lot of things in Lacey and Thurston County as reimbursement methods and values (even for intra-facility or hospital transport: private ambulances bread winner for years) are likely to dramatically shift. What if private ambulance service that currently handles the majority of hospital transport in Lacey decided it had enough of low profit 911 call service and won’t provide hospital transport? What could it mean also for pre-hospital care if the direction is to be treated at home and not necessarily taken to a very expensive emergency room? What happens if during the next pandemic flu epidemic that the local hospitals say no more patients because they are already full?
As our population of baby boomers continues to age and the demand for medical care continues to rise in our community, the answer to these questions will not come in a sweeping government notice when health care reform comes but will likely be a series of reactions to changes that are yet unclear in pre-hospital care.
But as we enter this era of uncertainty and guaranteed change in healthcare, it perhaps emphasizes the value on public emergency services and how that the future will likely bring a lot of potential change in how, technically speaking, Lacey Fire Fighters medically treat its customers. While some readers are expecting this to be a call to arms to remove private ambulance service in Lacey (far from it), it’s actually a realization that private ambulance service may not be a guarantee in the future because its “for profit” and that there is no mandate that a company provide service in the community. Lacey Fire Fighters are committed to serving in any and all capacities regardless of what the future may hold. We also understand that the financial demands on the community and its expectations especially in quality and consumptions of pre-hospital care will likely increase.
We advocate that fire departments in the region and state should be ready for radical changes in pre-hospital care and prepare their respective citizens through education on what these changes will before they are implemented. Further, maybe it’s time we consider that a 911 medical care call is not a guaranteed trip to the hospital and that we should be ready to provide more care in the home because the emergency room in the future might not always be an option. Fire department based paramedic/physicians assistants anyone? And before you laugh and say “no”, understand that some fire departments in our country are doing exactly that.
http://www.jems.com/news_and_articles/articles/bill_a_mixed_blessing_for_ems.html
http://www.jems.com/news_and_articles/articles/the_devil_is_in_the_details.html
http://www.aep.org/policy.asp#Pre-HospitalCarebyLicensedPractitionersOtherThanPhysicians