RE: New Ambulance Services Payment schedule

["Tom Waters" <tom@tomwaters.net>]

Ken/Alll :
Keep in mind the HCFA Fee Schedule is ONLY a billing document, NOT a
standard of care or How to Practice guideline.  Every State has it's own
laws/rules and definition of standard of care governing what IS an
ambulance, air ambulance, etc. How it shall be crewed, equipped, etc.
and many even have Tariff laws in place (now being modified to match
HCFA) to say what the levels are and what crew/equipment fall within
that level.  The rationale for the single payment structure is that it
is assumed that Air Transport would be at the advanced or critical care
level just because it is air.  Although there are cases I believe, where
basics and intermediates crew air transports, this was not really
discussed during all the meetings during the negotiated rule making
sessions now 2+years ago.

Tom

-----Original Message-----
From: flightmed-admin@flightweb.com
[mailto:flightmed-admin@flightweb.com] On Behalf Of Ken Lawson-Williams
Sent: Monday, April 01, 2002 23:33
To: flightweb editor
Subject: New Ambulance Services Payment schedule


I don't know if anyone here has had the time to look at this, (the
original (PDF) can be downloaded from the JEMS website) but something
struck me as odd and I'm wondering if anyone can help me figure it out. 

As I read it, an air transport gets paid the same (+mileage and rural
cost adjustment) no matter what the level of care delivered (unlike
ground). So what is to stop a program from reducing a crew to 1 (unless
2 are obviously or likely to be needed), or to scale back on the care
offerred and use EMT-B or EMT-I with (I hope) appropriate flight
physiology etc training?. 

Nothing I have read requires 2 attendants, and the level of care
(especially for transfers) can be determined at the time of booking (I
know, not true, but a manager could claim that hospitals never lie), and
a single EMT-B could be sent - provided the probable (I know, murphy
ALWAYS strikes . . . but again I'm looking at what-if's and poor
management or programs heavily financially hit by the new rules) course
of care during the transport was wiythin his scope.

Yeah, EMTLA again. But as already stated, it has more to do with the
ongoing level of care REQUIRED and PROVIDED by/to the patient than the
titles of the crew.

Also - there is no "wilderness" cost adjustment. So operators (primarily
fixedwing) who might choose to scale back to single engine (ie: PC-12)
to save on fuel in southern areas with lots of strips within gliding
range of 25000 feet cannot safely do so in areas like Alaska and Hawii
where there are often NO strips within gliding range, thus requiring
twin engine birds. Thus they will be financially very hard hit as fuel
costs have been specifically excluded from the adjustment for location -
the Govt will rely instead on the overall consumer price index changes
due to inflation. Not often close to the inflation in Aviation!!

Just food for thought.

Fly Safe. KLW

_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to
http://www.pairlist.net/mailman/listinfo/flightmed



_______________________________________________
Flightmed mailing list
To unsubscribe or change your email address, go to http://www.pairlist.net/mailman/listinfo/flightmed