Comments on: Hey, Box Jockeys!

By: Greg Friese

Greg Friese — Tue, 26 Jan 2010 03:16:26 +0000

Question #1: No

Question #2 No

Question #3: No

Question #4: No

Question #5: Yes

By: Greg Friese

Greg Friese — Mon, 25 Jan 2010 23:16:26 +0000

Question #1: No

Question #2 No

Question #3: No

Question #4: No

Question #5: Yes

By: SJMedic

SJMedic — Mon, 25 Jan 2010 10:53:45 +0000

1. Yes. If I was honest, I would tell half my patients to take some tylenol and go back to bed. Instead, per protocol, I have to offer them transport 3 at least times, explain the danger of not being immediately assessed by an ER physician, and have them sign an AMA form.

2. Yes. We have required training each year that discourages us from using phrases such as "Pt ambulated to the gurney without assistance." We are told to start our narrative with phrases like "Pt requires ALS transport because..."

3. Yes. A paramedic in my county was recently fired, then rehired (after the union intervened) after he AMA'd a patient involved in an MVA who adamantly refused transport and later turned out to have a C3-C4 Fx. He thoroughly documented the pt's refusal and she signed an AMA form though my company still tried to fire him when she sued. And he did nothing but tell her she needed to go to the hospital.

4. No.

5. No comment.

By: "bob"

"bob" — Mon, 25 Jan 2010 07:17:49 +0000

The thing that kills me about my private service is the price differential between a BLS “stretcher transport” and an ALS “scheduled ambulance” – which is about $400, even though we only run ALS units. I can see some difference in fees if ALS interventions are needed, but if its an interfacility run with only an active IV, I can't see the reasoning for charging so much more.

By: msparamedic

msparamedic — Mon, 25 Jan 2010 01:40:40 +0000

Just catching up on the blogs now…

YES to all. (Private service… only option here in La, unfortunately.)

but… bad day for the boss- because I refuse to hurt our system further. I am honest with all patients, down to whether or not their call is truly an emergency. If my judgement states that the person needs an IV or EKG, I run one… but on a toe pain call? No.
The list goes on.

By: carolinagrl

carolinagrl — Mon, 25 Jan 2010 00:14:10 +0000

Well for the first question, if it's truly emergent (rare) closest approriate facility. Otherwise wherever the patient wants to go. Crazy frequent flier guy has restraining orders against him at all the local facilities, hence 60 mile ride.

Question 2 this was primarily nursing home abuse/neglect witnessed with private transport. I tried to help but got severely popped for interfering up to and including fired. Horrific adventure this week—- morbidly obese paramedic unable to access patient in full arrest, salvageable patient and he died. I complained (almost) and my job is seriously on the line. Haven't turned in official written complaint yet and they immediately informed her. She's my asst. supervisor and I expect some ugly fallout. So stay tuned for more adventures from the deep south….lol. Y'all hiring?

By: The Gate Keeper

The Gate Keeper — Sun, 24 Jan 2010 21:44:58 +0000

I could honestly answer “No” to the above questions as they are asked, except to the last one which is of course “Yes”. But in a PI/QA context, things can often be said in a way that would defiantly “encourage” one to “reconsider” the way their respective duties are carried out and re-evaluate the manner in which decisions are made. (wink, wink)

A couple of people above have mentioned that it may be a southern thing, uummm….could be. I dunno. There is one thing I'm most confident in and that is karma (or insert your form of retribution), in that it will effect everyone if they are involved in fraudulent activities. First to the employer if they are caught and also to the provider if they are fudging to make reports billable….it only takes one time before that one incident comes back baring teeth to bite you.

By: The Gate Keeper

The Gate Keeper — Sun, 24 Jan 2010 21:19:34 +0000

I appreciate your brutal honesty and I, more than most, feel your pain. However there are two things you said that I wonder about. I also realize that protocols and SOP's are not multi-juristictional for the most part, so that could be the case…..

1) You said that you are made to transport the patient to wherever they want to go. Doesn't the “closest appropriate facility” come into play at all for your agency? Medicare/Medicaid will reimburse $9.00/mile but only to a certain extent without physician certification…just curious how this benefits the company if they're giving “free” rides.

2) MISTREATED PATIENTS?!?!?! There is ALWAYS a way to fix that problem. Facility pacification be damned. As an EMS provider we have a duty to advocate for the patients right to life, liberty and freedom from harm…what's going on here? Social Services might be a good place to start if an assult or battery charge can't solve the problem.

By: Twitter Weekly Updates for 2010-01-24 | Life Under the Lights

Twitter Weekly Updates for 2010-01-24 | Life Under the Lights — Sun, 24 Jan 2010 18:42:21 +0000

[...] @theHappyMedic: Latest from HMHQ: Hey, Box Jockeys! http://happymedic.com/2010/01/23/hey-box-jockeys/ [...]

By: Nathan

Nathan — Sun, 24 Jan 2010 17:11:19 +0000

We only have two billing amounts ALS or BLS. We only charge the ALS, if it's needed. We don't pad our bills (that I know of).

Question #5

Yes, which sucks.