The Wisconsin EMS Office recently published two important memos and helpful checklist information for Scope of Practice and Medication List.

>> EMS Numbered Memo 16-01 describes how a service can add First Responders to function as a member of a legal crew for the service.

>> EMS Numbered Memo 16-02 explains the difference between Mutual Aid and Coverage Agreements. Each has its specific purpose and one should not be used for both situations.

Helpful Checklists

>> Wisconsin Scope of Practice
>> Medication List

We switch gears and also discuss EMS Roaddocs

>> Click to listen to this podcast.

On Tuesday, March 8 EMS Live in Wisconsin discussed recent virus and bacteria outbreaks.  The Wisconsin Department of Health Services  is currently investigating into an outbreak of bloodstream infections caused by bacteria called Elizabethkingia.  The Elizabethkingia infection has been detected in 44 patients located in southeastern and southern Wisconsin.  >> Click for full details.

What risks do EMS responders have with the Elizabethkingia bacteria?  What are the presenting signs and symptoms?  What safety precautions or recommendations should be taken?  What patients are at risk?

We also discussed the Zika Virus that is receiving national and international attention.  The good news here is mosquitoes found in Wisconsin are not the same ones identified as a carrier of the Zika Virus.

Our guest on EMS Live Podcast was Stephanie Smiley, Director of Bureau of Communicable Diseases for the State of Wisconsin's Division of Public Health.

In addition, 20 minutes into the program we were joined by Justin Foley, who is a member with EMS Roaddocs, a motorcycle riding club in Wisconsin and Northern Illinois.  EMS Roaddocs is made up entirely of full and part time people who work in emergency services, either active or retired, that includes doctors, nurses, paramedics, EMT’s and Firefighters.

>> Click to listen to this podcast.

Next EMS Live in Wisconsin Podcast March 22

Join us Tuesday, March 22 for the next EMS Live program starting at 9:00 a.m. and lasting 30 minutes.  Our guests include Wisconsin DEA Supervisor Kathy Frederico and American Ambulance Association VP of Government Affairs Tristan North.  The US House of Representatives is considering legislation that impacts every ambulance service that carries controlled narcotics.  Dial into the program at 646-929-1081, or listen on any internet connected device at http://tobtr.com/8398779.

On February 12, the National Association of Emergency Medical Technicians (NAEMT) Board of Directors determined the organization's 2016 federal legislative priorities, to include:
 
HR 1818/S 235 - Veterans Transition Bill
HR 2366 – Field EMS Bill
HR 4365 – DEA Bill
HR 2274 - National Emergency Medical Services Memorial in DC
 
>> Click here to view the legislative priorities, and obtain further details on each of the bills.

EMS On The Hill Day, April 20, Washington, D.C.
NAEMT is also hosting its annual EMS On The Hill Day April 20 (briefing April 19) in Washington, D.C.  Participates personally meet with their U.S. Senators, House Representative and their Congressional staff.  The event is organized to ensure that Congress fully understands EMS' diverse role — from supporting healthcare systems by managing and redirecting non-emergent patients, to responding to disasters, accidents and other calls for skilled emergency medical care.  >> Click for EMS On The Hill Day information.

The rate hasn't changed since 2008 - and back then it was a 1% increase

>> Click to listen to this audio webcast.


Currently, one in five Wisconsin residents is on state funded Medicaid.  Like other states, Wisconsin is not immune from seeing its Medicaid population rolls increase.  When an ambulance is called by or for a Medicaid covered beneficiary (patient), the services paid for by the state doesn't come close to the actual cost to deliver care and transport.

Last week representatives with PAAW and the EMS System Management and Development Committee, which is part of the state's EMS Advisory Board, met with leadership from the Wisconsin Department of Health Services (DHS).  Last week's meeting had a few goals regarding Medicaid reimbursement rates to ambulance services:  1. Where does the money come from?, 2. How is the payment pie allotted?, and 3. What percentage goes to ambulance services? 

The state's current Medicaid budget is $9.1 billion; however, it isn't clear what percentage goes to ambulance medical care and transportation.  Besides having lower ambulance reimbursement rates than many other states, Wisconsin ambulance services also saw the number of non-emergency transports decrease since 2011 when the state contracted with a broker to manage them.  Besides selecting an ambulance service, typically the most expensive non-emergency option, the broker can also choose other modes of transportation, to include taxis, buses, and medical or wheelchair vans.

According to officials with DHS, a change in the ambulance reimbursement rates, or fee structure, will require either an adjustment by DHS or a legislative initiative.  One of the meeting's participants included Paratech Ambulance Vice President Larry Knuth, who commented on the webcast, "DHS would like follow-up with us on this to gain an in-depth understanding and where the industry wants to be.  DHS is open to discuss a future plan and any proposals".

EMS Chief Dana Sechler with Baraboo District Ambulance also attended the meeting.  He commented during the webcast, "The federal Government Accountability Office (GOA) did a study in 2007 and 2012.  It summarized that federal MediCARE reimbursement rates were less than the actual cost to run an ambulance call.  The interesting thing is when you compare federal MediCARE to Wisconsin MediCAID rates, Wisconsin MediCAID is less than half of MediCARE." (refer to the chart below) 

Nowadays, the ability for an ambulance service to meet its operational, financial sustainability and any debt obligations truly rests in a favorable payer mix, local taxes and per capita charges.  If your payer mix skews more towards MediCARE and state MediCAID patients, and less on insurance and private pay, it can be a difficult road to travel financially.

Without DHS increasing the reimbursement rate or industry stakeholders pursuing legislative action, growing budget gaps caused by low Medicaid payments will continue to plague the industry and lead to a greater cost shift to other payers, increase local property taxes, or potentially result in a reduction of services.

Federal MediCARE and State MediCAID Ambulance Reimbursement Rates - 2015

Description	Federal MediCARE	Wisconsin MediCAID	Minnesota MediCAID	Illinois** MediCAID
Per Mile	$10.74*	$5.56	$7.06	$5.00
BLS Non-Emergent	$216.44	$94.90	$221.34	$127.34
BLS Emergent	$346.31	$151.84	$430.03	$127.34
ALS Non-Emergent	$259.73	$113.88	$265.60	$198.49
ALS Emergent	$411.24	$180.31	$430.03	$198.49
ALS2	$595.21	$260.97	$608.77	$198.49
SCT	$703.43	$308.42	$719.45	$273.49

*MediCARE pays $10.74/mile for the first 17 miles, then $7.10/mile thereafter.
**Illinois MediCAID rates vary by county.  Lake County (borders WI) 2014 rates shown.

The webcast concluded with EMS Advisory Board Chairman Jerry Biggart reviewing several highlights and priority items the board is working on.  One of the items also discussed included EMS worker protection laws, since many states' like Minnesota are drafting legislation to enact them.  The good news for Wisconsin's EMS workers is protection laws already exist.  >> Click for Wisconsin's EMS protection laws.

>> Click to listen to this audio webcast.

Over 5,600 reached on PAAW's facebook page

PAAW would like to congratulate Crystal Wallin for reaching over 5,600 on its facebook page with her newest post "cheese curds and gravel".

Crystal is a La Crosse area paramedic with a captivating style in the way she shares an EMS work life and writes about the experience. 

According to PAAW Executive Director Joe Covelli, "Crystal approached us last year about writing a monthly blog post.  From the very first post it has been an absolute hit with our audience, as well as those outside of the EMS industry who find her writings fascinating".

To read Crystal's blog, "Standby for Tones", a collection of her featured writings, >> click here.

Whether it’s Amazon considering delivering packages by drones or regular citizens using them to film grandiose aerial footage to put on YouTube, drones are widely available and visible. Recent news reports describe how some fire and EMS agencies are integrating drones into first responder operations, too.  >> Click to read more.

To help one local community improve patient outcomes, lower healthcare costs and provide more accessible care to chronically ill patients, southern Wisconsin-based Ryan Brothers Ambulance Service last June opened the Triangle Health & Resource Center, a community paramedic clinic staffed by EMTs, paramedics and CP students undergoing clinical training.

After a local television news segment last spring spotlighted the community paramedic concept, the managers of the Brittingham Apartments in Madison’s lower-income Triangle neighborhood approached the ambulance service about bringing in a CP to provide care for more than 600 of their residents.

“We were looking for an opportunity for our community paramedics to do clinicals and provide a community service,” explains Patrick Ryan, one of the owners of Ryan Brothers. “The managers of Brittingham contacted us about staffing a health clinic that was formerly staffed by parish nurses from a local hospital. We met with them and decided to give it a try. So far it is working well and appears it will be well into the future.”  >> Click to read more.

Registration is now open for the EMS Leadership Academy, sponsored by the Wisconsin Office of Rural Health and the Wisconsin Healthcare Emergency Preparedness Program.  This series of four, two-day courses is intended to provide EMS staff with skills and strategies to achieve and maintain a high functioning service.
 
Registration is $50 each for Levels I and II (April 21-24 in La Crosse) and $45 each for Levels III and IV (June 2-5 in Weston) and will include meals.  You must register separately for each two day session.  A hotel room block has been reserved in La Crosse; details on the registration site.

The program is presented by Aarron Reinert and John Becknell.

For more information on the Academy and to register, >> click for Wisconsin Office of Rural Health website. 

>> Click for the event flyer.

Contact Kevin Jacobson at Wisconsin Office of Rural Health, 608-261-1888, with any questions.

>> Click for webcast on-demand playback.

This webcast of EMS Live in Wisconsin was recorded on Tuesday, February 9, 2016.  Co-hosts included Joe Covelli and Patrick Ryan, and the program lasted 30 minutes.

Our first guest at 5:00 minutes into the program was EMS Office Licensing Coordinator Helen Pullen with the State of Wisconsin.  We discussed what is required to renew your EMT, paramedic, or emergency medical responder license as all state licenses expire as of June 30, 2016.  The license renewal website is https://www.dhs.wisconsin.gov/ems/licensing/renewal.htm.

At 20 minutes into the program State of Wisconsin EMS and Trauma Medical Director Dr. Suzanne Martens joined us to explain House of Representatives bill 4365, Protecting Patient Access to Emergency Medication Act.  It has been recognized that EMS technically operates outside of the current DEA rules for controlled substances for pain and seizures.  The DEA has allowed this to continue, but has stated it cannot do so without a change in the actual regulations.  A draft bill to change these regulations has been written and proposed.  The House of Representatives is processing it, and will vote in the near future.  Without this bill change, all administration of controlled substances will require radio/phone contact for an order with medical control; and the ordering and stocking of these medications will be complex and costly, with potentially every ambulance being considered an "office".  Since the majority of requests for paramedic intercepts involves controlled substances, this impacts all levels of care.  >> Click for the HR4365 Toolkit and how to contact your local elected federal representative.

How you can support the effort:

Locate your appropriate Representative using a zip code search and activate an email communication.  >> Click to enter your zip code and submit to start the process.  Copy and paste the communication below in the body of the email using the template below and adding the Representative's name at the beginning, your name at the end, and any changes you wish.
 
Email template:

Subject: Please Co-sponsor H.R. 4365

Dear Representative  [name]   ;

As an Emergency Medical Services (EMS) provider, I am writing to ask you to cosponsor the Protecting Patient Access to Emergency Medications Act of 2016, H.R. 4365.  I am committed to the safety of patients; and it is out of that commitment that I request your support.

H.R. 4365 clarifies that the current practice of physician medical directors overseeing care provided in the field by paramedics and other EMS practitioners via “standing orders” is statutorily allowed and protected.  The use of “standing orders” is necessary so that physician medical directors can establish these pre-set protocols which EMS practitioners follow in delivering field EMS care. 

When minutes count, “standing orders” are essential to enable EMS practitioners to immediately administer controlled substances on a timely basis and save lives.  In the absence of standing orders, patients would not have access to the time-sensitive and potentially life-saving interventions they so desperately need.

Accordingly, H.R. 4365 ensures patients will continue to receive these vital medications by:

Codifying the practice of standing orders by a physician Medical Director for the administration and delivery of controlled substances, maintaining physician oversight of medical decisions, while,

Making the EMS Agency liable for the receiving, storing, and tracking of controlled substances, similar to current procedure at hospitals.
 
I again urge you to cosponsor this important legislation. If you would like to co‐sponsor or would like more information, please contact Preston Bell in Rep. Hudson’s (R-NC) office at Preston.Bell@mail.house.gov or in Rep. Butterfield’s office (D-NC) Dennis Sills at dennis.sills@mail.house.gov.

Sincerely,

Next EMS Live webcast Tuesday, February 23

The next live show is Tuesday, February 23 starting at 9:00 a.m.  the topic is Wisconsin Medicaid and ambulance reimbursement rates for patient transports.  Our guests include EMS Advisory Board Chairman Jerry Biggart, Baraboo Ambulance Chief Dana Sechler and Paratech Ambulance Vice President Larry Knuth.

Don't miss a beat of Wisconsin EMS action - listen to EMS Live!