Do you get questioned for using "costly" equipment?

[Fox800]

Do you ever get questioned/chastised by supervisors for using equipment that "costs too much to be using on everyone"? I have yet to hear this but my partner did at an old job. "We can't be doing that on everyone, make sure they REALLY need it." Buddy, I'm spending $ here to save you $$$$$$$$$ from a lawsuit in the future.

 

[looker]

Do you ever get questioned/chastised by supervisors for using equipment that "costs too much to be using on everyone"? I have yet to hear this but my partner did at an old job. "We can't be doing that on everyone, make sure they REALLY need it." Buddy, I'm spending $ here to save you $$$$$$$$$ from a lawsuit in the future.

Hey buddy be happy you have a job At the end of the day all private ems care about is the bottom line. Everyone got in to this business to make money unless they are non-profit. As for lawsuit(s), that is why I have so many insurance that in case i get sued i will not got out of business. Basically what that company was saying is that make sure you do your job properly and do not waste expensive stuff unless patient really needs it.

 

[Fox800]

Hey buddy be happy you have a job At the end of the day all private ems care about is the bottom line. Everyone got in to this business to make money unless they are non-profit. As for lawsuit(s), that is why I have so many insurance that in case i get sued i will not got out of business. Basically what that company was saying is that make sure you do your job properly and do not waste expensive stuff unless patient really needs it.

I understand this viewpoint. However, the key topic here is being second-guessed or chastised for using equipment that you deemed justifiable, but higher-ups want to argue about. Or being restricted in using equipment that the pt. would otherwise need, due to fiscal constraints.

 

[Flight-LP]

Hey buddy be happy you have a job At the end of the day all private ems care about is the bottom line. Everyone got in to this business to make money unless they are non-profit. As for lawsuit(s), that is why I have so many insurance that in case i get sued i will not got out of business. Basically what that company was saying is that make sure you do your job properly and do not waste expensive stuff unless patient really needs it.

Can you qualify the "bottom line" statement?

As a Director of a private service, I have to respectfully disagree. While we are solely supported on generated revenue, I would never chastise an employee for utilizing a resource made available to them for patient care and intervention. If you fail to realize the potential cost loss of utilizing such equipment and are unable to compensate for that realized loss, then you have made a bad business decision.

As far as the insurance comment goes, I wouldn't count on it. Recently an ambulance service in Florida was successfully sued for twice what their insurance policy covered. I'm sure they will appeal, however probably will not be successful. I've seen plenty of ambulance services come and go, hell we have over 300 of them in Houston. If there is one lesson I have learned, it is that this industry not only requires a sound business plan, but one with medical expertise as well. I've seen MBA grads think they could run an ambulance service, just to see them fall flat on their face because the had not knowledge or experience in providing excellence in their delivery of care. Everything from crappy clinicians due to no dedicated clinical department or QA / QI, to ineffective billing due to an unqualified sibling / spouse / girlfriend etc. thinking they can help their loved one out with the company.

You have to develop a leadership team that possesses strength in all aspects of the organization. Clinical ,Operations, Logistics, Communications, Administration, AP / AR, and Business Development are all a necessary expense if you truly wish to be have a reputable professional organization.

OP, never second guess yourself for utilizing a tool of your trade that may benefit a patients care or outcome. If a piece of equipment is indicated based on your clinical guidelines or protocols, then you should consider its utilization. If you are second guessed or chastised, then you should really evaluate the quality of your employer.

Regardless of the economy, NEVER compromise your ethical work standards. EMT's may be a "dime a dozen" in some places, but then again, so are POS ambulance companies!

 

[MrBrown]

We have been instructed to use the EZ-IO wisely as it is not cheap apparently

 

[Fox800]

We have been instructed to use the EZ-IO wisely as it is not cheap apparently

Hmm...I really didn't think that this would be that commonly used. I might do one every three months.

 

[Aidey]

I haven't personally, but I know that a person in my service have been talked too about the high amounts of equipment he uses. However, I think with him it is more of a clinical thing than budget. When the average medic uses 1 CPAP every 2 weeks, and 1 CO2 monitor a week and one guy is going through 4 of each a week it raises peoples concerns that there is an over treatment issue. (Those numbers are just examples, not reality)

 

[looker]

Can you qualify the "bottom line" statement?

As a Director of a private service, I have to respectfully disagree. While we are solely supported on generated revenue, I would never chastise an employee for utilizing a resource made available to them for patient care and intervention. If you fail to realize the potential cost loss of utilizing such equipment and are unable to compensate for that realized loss, then you have made a bad business decision.

As far as the insurance comment goes, I wouldn't count on it. Recently an ambulance service in Florida was successfully sued for twice what their insurance policy covered. I'm sure they will appeal, however probably will not be successful. I've seen plenty of ambulance services come and go, hell we have over 300 of them in Houston. If there is one lesson I have learned, it is that this industry not only requires a sound business plan, but one with medical expertise as well. I've seen MBA grads think they could run an ambulance service, just to see them fall flat on their face because the had not knowledge or experience in providing excellence in their delivery of care. Everything from crappy clinicians due to no dedicated clinical department or QA / QI, to ineffective billing due to an unqualified sibling / spouse / girlfriend etc. thinking they can help their loved one out with the company.

You have to develop a leadership team that possesses strength in all aspects of the organization. Clinical ,Operations, Logistics, Communications, Administration, AP / AR, and Business Development are all a necessary expense if you truly wish to be have a reputable professional organization.

OP, never second guess yourself for utilizing a tool of your trade that may benefit a patients care or outcome. If a piece of equipment is indicated based on your clinical guidelines or protocols, then you should consider its utilization. If you are second guessed or chastised, then you should really evaluate the quality of your employer.

Regardless of the economy, NEVER compromise your ethical work standards. EMT's may be a "dime a dozen" in some places, but then again, so are POS ambulance companies!

It sounds like a company had pretty low amount of insurance if they got sued for twice as much as they were insured. I agree that you need to know what you're doing prior to getting in to this business, i had 10 years NEMT(non emergency medical transportation) experience before jumping in to this and still had some learning to do. As for 300 EMS in Houston,wtf? Why would you have so many ems operators?

 

[WolfmanHarris]

Nothing like that here. Closest it comes is when I take certain non-disposable equipment out of Pyxis I have to enter a Damaged/Missing Equipment report on our QRS system and note on Pyxis why I'm taking out another LP12 battery, laptop, radio, etc.

 

[jjesusfreak01]

Nothing like that here. Closest it comes is when I take certain non-disposable equipment out of Pyxis I have to enter a Damaged/Missing Equipment report on our QRS system and note on Pyxis why I'm taking out another LP12 battery, laptop, radio, etc.

...pictures a little drawer popping open on the Pyxis containing a new toughbook and radio...

 

[ah2388]

nope, never been questioned for anything...

my thought regarding that is that if you dont want us to use it because its "to expensive" then dont make it available on the truck.

 

[WolfmanHarris]

...pictures a little drawer popping open on the Pyxis containing a new toughbook and radio...

You laugh, but that's exactly what happens. We even have little drawers with replacement pulse oximeter probes, NIBP cuffs, stretcher straps. Our Logistics branch only operates 12 hours per day, so this systems limits how often we need to bug a District Superintendent to go raid the warehouse for us and let's them keep track of the three regional pyxis stations.

 

[jjesusfreak01]

Man, just looked up the pricing on those probes. No idea they cost that much. I suppose when you have thousands of dollars worth of gear, it's not a bad idea to keep track of it.

 

[Fox800]

Man, just looked up the pricing on those probes. No idea they cost that much. I suppose when you have thousands of dollars worth of gear, it's not a bad idea to keep track of it.

Exactly...I know our Motorola radios and Toughbooks are about $5000 a pop...

 

[ffemt8978]

All the time. Chief doesn't like spending money on EMS if he doesn't have to.

 

[thegreypilgrim]

Never really been "chastised" or reprimanded but overall stingyness with supplies and equipment is a routine thing here. I've had supervisors tell me to reuse disposable peds pulses ox probes, "forget" to order medications until someone says "holy crap all our epi is expired" or something like that. They also only allow minimum stocking levels, and restrict employee access to replacements gear. Meaning every time someone uses a nasal cannula it must then be replaced to remain in service, and a supervisor must stop whatever he's doing to let you in the cage to get a new one. It's exasperating.

 

[thegreypilgrim]

Hey buddy be happy you have a job At the end of the day all private ems care about is the bottom line. Everyone got in to this business to make money unless they are non-profit. As for lawsuit(s), that is why I have so many insurance that in case i get sued i will not got out of business. Basically what that company was saying is that make sure you do your job properly and do not waste expensive stuff unless patient really needs it.

I don't know what bothers me more, the amount of times I hear the "this is a business" excuse as a valid justification for anything or how often people actually by into it. This sort of thinking is a prime example of why private enterprise should not be involved in EMS (and maybe healthcare in general). People's health trumps your "bottom line" regardless of whatever you tell yourself to get to sleep at night.

Having to explain your clinical decisions to some yahoo businessman with no medical knowledge whatsoever is enough to infuriate anyone.

As for your faith in your liability/malpractice insurance to cover your future litigation costs...yeah...good luck with that

 

[looker]

I don't know what bothers me more, the amount of times I hear the "this is a business" excuse as a valid justification for anything or how often people actually by into it. This sort of thinking is a prime example of why private enterprise should not be involved in EMS (and maybe healthcare in general). People's health trumps your "bottom line" regardless of whatever you tell yourself to get to sleep at night.

Having to explain your clinical decisions to some yahoo businessman with no medical knowledge whatsoever is enough to infuriate anyone.

As for your faith in your liability/malpractice insurance to cover your future litigation costs...yeah...good luck with that

I been involved in transportation business for the lat 10 years. Yes liability/malpractice insurance will cover my litigation costs as that is what required of them by law. As for private enterprise should not be involved in ems or maybe in health care in general, who do you think provides majority of the service? No city have enough ems unit to provide service to everyone. How about doctors, 99% of them have their own private practice, so you think all of them should be closed down? I am sorry to tell you this but at the end of the day everything is about the bottom line aka business decision.

 

[Veneficus]

I must agree with looker on this and point out even in social healthcare systems there is always somebody watching cost.

A major purpose of medicine is to preserve or create wealth. (Granted we are usually talking about the patient's individual wealth or producers in society) But when I am finished with school I will owe almost $200K and it will be the patients that pay for it.

PS. Having worked with poor populations for more than a decade, how much something costs is factored into every decision I make.

 

[thegreypilgrim]

I been involved in transportation business for the lat 10 years.

That's great. Many people in the modern world view EMS not as merely a means of moving people from point A to point B, but as part of the spectrum of public health. That is to say, EMS is becoming more and more of a community healthcare service - at least that is the direction it must head if it is to be a sustainable and cost-effective entity. This silly practice of trying to move as many bodies around as possible, and then charging Medi/Medi and private insurance outrageous transport fees for a service who's medical necessity is unproven at best will soon self-implode and EMS will be forced to completely reinvent itself one way or another.

Yes liability/malpractice insurance will cover my litigation costs as that is what required of them by law.

They typically are not required to cover instances of gross negligence or willful and wanton misconduct. Those are terms that have no legal definition either, and, thus whether or not they end up being applied in a given case largely depends on the quality of "lawyering" on either side. All they have to do is convince a group of average citizens...I wouldn't be willing to hedge my bets on that.

As for private enterprise should not be involved in ems or maybe in health care in general, who do you think provides majority of the service?

For what? EMS or healthcare in general? The majority of EMS in this country is volunteer-based followed closely by public service models like fire departments. Even conceding your point for the sake of argument, I fail to see how the premise of the majority of EMS service being provided by private enterprise in any way leads to the conclusion that this, therefore, ought to be the case. Furthermore, who provides the majority of financial reimbursement for healthcare services? The government. How many healthcare organizations could survive financially without the ability to bill Medicare/Medicaid?

I'm less concerned about healthcare in general and am willing to concede certain points regarding that.

No city have enough ems unit to provide service to everyone.

I suppose this depends on what you mean by "EMS" and "service", it's unclear how you're using those terms. If you're referring to "911 emergency service" then that's just completely false.

How about doctors, 99% of them have their own private practice, so you think all of them should be closed down?

Like I said, I'm less concerned about this - mainly because physicians have for the most part established themselves as credible examples of both health advocacy and responsible business practice. Private, for-profit EMS, on the other hand, has an absolutely abysmal track-record with this.

I am sorry to tell you this but at the end of the day everything is about the bottom line aka business decision.

Once again, I have yet to see any sort of rational justification for this.