Do you get questioned for using "costly" equipment?

[thegreypilgrim]

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

Well, I don't think anybody is advocating writing a blank check to anyone. Of course, even with public services their has to be effective financial management of the organization such that it can at least contribute to its own sustainability and not be a tax sink-hole. My point is the primary concern ought to be the provision of quality health care with all other concerns being subordinate to that; and, as much as can possibly done to avoid needless penny-pinching and frugality with regard to someone's life and health should be done. That sort of thing appears to be easier to control and regulate with public agencies than the sort of shadowy arena of private enterprise.

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.

Not denying that. Just saying the fundamental purpose of medicine is health, and it's easy to lose site of that in for-profit industry.

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

Understood, but again we're discussing how things ought to be and feasibly could be, not just the current realities.

 

[Veneficus]

My point is the primary concern ought to be the provision of quality health care with all other concerns being subordinate to that; and, as much as can possibly done to avoid needless penny-pinching and frugality with regard to someone's life and health should be done.

It is not that I don't agree but eventually the spectre is raised of what constitutes quality healthcare?

Is putting somebody on a vent with a G-tube and a pacemaker quality health care? When you address quality care, you must also look at the economics of that "quality."

Is doing a head CT on every patient that goes to the ED for a headache "quality care?"

That sort of thing appears to be easier to control and regulate with public agencies than the sort of shadowy arena of private enterprise.

Perhaps, but what happens when a "tea party" movement demands by popular vote to suck the budget of public health and welfare as waste? Then you have the same problem only now you have to undo legislation.(Which is a lot harder) For something more tangible look at how medicare and social security were looted to pay for other Federal endevors.

Not denying that. Just saying the fundamental purpose of medicine is health, and it's easy to lose site of that in for-profit industry.

For certain, but don't forget, we are not paying for Healthcare in either EMS or IFT. We are paying for transport. So just like you see with many municiple agencies and all privates, effective EMS (if you plan to keep providing it) is an excercise in trucking. (not saying I like it, but it is what it is) Figure:

You are paid by the load.
You have overhead like fuel, consumable equipment, personel, etc.
You must maximize loads in order to keep running. (applies even to the local FD because as their loads decrease so does their budget)
You often have to deal with labor issues from people who want their job to be as simple and well defined as possible.

Really is there a difference between a private providing the minimal level of care or a municiple provider doing the same?

Just being the devil's advocate, but at least the private doesn't try to hide it. If Joe Shmoe's EMS has a 3 lead Zoll without a pulse ox or auto BP is that somehow lesser care than Podunk's FD (or 3rd service) that has the latest LP 15, but doesn't know how to use capnography, doesn't run 12 leads because "they could be at the hospital faster" and runs the same treatments on every patient regardless of presentation, etc?

Understood, but again we're discussing how things ought to be and feasibly could be, not just the current realities.

Both EMS and IFT will never be healthcare in the US. In order for it to become such it would have to be part of public health. (which is already underfunded) No FD or private wants anything to do with that. No volunteer agency wants anything to do with that. How many wackers you see checking on the local frequent fliers or granny before 911 is called in order to prevent the call?

In all of medicine, the treatments that save the most lives are the most mundane.Your average IM/Peds doc will do more and save more people than any ED doc, intensivist, or critical care surgeon. It is just not as dramatic to give somebody a MMR vaccine.

Welcome to the good fight. Any ideas on winning it would be most welcome.

 

[looker]

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 many times it's moving patient from one place to another. You can charge medi-cal/medicare/private insurance all you want, but they will not pay more than their internal rates. It's that simple.

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.

While they are not required to pay for gross negligence they are still require to fight it till it's proven to be as such. Once court declare it to be gross negligence etc, insurance company can refuse to pay.

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 am sure in small town etc the ems is volunteer base but in any places that the population is big enough, there is always for profit company. Yes without government paying for health care much less people would be able to afford it. However it's all base on supply and demand.

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.

In Los Angeles, LAFD do not have enough units to respond to 911. Have you notice that many time private ems respond to accident because either lafd unit wasn't available or eta much extended.

 

[Veneficus]

If you want to save mega dollars in healthcare,

Lobby to require all nursing homes to have onsite dialysis or require a trial of peritoneal dialysis prior to Hemodialysis.

 

[ffemt8978]

Keep it on topic.

 

[thegreypilgrim]

It is not that I don't agree but eventually the spectre is raised of what constitutes quality healthcare?

Is putting somebody on a vent with a G-tube and a pacemaker quality health care? When you address quality care, you must also look at the economics of that "quality."

Is doing a head CT on every patient that goes to the ED for a headache "quality care?"

Clearly answering that question constitutes an incredibly complex analysis taking into account everything from economical to medico-legal to bioethical issues. It's certainly not easy to define, nor is it even clear that a hard and fast "criterion" for what constitutes quality of care is even necessary. You kind of just have to weigh quality of life vs. fiscal reasonableness vs. about a million other things. Part of the problem is indeed a kind of test/procedure overboard that typifies healthcare in the US - perhaps we need to learn a thing or two from our European neighbors who use considerably less technological resources than we do yet have equal if not better outcomes than we do here.

Perhaps, but what happens when a "tea party" movement demands by popular vote to suck the budget of public health and welfare as waste? Then you have the same problem only now you have to undo legislation.(Which is a lot harder) For something more tangible look at how medicare and social security were looted to pay for other Federal endevors.

Obviously movements like the Tea Party circus need to be ridiculed back into the obscurity from whence they came. Given the current political maelstrom and polarization that exists in this country at the moment that seems a daunting task, but I think part of the problem is the relative silence emanating from healthcare practitioners themselves. People who actually work in health care - physicians, nurses, etc. - need to support progressive economists like Paul Krugman to try and explain to Joe Sixpack that cutting out welfare, public health, and other benefit programs now will only worsen things.

For certain, but don't forget, we are not paying for Healthcare in either EMS or IFT. We are paying for transport.

This is no doubt true, but you know as well as I do that this ludicrous system won't last much longer. Soon Medi/Medi and private insurance will start to view it as unnecessary and simply stop reimbursement altogether for things like this.

Really is there a difference between a private providing the minimal level of care or a municiple provider doing the same?

Certainly not, but I think we're now treading far off course from the original debate.

Just being the devil's advocate, but at least the private doesn't try to hide it.

I think the issue boils down to what has the potential for greater damage: corporate willingness to sacrifice safety/clinical/legal/etc. standards of proper practice for the sake of profit or government inefficiency/mismanagement? For me, the choice is about as clear cut as something as screwed up as this can get. I mean Christ, just look at the whole litany of fiascos brought about by the former: the BP oil spill, the current financial/economic crisis, the whole quagmire of private security firms and their entanglement with the current Iraq and Afghanistan military campaigns, airline deregulation, energy deregulation, the list goes on. I mean I'm not advocating that all those things need to be replaced by public agencies, but to me EMS falls into the same general category of police, fire, and other public services. No one would dream of privatizing law enforcement, fire protection, health inspection, etc. so why is it OK for something like, "The emergency care and transport of the sick and injured" to be left up to some entity who's primary reason for existence is to turn a profit? To me it's simply irresponsible which trumps any economic/financial counterargument.

If Joe Shmoe's EMS has a 3 lead Zoll without a pulse ox or auto BP is that somehow lesser care than Podunk's FD (or 3rd service) that has the latest LP 15, but doesn't know how to use capnography, doesn't run 12 leads because "they could be at the hospital faster" and runs the same treatments on every patient regardless of presentation, etc?

I don't think either one of those examples are of any use for anyone, and unfortunately the majority of American EMS systems are either one of those two.

Both EMS and IFT will never be healthcare in the US. In order for it to become such it would have to be part of public health. (which is already underfunded) No FD or private wants anything to do with that. No volunteer agency wants anything to do with that. How many wackers you see checking on the local frequent fliers or granny before 911 is called in order to prevent the call?

I am aware of the obstacles and barriers, and you and I have discussed them at length in the past. I am inclined to share your pessimism in the matter, but part of me doesn't want to give up yet and consign the idea of a Paramedic health professional for EMS/IFT to the large pile of good ideas that failed miserably.

In all of medicine, the treatments that save the most lives are the most mundane.Your average IM/Peds doc will do more and save more people than any ED doc, intensivist, or critical care surgeon. It is just not as dramatic to give somebody a MMR vaccine.

I agree with you entirely, but once again I think this is somewhat off course and entering into a whole new topic altogether.

Welcome to the good fight. Any ideas on winning it would be most welcome.

When I actually have a specific idea/plan on fixing this disaster I'll be sure to share it! Haha

 

[ffemt8978]