As I write, members of the EMS Section are busy representing you with the Health Care Finance Administration (HCFA) in Ellicott City, Maryland.  At the center of the discussions is the negotiated rulemaking process which will determine future fee reimbursements for ambulance services.    The new fee schedule is mandated by the   Balanced Budget Act of 1997 in which Congress directed HCFA to implement the negotiated rulemaking.  Traditional rulemaking usually involves HCFA drafting a regulation, and then accepting input from the public before issuing a final rule. A total of five or six sessions before a final ruling is issued this summer. The new Medicare fees are to be implemented in phases starting in 2000.

Some of the issues on the table include defining levels of service.  Should there be different Medicare reimbursement rates for ALS, BLS, inter-facility transfers, critical inter-facility transports, etc.?  Should the fire service be reimbursed differently than privates, volunteer, or third service operations?  Should Medicare reimbursement rates be different for different parts of the country? 

Representing the IAFC from the EMS Section at the negotiations are  EMS Section Chairman Jack Krakeel; EMS Section Secretary John Sinclair; Alec Jensen of Tualtin Valley (OR) Fire & Rescue; Pete Lawrence of Oceanside (CA) Fire & Rescue; John Garitz of Springfield (OR) Fire & Life Safety; and IAFC EMS Program Manager Gary Horowitz.  

Out of the ten agencies at the negotiation table, three are from the fire service.   Besides the IAFC, there will be representatives from the International Association of Fire Fighters, and the National Volunteer Fire Council.

Why is this issue so important to the fire service that the IAFC has to have six EMS Section members present for five or six sessions?   First, many fire agencies bill for ambulance reimbursement from Medicare.  For example, a fire agency which receives $280 for an ALS emergency transport would be dramatically impacted if the new rate would be $150.   Less revenue received by a fire agency could have serious setbacks in their operating budget. Also, what if that new $150 rate also applied to private ambulance services. Conceivably, many small mom and pop ambulance companies could go out of business.   Who would be left to pick up the slack in the community?   Most probably the fire service!    Even fire agencies which do not transport may be impacted under the new fee schedule.  The IAFC is taking the position that reimbursement should be tied to treatment and not transport.  In that case, a fire agency which did not transport but did perform first response could receive reimbursement for services provided.  However, it is unknown whether this topic would be open for discussion or if only existing services are available for debate.

Did you receive your brochure for Fire-Rescue Med in the mail?  Did you look at it?  Did you register?  The answer to all three questions should be yes! (**Note - It is permissible to skip the first two questions and answer yes to the third).    

No other conference is strictly designed for fire service managers with respect to EMS management issues.   So if you want to learn how to read EKGs or what is the best drug of choice for someone having an allergic reaction to peanuts after a plane ride, you need to find another conference.  There are no clinical sessions at Fire-Rescue Med.  However, if you want to learn some of the latest trends or management concepts impacting fire service EMS, you need to register for Fire-Rescue Med.   You can call the IAFC at 703/273-0911 to register or to obtain a brochure.   I hope to see you there.

Prudential Insurance is again offering their Helping Hearts Program.  The Helping Hearts Program provides grants of as much as $1,000 to qualifying volunteer rescue squads and fire departments in any state to help defray the cost of purchasing an automatic external defibrillator.   To be eligible, volunteer fire agencies must meet their state debrillation training requirements and raise the rest of the cost of the defibrillator themselves. Agencies interested should contact their local Prudential office or download an application from their web site at www.prudential.com/community.