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Calling 911 in New Jersey Dangerous to Wallets

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  • drparasite
    replied
    Originally posted by Ohiovolffemtp

    3. Why doesn't NJ offer EMT-Intermediate? With the EMT-I 99 corriculum, intermediates can provide most of the drug therapy medics can outside of cardiac drugs (that are among the most seldom used anyway).

    4. Unless the FD's have a significantly higher call volume than we have here, they're probably grossly underutilized. Here probably 60-80% of call volume is EMS, and many of the fire calls are EMS related: car wrecks, EMS assists, etc. There just aren't that many workers anymore.

    While I recognize the issues strong feelings can bring, I would think that if the current BLS providers had a few medics - which could probably be part-time employees - that did ALS intercepts, you could resolve this issue.

    It works in Ohio - and we're only 8-10 hours west.
    you mention a lot of good points. The reason NJ doesn't have an intermediate level was told to me by a paramedic after we worked a code togeter. He said the EMT-I program didn't work in New Jersey, because we have so many hospitals in the state, that it's just not practical. his words, not mine. Personally, would love to be able to intubate someone who was in resp or cardiac arrest when the medics were unavailable. but i don't see it happening anytime soon.

    in regards to call volume for FDs, I can only speak from what i know. my Department runs between 700 and 800 fire calls a year, with no EMS first responding. My department is one of 3 fire districts/departments that cover my suburban hometown. The Rescue Squad gets dispatched to between 4500 and 5000 calls per year. and both are strictly volunteer organizations and the majority of their calls are within the town boundries.

    oh, who would you propse run the ALS intercepts? ie, who would pay the medics salaries, as well as upkeep on the equipment? because i don't think some of the smaller departments would be able to afford it.

    paid departments might be able to (don't have the numbers of their call volume) but I don't know if volunteers could.

    Leave a comment:


  • Ohiovolffemtp
    replied
    George,
    First, glad to hear your ticker is OK. We'd be lost without your fiestiness.

    New Jersey sure seems like an odd place. Maybe it's because it's full of small urbanized towns - at least in the north, but it's extremely different from Ohio. There are a ton of things that don't make sense:

    1. Why would permitting the local ambulance service to operate at the medic (or EMT-Intermediate) level force it too? There are lots of FD's here that don't provide medic service. Even Cincinnati has 4 medic ambulances & 6 BLS ones. Public demand might (and should) push medic service, but only a small percentage of calls require it. So, there would always be a place for EMT-Basics.

    2. Pricing seems outrageous. My part-time FD bills about $500-600 for an ALS transport - whether we code a person and use dozens of drugs, or whether it's IV, O2, & cardiac monitor. My vollie FD only bills non-residents, and about $500 call. We're also paying a lot less it sounds like for some things. Lifepack 12's are about $12K. Many drugs are cheaper.

    3. Why doesn't NJ offer EMT-Intermediate? With the EMT-I 99 corriculum, intermediates can provide most of the drug therapy medics can outside of cardiac drugs (that are among the most seldom used anyway).

    4. Unless the FD's have a significantly higher call volume than we have here, they're probably grossly underutilized. Here probably 60-80% of call volume is EMS, and many of the fire calls are EMS related: car wrecks, EMS assists, etc. There just aren't that many workers anymore.

    While I recognize the issues strong feelings can bring, I would think that if the current BLS providers had a few medics - which could probably be part-time employees - that did ALS intercepts, you could resolve this issue.

    It works in Ohio - and we're only 8-10 hours west.

    Leave a comment:


  • Bones42
    replied
    Ambulance regulation bill proposed

    Published in the Asbury Park Press 7/11/03
    By NAOMI MUELLER
    TOMS RIVER BUREAU
    BRICK -- Assemblyman David W. Wolfe, R-Ocean, says he will introduce a bill that would give the state Department of Health and Human Services oversight of ambulatory care in New Jersey.

    The bill, which Wolfe said he plans to introduce when the Assembly reconvenes in August, was prompted by a group of residents upset by the amount of money Monmouth-Ocean Hospital Service Corp. charges. Residents voiced their concerns over what they called price gouging at Tuesday night's Township Council meeting.

    But MONOC spokesman John DeFillippo yesterday defended the amount MONOC charges for its services -- an average of $1,285 -- saying that because the state does not subsidize paramedic services, all of the company's costs are paid for by the 1 percent of the population who actually rely on that care.

    DeFillippo also defended the more than 600 lawsuits MONOC has filed against Monmouth and northern Ocean County residents who have not paid their bills, another source of criticism from the residents.

    It is that threat of litigation and promise of a high bill that prevents many residents, especially seniors and those on fixed incomes, from calling 911 when they otherwise would have, said Maureen Glover, 47, of Brick.

    Glover said she received a $1,589 bill from MONOC, whose workers, she said, checked her vital signs and put in an IV, which she said was never used, while she was in a Wall ambulance in the hospital's parking lot.

    While her insurance company paid the $300 charged by Wall, Glover said it only paid $10 of MONOC's bill. Eventually, Glover said, she settled her case with the paramedic company in court for $500.

    During the past two years, Glover said, she has made it her cause to not only fight what she calls MONOC's outrageous prices, but also to let residents know that when they call for ambulance service, they might be accepting a world of debt.

    "I feel so bad when I think of seniors laying in bed at night, in need of an ambulance but afraid to call because of the cost," Glover said.

    But DeFillippo called such a decision foolish, emphasizing that under law, MONOC, as well as all other paramedic companies, are required to treat everyone, regardless of their ability to pay.

    And, DeFillippo said, adults have the right to refuse care and if that care is refused, the patient will not be billed.

    He also said the company only receives an average of $667 per patient, about half of its average charge. He said that if a patient can prove that he or she cannot afford the service, the bill is waived. In 2002, DeFillippo said, MONOC performed $427,000 worth of charity care.

    Mary Ellen Patterson of Brick said she learned her lesson the hard way, after receiving a $1,215 bill for a visit from MONOC after she collapsed in May 2002. In addition to appealing her bill to MONOC, Patterson, 69, said she has made a decision not to call 911 if she can help it. In June, Patterson said, her neighbor drove her to the hospital when she had a hard time breathing.

    Although Patterson said she recognizes the difference between volunteer emergency medical service workers and paramedics, she said the paramedics did nothing other than assess her condition after she collapsed.

    It was the EMS workers from Brick who actually monitored her condition and took her to the hospital, Patterson said.

    She added that her insurance has denied the $1,215 bill and that she does not have the money to pay it.

    Naomi Mueller: (732) 557-5734 or [email protected]

    Leave a comment:


  • KyleWickman
    replied
    That was more of an off the cuff comment. It's had to show expresions in the forms.

    Leave a comment:


  • drparasite
    replied
    I am a career firefighter that is a first responder-D, just like every other career firefighter in my department. We do not go on med calls. I rather see us do it then them. Our taxpayers pay big money to have us, why not use us to our full potential.
    carteret, NJ did just that. not sure if that was better or worse, but they did it (well, during the daytimes anyway).
    You think that the ALS charges in NJ are high? I saw a bill for a ride in the New Jersey State Police NORTHSTAR chopper. WOW!!!
    your comparing apples to oranges when getting the chopper involved costs are much higher than a ground ambulance. but on a related note, i thought the DMV has a surcharge that made the cost for the chopper the same as for a ground ambulance. i believe it was teh northstar people that actually told me that (don't have any first hand knowledge though).

    oh, and george, i have only one thing to say to you...

    Leave a comment:


  • KyleWickman
    replied
    MONOC has been trying to get full time EMS coverage from several towns.
    That is exactly what is happing. I know of a large health care system in my area that is buying up ambulances. Then they are going to towns where the volunteer membership is failing and offering their services for free…to the town. For now they are just doing it during the day. They just bill the “customer.” This bugs me because eventually they are going to just take over. I am a career firefighter that is a first responder-D, just like every other career firefighter in my department. We do not go on med calls. I rather see us do it then them. Our taxpayers pay big money to have us, why not use us to our full potential.
    You think that the ALS charges in NJ are high? I saw a bill for a ride in the New Jersey State Police NORTHSTAR chopper. WOW!!!

    Leave a comment:


  • GeorgeWendtCFI
    replied
    so you are saying that your town should have ALS coverage 24/7, but mine shouldn't? so if i'm having a heart attack, I'll get my BLS crew only, and they will have to see if an ALS crew is available (which is what our current system is).
    Yup, that's exactly what I am saying.

    Leave a comment:


  • Bones42
    replied
    DrP - your comment on the public's mentality is true. My comment was about the BLS Squad members mentality, not the publics. I would bet many BLS Squads care very much if it is them taking the call or MONOC (or someone else) if it's in their area.

    Leave a comment:


  • drparasite
    replied
    The one problem with your post is I never said most of what you are implying. I never said that the law said anything other than a hospital based ALS Unit is the only Unit allowed. I never said that ALL volunteer squads would be required to provide ALS service on a 24/7 basis. AND I never said that billing for care wouldn't change a squads' status.
    George, please stop getting so defensive. I did not imply anything. I mearly stated that those were 3 major problems with having EMS squads run ALS. "I never said that ALL volunteer squads would be required to provide ALS service on a 24/7 basis." so you are saying that your town should have ALS coverage 24/7, but mine shouldn't? so if i'm having a heart attack, I'll get my BLS crew only, and they will have to see if an ALS crew is available (which is what our current system is).
    The point of my post was that, by allowing an EMS agency to provide ALS if they so desire, would create a competitive atmosphere which would drive costs down.
    maybe, maybe not. if raritan twp starts to run its own ALS ambulance, i don't think it will drive costs down. the reason being the township (whatever organization running EMS) has a monopoly on that town. if it's a commercial service providing ALS, you might be able to get a competative bidding proccess in place. if not, you would need to regulate the costs and fees somehow
    The one's who need to do the pushing are the BLS Squads and I'm betting most in this area are too busy working on finding more members than to challenge MONOC for coverage. Basic mentality - "It's not hurting my Squad to have people complain about MONOC's bill."
    again, in this case, it's a fight for survival. MONOC has been trying to get full time EMS coverage from several towns. this often entails going to the public safety director, and convincing him or her that MONOC would provide a better service than the squad itself. if the director choses MONOC, the squad goes out of bussiness overnight. it's happened before. as for the mentality, i need to disagree with you. the mentality many people have is that if a person calls 911, they don''t care if it is a local squad or a monoc (or any commercial service) rig. this is what several people think, both in the volunteer EMS community, in the paid EMS community, as well as in the public itself (at least from where i sit).

    Leave a comment:


  • Bones42
    replied
    Perhaps this story will be the impetus behind changing it.
    Unfortunately, this is far from the first we have heard/dealt with complaints about MONOC. An article in the Press and an article on Firehouse.com won't come close to doing it. The one's who need to do the pushing are the BLS Squads and I'm betting most in this area are too busy working on finding more members than to challenge MONOC for coverage. Basic mentality - "It's not hurting my Squad to have people complain about MONOC's bill." I don't agree with that mentality, but you can only squeeze so much from a stone. In MONOC's area, very very few FD's do any type of First Responder/EMS coverage, and most do not want to do that, mine included. Heck, we still have EMS Squads doing extrication around here.

    Also, in Ocean County, MONOC does have a little competition, at least in the Dover Township area, Life Medics out of Community Hospital. Life will come up into the southern end of our area on calls that MONOC is not available.

    Leave a comment:


  • GeorgeWendtCFI
    replied
    good idea, in concept. and i think it would be interesting. however, thers is a slight problem with that... well three problems: first, current laws say that all medic units must be hospital based (monoc being the lone exception). secondly, the majority of the BLS squads in NJ are volunteer. requiring them to all be ALS compliant would require them to hire full time paramedics to ensure ALS coverage 24/7, which would cause financial problems, which would lead to problem #3. in NJ, the moment you start charging for servcies, you are no longer considered volunteer. even if you don't have paid staff members, and no members receive compensation for their work, the moment you bill, you are no longer considered volunteer by the state of new jersey. i don't agree with it, nor do i think it makes any sense, but that is what it is.
    The one problem with your post is I never said most of what you are implying. I never said that the law said anything other than a hospital based ALS Unit is the only Unit allowed. I never said that ALL volunteer squads would be required to provide ALS service on a 24/7 basis. AND I never said that billing for care wouldn't change a squads' status.

    The point of my post was that, by allowing an EMS agency to provide ALS if they so desire, would create a competitive atmosphere which would drive costs down.

    i don't think it's a great system, but that's what we are stuck with
    We are only stuck with it because the legislators havenb't been pushed to change it. Perhaps this story will be the impetus behind changing it.

    Leave a comment:


  • Ltmdepas3280
    replied
    ?

    Is New Jersey a home rule state, by that I mean can the local goverment make laws to do what is in the best interest of the locals. This could be a way of overriding this crazy system, which sounds like it needs to be....... Also this sound like a form of rationed health care.

    Leave a comment:


  • Bones42
    replied
    MONOC is based out of Meridian Health, which includes a group of hospitals. That is how they get their Hospital Basing. It's kind of gray in that respect. Also, MONOC does provide BLS coverage and does do BLS transports in some areas, although very few. They have worked out an agreement with a few areas to provide this coverage due to excessive response times by the local BLS squad. Also, every town does not have to have a BLS squad, they only have to provide the service/coverage for the town. My Squad covers 3 towns as an example. And Yes, NJ's setup is what we are stuck with as the FAC dinosaurs will never change it.

    Vince Robbins, CEO MONOC: "We need to get that money."

    Vince Robbins: "It's our money, we need to have it to finance our operation."
    These two statements by Vince say it all. Met him, know him, have dealt with him in the past.

    And DrP, I agree wholeheartedly with your 3 problems.

    Leave a comment:


  • drparasite
    replied
    They fought tooth and nail to oppose the establishment of ALS units...yes, a skewed priority. It was all about them...not the patient.
    they weren't the only ones. the hospital nurses all over the country (not just in NJ) also opposed the creation of paramedics. medics were to be able to do so much more, and yet didn't need a doctor looking over their shoulder the entire time. they were worried the paramedics were going to make the nurses jobs obsolete and unneccessary. maybe the EMTs thought the same thing would happen.

    Leave a comment:


  • drparasite
    replied
    The way to bring the costs down overnight in NJ is to allow, like the rest of country, EMS agencies to run ALS.
    good idea, in concept. and i think it would be interesting. however, thers is a slight problem with that... well three problems: first, current laws say that all medic units must be hospital based (monoc being the lone exception). secondly, the majority of the BLS squads in NJ are volunteer. requiring them to all be ALS compliant would require them to hire full time paramedics to ensure ALS coverage 24/7, which would cause financial problems, which would lead to problem #3. in NJ, the moment you start charging for servcies, you are no longer considered volunteer. even if you don't have paid staff members, and no members receive compensation for their work, the moment you bill, you are no longer considered volunteer by the state of new jersey. i don't agree with it, nor do i think it makes any sense, but that is what it is.
    I just think it's weird that in our town if someone has a heart attack, the paramedics come from the emergency room 2 towns over. Granted their is a BLS service in our town but still I work and live in a very populated area. Sometimes MICU units are very busy or too tied up to even respond. To top it all off, my fire department used to do 1st responder. They gave it up in the 70's. Now that we are trying to get it back, our 1st aid squad does not want us. It's a very long story.
    been there, done that. ever worked a cardiac arrest BLS since no ALS unit were available? it sucks. some paid FDs do first response, but I don't know of many volunteer ones in NJ that do.

    for those of you unfamiliar with NJ's EMS system, it pretty much goes like this: every town has one EMS/Rescue/First Aid/whever squad in it, traditionally run by volunteers. some of the busier towns have more than one squad. BLS transports everything. cardiac arrests, major traumas, breathing problems, stubbed toes, everyting. this is the law of NJ. the only exception to this is where the ALS provider and the BLS provider are the same organization (IE, UMDNJ-EMS newark, MONOC, etc), and this is only in full time paid EMS organizations. ALS is all run out of the hospitals (which MONOC being the exception), and is dispatched and covered regionally. this means in most areas, there are 3-5 paramedic units for more than 10 towns. they get sent, along with the BLS squad, to all life threatening emergencies. but BLS will always do the transport, with ALS assessing and treating the patient in the BLS ambulance, with the ALS vehicle (either ambulance or flycar depending on the organization) following behind.

    i don't think it's a great system, but that's what we are stuck with

    Leave a comment:

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