Take a Stand on Medicare Fraud and Abuse!

Just days ago, the report of a sweeping fraud and abuse enforcement measure impacting more than 100 healthcare companies including ambulance providers hit news agencies (read article here).  And, while the issue is currently “in the news” and on the minds of EMS policy makers and EMS regulators, there is no better time to produce and present targeted business communications during meetings with your local policy makers that put your ambulance service out in front of the fraud and abuse issue.

Ensure those who regulate and promulgate policy about how your EMS business conducts circumspect business practices with Medicare and Medicaid as well as with private insurance and end-user private pay clients.  Some public/private ambulance services are even more on the offense regarding the fraud and abuse issue using ad hoc specialty fraud and abuse prevention coalitions to influence state and federal legislators.

Bob Kellow from the Texas EMS Integrity Coalition writes,

The Texas EMS Integrity Coalition (hereafter, the “Coalition”) is a growing grassroots group of legitimate Texas medical transportation providers who are dedicated to the sole mission of preserving the integrity of Texas’ emergency medical service (EMS) providers by eliminating fraud, waste and abuse of federal and state healthcare reimbursement programs within Texas’ emergency and non-emergency medical transportation industry.
The Coalition recognizes its responsibility to “get in front” of the ambulance fraud problem by banding together for the purpose of assisting federal and state healthcare payers; creating liaisons with federal and state investigators and prosecutors; bringing widespread visibility to the ambulance fraud problem; engaging in efforts to reform Texas’ EMS rules and regulations; securing adequate funding for Texas’ EMS lead agency; promoting healthcare consumer education; and,  requesting a Centers for Medicare and Medicaid Services (CMS) moratorium on the issuance of new enrollee Medicare ambulance provider authorizations throughout Texas as an interim measure, in full recognition that more complex plans and solutions will be developed in the near future.

Of particular interest to local policy makers are the answers to these questions (Paraphrased from Bob Kellow’s letter to Senator John Cornyn and Senator Kay Hutchison):

• Have federal and state authorities identified local ambulance providers as being offenders for ambulance-related Medicare and Medicaid fraud?
• Is there evidence of ambulance companies’ illegal billing for unnecessary services or services not actually provided; falsification of claims; upcoding of covered claims; illegal inducements and kickbacks, and deep discount pricing arrangements in exchange for exclusive business agreements with healthcare facilities?
• Are local regulators aware of fraudulent activities that constitute violations of the federal False Claims Act (31 USC §§3729 – 37330) and the federal “Anti-Kickback Statute” (42 USC §1320a-7b) as amended by the Patient Protection and Affordable Care Act of 2010 (PPACA) [P.L. 111-152.] And, do local regulators have the authority to do something about offenders?
• Are local healthcare consumers unknowingly being co-opted into illegal schemes to commit ambulance fraud, especially the elderly and the economically disadvantaged?
• Is there a proliferation of with new ambulance provider license applications? Are ambulance licenses almost effortless to acquire?  Have lead agency enforcement efforts have been scaled down due to funding cuts?
• Are healthcare facility administrators who are routinely absolved of criminal wrongdoing in connection with ambulance fraud that involves kickbacks, deep discounts and illegal inducements even though they share equal liability under the False Claims Act and the “Anti-kickback Statute?”

Share on Facebook

EMS Today Presentation hand outs:

1. Successful Grant Proposals: Assembling the “Expert” Team

2. Throwing Your Hat in the Ring: Responding to RFPs

Downloadable Resources

Sample Letter of Support- Whether you are going through an RFP process or responding to a grant, an application backed by letters of support demonstrates your organization’s credibility and integration in your health care community. If you have already established relationships with other health care providers in your service area, use this letter as a guide when requesting documented support for your services. The more letters of support that you can obtain from fellow health care providers, the more credible you come off with the your claims about the quality of your service. Sample Letter of Support for EMS Agencies PDF

List of Health Care Data Sources- When carrying out business development efforts, it is invaluable to understand the health care trends in your community. A solid needs assessment will be backed by statistical evidence and state benchmarks to demonstrate where your service population stands in terms of health care indicators such as chronic illness, access to health care, insurance coverage, etc. This downloadable list of data sources helps to point you in the right direction for finding health care information specific to your county and state. Sources of Health Care Data PDF

Share on Facebook

The first presentation provides a case study and tips for authoring successful grant proposals and  for assembling the “expert” team to build credibility for your EMS agency when applying for government, state and commercial funding.

This presentation is scheduled for  March 1st, 8:30- 10:00 am.

The second presentation offers recommendations for preparing for and submitting a winning RFP response for EMS market share. It will be held March 2nd from 8:30- 10:00 am.

While the actual process for responding to an RFP  and applying for a  grant varies substantially, here are just a few strategic planning tips for positioning an EMS organization for competition well before an RFP release or grant publication.  In my upcoming blogs I will be sharing more detailed tips for RFP response and grant writing processes respectively. Stay tuned for free writing samples, data resources and hand-outs from my presentations at EMS Today.

Quick Strategic Planning Tips:

• Who is receiving funding locally? Align yourself with organizations that are successful grant recipients and health care leaders in your community. Evaluate how you can add value to their operations and how you can offer mutual partnership benefits.
• Get aggressive about community outreach: support local organizations by participating on boards, committees and by volunteering time to local events, charities, festivals, business development efforts, etc.
• Develop a “Community VIP List” of stakeholders that influence EMS operations and keep them updated on your company performance and outreach efforts.
• Publicize your organization’s leadership achievements, (industry award recognition and election to board positions or committee accomplishments).
• Demonstrate your dedication to illness and injury prevention by making your efforts more  visible by participating  at health fairs, public health events,  offering free health screenings, etc.

Share on Facebook

Program Components:  Each complete No Panic Please! set contains the following classroom materials:

• Six (6) color posters (Children hold the posters up in front of the class during the presentation)

• One hundred (100) “Jr. EMT” stickers bearing the name of the local EMS provider


(Your company’s name in the box above)

• One (1) instruction manual for the EMS presenter
• One hundred (100) Coloring books

In the face of competition and the ever-present threat of public takeover of ambulance services, it is becoming increasingly important for primary EMS providers to ingrain themselves in their local communities through relationship building initiatives. The most successful EMS providers align their efforts with the priorities of those relevant stakeholders (elected officials, EMS policy makers and regulator) who ultimately influence their businesses. The availability of credible community education and injury and illness prevention is often at the forefront of such stakeholders’ agendas.

EMS agencies, associations and ambulance services earn the perception of being uniquely qualified to offer community education and information about emergency medical services, CPR and first aid by offering EMT classes and other credentialing courses for teens, adults and for members of the medical community.  Additionally, many EMS providers build goodwill equity in the communities they serve by visiting local schools and preparing elementary grade level children for a possible ambulance response.

We specifically designed No Panic Please! for EMS ambulance providers who offer ambulance tours at local schools. Geared for children in Kindergarten through third grade, No Panic Please! offers interactive learning activities (instructors’ manual, posters, and take home coloring books & arm patches).

In addition to touring an ambulance, children learn that even though many changes are occurring in their bodies when they are suddenly hurt or scared, they can choose to Act, but Calmly (the “ABCs” of No Panic Please!) regardless of how they feel or how others are behaving. No Panic Please! program materials are designed to bear the names of the EMS providers.

Benefits of No Panic Please! for EMS providers:

• Increase community presence of EMS
• Build relationships with local educators and other community groups
• Demonstrate your company’s local goodwill through measurable program results
• Generate local interest in EMS related services and education courses
• Attract media coverage for your organization

As an American Ambulance Association (AAA) Strategic Alliance Partner, we are offering special discount to AAA members. Contact us at 619-546-8320 ext. 100 or email janet@oa-emsconsulting.com for more information about the program. The order form is available HERE.

Share on Facebook

An excerpt from the JEMS article is below:

A.J. Heightman, MPA, EMT-P | Teresa McCallion, EMT-B | From the October 2011 Issue | Saturday, October 1, 2011

More than 400 EMS leaders gathered in Miami Beach, Fla., for this year’s Pinnacle Conference. The conference featured so many powerful speakers and topics that many attendees forgot they were at beautiful, sunny Miami Beach, giving up their beach chairs for conference room chairs. EMS managers from throughout the U.S. and multiple other countries got solid advice from EMS industry leaders on how to not just survive this rough economy, but to thrive during it. The following three sessions served as a warning to EMS managers that they had better not sit dormant in their offices. It’s going to take innovative thinking to keep operations running efficiently and effectively in the face of a fragile financial and community climate and a new wave of investor-backed privatization hitting the EMS industry…

…Fireproofing Your EMS System

Taney County (Mo.) EMS Executive Director Darryl Coontz, and Janet Smith, president of EMS consulting group Janet Smith & Associates, presented to a standing-room-only crowd at a Pinnacle Power Session. They introduced themselves as “primary EMS providers, “representing agencies that are using one of the following models: private for-profit or not-for-profit; third-service municipal or third-service county; hospital-based; health-department-based; public utility; or a tribal EMS model.

They noted that all primary EMS providers are interested in engaging in the public vs. private conversation of how to protect the ambulance transport component of an EMS system from being commandeered by or merged into the local fire service.

So although this session was billed as protection from fire service takeovers, it also addressed avoiding a take-over by any other entity or agency….To read the full story, click HERE.

**Please note: As a true EMS person who embraces harmonious fire and EMS partnerships, the Pinnacle topic Darryl and I addressed pertained only to those systems where exemplary Primary EMS providers’  we’re experiencing takeover attempts by fire departments.

Many thanks to Pinnacle and JEMS for bringing this topic to light!

Share on Facebook

When I read the following in the New York Times, I have to take pause.

“…Emergency medicine carries a deep aura of romance in America, with its first-responder traditions of adrenaline, acuity and bravery. But here in this rural mountain area of the West, and in a handful of other places around the nation, a new vision is gaining ground — that emergency workers should not wait around for crises to happen, but rather go out and prevent them.”

So what’s new?  Illness and injury prevention by many ambulance companies and other EMS providers has been a main stay community relations strategy for decades. Now, almost 30 years since presenting my first No Panic Please! program’s’  illness and injury prevention messages for Las Vegas kids as a Mercy Ambulance paramedic,  there is finally talk about possible funding for such EMS provider initiatives when they occur as part of a Community Paramedic’s responsibilities.

On the private sector side, numerous injury and illness prevention initiatives have been gifted for decades and offered graciously at these providers’ expense.  The American Ambulance Association’s Industry Image Committee produced a drowning prevention public service announcement for their members’ use as far back as 1988.  As its producer, I remember I used my then one year old nephew as the star of the PSA. He’s in college now.

The Association’s Community Service Awards programs pitted the formidable programs of numerous providers all across America in public safety and community education award categories for almost a decade.  Then and now, private ambulance providers and other primary EMS responders offer illness and injury prevention programs, TV programming and presentations as  a way to “give back,” to position their companies as proponents for safety and to keep a 9-1-1 call from happening in the first place.

To name a few- in the late 90s, Metro West Ambulance in Hillsboro, Oregon served as Executive Producer with company paramedics starring in their own Rescue 9-1-1 type show that gave viewers a state-based illness and injury prevention TV series- Close Call Oregon’s Emergencies (two full hours of ½ hour segments were broadcast on the local NBC TV station).  An Orange County, California version of the program was co-sponsored by the Orange County Fire Authority and Medix Ambulance in the early 2000s and broadcast to many more southern California citizens than the ambulance service would ever transport in another effort to distinguish the company and its government partner as uniquely qualified community educators.

This year, Nature Coast EMS in Citrus County, FL along with the production services of On Assignment and local WYKE, offered County citizens 26 episodes of its Every Minute Counts injury and illness prevention talk show.  It is now in re-runs, featuring local health care experts along with the prevention advice of the show host and company’s president, Mike Hall, as well as guest paramedics.

All I can say is “Bravo” to them and many other private, public and primary EMS providers  for paving the way for the community paramedic concepts that include such initiatives and that are gaining traction as part of a few pioneering “community paramedic” models throughout America.  The projected rising demand for healthcare services in the next ten years as a result of ageing baby boomers and increased life expectancy means the expanding the role of EMS providers can help reduce injuries, illnesses, inappropriate Emergency Department visits and unfortunate hospital readmissions.

I am interested in hearing feedback regarding the injury and illness prevention efforts currently underway in any of your communities.  Who does them?  What’s working?  Who, if anyone pays for it?

The recent New York Times article about Community Paramedic programs can be found here.

Share on Facebook

Here are some tips for effective media relations:

1.    Stay aware of press deadlines: as you prepare to structure a media relations policy, keep in mind that reporters must move quickly. If you’re sensitive to their deadlines, both on a local and national level, you’ll increase your chances of getting coverage for stories you generate.

2.    Keep a neutral distance: even though it’s possible to develop good relationships with reporters, never make the mistake of believing the media is on your side. Also, never make the mistake of thinking it’s against you. While you can’t expect the news media to be a cheerleader for you, you can expect to be treated fairly, especially if a good relationship already exists.

3.    Retain control over your information: occasionally, reporters will want you to give them an exclusive so they can edge out competitors. It’s not a good idea not to agree to this. If you hold the keys to an important news story, provide accurate information to all media sources as soon as possible.

Remember, you can take control. Don’t succumb to pressure. Without you and your information, there’s no story. Above all, abide by the truth. By doing so, you can develop a successful, long-lasting relationship as a credible and accurate news source.

News reporters are driven by a different mission and set of goals than public relations professionals are. Sometimes, you’ll meet a reporter who pursues a personal “claim to fame” by using mud-slinging tactics, insinuations and half-truths to sensationalize a story. However, most reporters will follow self-ascribed guidelines and remain objective parties with a focus on communicating the truth to the public.

4.    Cover your back: make it a priority to educate at least one media reporter from each of your newspapers and television stations about your company. By doing so, you’ll have at least one news resource that understands your business and can speak out when you’re unfairly represented.

No matter what guidelines you establish with the media, reporters will always try to get more information than you provide. As a result, they use techniques to get at the “truth,” as they see it, before they talk to you. Some of these techniques are identified in Communications Briefings, a useful monthly newsletter for communications specialists.

These techniques are explained as they apply to our industry, in the examples that follow:

Needling
“Oh come on now, you don’t believe that, do you?”
Response: “Yes I do, Bob, and…” Go on to another positive point.

Twisted Facts
“So your profits are up 50%?”
Response: “Perhaps I could clarify that, Bob. Our profits are about three percent, up 50% from last year’s two percent profit. But with that 50% increase from last year, we added 27 new jobs.”

Putting Words In Your Mouth
“So, the germs found in an ambulance are potential killers?”
Response: “Our quality control inspectors, along with our OSHA compliance officer, have identified any areas of weakness in our current system and implemented changes that will keep the public safe.” Or, “We’ve never had a decontamination process. We’ve always kept patients and ambulance crews safe from infection.”

False Assumption or Conclusion
“So, I assume you’re going to…”
Response: “Well, Bob, I wouldn’t agree with your conclusion…”

The Hypothetical Question
“But what if the Japanese…”
Response: “That’s a hypothetical question, Bob, and there are just too many variables here for us to hazard a guess. What we’re hoping will happen and what we’re working toward is…”

Baiting
“Why does OSHA keep coming after your company?”
Response: “Bob, that’s something you might want to talk about with them directly. What I can tell you is that our company is dedicated to…”

Pregnant Pause
You answer a question and the reporter remains silent.
Response: Don’t blurt out more information to fill the silent vacuum.
Instead, ask, “Does that answer your question?” It’s even better to add other positive points until the reporter takes the microphone away.

During an interview, there will be times when you’ll feel the urge to skip a fact, or misrepresent the truth; your tension causes you to consider these options. Remember that mishandling the media can make a bad situation even worse. On the other hand, effectively handling the media can assure you of fair treatment even when the worst problems arise. You can expect the same fair treatment if you adhere to these principles.

Share on Facebook

Reputation: Companies known for their longevity and prosperity enjoy a positive reputation for the track record produced over a long period. It’s this track record that determines the reputation and credibility we depend on for positive public opinion. Professional communication is a critical factor in competing in any medical market. After all, without a reputation for professional communication skills, how can we maintain a reputation for professional medical skills?

Ethical Competitors: Competition between EMS providers can be fierce. Longstanding ethical competitors win out over time and don’t worry about short-term losses because they’re confident about the long-term gain when they continue to take care of their market. We all compete for market share within local service areas and for the shrinking healthcare dollars available through third-party payors; companies with quality reputations compete creatively, innovate market solutions, and offer consistently good customer service. It goes without saying that ethical competition means offering ambulance services according to the laws that govern us all.

Relationships: By developing close relationships, government regulators and elected officials will feel confident that your ambulance company is committed to responding to the community’s EMS needs. Local physicians, nurses and policymakers will respect and appreciate the high clinical standards of your paramedics, specialty care transport paramedics and EMTs. The media will see your company as a credible news source. A spirit of trust and cooperation will be insidiously implied between field medics and patients and between you, the ambulance company owner and your employees.

Looking outside your organization to identify your external customers is a greater challenge than identifying the relatively short list of internal customers. In the ambulance industry, your potential market consists of every individual in the communities you serve. You must segment these external audiences so you can see how to match your strategies to the challenges of each audience. The first external segment you should consider is the inter-agency audience: EMS policymakers, regulators and public safety agencies with whom you work or depend on for direction.

Your acumen for collaboration, cooperation, anticipation and then addressing the needs of the EMS responders in your service area will go a long way toward preventing any potential public takeover. Many companies could have avoided the erosion of their businesses by working hard at “getting along” on both the line and administrative business levels that exist for any EMS system. Take every opportunity to share credit for EMS system successes. Champion non-transport EMS models for fire services whenever possible.

Share on Facebook

Your company’s image affects how the ambulance industry as a whole is perceived by local EMS policymakers and elected officials; it also determines whether or not they trust your company as one that’s earned a place in your community’s healthcare system.

In today’s competitive healthcare environment, ambulance companies are vying for patients, increased service areas, specialty contracts and the best employee resources. You can experience success in these areas if you give attention and respect to your company image. Since all public opinion begins with something an organization does, it makes sense to perform acts that lead to positive public opinion.

By strategically capitalizing on your organization’s strengths and minimizing its weaknesses, your company’s image, or the appearance it presents to the public, will be viewed as an asset to the community you serve.

A few takeaway pearls for realizing a stellar image are:

• Appear to be as you desire to become.
• Actively seek visibility and credit for your past and present acts by demonstrating corporate citizenship, charity and community  involvement. (Support local causes of Chamber of Commerce, healthcare departments, etc.)
• Nominate your company’s employees for EMS and community awards. (Stars of Life Washington D.C. event)
• Publicize company achievements.
• Align your company with other health and injury and illness prevention causes and advocacy groups. (local non-for-profits in your area- American Heart Association, Heart and Stroke Foundation, etc)
• Align with current developments (AHA’s new CPR guidelines, dedication to reduce readmission rates with new healthcare reform)

Want to find out how others view your company?  Image research determines how specific audiences feel about your organization. It measures the most important contributions of public relations to the success of your company. Contact Janet Smith to find out more about image research and its findings’ implications for companies in the private ambulance sector.

Share on Facebook

Throughout the past twenty years, the private ambulance industry has experienced a renaissance with respect to sophisticated branding, marketing and public affairs. To a large extent, this effort has been championed by the American Ambulance Association (AAA), which represents ambulance services across the United States that participate in serving more than 75% of the U.S. population with emergency and non-emergency care and medical transportation services. Since its foundation in 1979, the Association has positioned itself as the voice for the nation’s ambulance providers. It recently published the ‘AAA PR Handbook’, which provides fundamental and advanced strategies, objectives, and tactics that can be implemented at ambulance services large and small.

This series of blogs brought to you by Janet Smith, the Handbook’s author, features highlights from the full text and examples of relevant EMS issues. We encourage your participation in discussion and feedback.

Share on Facebook