Reducing the Cost of Health Insurance (-pat on my own back)
I helped save over $1,200 of tax payer money last night!
One of my part time jobs is with a private ambulance service in a major city. Most of our work is moving people from one medical center to another. (from an Emergency Department to a nursing home or from a community Emergency Department to one that has the specialist or rooms for the patient.)
As a result most of the people using this service are on Medicare or Medicaid (50% or so) or uninsured (10% or so). Ambulances are not cheep. If you have ever used one you have seen that.
There are three levels of care in the area I’m in, and in the four different states i’ve done private ambulance work in. (the army moves you about a lot so you get a look at how different states do things)
The first level is ‘ATS’: Alternative Transport Service or “Wheelchair Van”. This is mostly people who can’t walk far or at all who need to go home from the hospital or to a nursing home after a surgery. They don’t need much help medically and most drivers are not Paramedics or EMT’s, they just get CPR trained and how to work the lift. Not a lot of training to get, and often they are paid a bit less than an EMT. (Here they start at $9.50 per hour) The cost for this service is ruffly $50 plus a $3.75 per mile charge from where you start to where you end.
The second level is “Basic Life Support” Ambulance. Here is a real ambulance, but just a basic level of medical care. Oxygen, splinting, monitoring of vitals, and other basic care as allowed by the state you are in. One driver and one person in the back with the patient. These two are trained at least to the EMT Basic level of Emergency Care. Requires a State certification and continuing education to maintain it. The cost for this service starts at about $350, more if Oxygen is used, or other equipment, as well as the per mile charge which here runs $6.25. (Here we see EMT-Basic’s start around $10 to $10.50 an hour)
The third level is “Advanced Life Support” Ambulance. Here the patient is getting a Paramedic providing care/support. They may be receiving medication in transport, IV, Cardiac Monitor, ventilation, etc. All the “cool” stuff you see on TV, but more likely what the person had in their hospital room going with them. (even the machine that goes “BING”). Again you will have two people in the ambulance, one at minimum is a Paramedic, the other often is an EMT-Basic. This service starts at $950, more if equipment and medication is used on top of the per mile charge. (Here a Paramedic will start at $14 per hour).
Now, how did I “save” tax payers money? Two calls last night came in as “ALS” because the patient was receiving fluids through an IV. Which meets the requirement for ALS. On arrival the fluid was about done and the Nurse was going to change out a new bag. I asked if the fluid was needed for the 20 minute trip and he said no the receiving hospital could hang it there. Since there was now no fluid hanging, it no longer meet the standard for ALS, but rather BLS. I let the nurse know this and he was not aware that there was a price difference.
When we came back for the second trip, same set up but this time the nurse planned ahead and ended the IV fluid. Making the trip BLS. Both patients were on Medicaid.
I hope this will develop a longer term savings because I explained to the nurse team and doctor at this standalone Emergency Department the rules for pricing and care. The nurse I dealt with said he would be more aware of transport decisions for level of care. You can send a person with an IV Lock (an IV without fluids running) for short transports as a basic run and $600 less. If you are just sending the patient with fluids running for the only reason of keeping the IV open – preventing clotting of the catheter- it becomes ALS. Short trips don’t need the IV bag flowing, so why not keep costs low?
If we could get more Health Care providers to consider the cost before ordering something, we could see lower costs.