Wednesday, March 6, 2013

We Live in Interesting Times

It's an interesting time to be in this business, what with the changes to operating models, reimbursement, and strategies for success. If you read the quarterly reports for publicly-held HEMS companies, you can see that they are doing better with the community-based operations than they are with the hospital-based programs. They also have several irons in the fire, so the comings and goings of a single contract may be more about what one regional fellow is or is not doing. Having said that, a relationship with a receiving hospital is still key, especially with regard to interfacility transports. While the closest available aircraft "should" be the one getting scene flights, a patient getting sent to a tertiary-care facility involves a discussion between physicians, and some give-and-take. If I am a doctor in rural America, and I am on the phone with a doctor at a metro hospital, what I really want is to be freed of responsibility for the patient in question. What happens at the rural hospital is more about providing billable services prior to sending a patient, so it's a balancing act for rural staff; "Let's send this guy to CT and check him out...Oh heck, he needs to go to (insert your metro hospital's name here)..." What the patient really needed from the outset was to go to to a trauma center, but someone has to pay for the country hospital to be there. Many is the time I have been waiting for a rural facility to finish messing around with a patient who they will not help while all the arrangements are made and the "wallet biopsy" is completed. Sticking with the CT thing, the one from the rural facility will not be good enough for the trauma center folks - they will take another one, and the patient or his insurance company will pay twice. Those scanners are expensive you know... Sometimes Rural Hospital Inc. waits a little to long and the victim circles the drain, then you see a real interest in us getting the patient the hell outta there, before he codes on them. OOPS. It really is all about the money. You would be amazed how often a really sick man or women - or child - is driven by ground AWAY from the hospital that could fix them, to be subjected to rural health care for a couple of hours, and to ultimately be flown to real health care and doctors who will do the hard things. Some day the regulators will figure all this out and protocol will be immediate transport to the most appropriate facility... Here's a tip for you. If you crash in the country, and can talk, tell the first responders you have no insurance and very little money. If you can speak Spanish, all the better - you will be flown to a trauma center directly, as you aren't a source of revenue to the local facility, and trauma centers take everyone. (They often train young surgeons, so they need tore-up folks for practice.) You will have a better chance at staying alive and getting out of the hospital sooner by passing no-go and not paying two thousand dollars. So back to the receiving hospital and the doctor on the phone. She says, "sure, I can take your patient, and I will send my helicopter." The trick is to be "that" helicopter. And while hospitals used to pay for a helicopter out front, now days the money might be going the other way - legal or not. As this is a relatively new development, some management folks might not have cottoned to it yet, and contracts will be lost. It'll all work out in the long run...

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