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Product Applications From the Field: November 2019

911 Billing Services & Consultant

Putting the Financial House in Order

Connections make the business world run—especially when you can turn to someone you know does good work. 

Two years ago Kentucky’s Barren-Metcalfe Ambulance Service needed some good work. New Director Charlie O’Neal arrived to find a service not generating the revenue it could. Coding and tracking weren’t consistent, runs weren’t always submitted for payment, and payer refusals weren’t always followed up. Its billing company didn’t provide explanations of benefits, and its compliance program consisted of little more than a contractor dropping off paperwork. 

For help O’Neal turned to 911 Billing Services & Consultant. He’d worked with CEO Linda Basham at previous jobs and trusted her team could turn things around. 

“I’m confident telling anyone that Linda will improve their documentation processes, their compliance programs, and their cash in the bank,” O’Neal says. “Those are three areas where I know she’ll have a positive impact for anyone.”

Upon taking over, Basham and COO Beverly Sargent visited Barren-Metcalfe to deliver training, including developing an in-house compliance officer, and the service did its part with upgraded documentation hardware and software and a comprehensive QA/QI program. That all led to a significant bottom-line improvement: an increase in revenue of almost $100 per run, plus a service that’s in a stronger position all around. 

“They handle everything from billing our payers and patients to doing a comprehensive program to make sure we maintain compliance with Medicare and CMS regulations,” O’Neal says. “They’ve provided training opportunities to make sure all our command staff are certified ambulance documentation specialists, which has helped improve the quality of our documentation and our receivables. They take good care of us cover to cover.”

The benefits even trickle down to patient care, O’Neal says.

“If employees understand the documentation process,” he notes, “they may forget something, but in the back of their mind, the light bulb will come on that says, Oh, I have to document that in my run form. They’ll realize there was something they overlooked or hadn’t gotten to yet. So I really think in the long run our patients will receive better care as a result of the overall program.” 




Streamlined Communication Between Providers

Communications between EMS and emergency department staff can be like a game of telephone. In a chaotic environment, verbal reports can easily be misunderstood, which can potentially impact  patient outcomes. 

Pulsara was implemented as a regional project in the Des Moines, Iowa metropolitan area in 2017. The Central Iowa EMS Directors Association worked with hospitals through its Metro STEMI Task Force over a two-year period to include more than 20 EMS agencies and six hospitals in the implementation. Brian Helland, assistant chief of operations for the Clive Fire Department, says since implementing Pulsara, the streamlined system changed the game for his crews. “It’s a uniform method for communicating those time-critical diagnoses, like STEMI or stroke alerts,” he says.

Providers can send alerts to the ED for STEMI, stroke, sepsis, trauma, SCA, and other general issues, allowing EMS to make one report instead of several on the phone and at the ED. Patient info can be shared with the hospital prearrival so staff can preregister patients and get EMS back on the road for the next call.

“It was an eye-opener for the hospitals to look more into what we do in EMS, and it was also a real eye-opener for a lot of the EMS providers to see just how complex the communication within a hospital can be,” Helland says.  “Hospital staff said they now had a single method to notify people for these teams, so it was a much easier process. 

“The alerts allowed us to find out when we have outliers and which part of the process broke. The hospitals saw a significant decrease in door-to-CT times for stroke after the implementation of Pulsara.”

Pulsara stores the data so administrators can create monthly CQI reports for the crews to review and provide focus points for their quality improvement initiatives. 

Hospitals can also provide instant feedback through the app, helping EMS personnel adjust treatment as necessary. This is helpful for understanding stroke and STEMI patient outcomes, like why a patient was or wasn’t given tPA “if it wasn’t a true stroke and there was some sort of mimic. Those little lessons are worth their weight in gold,” says Helland. 




Reliable Rescue Manikin Now Has Clinical Capabilities

For decades, military, fire, police, and emergency response teams worldwide have depended on Rescue Randy to practice extrication and rescue from challenging environments too hazardous for human volunteers. Its lifelike weight and feel allows rescuers to simulate a wide range of patient extrication and transport scenarios to be ready for the real thing when the call arrives.

As the official manikin of the Firefighter Combat Challenge, Rescue Randy is built with durable vinyl with 4,100-lb. test plastic-coated cables. Features include articulated joints and realistic human weight distribution.

Now the popular mainstay has been outfitted with clinical capabilities that allow responders to practice treating the three most preventable causes of death during rescue scenarios—applying tourniquets and occlusive dressings to stem major bleeding; establishing an airway to address airway obstruction; and performing a needle decompression for a collapsed lung, among other lifesaving interventions.

Casualty Care Rescue Randy is the result of a U.S. Dept. of Defense grant to develop a clinical dimension for the popular manikin, says Hugo Azevedo, innovation and business development senior executive at Nasco Healthcare. “There’s been a push in EMS for training in tactical casualty care,” Azevedo says. “The military space is tuned into the need for this training, and civilian institutions are moving into this direction as well.”

Customers have two purchase options. A new Rescue Randy system embedded with clinical capabilities is available to buy, and individuals and agencies that already have a Rescue Randy can potentially upgrade their manikin with a separately purchased Casualty Care Rescue Randy Suit that contains the clinical functions.

Future enhancements to the system currently being developed include automation for pulses, bleeding, and added intricacies to the training curriculum.

“It’s in the DNA of our organization to help the practitioners of today and tomorrow face some of the horrors that are a sad reality in today’s world,” Azevedo says. “Nothing prepares them better for the difficult circumstances and extreme levels of stress they are exposed to in their careers than the training solutions we're bringing to the market every day.” 




Modular Simulation Ecosystem for Sound Clinical Judgments

An EMT or paramedic student’s ability to transfer their skills into the field depends on the quality of their simulation training in school. That’s why iSimulate developed a smart simulation technology to arm students with the capability to make sound clinical judgments once they trade the classroom for the streets.

EMS students in McLean County, Ill. have reaped the benefits of iSimulate’s mobile solution REALITi 360, a modular simulation ecosystem equipped with CPR feedback, camera review system, and a patient simulator. The county’s EMS system manager, Travis Wilson, says in comparison to cardiac monitors they’ve used in the past, they’ve gotten the best bang for their buck with iSimulate. 

“We love it. It's probably one of our best investments,” Wilson says. “Every place we’ve taken it, people have been impressed by it and wanted to train using it.” 

When their training monitors were on the fritz last year, Wilson's agency tested iSimulate in the exhibit hall at EMS World Expo and decided it was the best on the market. It's affordable, costing half the price of other monitors, and offers unique features, like a collection of interfaces of defibrillators from manufacturers like ZOLL, Philips, and Lifepak. 

The REALITi 360 package includes a blood pressure cuff and capnography, pulse oximeter, and prerecorded lung sounds, and allows users to pace, cardiovert, and defibrillate. It also comes with 9–12 leads, allowing the creation of dynamic EKG rhythms. Instructors can  choose from millions of EKG waveforms and change them as the scenario progresses, enabling students to sharpen their on-the-fly decision-making skills. Paramedic students love this because of “how they can actually interact with the monitor as it changes over time based on how they treat the patient,” says Wilson. 

Convenience is another hallmark of the software, as it doesn't require a connection if you want to bring training outdoors.

“It's fairly intuitive. We previously bought a high-fidelity manikin, but iSimulate compared to that is like night and day,” Wilson says. “Within a couple of minutes, you're able to get the hang of it and create a scenario fairly easily.”  




Data Analysis and Reporting in Real Time

If you deliver EMS in 2019, much is expected of you. You need to collect wall-to-wall data on your operations and the patients it serves, analyze it promptly, and turn it continually into quality improvements. Fortunately, technology is available to help. 

Arizona’s Surprise Fire-Medical faced the same challenge as most EMS providers. It used electronic charting but wanted to do more with the data it was collecting. “We realized that while we could see the data much better visually, our EMS data was siloed out from the rest of the operations with our previous vendor,” says Assistant Chief Brenden Espie. “We didn’t have the functionality to report it really well.” Leaders didn’t want to switch again, however, until they had a solid all-in-one product that could serve all their needs. 

The product to deliver the visual analysis they needed was ImageTrend Continuum, which actively monitors data and delivers prebuilt reports that can help guide operational and care decisions. Using data sets from EMS, fire, registries, dispatch, hospitals, and more, Continuum delivers both predefined analytics based on established best practices and the ability to tailor to each department’s needs. Leaders are apprised via text or e-mail alerts, summary reports, or dynamic dashboards and playlists.

The dashboards are preconfigured and update automatically. Users can drill deeper with filters such as time frame, agency or department, and other criteria. Extending to the community, playlists of particular dashboards can feature relevant information, and data is displayed in maps, graphs, charts, and tables. Active Data Monitoring provides tailored alerts. 

For Surprise this has increased operational awareness and helped prompt improvements. 

“What Continuum can do is put information out there to share with the crews today,” says Espie. “With something like response times, they can realize, Hey, we’re good, but maybe we’re not as good as we thought we were. Maybe we could get to the truck quicker or shave a few seconds off if we positioned our gear differently. It shares the true performance and just kind of resets people’s clocks a bit.” This can happen with near-immediacy, rather than with the delays of the past. 

Surprise is in the process of extending the dynamic dashboards to display on large screens at all its stations. 




Safely Secure Portable Medical Devices 

The space in the back of an ambulance is limited. Paramedics often have to reach over patients to grab items. Medical devices are on the floor and could easily be stepped on. Sometimes equipment is placed on the stretcher. All of this creates an unsafe environment. Technimount Solutions offers a safer way to transport devices without affecting crews’ work.

The Stretcher Safety Arm  mounting system for Stryker stretchers allows users to securely position medical devices such as defibrillators directly on a stretcher. Not only is it out of the way, but it can easily be transported from place to place.

Justin Reed, EMS chief for the Cy-Fair Volunteer Fire Department in Texas, was immediately sold on the device after watching a demo on YouTube. 

“We needed a solution to get the monitor off the floor and onto somewhere it would be secured,” he says.

Technimount representatives met with Reed at Pinnacle 2017 in Boca Raton, Fla., to demonstrate the Safety Arm in person. Cy-Fair ultimately purchased the device for its entire fleet of 20 ambulances. 

“The device has been a game changer for our crew in that they don’t even notice it’s a new piece of equipment because it’s so functional,” says Reed. “Having that arm there to get the monitor out of everyone’s way helps us in every single aspect.”

For the patient, he explains, it places the monitor in front of them, allowing the paramedic to better engage in dialogue with the patient about what is happening. 

“With that monitor front and center, you can also show the patient their blood pressure and heart rate,” he says. “In addition, the real estate in an ambulance is prime, and having the monitor out of the way opens up the square footage we need. It’s out of the way—out of sight and out of mind.” 



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