[Congressional Record Volume 145, Number 74 (Thursday, May 20, 1999)]
[Senate]
[Pages S5734-S5736]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
EMERGENCY MEDICAL SERVICES EFFICIENCY ACT
Mr. GRAMS. Mr. President, I rise today on behalf of all those who
serve their fellow citizens through their active participation in the
nation's emergency care system to make my remarks on the introduction
of S. 9-1-1, the ``Emergency Medical Services Act of 1999.''
Mr. President, as a Senator who is deeply concerned about the every-
expanding size and scope of the federal government, I've long believed
Washington is too big, too clumsy and too removed to deal effectively
with many of the issues in which it already meddles. However, I also
believe there's an overriding public health interest in ensuring a
viable and seamless EMS system across the country. By designating this
week as national EMS Week, our nation recognizes those individuals who
make the EMS system work.
There's no more appropriate time to reaffirm our commitment to EMS by
addressing some of the problems the system is presented with daily.
I've often said that Congress has a tendency to wait until there's a
crisis before it acts, but Congress cannot wait until there's a crisis
in the EMS system before we take steps to improve it. There's simply
too much at stake.
Whether we realize it or not, we all depend on and expect the
constant readiness of emergency medical services. To ensure that
readiness, we need to make efforts to secure the stability of the
system. This has been my focus in drafting the EMSEA.
The most important thing we can do to maintain the vitality of the
EMS system is to compel the government to reimburse for the services it
says it will pay for under Medicare.
In the meetings I've had with ambulance providers, emergency medical
technicians, emergency physicians, nurses, and other EMS-related
personnel, their most common request is to base reimbursement on a
``prudent layperson'' standard, rather than the ultimate diagnosis
reached in the emergency room.
While the Balanced Budget Act of 1997 [BBA] contained a provision
basing reimbursement for emergency room services on the prudent
layperson standard, I find it troubling HCFA refuses to include
ambulance transportation in its regulations as a service covered by the
patient protections enacted as part of Medicare Plus Choice. I also
believe it is unacceptable that beneficiaries participating in fee-for-
service are not granted the protections afforded to those in Medicare
Plus Choice.
There has been a great debate in the Senate for the last year
regarding protections for consumers against HMOs. Many of my colleagues
would be startled to learn of the treatment many seniors have
experienced at the hands of their own government through the Medicare
fee-for-service program. The federal government would do better to lead
by example rather than usurping powers from state insurance
commissioners by imposing federal mandates on health insurance plans
already governed by the states.
To illustrate how prevalent the problem of the federal government
denying needed care to Medicare beneficiaries is, I want to share with
you a case my staff worked on relating to Medicare reimbursement for
ambulance services. I mentioned this case last year, but it is worth
repeating. Please keep in mind that this is the fee-for-service
Medicare program.
In 1994, Andrew Bernecker of Braham, Minnesota was mowing with a
power scythe and tractor when he fell. The rotating blades of the
scythe severely cut his upper arm. Mr. Bernecker tried to walk toward
his home but was too faint from the blood loss, so he crawled the rest
of the way. Afraid that his wife, who was 86 years old at the time,
would panic--or worse, have a heart attack--he crawled to the pump and
washed as much blood and dirt off as he could. His wife saw him and
immediately called 911 for an ambulance.
He was rushed to the hospital where Mr. Bernecker ultimately spent
some time in the intensive care unit and had orthopedic surgery. A
tragic story.
In response to the bills submitted to Medicare, the government sent
this reply with respect to the ambulance billing: ``Medicare
Regulations Provide that certain conditions must be met in order for
ambulance services to be covered. Medicare pays for ambulance services
only when the use of any other method of transportation would endanger
your health.'' The government denied payment, claiming the ambulance
wasn't medically necessary.
Apparently, Medicare believed the man's wife--who was, remember, 86
years old--should have been able to drive him to the hospital for
treatment. Mr. and Mrs. Bernecker appealed, but were denied and began
paying what they could afford each month for the ambulance bill.
After several years of paying $20 a month, the Berneckers finally
paid off the ambulance bill. Medicare later reopened the case and
reimbursed the Berneckers, but unfortunately, Mr. Bernecker is no
longer with us.
I have a few more examples I'd like to share with my colleagues to
assure them this is not an isolated incident. In fact, I encourage all
of my colleagues to meet and speak with their EMS providers to see
first-hand how the lack of consistent reimbursement policy impacts
their ability to provide services. This one provision of the Emergency
Medical Services Efficiency Act will bring fairness and clarity for
both the beneficiary and the EMS provider trying to help those in need.
In Austin, Minnesota, a 66-year-old male was found in a shopping
center parking lot slumped over the steering column of his car. The car
was in drive, up against a light pole with the wheels spinning and the
tread burning off the tires. An Austin policeman at the scene requested
an ambulance and the driver was transported to the emergency room.
Ambulance transportation reimbursement was denied based on the
assumption that the driver could have used other means to get to the
emergency room. Apparently, since he was already in the car, he was
supposed to drive himself to the hospital despite being unresponsive.
Another case in Minnesota involved a 74-year-old male who was
complaining
[[Page S5735]]
to his family about an upset stomach when he collapsed. The frightened
family began CPR and summoned an ambulance via 9-1-1. The city's fire
department was the first on scene and applied an automatic external
defibrillator, which advised against shock. Paramedics arrived and
continued CPR en route to the emergency room. The patient ultimately
died of cardiac arrest. Again, Medicare fee-for-service denied payment
for the ambulance because it was deemed unnecessary.
Finally, Mr. President, a 74-year-old female complained of flu-like
symptoms. Her family checked on her and found she was acting confused
and strange. They summoned emergency medical services. Paramedics
arrived to find the woman awake but confused as to time and events.
They discovered she had a history of cardiac disease and diabetes. The
paramedics tested her blood-sugar level and found it below 40. For
those of you unfamiliar with diabetes, a blood sugar level below 70 is
dangerous and could lead to seizure. But once again, Medicare denied
payment.
Mr. President, I have a stack of actual run tickets from EMS
providers in Minnesota, with names and other identifiers deleted, all
demonstrating what a problem this is for Medicare beneficiaries and EMS
providers. Again, I urge all of my colleagues to meet with their EMS
providers and ask how these denials affect them.
Title II of the Emergency Medical Services Efficiency Act creates a
Federal Commission on Emergency Medical Services which will make
recommendations and provide input on how federal regulatory actions
affect all types of EMS providers.
EMS needs a seat at the table when health care and other regulatory
policy is made. Few things are more frustrating for ambulance services
than trying to navigate and comply with the tangled mess of laws and
regulations from the federal level on down, only to receive either a
reimbursement that doesn't cover the costs of providing the service or
a flat denial of payment.
Mr. President, I came across this chart two years ago which
demonstrates how a Medicare claim moves from submittal to payment,
denial, or write-off by the ambulance provider. Look at this chart and
tell me how a rural ambulance provider who depends on volunteers has
the manpower or expertise to navigate this mess. And, in the event it
is navigated successfully, ambulance services are regularly reimbursed
at a level that doesn't even cover their costs.
Mr. President, I have heard complaints from many individuals about
the cost of ambulance care. In fact, some within this very body
criticize ambulance providers for the high prices they charge for their
services. While I do not doubt there are cases of abuse, I know for a
fact an overwhelming majority of EMTs, Paramedics, Emergency Nurses and
EMS providers are trying to provide the best possible care for their
patients at a reasonable price.
Let's talk about how much it costs to run just one ambulance. There's
the cost of the dispatcher who remains on the line to give pre-arrival
assistance. The ambulance itself, which costs from $85,000 to $100,000.
The radios, beepers, and cellular telephones used to communicate
between the dispatcher, ambulance, and hospital. The supplies and
equipment in the ambulance, including everything from defibrillators to
bandages. The two Emergency Medical Technicians or Paramedics who both
drive the ambulance and provide care to the patient. The vehicle
repair, maintenance, and insurance costs. The liability insurance for
the paramedics. And the list goes on.
Yes, the costs can be high, but it's clear to me that, with the
uncertainty ambulance providers face out in the field each day, they
need to be prepared for very type of injury or condition. Mr.
President, that's expensive.
I'm convinced those who complain about the high costs of emergency
care would be the first to complain if the ambulance that arrived to
care for them in an emergency didn't have the life-saving equipment
needed for treatment.
Let's be honest with ourselves: we want the quickest and best service
when we face an emergency--and that costs money.
Mr. President, many of our political debates in Washington center
around how to better prepare for the 21st century. I've always
supported research and efforts to expand the limits of technology and
continue to believe technological innovations and advances in
biomedical and basic scientific research hold tremendous promise.
Under the new EMSEA, federal grant programs will be clarified to
ensure EMS agencies are eligible for programs that relate to highway
safety, rural development, and tele-health technology.
Emergency Medical Services have come a long way since the first
ambulance services began in Cleveland and New York City during the
1860s.
Indeed, the scientific and technological advances have created a new
practice of medicine in two short decades, and have dramatically
improved the prospects of surviving serious trauma. There's reason to
believe further advances will have equally meaningful results.
Innovations like tele-health technology may soon allow EMTs, nurses,
and paramedics to perform more sophisticated procedures under a
physician's supervision via real-time, ambulance-mounted monitors and
cameras networked to emergency departments in specific service areas.
By not considering EMS agencies for federal grant dollars, we may cause
significant delays in the application of current technologies. That
would be a mistake.
In August of 1996, the National Highway Traffic and Safety
Administration and the Health Resources and Services Administration,
Maternal and Child Health Bureau issued a report, ``Emergency Medical
Services: Agenda for the Future.'' The report outlined specific ways
EMS can be improved, and one of the stated goals was the authorization
of a ``lead federal agency.''
After consultation with those in the EMS field throughout the
country, I believe the most appropriate action is to take our time and
get it right by conducting a study to determine which current or new
office would best coordinate federal EMS efforts.
Those are the major provisions of the legislation I introduce today.
Mr. President, in 1995, there were approximately 100 million visits
to emergency departments across this nation. Roughly 20 percent of
those visits started with a call for an ambulance. Each one of those
calls is important, especially to those seeking assistance and to the
responding EMS personnel. While EMS represents a small portion of
health care spending overall, it is critically important. It serves as
the access point for the sickest among us and it would be tragic for
Congress to deny its role in improving the system.
Over the past several years, I've been privileged to get to know the
men and women who dedicate their talents to serving others in an
emergency.
The nation owes a great deal to the EMS personnel who have dedicated
themselves to their profession because they care about people and want
to help those who are suffering. Nobody gets rich as a professional
paramedic, and there's no monetary compensation at all as a volunteer.
The field of emergency medical services presents many challenges--but
offers the reward of knowing you helped someone in need of assistance.
Every year, the American Ambulance Association recognizes EMS
personnel across the country for their contributions to the profession,
and bestows upon them the Stars of Life Award.
This year, 94 individuals have been chosen by their peers to be
honored for demonstrating exceptional kindness and selflessness in
performing their duties.
Mr. President, Minnesota suffered a tremendous loss this year. On
January 14, while extricating a victim of an automobile accident, two
EMTs were hit by a car. Brenda HagE, an EMT and Registered Nurse, was
transported in traumatic arrest to a nearby hospital where she was
pronounced dead. Ms. HagE is survived by her husband Darby and two
children.
I ask that the Senate observe a moment of silence for Ms. HagE and
all EMS personnel who have died in the line of duty.
Mr. President, I've talked with many professional EMTs, paramedics,
and emergency nurses, and most tell me they wouldn't think of doing
anything else for their chosen career. Similarly, volunteer EMS
personnel tell me of the indescribable satisfaction they feel when they
help those in their community get the care they need.
[[Page S5736]]
So, in honoring them during this National EMS Week, I can think of no
better way to recognize their service than through legislation that
will help them help others.
I ask my colleagues to support them by supporting S. 9-1-1, the
``Emergency Medical Services Act.''
Mr. President, I ask unanimous consent that the names of the 1999
American Ambulance Association Stars of Life honorees be printed in the
Record.
There being no objection, the list was ordered to be printed in the
Record, as follows:
1999 Stars of Life
AZ--Theresa J. Pareja, Rural/Metro Fire Department;
AR--Rae Meyer, Rural/Metro Ambulance and John C. Warren,
Columbia County Ambulance Service;
CA--Marti Aho-Fazio, American Medical Response--Sonoma
Division, Dean B. Anderson, American Medical Response--Sonoma
Division, Chris S. Babler, Rural/Metro Ambulance, Carlos
Flores, American Medical Response, May Anne Godfrey-Jones,
Hall Ambulance Service, Inc., Randy Kappe, American Medical
Response, Frank Minitello, American Medical Response, and
Penny Vest, Hall Ambulance Service, Inc.;
CO--Doug Jones, American Medical Response;
CT--Todd Beaton, American Medical Response, Michael Case,
Hunter's Ambulance Service, and John M. Gopoian, Hunter's
Ambulance Service;
FL--Clara DeSue, Rural/Metro Ambulance, Leroy Funderburk,
American Medical Response--West Florida, Andrea Hays, Rural/
Metro Ambulance, and Keith A. Lund, American Medical
Response;
GA--Deborah Lighton, American Medical Response--Georgia and
Kelly J. Potts, Mid Georgia Ambulance Service;
IL--Carolyn Gray, Consolidated Medical Transport, Inc.,
James Gray, Consolidated Medical Transport, Inc. and Cristen
Miller MEDIC EMS;
IA--Paul Andorf, MEDIC EMS, Dennis L. Cosby, Lee County EMS
Ambulance, Inc., and Danny Eversmeyer, Henry County Health
Center EMS;
KS--Tom Collins, Metropolitan Ambulance Services Trust and
Bill D. Witmer, American Medical Response;
LA--Pattie Desoto, Med Express Ambulance Service, Inc.,
Michael Noel, Priority Mobile Health, John Richard, Med
Express Ambulance Service, Inc., Scott Saunier, Acadian
Ambulance & Air Med Services, and Pete Thomas, Priority
Mobile Health;
MD--Lily Puletti, Rural/Metro Ambulance and Michael Zeiler,
Rural/Metro Ambulance;
MA--Daniel Doucette, Lyons Ambulance Service, Leonard
Gallego, American Medical Response, Mark Lennon, Action
Ambulance Service, Inc. and Edward McLaughlin, Lyons
Ambulance Service;
MI--Steve Champagne, Huron Valley Ambulance, Edgar
``Butch'' R. Dusette Jr., Medstar Ambulance, Mary Elsen,
Medstar Ambulance, Steven J. Frisbie, LifeCare Ambulance
Service, Richard Landis, American Medical Response, Tony L.
Sorensen, LIFE EMS, and Norma Weaver, Huron Valley Ambulance;
MN--Barbara Erickson, Life Link III and Jesse Simkins, Gold
Cross Ambulance;
MS--Carlos J. Redmon, American Medical Response (South
Mississippi);
MO--Michelle D. Endicott, Newton County Ambulance District
and Lynette Lindholm, Metropolitan Ambulance Services Trust;
NH--David Deacon, Rockingham Regional Ambulance, Inc.,
Jason Preston, Rockingham Regional Ambulance Inc., Joseph
Simone, Action Ambulance Service, Inc., Joanna Umenhoffer,
Rockingham Regional Ambulance, Inc., and Roland Vaillancourt,
Rockingham Regional Ambulance, Inc.;
NJ--Laurie Rovan, Med Alert Ambulance and Roberta Winters,
Rural/Metro Corp.;
NM--LeeAnn J. Phillips, American Medical Response;
NY--Susan Bull, Rural/Metro Medical Services, Nicholas
Cecci, Rural/Metro Medical Services Southern Tier, Daniel
Connors, Rural/Metro Medical Services, Scott Crewell, Rural/
Metro Medical Services--Intermountain, Frank D'Ambra, Rural/
Metro Corp., Doug Einsfeld, American Medical Response--Long
Island, Kevin Jones, Rural/Metro Medical Services--
Intermountain, Patty Palmeri, Rural/Metro Corp., Carl Sharak,
Rural/Metro, Samuel Stetter, Rural/Metro Medical Services
Southern Tier, and Jean Zambrano, Rural/Metro Medical
Services;
NC--Chris Murdock, Mecklenburg EMS Agency, Corinne Rust,
Mecklenburg EMS Agency, and John Sepski, Mecklenburg EMS
Agency;
OH--Duane J. Wolf, Stofcheck Ambulance Service, Inc. and
Eric Wrask, Rural/Metro;
OR--Larry B. Hornaday, Metro West Ambulance, Tony D.
Mooney, Pacific West Ambulance, and Mark C. Webster, American
Medical Response--Oregon;
PA--Jerry Munley, Rural/Metro Medical Services;
SD--Travis H. Spier, Rural/Metro Medical Services--South
Dakota;
TN--Brian C. Qualls, Rural/Metro and Rodney B. Ward, Rural/
Metro--Memphis;
TX--Robert Moya, American Medical Response, Luis Salazar,
Life Ambulance Service, and Mike Sebastian, Life Ambulance
Service;
UT--Monica Masterson, Gold Cross Services and Robert
Torgerson, Gold Cross Services;
VT--John G. Potter, Regional Ambulance Service, Inc.;
VA--Beverly Leigh, American Medical Response--Richmond;
WA--Jack N. Erickson, Olympic Ambulance, Gary D. McVay,
American Medical Response--Washington, Aaron J. Schmidt,
Olympic Ambulance Service, and Rand P. Whitney, Rural/Metro
Ambulance.
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