COUNTRY HEALING: MEDICARE CHANGES AFFECT RURAL AMBULANCE SERVICE

CHAFFEE, Mo. -- Medicare changes coming in January could make it more difficult for many rural ambulance districts to get reimbursed by the federal program, but those districts likely won't change the services they offer to patients.

Whether it's broken bones or bleeding, patients who ask to be taken to a hospital won't be denied, said Larry Chasteen, manager for the North Scott County Ambulance District.

For many areas of the country, rural ambulance services are the first to treat patients in an emergency. That's also true for the North Scott County service, which sees nearly 1,400 patients a year, for complaints ranging from shortness of breath to heart attacks and traffic accidents.

And because about half those patients are billed through Medicare, the changes will have a significant impact on the service, Chasteen said.

Starting in January, Medicare will require ambulance services to list specific complaints instead of marking basic conditions on patient status reports. Those changes will affect how patients are billed for the service, and ultimately, whether the service will be covered by Medicare.

But the North Scott County Ambulance District is subsidized through a county tax, assessed at 30 cents for every $100 valuation, paid by residents within the district's boundaries, which covers nearly 250 square miles and about a quarter of Scott County. Thus, that impact won't be quite as great as for private services.

Medicare officials will sometimes deny coverage for the ambulance call and transportation to a hospital because the emergency didn't require an ambulance.

"We're not going to deny transport," Chasteen said.

Adding more details

The changes just mean that paramedics and EMTs have to be more thorough with their diagnoses and complete more paperwork.

There are already 93 different codes used to classify a patient's medical problems. However, not all those codes are used by the Health Care Financing Administration, which oversees Medicare and Medicaid.

"It changes again and it makes it more strict to determine what they pay and who we can haul," Chasteen said.

The codes used by the paramedics and hospitals aren't always as specific as Medicare requires. "We don't want to diagnose and then have it be medically unnecessary," said Bill Kasting, a paramedic. "We don't make assumptions because we aren't doctors."

For most cases, the transport logs are carefully documented so that any questions can be answered. And it helps to make sure the hospitals and doctors know what actually happened, Kasting said.

During some serious traffic accidents, Polaroid photographs will also be taken to include with the patient's reports.

And while they are trained to handle nearly every emergency, most ambulance crews have little control over traffic.

So the North Scott County Ambulance district is building a satellite station on Highway 61 near Kelso, Mo., in hopes of building faster responses to emergencies in the southern portion of the district.

Better response

With traffic problems and frequent congestion along the Interstate 55 and Highway 61 interchange, moving the station will make it easier to get out to other parts of the county, said Chasteen.

"It's tough to get out of Scott City," said Kasting, also an assistant manager for the district.

The new building, which cost $266,000, is already under construction and should be finished by June.

The district now has an office in the Scott City fire station and a headquarters station on Highway 77 just outside Chaffee.

When the district built its current headquarters, the crew found that it helped decrease the response times. The board of directors is hoping for the same scenario in Scott City.

The crews work 24- and 48-hour shifts, depending on their schedule. Every ambulance crew has a trained EMT on the shift, and all the employees are trained as paramedics. A few are nurses.

Kasting, who has worked in a hospital emergency room, said it might be easier for someone to make more money as a nurse than as an EMT or paramedic.

"We're in this business to help, and that's what we want to do," he said.

Working in an ambulance district doesn't mean that every day is like working in an emergency room, with the bustle of people. Sometimes it's more about being patient than treating patients.

Sounding the call

When a call comes in, a pager system sounds in the station so that the crew, no matter where they are in the building or what they are doing, will hear.

"You drop whatever you're doing and go to the shed," Kasting said. "You take the run and know the advantage of this is saving lives."

Half-cooked meals on a stove and dishes left on the table are some signs that a call came in while the crew was in the middle of something else. "There have been a lot of steak dinners lost at this table," Kasting said while seated in the kitchen area of the station.

Television reality shows can glamorize the job because the TV crews spend weeks getting enough footage for a half-hour show. "The reality is that it can take 40 minutes for a run, and that's not uncommon," Kasting said.

Ambulance calls seem to come most frequently between 6 a.m. and 8 a.m. weekdays and on Friday and Saturday nights. A lot of times the situation isn't life-threatening, but the person has been in pain through the night and wants treatment.

Maintaining care

When the North Scott Ambulance arrives on the scene of an accident, which most frequently occur between 4 and 7 p.m., they are usually greeted by a team of First Responders from towns around the county.

And sometimes those First Responders are also paramedics and EMTs who work for the district. "It's not that they just work this job," Chasteen said. Many also are volunteer firefighters in the smaller towns.

The response from the outlying communities helps decrease the response time for the ambulance service. "It helps because we can make sure we never leave a patient," Kasting said.

Although they aren't frequent, bad trauma situations can be draining on a staff. "This job can get old pretty fast if you're doing it seven days a week," Chasteen said.

He encourages the employees to have hobbies or second jobs outside of the profession. "If they work for extra money, I say do something totally unrelated."