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Even if the AMR dispatcher determines this is the type of call the 911 system should handle, routing the call back into the 911 system is a problem. Besides the obvious delay to the 911 system, the caller and the AMR dispatcher will most probably be in two different states. The only way to route the call back into the 911 system is for the caller to hang up and dial 911.
Another consequence is that fully insured patients are being removed from fire-based EMS systems, resulting in decreased run numbers and financial reimbursement.
There are other questions:
- Is the cost reimbursable or will it be denied as medically unnecessary?
- Will AMR be responsible for reimbursing the fire agency?
- If there is reimbursement for transport, what will the rate be?
The fire service needs to be aware this will not be the last large contract to be signed between a managed-care organization and an ambulance provider. Certainly a major component to the success and profitability of other large managed-care organizations will be their ability to control and manage health care costs through "access management."
Gary Ludwig is the chief paramedic for the St. Louis Fire Department and is currently serving his fourth term as an elected member of the EMS executive board for the International Association of Fire Chiefs. He was awarded Missouri's EMS Administrator of the Year for 1998.