Thursday, February 19, 2009

Why was Pam Adams Silenced?

Why did Pam Adams publish nothing during the next 16 years about Dr. Hevesy being on Advanced Medical Transport's (AMT) salary? Or about AMT's Medicare fraud conviction?

Why did Pam Adams publish nothing on Haitian Hearts kids being allowed to die due to OSF's negligence?

I don't think her Journal Editors would allow her to write about these stories.

Her articles would be too bad for Peoria and for the Journal.

Here is an article that Pam wrote in 1992 regarding the newly formed Advanced Medical Transport.

Below the article are my comments.

Journal Star (Peoria, IL)
November 8, 1992



Rona Ramage thought she was taken for more than an ambulance ride when the $440 bill arrived.

"I thought it was a mistake," she says. "They didn't do anything but get me out of bed and take me across town."

The $400 was the base rate, the $40 was a $5-a-mile-charge.

Ramage's injuries were no more than a muscle spasm, but her husband didn't know that when he dialed 911 for an ambulance last June. She had gone to bed with a stiff neck, only to awaken unable to move without excruciating pain.

Though the pain was gone in a few days, it came back a few weeks later when her insurer asked for an itemized bill because the ambulance charge was so high.
Angry at the cost, Ramage started asking questions. And she got a stiff-necked lesson in what it means for a city to have almost state-of-the-art ambulance service -- Advanced Medical Transport of Central Illinois.

AMT, the only ambulance service in the city of Peoria and parts of the rest of the county, is a not-for-profit corporation owned by Saint Francis and Methodist medical centers and Proctor Hospital. (Although officials say their eventual goal is to convert it to a for-profit private company.)

The good news is, until AMT was started in 1991, Peoria had never had such a high level of ambulance service. "The city has not been this well covered, ever. It's one of those things nobody knows," says Dr. Jim Thomas, emergency services director at Methodist and associate medical director for the Peoria Area Emergency Medical Service System.

AMT has 14 paramedic ambulances to cover Peoria, Bartonville, Dunlap and Limestone Township. Each ambulance is staffed with a paramedic and an emergency medical technician.

In years past, there were only two paramedic ambulances to cover the area.

The bad news is, citizens pay high-level prices for care that involves highly trained paramedics operating out of ambulances that are basically mobile emergency rooms, or Advanced Life Support systems.

The base rate increased from $300 to $400, which does not include mileage or charges for any medical services provided by paramedics. The other bad news is that AMT's aggressive tactics created tensions with some other Emergency Medical Service providers -- fire department rescue squads, volunteer fire departments, ambulance companies -- most of whom operate with Basic Life Support systems, staffed with emergency medical technicians. Those emergency technicians only provide the basics until a paramedic arrives or the patients gets to the hospital.

"There's the general feeling that when something is more expensive, it's a bad thing. The other issue gets to be, in some ways the ambulances appear to encroach on what may have been viewed as the work of government units, like a fire department," says Peoria County State's Attorney Kevin Lyons, himself a member of the volunteer fire department in Hanna City.

"I hate to say it's competing for victims, but it is."

Dr. George Hevesy of St. Francis is project medical director of the Peoria Area Emergency Medical Services System, a state-mandated entity made up of public and private agencies responsible for pre-hospital care in a 16- county region.

Because St. Francis is the resource hospital for the system, Hevesy acts as sort of an emergency czar, with ultimate responsibility and supervision of the medical aspects of ambulance companies, fire departments, rescue squads and their paramedics or emergency medical technicians.

"I do not -- nor will I -- allow competition for victims," Hevesy says. "The patient loses because the focus is not patient care, but politics."

Hevesy, along with associate medical directors of the area's emergency services system who are based at Methodist and Proctor, were strong proponents of an Advanced Life Support system with fast response and flexible deployment. Good or cheap Ramage questioned the care she got, but what she really wanted to know was how AMT could get away with charging so much.

Hevesy's answer is that area residents either can have a good, fast system or a cheap system.

Basically, Ramage paid Advanced Life Support prices when all she needed was basic care. But people don't always know that when they dial 911 -- which automatically means that they will receive advanced care.

Ramage got a clue to the complexities when she called the American Ambulance Association and the Illinois Department of Health, which regulates emergency medical service systems.

She also called other area ambulance companies to compare prices. That's when she learned, "There's a great deal of animosity out there about AMT." Using the information she gathered, Ramage railed at AMT until it reduced her bill to $175, Blue Cross/Blue Shield's usual and customary fee.

Andrew Rand, director of AMT, says the care Ramage received did not deviate from accepted standards and that the reduced bill was a last resort to resolve a problem with a persistent, irate customer.

"The American public will always expect ambulance service at taxicab rates. Those aren't taxicabs," he says, gesturing toward the fleet of ambulances beyond his office walls.

Quick response sought Rand, 31, is a paramedic with a degree in finance. The three hospitals hired him to shepherd a fragmented, slow- responding, money-losing system into an efficient, life-saving, financially black fleet with at least one paramedic on each ambulance. They also wanted a system capable of responding to 90 percent of the life-threatening emergency calls within 10 minutes -- 12 in outlying areas.

AMT was created in September 1991 by merging each hospital's paramedics unit with their Mobile Medics Ambulance, itself the result of the hospitals' earlier attempts to improve ambulance services.

Along with adding paramedic rigs, the way of keeping them at hospitals changed. System Status Management strategically placed ambulances throughout the coverage area to match supply with demand. Locations are determined by use.

In reorganizing, Rand also increased the ratio of scheduled calls, for instance non- emergency transportation between hospitals and nursing homes, to 40 percent. It had previously been about 15 percent, he says.

The base rate for scheduled, non-emergency transportation, is $200. Though most scheduled transportation is paid by Medicare or Public Aid, emergency transportation for Public Aid recipients drains AMT's revenues, Rand says.

Another reason costs were lower in the past is that the hospitals were absorbing the ambulance company's losses, Dr. Thomas says.

Reimbursements from Medicare and Public Aid are $84 and $70, respectively. About 50 percent of AMT's payment sources are from Medicare and Medicaid; 32 percent from individuals; and 16 percent from private insurers.

"As we expand, we can cut costs," he says. "That's just based on economy of scale. " Broad changes AMT bought out B&B Ambulance, a privately owned company in Limestone Township, in September. In a little more than a year, AMT has been the catalyst for broad changes in emergency services. Even its critics agree that ambulance service is better.

But change is difficult, Rand says.

AMT's employees, including paramedics and EMTs, had to accept a new role "as care givers, not just lights-and- sirens response," he says. "That was very, very difficult."

Other emergency service providers, seeing AMT's growth and prestige, may have felt like they were targets, he says. "That was not our aim."

And AMT needs to improve its marketing, when it comes to explaining fees to the public, he says.

Eventually, says Thomas of Methodist, the goal is for AMT to phase out its dependence on the hospitals until it is a private company.

My comments today, February 19, 2009:

1. Wow.

2. I don't know where to begin.

3. Pam Adams described Dr. Hevesy in his role as Project Medical Director for the Peoria area as an "emergency czar". I think many EMS agencies in the area would agree with that description.

Dr. Hevesy's comments above were very definitive regarding the fact that under his watch he was not going to allow competition between EMS agencies for patients. (The fact that he was paid by AMT may have helped him implement his policy regarding no competition.) The Peoria Fire Department (PFD) has said multiple times that Dr. Hevesy created obstructions when the PFD wanted to upgrade their services for the people of Peoria.

4. OSF and the Peoria Area EMS (PAEMSS) should have never allowed Dr. Hevesy to receive a salary from AMT. As Director of all ambulance agencies in the area, none of which paid him except AMT, he should have never accepted a salary because of the appearance of negative conflict of interest.

5. One of AMT's employees would turn in AMT to the Feds several years after this article was written. AMT was upcoding and charging the patient and taxpayer too much.

6. Why did the three hospitals in Peoria allow Andrew Rand to resume his job at AMT after AMT was found guilty of Medicare fraud?

7. Dr. Hevesy stated above that Peoria can have a "good, fast system or a cheap system" was not true. The Matrix study performed 10 years later in Peoria revealed that the PFD was responding faster to life threatening 911 calls than was AMT.

8. Too bad Pam Adams was silenced regarding EMS after this article in 1992.

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