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twitterIt pays EMTs to dot I’s and cross T’s
In Vegas, they get bonus for proper paperwork, but city touts savings
Wednesday, April 22, 2009 | 2 a.m.
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Las Vegas pays its paramedics and EMTs a bonus said to be unique — for properly filling out paperwork. Those payments totaled more than $600,000 last year, and Clark County officials are worried the emergency workers in their fire department will try to copy their city colleagues.
Las Vegas’ emergency medical technicians and paramedics are paid extra for properly filling out paperwork after transporting someone to the hospital, $20 for an EMT and $30 for each paramedic.
Diana Paul, spokeswoman for the city, said the “quality assurance documentation pay” has been in place since January 2002 to improve the completion of paperwork in order to “get a better collection rate” from individuals and insurance companies. Through the end of 2008, the bonuses totaled $2.6 million.
Dean Fletcher, president of Firefighters Local 1285, said he knows of no other fire department in the country that gets documentation pay. Neither did other fire departments in the valley or a handful of out-of-state fire departments contacted by the Sun. They all consider filling out the paperwork properly just part of the job.
“So these guys are on duty and they respond to the call, and they transport, and they get an extra $20 to $30 to fill out the paperwork? Really?” Frank Salomon, the Phoenix Fire Department’s deputy chief in public affairs said. “I want a job there!”
Salomon said his department gives out a “penmanship” award with a pat on the back and a pen for doing a good job filling out paperwork.
“How about this being an incentive: You get to keep your job,” he added.
When the Las Vegas policy was outlined to Denver Fire Department spokesman Lt. Phil Champagne, he chuckled at first — then he called the Las Vegas policy “utterly ridiculous.”
Chris Colwell, Denver Paramedic Division medical director, said, “Accurate documentation of the medical care and the medical trip report is, as we call it, part of the paramedic’s job.”
But Fletcher, whose union represents 622 Las Vegas firefighters, said paperwork completed by EMTs and paramedics is time-consuming and “you have to hit all the bullet points to help with the collection rate ... it’s an additional job duty that was part of our contract.”
The extra pay was sold to the city as a way to bring in more money from the people taken to the hospitals and their insurance companies, and since it has been in place, collections for ambulance services have increased.
In the first year of the bonus pay, the city collected $1.1 million from patients and their insurers. But from July 1, 2008, through April 15, 2009, the fire department’s emergency medical service has collected $3.4 million.
Paul could not say, however, that incentive pay alone resulted in increased collection rates. She said the increase “can be greatly attributed to the fact that transports have increased, and as we have built seven new fire stations and now have 19 rescues (ambulances) in service.”
Fletcher said the city had 10 in service in 2001.
After making about 8,000 transports annually for four years, Las Vegas Fire & Rescue took people to hospitals 12,595 times in 2008. Fletcher said the jump was due to a top-down departmental focus on ambulatory transports. Paul said the department is trying to meet terms of an agreement made in 1999 with a private ambulance contractor. Under that agreement, the city fire department is supposed to transport about two people each day for every one of its ambulances.
Fletcher said he is certain incentive pay has resulted in better service and better collection rates.
“In our city budget, we’re projected to bring back to the city ... collections of $4.5 million,” Fletcher said.
Even with the increase in dollars to city coffers, the city is still only collecting less than 50 percent of the money it is owed for fire department ambulance service, Fletcher said. He attributed that to the transportation of the homeless and other indigent residents who can’t afford to pay.
The cost for being transported by a city ambulance has increased significantly. In 1999 it ranged from $350 to $450 depending on the level of service required. Some categories of service are Advanced Life Support Non-Emergency, Advanced Life Support II and Basic Life Support Non-Emergency. Current rates range from $605 to $778.
Las Vegas City Councilman Gary Reese, who is likely to run for mayor in 2011, favors the documentation pay policy. He said if the city is going to get “an unexpected several million and you’re the one giving it to me, I don’t mind giving you $1 million back.”
As a council member when the contract was approved, Reese said he had one question: “Can it pay for itself? And oh heavens yes, it can.”
And no matter the opinions of other fire departments, challenges to the paperwork bonuses have not come up in current contractual negotiations between the city and the union. A contract is expected to be hammered out by June.
The bonus issue did, however, arise during a meeting of the Clark County Commission this month when talk focused on Assembly Bill 225. The bill won Assembly approval Monday. If signed by the governor, it would let Clark County collect fees if its fire department begins routinely taking patients to hospitals. (The department now only rarely — usually in life-threatening situations — makes hospital runs.)
In the bill’s current form, the county fire department could make no more than 1,000 hospital trips per year and could exceed that amount only when private ambulance service is not available.
Commissioner Steve Sisolak said he worries that the city’s bonus policy could eventually spread to the county fire department. The county’s labor contract with its firefighters expires June 30, 2010.
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This is another waste of our tax dollars. This should be a crime. They already are overpaid.
The fire unions and their managers will go to any length to hide their pay. Anything to make the salary look low while adding in bonus pay for anything. Here is a mush better idea. Get the city completely out of the ambulance business and have a reduction in staff to match. Contract with a private operator and apply the saving in salaries, benefits, and BONUS PAY for doing their job to other needs in the city. This is ridiculous.
"utterly ridiculous"
To what I saw play out yesterday. A man was sitting on a large rock on Vegas Dr. near Buffalo. He was older, not older than me, looked a little disheveled but not "down and out". I thought maybe he had walked to far in the heat and was in need of some rest...water?
An ambulance pulled up, I do not know if the ambulance was sent there because someone called or if they were just driving down the street. The attendants were attempting to talk the man in to going with them to the hospital. The man refused, I thought it odd that the EMT's never offered the man something to drink...water.
While the man was talking to the EMT's a cab pulled up, the cab the man had called for and was waiting for and the cab he left in.
So, Mr. Reese; have you considered the unintended consequences of this incentive pay? Such as the possibility a paramedic or EMT who needs some extra cash is providing unwanted, unneeded "transport" with "accurate paperwork". Or worse the same situation and an EMT hurrying and not providing best care so they can get back on the street for more meat and cash bonuses?
This is completely and utterly ridiculous. Here is a suggestion; just do your damn job. The spoiled "hero complex" attitude of this really galls me. The article say to properly do paperwork it "takes time". Really?, Really??!! Do they have something more important to do? You know like schedule part-time work or decide what to watch in the day room.
The next article about the fire departments should include bonus money for successfully wiping their butts, because you know that takes time too.
Why are people rewarded for simply doing their job right...because so many other people aren't. When did this happen? It used to be everyone was expected to do a good job, it was required, and respected, no matter the grade of pay or status. Our country, it's employers, etc. let that slip; accepting "mistakes", etc. for cheaper wages; and now rewarding medeocracy (or filing paperwork appropriately) get rewards.
To my fellow medics; be ashamed! This article does nothing less than pain you in a negative light, it also serves to let the public believe that if you don't get your bonuses and accolades you will not perform, the latter would scare the heck out of me if you were attending me.
Thats it - I want extra too for doing my job!
Next thing the union will ask for is a paperwork bonus for having cleaned themselves properly after having expelled solid bodily waste.
I was thinking about this and have a question; how long before the illegal immigrants start doing this job for less money because as they stated, " we do the jobs Americans won't?"
How about you have a heart attack and hear "por favor no te mueve, Mi paramedico."
As an IAFF Executive Board Member (Past) I can tell you that you are you're own worst enemy.
Phyremedic
A past IAFF Executive board member? Highly doubtful. Then you woke up from your dream of being a firefighter...
Another one sided article from a Las Vegas newspaper!
AMR's lobbyist at thier finest!
Get all the facts before you cast judgement on the medics...
HL9000, do tell. The report looks pretty straight forward. Why don't you enlighten us "wanna-bee's".
The reason you probably won't answer is you are too busy with you part-time job or crossing the "t's" and dotting the "I's".
This is such union crap. BTW, nice job blaming AMR.
and nevada and clark county and las vegas say the economy has them in debt.no its these uncalled for perks that have all three in debt.the politicans come up w/these bills and put their names on them so they have groups like those getting these perks to vote for them as a group.when will all this waste stop,answer,when these career politicans are voted out of office.
Getalife, The article fails to tell you many points:
First, the Fire department does not transport all medical calls, AMR and Medic West are contractually obligated to provide that service. The Fire dept only transports traffic accidents 100%. As far as all other calls, there is complete discretion, but no obligation.
Second, the city approached the union about this for revenue generating, the more transports, the more money goes back to the city, which reduces your taxes. Let me remind you, this money goes back to the general fund, which helps all city departments, not just Fire. As Reese states, it pays for itself, and it generates money!
When the Fire Dept goes on a medical call, with no transport, this requires only a computer documented report. But when a person is transported, it requires alot more generated paperwork, handwritten report, computer entry, billing, Ect. If the taxpayers would like the fire dept to do all transports on thier dime, thats fine, but it would cost the tax payers even more, with or without documentation pay. And of course you would be the first one to complain about higher taxes!
HL9000, OK, so answer the question why is "bonus" pay given to accurately do the job. I don't care if it does take longer, you are on the clock, please explain the bonus money.
When you say the money goes back to the general fund are you implying that the $20 - $30 bucks each person makes goes into a collective kitty and then goes back into the general fund. The way I read it the money $$$$ goes into the wallets of the paramedic or EMT. Is this wrong?
Getalife, What I am saying is the $600-700 dollars that it costs the insurance company for transport goes directly back to the city. It was not until recently that the fire dept transported medical calls at all. This was always done by private ambulance companies.
Like I said, by having the fire dept do some of the transporting, it generates money for the city in revenue. The Bonus pay was what the city offered the union in the last contract agreement.
Now keep in mind, there is a fine balance on how much transporting the city can do. We are not equipted with enough ambulances or personel to do all the transports. If the department was to increase transports to say 50% of calls or more, there would need to be more staffing and equiptment to do this. By having ambulances or rescues as we call them available to run calls, and not be stuck at hospitals, keeps 911 call response times down to 4-6 min and engines available if fire or medical calls come in.
Just FYI, if you do live in the city of las Vegas, you have one of 8 Fire Depts in the world, that have both an ISO 1 rating and accredidation status. The lower your ISO, 1 being the best, lowers insurance costs to busineses throughout the city.
You might want to look at the department in whole, instead of just concentrating on $20-30 dollars. What i am getting at is, are you upset about the bottom line dollar being tax costs to run your fire dept, or are you just puting all your emotion into personel making extra money for transporting, which actually saves money in the long run when you do all the numbers.
HL9000, stop wasting your breath. The article was written from a very disadvantageous aspect. I know you would give me the shirts off your backs without having to be asked. What people fail to understand is that it takes a lot to process and maintain the nature and integrity of a LOT of these transports. It's easy to become a back seat driver when you're sitting in the back seat.
It's been a long time since I took my BASIC EMT course, though I doubt this has changed; as I recall proper and accurate documentation was part of the course, wasn't it?
Then it must part of your job. Complete and accurate paperwork is what makes the city money to help pay your wages and buy your toys (even if it's indirectly). That should be incentive enough! If we "reward" you for doing what you were hired for, then what are we to expect next? Bonuses for giving a patient an IV? Or putting on a splint? Maybe even "convincing" a patient they need to go to the hospital, even if they don't. Heaven forbid you apply this kind of thinking to your fire fighting duties!
HL9000, You mentioned that you have paperwork to do, documented report, computer entry and billing. First two I understand. But not billing. Doesn't the AMR billing department do all of your billing for you. Last I checked EMT's and Medics don't do billing. You get the advantage at most times to return to your quarters after a call is done to complete whatever documentation that was not done in the PCR. The private companies have to return to service and complete whatever documentation is left at the end of their shift. I won't even go into the "holding short in quarters" that we see so often.
On a separate note. What if the patient just wrote on the bill they receive, "paid by taxes" because isn't that what our taxes pay for.
EMS 702
You are correct, billing is done by AMR. What I meant was the additional billing info that is entered.
Its obvious you work for one of the private companies, which is fine, but dont get off the subject by crying about having to do your reports at the end of your shifts. Yes we go back into quarters to enter PCR info, but we are still in service, dont make it sound as if we are out of service to do this. That is a entirely incorrect statement.
If you dont like the idea about having to enter your info at the end of your shift, you should probably persue this with your union.
Oh, please go into holding short in quarters. I would love to hear the your rumors or innuendos on this. I would be happy to debate you on this.
If the public wants a completely free Fire Dept. service for transports by increased taxes, thats up for them to decide. You might want to think about that though?
By HL9000 4/22/09 at 4:14 p.m
"A past IAFF Executive board member? Highly doubtful. Then you woke up from your dream of being a firefighter..."
I will gladly compare IAFF cards with you. Do you really think that anyone whom disagrees with you must be a fake? What a luxury it must be in your small world.
Better to be thought of a fool than to open your mouth and remove all doubt. Good luck to you Sir.
HL9000, I do have to say that I appreciate what the fire department does and have great respect for them. I in no way want to get in any kind of pissing match with anyone. The fire department and private companies have a long standing good working relationship. At least I believe those that work in the field and run calls together. I like to leave politics to the ones who's job that is. Frustrations arise I guess when services provided by both entities get different treatment. But again that is probably a union issue. Unfortunately perception by press and other media is, "don't you all make enough already". I don't wish to debate too many issues with you. I have had bad experiences with a few City Fire crews that have left a bad taste. I am sure all your experiences with the privates have not always been stellar. As for the Holding in Quarters thing, I don't understand it. But that is off topic and meant for different time. I vented and got off topic. I do appreciate your insight to the issue at hand. Sometimes though from the perspective of a tax payer, and not an EMT or Medic working for Public or Private provider. It can seem like its just more money going somewhere other than what taxpayers feel it should go. I in no way want it perceived that public and private do not work well together, where in actuality when a person's life is in the balance, this will be and has always been our first priority, no matter who transports.
Phyremedic, what local do you belong or did belong to?
I am a fool, look at the bottom line fiscal dollar. Or were you absent the day they tought math class in school? You might have a valid argument if the documentation pay was given and the city was losing money over it. That is not the case here is it? It is generating an upwards of 5-6 million to reduce your taxes!
Transports generate money, which in turn reduces city taxes period. Debate me on that please!
Just wondering...does their pay get reduced if the paperwork is not correct...probably not!
First...If the city fire department was really interested in better serving the community they would transport a portion of All medical calls not just the auto accidents where the odds are much higher that the patient is insured. Make sure to leave those "St. Vinny" transports for AMR/MEDICWEST.
Do you think the public would stand for the police getting $20-30 for each accurate ticket they write! PLEASE. This "quality assurance pay" was for keeping these guys in the paramedic program after putting more of a work load on them. It appears that it works because these guys
waste no time clearing for the next "dash for cash". I really don't mind if these guys get extra pay in their salary because they transport but don't lie about it and call it something it isn't. As far as the tax "debate" goes getting that 2.6 million back would certainly reduce the city tax load.
Unless you work as a CLV EMT or paramedic or have ever worked for as an CLV EMT or paramedic, it's probably best to ponder in silence.
It's easy to be a back seat driver when you're sitting in the back seat.
This is obviously an incentive pay, I don't think anyone is going to argue that. Everyone keeps saying that the city fire dept. should just do their jobs and transport these people to the hospital. What the general public fails to realize is that it is NOT the job of these firefighters/paramedics to transport these patients, it is the AMR/Medicwest's job that's why there is a contract in place with these private companies. So would you rather the more than 14 million dollars in 7 years that has been generated through these transports, go to the city (citizens of Las Vegas) to help keep your taxes lower or maybe we could just hand that money to the private companies like AMR and Medicwest and we would be 14 million dollars more in debt! This whole article is about the talks going on for the county fire dept. to start transporting...for what reason...to make money for the county just like the city fire dept. makes money for the city.
Yeah that 14 million could help pay the fraudulous overtime paid to these heros. Just as any county agency it is infested with corruption. Take a look at list at the highest paid employees in clark county. What a joke!!! "I'll call in sick, you work for me and collect overtime, and I'll return the favor." This is the problem with union employees who are not accountable for their job performance. But we as tax payers we our powerless to correct the situation, just tell us where to send the check.
Bitter much? That's kind of an insult to the higher ups for the city, county etc don't you think? Don't you think there are people that are paid to figure out if it is cheaper to hire more people or to just pay overtime or do you think those people are in cahoots with the "heroes" too? You sound really educated on the information that you're providing chooch! Did you get ALL of your information from the newspaper? Unlike AMR, at least the fire dept. won't go on strike everytime they don't get their way! The strike I'm sure is somehow for the good of the public I'm sure right, so that's what it's all about! Oh and by the way, how is the overtime fraudulent? Do these people not actually work those hours? Oh right, they call in sick so that the other one can work for them, I'm sure that's how their system works. Maybe the fire departments can just shut down their stations for 16 hrs a day and work a normal 9-5 job like everyone else, then there won't be any overtime and all you cry babies can stop complaining!
First let me state that I work for the LVFD. I welcome all discussion on this topic, but let me clarify a few things.
The city of Las Vegas GAVE this pay to the Firefighters. We did not ask for it. If you don't like the policy, BLAME THE CITY, not the Firefighters. The city wanted to make money and felt it was a good policy to aid in that goal. When the contract came to a vote, a majority of the LVFD union voted for it. I personally voted against that contract for many reasons, but that is not important. I worked for Mercy and AMR before I worked for the LVFD, so I know both sided of that story. I transported my 2 pt's for the LVFD before "documentation pay" and I transport my 2 pt's a day after it was given to me BY THE CITY. I and a vast majority of my FF/Paramedic co-workers do not and would never drive around hoping, waiting, and praying to find the next transport, so I could make an extra $30. It just isn't worth it. I respect the contract with AMR and believe it is their job to transport everyone else after I get my "2 a day" done.
Why car accidents? ...for insurance? NO. AMR and LVFD signed a contract to have the LVFD do all car accidents because it could be proven that the LVFD is better equipped to handle these call types. Our firefighting gear offers us greater protection from jagged and sharp metal and glass. We have extrication equipment we can be used to free trapped victims. Since no other call type can be proven to be done better by the LVFD paramedics, no other call type was added to that agreement.
If we want to talk about overtime, bring that discussion here. The City of Las Vegas did an audit and concluded a cost savings by hiring less people than needed and over timing the people they already had. The savings come from paying less salary, insurance costs, pensions, and other related costs that come from hiring more people. A fair percentage of that OT is mandatory. I get a call at 6am (right before I get off shift) and am told you are not going home today, putting me on 48 or even 72 hours straight. Do I make more money? Yes, but I work a lot more hours to get that money. I average 70 - 90 hours a week (even if I don't want to work that much). My normal work week is 56 hours a week. Again OT is a negotiated item between the City and the union. When the City saves money on their bottom line, OT will go away. Until then it will not....END OF STORY
Phyremedic
I knew you wouldnt respond to my last post!
Firemen are heros and they deserve good pay and benifits. I bet you wont be complaining about the fact they are paid well when your house is on fire or you mother breaks a hip and they come to help. I think alot of people responding to this artical are jellous of firefighters...mabey you should have tested better.
As a firefighter /paramedic in California with 29 years of service a quick observation. This "documentation pay" is being used by our local PRIVATE ambulance service. They have been doing this for years. Our Fire Department does not transport. They found that after they (the privately-owned ambulance) started this policy their collection rate increased by over 40%.
So for all of you Firebashers out there, this was something that got started initially by private-enterprise to increase their efficiency and now that a government run agency is doing the same thing all you can do is b*tch and whine about it.
Make up your minds you naysayers. You need to put your your brains into service and use some level of intelligence before writing some of the ignorant comments that I have read on this blog.
For those of you who think we are so "overpaid" let me ask you how much you think it's worth to walk around the rest of your life with burn scars because you were just doing your job.
TO PHYREMEDIC - As a former IAFF Executive Board Member, did you always talk down to your Brothers and Sisters like that or did you just start that after you retired? Shame on you.