Las Vegas Sun

September 14, 2014

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It pays EMTs to dot I’s and cross T’s

In Vegas, they get bonus for proper paperwork, but city touts savings

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Should the city's paramedics and EMTs continue to receive bonuses for filling out paperwork correctly?

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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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