Luckily for me, jumping on “the box” was also an adventure. Of the calls we responded to, about 80 percent were ambulance runs. If I remember correctly, during my first year as a professional firefighter, we took approximately 2500 calls. Of these calls, we had only one large memorable fire. We did have enough CPRs, MVAs, and other exciting calls to make the job an adventure. No two days were ever the same; this was enough to make firefighting my career of choice. Every run we responded to meant someone felt they needed emergency assistance and that left me satisfied after my shift.
As firefighters, we did collect billing information, but we were somewhat lackadaisical about it, and our documentation was written mainly to protect ourselves from lawsuits. We received very little training on the importance of our documentation relative to collecting revenue. If the patient was coherent and we remembered to do so, we would make an attempt to obtain insurance information. We knew that someone else would track down the information if we did not get it. This was our culture. We were there to help the patient, not go after their money. We really didn’t see the importance.
After an injury, I could no longer fight the occasional fire without putting my fellow firefighters in harm’s way. I became a liability and was forced to switch career paths. I moved on to a private EMS organization where I did mostly hospital transports. Things were very different in this environment. I was still making a difference, only now I was required to obtain complete billing information and documentation for every run. I really struggled to comprehend why this was so important that a supervisor would track me down to retrieve the information needed to bill the patient. To this company, billing was (and still is) just as important as providing patient care — they were in the business of medical transportation).
The fact that they were a “business” was clearly relayed to me, and in turn. we had the best equipment available and were driven by state-of-the-art EMS technology. This was a direct result of good billing practices.
I took calls for the private ambulance company for a few years but my previous injury was further aggravated and forced me to move in yet another direction. I took a job working with a global company that specializes in providing accounts receivable and consulting services for fire departments. This position bridged the gap between the confusion that plagued me when my EMS supervisor hounded me for billing information, and the time when wearing my fire department badge meant simply answering the call for help. I now saw the” big picture” from a new point of view.
Today, I have the opportunity to meet with fire chiefs struggling to maintain staffing levels while staying current with the latest innovations in technology to keep their fire fighters safe. I meet with EMS coordinators who have to balance quality patient care, cost of equipment and union contractual agreements to serve their residents. I can see the piece of the puzzle that I was missing as a front line fire fighter.
Now that I am able to see “the big picture”, I can tell you that culture and clear expectations are the keys to successfully utilizing EMS transport fees as a tool to fund fire based EMS. As a rookie fire fighter, I was trained to do my best for the patient. I was never trained to do best for the patient and my employer. The culture of “billing for service” was not a clear focus at our department; our culture meant wearing the blue uniform and badge with pride and saving lives. As a fire fighter, I was expected to keep the public safe and rapidly transport the sick and injured when necessary. I worked for a great fire department, with an outstanding pay/benefit package; the City I worked for is one of the more affluent suburbs in the Detroit metropolitan area. Times were different then. Today, that department is looking for ways to bring in more money, just like most fire departments in the country. Today, fire departments are looking to maximize revenue returns to keep staffing levels at par and maintain modern apparatus and gear. As a firefighter you train hard to be the best at what you do. You do revolution after revolution, practice extrication, and learn new life saving techniques. Good documentation and billing techniques should be practiced too. The end result directly affects you!