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department health services Since we're on a fire department tangent... (1 viewing) (1) Guests
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TOPIC: department health services Since we're on a fire department tangent...
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department health services Since we're on a fire department tangent...
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Unfortunately ever so true. Sudden cardiac death is the friend of the health insurance industry. Unlike property insurers, they don't have to pay to replace. Maybe we'd do better with the life insurance companies. Sent from my BlackBerry - please forgive the brevity and the typos.
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department health services Since we're on a fire department tangent...
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You aren't supposed to win on your own... it is the collective that wins. Actually, there are a number of things that can reduce cardiac arrest risk which also reduce cardiac disability risk which are the different between productive dues paying member of society and the disabled happy to be insured person. Cheers, Nick On Tue, Aug 25, 2009 at 13:06, <
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wrote: Unfortunately ever so true. Sudden cardiac death is the friend of the health insurance industry. Unlike property insurers, they don't have to pay to replace. Maybe we'd do better with the life insurance companies. Sent from my BlackBerry - please forgive the brevity and the typos. From: David Shrader [
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] Sent: 08/25/2009 03:08 PM AST To:
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Subject: [NEMSMA List Serv] Re: Since we're on a fire department tangent... And to negotiate that incentive, we need both unity as an industry and proof of economic benefits from our services. Both may be hard to achieve. The first for obvious reasons (or at least obvious to most of this group). The second may be impossible. In the suppression world, a building that does not burn down does not necessarily end up creating more risk for the insurance company each year simply by surviving. People who are saved by EMS often cost a great deal more for a while and if they live to a ripe old age they cost a lot more yet as they become elderly. Oddly, even prevention, on the whole just adds costs. If you get your $5k colonoscopy every couple of years, that's a new cost. It doesn't prevent colon cancer and a few people will have complications and even deaths from the procedure, but you might find the disease early. If you find it early, you go through a round of surgery, chemo and radiation (very high costs) and then live to have more ailments (and costs). Of course, if everyone gets the screening, the company pays for 9 healthy people to be screened repeatedly in order to eventually find the one with disease. If you don't do the prevention, don't spend the $5k, around 90% of people won't get the disease anyhow and the insurer will have saved a bundle and only have to pay to treat those who actually end up with the disease. If you catch it later, more of them die earlier and long term costs are further reduced. I know its a harsh way to look at it, but the industry does in fact think through these issues this way. Fire insurance is more like death and disability insurance than what we currently call health insurance. If your property insurance included your utilities, cleaning lady, yard service, periodic painting, appliance repair, light bulbs and redecorating, it would look a lot more like health insurance. In that case, and if houses had a finite average life span of 85 years or so before inevitably dying, the insurance would, of course be much more expensive and at some point, from an actuarial point of view, it would be cheaper to burn it down than to maintain it. I don't know if we will prove that we can save money for insurers. I fear that they will see us as creating more risk and costs. I do think that what we do is right for people, though. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
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www.thepolarisgroup.org On Aug 25, 2009, at 2:45 PM, <
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wrote: We have often talked about an ”ISO” rating for EMS but until the medical insurance companies provide some type of monetary incentive to the user it would be a tough sell. From:
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[mailto:
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] On Behalf Of David Shrader Sent: Tuesday, August 25, 2009 2:33 PM To:
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Subject: [NEMSMA List Serv] Re: Since we're on a fire department tangent... Couldn't agree more. That was part of my earlier points about fire suppression and EMS practices. Suppression standards have developed over a hundred years or so and are tied to economic incentives for communities. Reduce Fire spending enough and the citizens get hit with huge increases in insurance premiums. My own town nearly took precipitous steps last year that would have led to a downgrade from a 5 to a 10 (unrated) rating. The average homeowner who could still get insurance, would have seen an eight fold increase in property insurance premiums and many mortgages (including mine) would have been foreclosed due to lack of ability to insure some properties at any cost. Fortunately, because the standards are clear, we were able to show that spending $500k for a volunteer fire department was much cheaper and less politically risky than having the residents pay $3 Million more for insurance and have 25% or more lose their homes with corresponding losses of property value and therefore tax revenue for the entire Town. BTW, we will undergo a new rating inspection soon and are shooting for rating of 3 to further drop the cost of insurance for commercial property owners. To a politician, EMS systems just cost money and there is no economic offset to provide political cover for spending enough to do it right. Arguments like: how can you put a price on a single life? don't hold up well over time and without some externally set expectations or economic incentives we will always find ourselves on the short end of the stick when the mandated services (Fire, police, courts, etc) get the first bites of the pie. Some communities have taken steps by enacting ordinances and adopting standards _base_d on the meager evidence and consensus standards that we can produce. By doing so, they at least make a public statement of expectations and take away the uncertainty for EMS management in the budgeting process. Its always easier to hit a target (performance) if you can see it. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
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www.thepolarisgroup.org On Aug 25, 2009, at 2:06 PM,
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wrote: That is part of my point. EMS has no science to point the way and is therefore able be pushed around by politics and unions and we end up with poor performances. Neal Smith Sent on the Sprint® Now Network from my BlackBerry® From: David Shrader Date: Tue, 25 Aug 2009 14:02:27 -0400 To: <
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Subject: [NEMSMA List Serv] Re: Since we're on a fire department tangent... While your conclusion is certainly true in many places, I routinely (and I think increasingly) run into Fire departments that do not want to take over EMS. Some get pushed into it by labor or politics and some by poorly performing providers. Most that I see, that are not currently in the ambulance portion of the business would just a soon keep it that way. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
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www.thepolarisgroup.org On Aug 25, 2009, at 1:55 PM,
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wrote: After reading this for a few days now I think I can make a reasoned sugestion. Good, bad, or indifferent. The fire side has spent many decades and some science in what is really a good PR compaign. It doesn't matter if ISO is right it is accecpted and the fire staffing levels and 2 in 2 out rule is pretty much set in stone. If EMS spent the time in scientific research and was able to show how BLS, ALS, and tiered response, response times and all we hold dear to be true and the states and feds mandated an EMS response we would be better believed. Until that it will always be about the money. FD will try to take EMS not because they do it better, but the runs ... read more »
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department health services Since we're on a fire department tangent...
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You are right. And if the cardiac prevention wins you end up succumbing to cancer or some other expensive disease process. To paraphrase Dr. Norman Hadler: As we grow older, we can prevent and cure some diseases. You have about 85 good years on the planet, give or take. The closer you get to your limit, the more diseases that are competing to finally do you in. We cure elderly patients of cancer only to see them die shortly afterward of cardiac, stroke, _meta_bolic or other disorders. Eventually something will get you. This time of year, where I live, its most likely to be a drunk tourist behind the wheel. But maybe I've just had enough of the summer season for this year. *David A. Shrader* David A. Shrader, President *The Polaris Group* *EMS & Public Safety Consultants* 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
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www.thepolarisgroup.org On Aug 25, 2009, at 4:09 PM, Nikiah Nudell wrote: The actuaries have that figured out too. You aren't supposed to win on your own... it is the collective that wins. Actually, there are a number of things that can reduce cardiac arrest risk which also reduce cardiac disability risk which are the different between productive dues paying member of society and the disabled happy to be insured person. Cheers, Nick On Tue, Aug 25, 2009 at 13:06, <
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
wrote: Unfortunately ever so true. Sudden cardiac death is the friend of the health insurance industry. Unlike property insurers, they don't have to pay to replace. Maybe we'd do better with the life insurance companies. Sent from my BlackBerry - please forgive the brevity and the typos.
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The administrator has disabled public write access. |
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department health services Since we're on a fire department tangent...
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I saw a recent news story on the average life span. The longest, if I remember right, are females in Switzerland at 83 and the shortest are males in Swaziland at 25. The life expectancy research shows a direct linear trend as life expectancy increases with time. So for every year longer that you live, your life expectancy increases. How is that for logic. Cheers, Nick On Tue, Aug 25, 2009 at 13:28, David Shrader <
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wrote: Nick: Your second sentence reminds me of the Borg! You are right. And if the cardiac prevention wins you end up succumbing to cancer or some other expensive disease process. To paraphrase Dr. Norman Hadler: As we grow older, we can prevent and cure some diseases. You have about 85 good years on the planet, give or take. The closer you get to your limit, the more diseases that are competing to finally do you in. We cure elderly patients of cancer only to see them die shortly afterward of cardiac, stroke, _meta_bolic or other disorders. Eventually something will get you. This time of year, where I live, its most likely to be a drunk tourist behind the wheel. But maybe I've just had enough of the summer season for this year. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
www.thepolarisgroup.org On Aug 25, 2009, at 4:09 PM, Nikiah Nudell wrote: The actuaries have that figured out too. You aren't supposed to win on your own... it is the collective that wins. Actually, there are a number of things that can reduce cardiac arrest risk which also reduce cardiac disability risk which are the different between productive dues paying member of society and the disabled happy to be insured person. Cheers, Nick On Tue, Aug 25, 2009 at 13:06, <
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
wrote: Unfortunately ever so true. Sudden cardiac death is the friend of the health insurance industry. Unlike property insurers, they don't have to pay to replace. Maybe we'd do better with the life insurance companies. Sent from my BlackBerry - please forgive the brevity and the typos. From: David Shrader [
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
] Sent: 08/25/2009 03:08 PM AST To:
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Subject: [NEMSMA List Serv] Re: Since we're on a fire department tangent... And to negotiate that incentive, we need both unity as an industry and proof of economic benefits from our services. Both may be hard to achieve. The first for obvious reasons (or at least obvious to most of this group). The second may be impossible. In the suppression world, a building that does not burn down does not necessarily end up creating more risk for the insurance company each year simply by surviving. People who are saved by EMS often cost a great deal more for a while and if they live to a ripe old age they cost a lot more yet as they become elderly. Oddly, even prevention, on the whole just adds costs. If you get your $5k colonoscopy every couple of years, that's a new cost. It doesn't prevent colon cancer and a few people will have complications and even deaths from the procedure, but you might find the disease early. If you find it early, you go through a round of surgery, chemo and radiation (very high costs) and then live to have more ailments (and costs). Of course, if everyone gets the screening, the company pays for 9 healthy people to be screened repeatedly in order to eventually find the one with disease. If you don't do the prevention, don't spend the $5k, around 90% of people won't get the disease anyhow and the insurer will have saved a bundle and only have to pay to treat those who actually end up with the disease. If you catch it later, more of them die earlier and long term costs are further reduced. I know its a harsh way to look at it, but the industry does in fact think through these issues this way. Fire insurance is more like death and disability insurance than what we currently call health insurance. If your property insurance included your utilities, cleaning lady, yard service, periodic painting, appliance repair, light bulbs and redecorating, it would look a lot more like health insurance. In that case, and if houses had a finite average life span of 85 years or so before inevitably dying, the insurance would, of course be much more expensive and at some point, from an actuarial point of view, it would be cheaper to burn it down than to maintain it. I don't know if we will prove that we can save money for insurers. I fear that they will see us as creating more risk and costs. I do think that what we do is right for people, though. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
www.thepolarisgroup.org On Aug 25, 2009, at 2:45 PM, <
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
wrote: We have often talked about an ”ISO” rating for EMS but until the medical insurance companies provide some type of monetary incentive to the user it would be a tough sell. From:
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
[mailto:
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
] On Behalf Of David Shrader Sent: Tuesday, August 25, 2009 2:33 PM To:
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Subject: [NEMSMA List Serv] Re: Since we're on a fire department tangent... Couldn't agree more. That was part of my earlier points about fire suppression and EMS practices. Suppression standards have developed over a hundred years or so and are tied to economic incentives for communities. Reduce Fire spending enough and the citizens get hit with huge increases in insurance premiums. My own town nearly took precipitous steps last year that would have led to a downgrade from a 5 to a 10 (unrated) rating. The average homeowner who could still get insurance, would have seen an eight fold increase in property insurance premiums and many mortgages (including mine) would have been foreclosed due to lack of ability to insure some properties at any cost. Fortunately, because the standards are clear, we were able to show that spending $500k for a volunteer fire department was much cheaper and less politically risky than having the residents pay $3 Million more for insurance and have 25% or more lose their homes with corresponding losses of property value and therefore tax revenue for the entire Town. BTW, we will undergo a new rating inspection soon and are shooting for rating of 3 to further drop the cost of insurance for commercial property owners. To a politician, EMS systems just cost money and there is no economic offset to provide political cover for spending enough to do it right. Arguments like: how can you put a price on a single life? don't hold up well over time and without some externally set expectations or economic incentives we will always find ourselves on the short end of the stick when the mandated services (Fire, police, courts, etc) get the first bites of the pie. Some communities have taken steps by enacting ordinances and adopting standards _base_d on the meager evidence and consensus standards that we can produce. By doing so, they at least make a public statement of expectations and take away the uncertainty for EMS management in the budgeting process. Its always easier to hit a target (performance) if you can see it. David A. Shrader David A. Shrader, President The Polaris Group EMS & Public Safety Consultants 273 North Dogwood Trail Southern Shores, NC 27949 252-441-8844 Direct Voice 252-441-8856 Fax 252-255-8262 Cell
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
www.thepolarisgroup.org On Aug 25, 2009, at 2:06 PM,
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
wrote: That is part of my point. EMS has no science to point the way and is therefore able be pushed around by politics and unions and we end up with poor performances. Neal Smith Sent on the Sprint® Now Network from my BlackBerry® From: David Shrader Date: Tue, 25 Aug 2009 14:02:27 -0400 To: <
This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
Subject: [NEMSMA List Serv] Re: Since we're on a ... read more »
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department health services Since we're on a fire department tangent...
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Neal Smith Sent on the Sprint® Now Network from my BlackBerry®
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department health services Since we're on a fire department tangent...
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over BLS units for a first response? What ALS interventions have been shown to be that time sensitive that they should arrive in the first wave of response? We have continuously been reviewing this subject matter in our area for a number of years. Any dialogue posted here represents my personal thoughts and inquiries and are not representative of my employer. Brent Browett, AEMCA, ACP, BSc, MA, Director, Emergency Medical Services, Hamilton Emergency Services www.hamilton.ca
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