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Give EMS compliance training the respect it deserves

It's time for EMS leaders and educators to take compliance training as seriously as clinical training – caregivers' careers and patients' lives depend on it


By Anthony Minge

It seems like you can’t go a day lately without seeing a report or article related to compliance issues in health care. The statutes, guidelines, regulations and laws governing the industry are complex and seem endless. There are rules for privacy, signatures, legibility, localities, physician certification statements, coding, billing – the list goes on and on.

While ambulance services represent just a very small segment of a much larger industry, we are not immune from vigilant governmental monitoring and – with a growing frequency – persecution.

Among others, CMS, HHS, the OIG, FBI, and the DOJ are keeping a watchful eye on almost everything we do. It’s a virtual alphabet soup of compliance cops! If you haven’t heard about someone who has had a compliance violation, or perhaps even experienced one in your own service, you have probably been out of the country for at least the past decade.

While it’s easy to see these folks targeting the big agencies, it has become common knowledge that no one, from the smallest ambulance services to the biggest metropolitan EMS agencies, gets a free pass. I’m reminded of a song by legendary country singer Waylon Jennings, and to paraphrase it, “Don’t you think this compliance bit’s done got outta hand?”

It is certainly not a stretch to find something to gripe, moan and complain about with all these rules and regulations we are required to keep abreast of. In addition to adhering to regulations, we are required to monitor a wide variety of documentation, regularly check and update policies and procedures, and provide training for our staff.

Everyone knows that compliance training day is a much-anticipated event in every EMS organization – I wish I had a nickel for every snide remark or eye-roll when the topic of compliance training comes up. Even supervisors, directors, chiefs, CEOs and boards of directors often question the need for it – but I can assure you they’re wrong.

As an industry, we have become well accustomed to annual clinical training. We are required to attend regular educational sessions and skill labs to demonstrate proficiency, and maintain certifications and licenses. It’s not even a stretch to say that some people actually, believe it or not, look forward to honing their talents or learning something new. And why not?

It’s easy to see the value of learning a new clinical therapy or procedure, or practicing one you infrequently perform. The connection between this training and safe treatment and transport of patients is clear to see.

Compliance training, on the other hand, just doesn’t get the same respect. Some agencies have gotten smart about tucking required HIPAA training into other regular meetings. It’s like hiding peas in a chicken pot pie. Maybe they won’t notice if we put good stuff all around it.

Compliance training ROI

At the end of the day, it’s all about return on investment. Time and money are required to attend compliance training and employees or managers want to know what they get out of it. Will it help patients? Will it save money? Will it increase revenue?

The answer to each of these questions is, yes. Far too often, educators introduce compliance training by saying, “I don’t like it any better than you, but it is something we have to do.” If they don’t actually speak those words, they make it clear with their body language or by trying to rush through the training as quickly as possible to check the box.

That is the wrong attitude. Compliance training is required because it protects our patients, our services and ourselves. But only if we take it seriously.

High-quality documentation that is honest, accurate and complete can help inform other health care providers so the patient receives the right ongoing treatment after the transport is complete.

Compliant patient care reports also ensure proper billing for services, which benefits both the patient and the agency. Billing errors stemming from non-compliant practices, even when unintentional, result in millions of Medicare and Medicaid dollars being processed inappropriately – which is fraud. Compliance training helps prevent mistakes that can result in monetary penalties and other unpleasant events, including prepayment review or exclusion from federal health care programs.

Finally, it can help protect the caregiver’s license. Regulators have increased reprimands, personal fines, suspensions and revocations of individuals’ licenses in response to violations.

No tolerance for ignoring EMS rules and regulations

EMS is a proud and noble profession. A commitment to delivering frequent and relevant clinical training is common in most ambulance services. Tolerance for caregivers with poor clinical skills who deliver subpar patient care is low – the same should be true for non-compliance with any of the rules and regulations governing any aspect of treatment, transport, documentation and billing.

No one mocks or pokes fun at the need for ongoing clinical training, and it is time for compliance training to get the same level of respect. The EMS profession should approach compliance training with the same level of intensity that has been given to that of clinical education. It is doubtful there will ever be three cheers for compliance training, but maybe a small round of applause is due for the hard work of staying on the right track.

About the author
Anthony Minge, EdD, is a partner at Fitch & Associates. He has extensive experience in health care finance, specializing in managing billing and collections functions in multiple areas, including pharmacy, home health, hospital, lab, and ground and air medical transport. Prior to joining the firm, he was the business manager for Northwest MedStar in Spokane, Wash., one of the largest air medical programs in the Pacific Northwest. He recently received a Doctorate of Education in Organizational Leadership.

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