The cost of providing health care for employees is soaring and uncertainty abounds about what the landmark health reform legislation signed March 23 by President Obama will mean for employers. Against that backdrop, the North American Ambulance Alliance (N3A) is launching medTRANS Insurance Ltd., otherwise known as a “captive,” in which participant employers band together in a jointly owned health insurance company.
“The profit motives are significantly different than a commercial insurance company,” explains Phillip Holowka, N3A’s executive director. “We don’t have shareholders to satisfy and executives to pay. We are much more about cost containment.” Captives are used in many other industries, including construction, trucking and air travel.
medTRANS will be governed by a board of directors made up of member companies, who will choose vendors (billing companies, pharmacies, benefits managers, etc.) and conduct reviews of claims data, all while placing a strong emphasis on employee wellness initiatives, according to Holowka. “If you’re not proactive enough, you’ll be out,” he says. “This is a collective; you have to get involved. You are rated every year by your peers. Your rate increases are decided by your peers.”
While medTRANS is a for-profit company, profits will be returned to the owner-employers. The first several employers were scheduled to begin offering coverage through medTRANS on April 1; another 33 are in the pipeline to join in the coming months, Holowka says. medTRANS needs at least 1,500 “employee lives” to be economically viable, and Holowka believes the company will reach that benchmark shortly.Only employers with 20 or more employees are eligible. For more information, contact Holowka by phone at 866-N3A-6090, ext. 703; or via e-mail at pholowka@n3a.org.
Looks like you’ve chosen the right field. The U.S. market for the provision of ambulance service is projected to exceed $11.3 billion by 2015, according to a report by Global Industry Analysts Inc., a San Jose, Calif.-based market research company. Rising life expectancies means more chronic illnesses, while advancing medical technology and portability are making it possible for prehospital providers to do more diagnostic work on scene, potentially meaning a larger role for EMTs and paramedics in health care.
With more than 13 percent of the population currently over the age of 65 and expected to rise to 20 percent by 2030, “The U.S. holds strong prospects for ambulance providers,” Global Industry Analysts reports. Increases in the number of nursing homes and home care recipients will further fuel demand for non-emergency ambulance services.
The report, which is geared toward manufacturers, management consultants and investment research groups, is available for purchase at strategyr.com/Ambulance_Services_Market_Report.asp for $3,950, although portions can be purchased for $100.
EMS has a reputation for high turnover among its rank-and-file employees. But a new study finds retention problems may not be as rampant as is sometimes depicted in the media and EMS trade publications, researchers say.
A study of 40 EMS agencies of all types—fire-based, private and others—found the average annual rate of turnover is 10.7 percent; not great, but perhaps not as bad as perceptions, says lead study author Daniel Patterson, Ph.D., an assistant professor in the department of emergency medicine at the University of Pittsburgh School of Medicine and director of research at the Center for Emergency Medicine of Western Pennsylvania. The turnover rate varied somewhat depending on whether the staff was paid or volunteer, with paid staff turnover at 10.2 percent and volunteer at 12.4. Though the study included agencies from around the nation, Patterson notes that the sample was not meant to be nationally representative, and turnover rates may vary widely depending on the agency.
Why is turnover detrimental to an organization? For many reasons, Patterson says: High turnover is bad for morale; it can signal to employees that there’s a problem within the organization; and it can lead to the best employees leaving and the weakest remaining—not to mention that it’s costly. The study found the direct and indirect costs can be substantial: on average, $7,161 per paid employee, or more than $86,000 a year.
Direct and indirect costs include staff hours put toward getting the employee up to speed; cost of collecting, refurbishing or replacing equipment; time spent doing exit interviews; and costs to find a replacement, such as advertising for the position, attending job fairs, and time spent interviewing and training a new employee. “Don’t pretend that when someone leaves your agency it won’t cost you anything,” Patterson says.
A new study shows there may be much work to be done in improving the health of the EMS workforce, at least if a group of providers from in and around Pennsylvania are any indication. Researchers asked 119 EMTs and paramedics who attended a regional EMS conference in Pennsylvania to fill out a survey regarding their sleep habits and overall health. About 42 percent of those workers were overweight; 43 percent were obese. Nearly 60 percent had been diagnosed with more than one chronic health condition, including diabetes, high blood pressure or sleep apnea. Based on their answers to the Chalder Fatigue Questionnaire, nearly 45 percent were experiencing severe mental and physical fatigue. In fact, the study found that sleep quality and fatigue levels for EMS workers were closer to those of clinically depressed patients than to healthy controls reported in previous research.
“It definitely seems a little bit alarming,” says Daniel Patterson, Ph.D., of the University of Pittsburgh School of Medicine, noting that the sample was not nationally representative. “It appears, based on the results of this study, that we have some bad sleep and bad fatigue going on that represent threats to our safety and to patient safety.”
The main purpose of the study was to validate the tools used to measure sleep quality and fatigue, Patterson notes. The next step is to conduct the survey using more participants from around the nation.
This study, as well as the study on workforce turnover, is in the April–June 2010 issue of the Journal of Prehospital Care.
Paramedics Plus is likely to become the new ambulance provider for Alameda County, Calif. The Alameda County Health Care Services Agency has issued a notice of intent to recommend awarding the contract to the company, which is a subsidiary of the East Texas Medical Center. Paramedics Plus will do business as Sunstar Paramedics in Alameda County, with the new contract slated to begin Oct. 11.
State regulations require that exclusive operating area agreements be subject to a competitive bidding process every 10 years, says N. Dale Fanning, acting director of Alameda County EMS. In this process, Paramedics Plus won out over its much larger rival, American Medical Response (AMR), which has held the contract since the 1990s. Paramedics Plus was chosen by a panel of five experts, according to Fanning. “Paramedics Plus had a very solid proposal, as did AMR,” he says. “Our panelists selected Paramedics Plus as the strongest overall proposal.”
Paramedics Plus’ largest contract currently is Pinellas County, Fla., where the company did 136,000 EMS transports last year, according to Jeff Taylor, Sunstar Paramedics’ director of operations, who will serve as chief operating officer in Alameda County. There are about 88,000 EMS transports each year in Alameda County, which includes 1.5 million residents. According to information from AMR, gross revenue from the contract was projected to be $170 million in the 2009–2010 contract year, with pre-tax income on those revenues equaling $5.2 million, Fanning says.
AMR has submitted a protest to the award. The county board of supervisors was to make its final decision April 13.
