Patients or Customers?

Any clinician would agree that the business of emergency medical services is in a state of constant flux. Yes, I said business because that’s what it has become. And having a business means having customers. Twenty years ago, when I started out as a paramedic, things were quite simple with health insurance issues:  we simply didn’t ask for the information because we didn’t need it. I worked for a municipal fire department agency that didn’t bill for an ambulance transport to the hospital, no matter if the patient had a lacerated toe or a full-blown ST-segment elevation myocardial infarction.

In fact, back then, our state run reports were about ¾ of a page long. Who, what, when, where, why and what did we do. Basic patient history, medications and allergies. Run times. Nowhere on it was a place to fill out health insurance information. You needed a rescue, you called 911, we came, we rendered care, we transported. End of story.

Today, not so much. Thanks to ever-changing insurance regulations and Medicare and Medicaid requirements, our patients have become paying customers. They are going to get a bill for their ambulance ride and the interventions done in the back and, in some instances, the mileage to the hospital as well. Some agencies are billing patients for just showing up and taking a patient care refusal (no transport).

That means providing not only superb clinical care; we need to provide good customer service as well. But what does that exactly translate to in EMS terms? In a restaurant, good customer service means you got seated quickly, the wait staff was great, the place had a pleasant atmosphere, the food was cooked to order and the bill didn’t leave you penniless.

EMTsBut in the middle of an overturned vehicle on the interstate, while you’re trying to start IVs and extricate a patient from the heap of metal they’re trapped in? Obviously good customer service there equals good patient care, rapid transport, plus a good bedside manner. We often see people on the very worst days of their lives, and asking to see their health insurance card is literally adding insult to injury. But agencies and municipalities that bill for services rendered are on a huge push for EMS providers to obtain that information and to turn in a “billable” run report.

To that effect, I would add good documentation as part of customer service. A well-documented run report, especially if advanced life support care was given, can mean the difference between the patient’s insurance covering the ambulance transport because it was necessary, or instead determining that the person could have gone by other means to the ER. Documenting also why you bypassed a closer hospital for one a bit farther down the road (like, say, specialized care was needed, or the closest hospital was on ambulance divert) can save the patient a billing headache later.

Family members are customers, now, too. We can’t forget them. The patient’s family also needs a good bedside manner from the clinicians taking care of their loved one. Explain everything you are doing and why. If they are accompanying a critical close relative to the hospital, they need to know why you have to have Aunt Mary’s identification and insurance card. Don’t just go digging for it in someone’s personal effects (a practice referred to a few times on HBO’s The Sopranos as a “wallet biopsy”). Enlist their help; explaining to them that you need the insurance information so that the insurance company gets the ambulance bill and not the patient works like a charm. So does simply taking the extra second to be nice and smile. I realize that it’s tough to do when people are screaming and cursing and blaming you and your partner for everything under the sun that went wrong. Hey, we can’t make everybody happy all the time, but we can at least try to be empathetic.

Let’s face it:  healthcare, even EMS, is a multidimensional marketplace. People want what they paid for, or they will go somewhere else. Our patient/customers have greater rights and choices when it comes to their healthcare then they ever have before. And providing customer service – seeing them as customers – does not mean we no longer approach them with humanity. The two aren’t mutually exclusive; we have an equal responsibility now to provide excellence in clinical care and also to inform them of their choices regarding that care.

Health insurance coverage has become a quagmire for all involved – patients, caregivers, hospitals, facilities, emergency workers – everyone. Taking a few extra seconds to give our patients that good customer service – and maybe helping to cut through some of the uncertainty for them – is a task we should all be undertaking. Stay safe out there, everyone! Take care of each other.

Disclaimer: The content in this article is the opinion of the writer and does not necessarily reflect the policies or opinions of US Patriot Tactical.

Leah Dallaire

Leah Dallaire

Leah G. Dallaire is a highly accomplished freelance writer, editor and consultant with 28 years of experience. She has also concurrently been a paramedic for 20 years; the last 17 she spent serving the citizens of Pinellas County, Florida, which has a call volume of about 209,000 runs per year. She holds an M.A. and a B.A. in Writing & Literature from Union University. She has also just finished her first novel.
Leah Dallaire
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