In response to the ongoing shortage of 0.9% sodium chloride injection (normal saline), Baxter Healthcare Corp. of Deerfield, Ill., will temporarily distribute normal saline in the United States from its Spain manufacturing facility. FDA is temporarily exercising its discretion regarding the distribution of Baxter’s saline product from Spain and Fresenius Kabi’s saline product from Norway as needed to address this critical shortage, which poses a serious threat to patients.

 

FDA inspected Baxter’s Spain facility where its normal saline product is made to ensure the facility meets FDA standards. FDA asks that health care professionals contact Baxter directly to obtain the product.

 

In addition to these sources of normal saline, U.S.-based manufacturers – Baxter Healthcare Corp., B.Braun Medical Inc., and Hospira Inc., – are currently producing and releasing normal saline. Baxter’s saline product from Spain will be distributed temporarily in addition to Baxter’s FDA-approved version that is currently manufactured and distributed in the United States.

 

While the shipments described above will help reduce current disruptions, they will not resolve the current shortage of 0.9% sodium chloride injection.

Preventing drug shortages is a top priority for the FDA, and we are doing everything within our authority to improve access and alleviate this shortage.

 

The Professional Ambulance Association continues to report and share information as it becomes available.  To review Bound Tree Medical's weekly pharmaceutical backorder report, click here.

The following was emailed on the afternoon of April 25 by the State of Wisconsin EMS Office to EMS Stakeholders:

Brian Litza is no longer with the Wisconsin EMS Office. He has resigned effective 2014-04-24.

Jennifer Ullsvik will be taking his responsibilities on an interim basis. All communication that would normally go to Brian should be directed to Jenny. She will work with the EMS Office staff to continue to move EMS in Wisconsin forward. Her contact information is:

Jennifer Ullsvik, MS JD, Section Chief

Emergency Health Care and Preparedness

Division of Public Health

1 W. Wilson Street, Room 1150

Madison, WI 53701

Phone: 608.267.7178

jennifer.ullsvik@wi.gov

 The day to day operations of the EMS Office will not change. We remain committed to the positive customer service and professionalism that the office has encouraged.

New rules from the Federal Aviation Administration (FAA) will have a significant impact on helicopter air ambulance services.  These regulations implement new operational procedures and require additional equipment for helicopter air ambulances in response to an increase in fatal helicopter air ambulance accidents.  The new rules identify four common factors in those accidents- inadvertent flight into Instrument Meteorological Conditions, loss of control, controlled flight into terrain, and night conditions.

 

The rule becomes effective April 22, 2014 and includes the following provisions: 

• Requires all helicopter air ambulance operations with medical personnel on board to be conducted under Part 135 operating rules, not just the flights involving actual transport of the patient. 
• Introduces new weather minimums and visibility requirements.
• Mandates flight planning of terrain and obstacles.
• Requires a pre-flight risk analysis focusing on characteristics of the planned flight path, flight crewmember availability to safely conduct the operation, weather, and if the flight has been rejected by another operator.
• Requires that all medical personnel be given a safety briefing with information specific to helicopter air ambulance flights prior to each flight or receive eight hours of helicopter safety training every two years.
• Mandates that operators with 10 or more helicopter air ambulances establish operations control centers staffed with operations control specialists.
• Requires all helicopter air ambulances be equipped with both helicopter terrain awareness and warning systems by April 22, 2017 and flight data monitoring systems by April 22, 2018.
• Mandates that all helicopter air ambulance pilots hold instrument ratings and demonstrate the ability to recover from inadvertent flight into instrument meteorological conditions.

The rule does not apply to public aircraft unless it operating for a commercial purpose.  This means public agencies who are not paid for their services are not bound by the new rule.

 

Click HERE for a more detailed summary of the Final Rule.

Source:  Page, Wolfberg and Wirth EMS Attorney Law Firm

Gov. Scott Walker signed seven bills Monday aimed at fighting the state's growing heroin problem during stops around the state.

 

The new laws include ones that will allow drug users to call 911 about overdoses without fear of prosecution, expand treatment alternatives and create quicker punishments for offenders who violate the terms of their probation.

 

Walker signed the bills at events in Marinette, Stevens Point, Eau Claire and Milwaukee. The Marinette County Courthouse was chosen as one venue because it is in the district ofstate Rep. John Nygren (R-Marinette), who has taken a lead in drafting the measures. Nygren's daughter Cassie has struggled with heroin addiction.

Bell Ambulance in Milwaukee also served as one of Gov. Walker's stops highlighting the new law (picture insert).

 

"Wisconsin, like many states across the country, is experiencing a dangerous trend undefined an escalating number of cases of heroin use, addiction and overdose," Walker said in a statement. "Heroin addiction does not discriminate, and we have to take action to protect our friends, family members and neighbors who need help."

 

Supporters have dubbed the bills Heroin Opiate Prevention and Education, or HOPE.

"I know that our HOPE agenda isn't the 'silver bullet' to overcoming our state's heroin epidemic," Nygren said in a statement. "Rather, these seven bills are an important first step in the right direction."

 

The new laws will:

 

■ Give people immunity from criminal prosecution for drug possession if they bring a fellow drug user to an emergency room or call911 because they believe the person is suffering from an overdose.

The measure does not provide immunity for drug dealing or other serious crimes.

 

■ Allow any first responders to administer naloxone if they are trained. Known by its brand name of Narcan, naloxone counteracts overdoses from heroin and other opiates. Currently, only certain emergency medical technicians are allowed to administer the drug, and the bill would make it more widely available.

 

■ Allow communities to create programs to dispose of prescription and illegal drugs to curb abuse of substances that can lead to heroin addiction.

 

■ Require people to show identification to pick up prescriptions that are considered to have a high potential for abuse.

 

■ Create two or three state programs to help treat heroin addicts in high-need, rural areas at an estimated cost of $2 million a year.

 

■ Add $1.5 million in funding annually for treatment alternatives and diversion programs that focus on substance abuse treatment for those who commit crimes.

 

■ Implement "swift and certain" punishments for those who violate the terms of their probation or parole. Advocates say making certain punishments happen quickly helps deter those on probation from reoffending.

 

Source:  Milwaukee Journal-Sentinel

The EMS attorney firm Page, Wolfberg and Wirth shared on the afternoon of April 1, the White House reported the President just signed a bill extending the Medicare ground ambulance bonus payments until March 31, 2015 and delaying the implementation of ICD-10 codes until at least October 1, 2015.   

 

This means that the 2% urban, 3% rural and 22.6% super-rural bonuses that were set to expire on March 31, 2014 will remain in place for another year.  Ambulance services should not see any interruption in these bonus payments.  In addition, the ambulance industry now has until at least October 1, 2015 to prepare for the transition from ICD-9 to ICD-10 code sets. 

 

H.R. 4302 provides temporary relief to certain providers while Congress considers a more permanent fix to combat rising Medicare costs.  In the meantime, ambulance services are already exploring new delivery models and considering non-traditional revenue sources in order to be successful in the healthcare reform era. 

 

This delay does not mean sit and wait another year.  ICD-10 codes are coming and now is the time to get prepared for ICD-10 compliance and to use this delay to get ready - like training your crews to be more focused on "specificity" in patient care documentation - which will take time to do.

 

Source:  Page, Wolfberg and Wirth EMS Attorney Firm

 

ICD-10:  What is it?

The Professional Ambulance of Wisconsin completed an interview in 2012 that is relevant today yet regarding a forthcoming change from ICD-9 to ICD-10, and what this change means for those who write patient care reports and do the billing.  ICD-10 increases the EMS billing codes by several thousand and places significant emphasis, or "specificity", on patient care reports.  Click here to listen to the interview PAAW previously completed on this topic.

On March 28, the Centers for Medicare and Medicaid Services (CMS) announced that it had instructed its Medicare Administrative Contractors to hold claims paid under the Medicare Physician Fee Schedule for the first 10 business days of April (i.e., through April 14, 2014).
 

CMS indicated that this delay was necessary to prevent implementation of a negative update (i.e., a cut) to the physician fee schedule that was scheduled to take effect January 1, 2014.  However, the passage of the Pathway for SGR Reform Act of 2013 delayed the implementation of that payment reduction through March 31, 2014.  CMS indicated the most recent delay was intended to give Congress time to pass additional legislation that would further delay these cuts.

While the announcement did not specifically mention a delay in the processing of Medicare ambulance claims, the temporary adjustments for ground ambulance (urban (2%), rural (3%), and the super-rural bonus) are also currently scheduled to expire on March 31, 2014.  Therefore, ambulance services should be aware that this delay may also impact the processing of ambulance claims.

 

Source:  American Ambulance Association

Large Volume IV Fluids Supply Update

IV bags continue to be on a nationwide shortage.  To make matters worse, this week Baxter cancelled all existing backorders and reduced their allocation quantities.  "These two action steps by Baxter will have  a notable negative impact on what is already an extremely strained supply chain", according to Stacey Barksdale Price, Product Manager of IV Therapy and Pharmaceuticals at Bound Tree Medical, the nation's largest EMS product dirstributor.

The American Society of Health-System Pharmacists (ASHSP) recently shared the Intravenous solution conservation strategies document attached.   Barksdale Price noted, "Be encouraged by the May / June relief timeline that is mentioned in this document.  We are seeking to understand the remedial efforts taking place at the manufacturing level that supports that resolution timeline.  As more information is available, we will be sure to keep you updated."

To view the latest backorder report, click here.

To listen to an EMS to the Point audio interview with Stacey Barksdale Price regarding the ongoing IV fluids and EMS pharmaceutical backorder problem, click here.

The American Ambulance Association released on March 10 its 2014 State Medicaid Rate Survey results.  During the past few weeks, members of AAA’s Medicare Regulatory Committee researched the Medicaid rates paid to ambulance service providers in every state, and consolidated that information into a single reference guide.

With this year’s Rate Survey, the Committee also added a chart showing the status of crossover payments for dual-eligible patients (i.e., beneficiaries with both Medicare and Medicaid).

Federal Medicaid monies are distributed to each State, and each State is responsible for establishing a Medicaid rate paid for modes of transportation to cover its insured beneficiaries, to include ambulance transportation.

Below is a chart showing Wisconsin’s Medicaid ambulance rate and that of surrounding states from AAA's Medicaid Rate Survey.

STATE	BLS	ALS	ALS-2	PER MILE	OXYGEN	SUPPLIES
Wisconsin	$94.90	$113.88	$260.97	$5.56	$14.73	$14.73
Illinois (Lake County)	$127.34	$198.49	$198.49	$5.00	$15.05
Iowa	$69.98	$113.29		$2.16	$10.79	$4.32
Michigan	$105.32	$191.88	$191.88	$3.27
Minnesota	$206.33	$250.06	$573.13	$6.97

Prior to having knowledge of the AAA Medicaid Rate Survey, the Professional Ambulance Association of Wisconsin’s Board of Directors on January 9, 2014 identified Wisconsin’s Medicaid rates as an area of concern.  Wisconsin ambulance providers have not received a Medicaid fee increase in many years.  PAAW established a committee to further discuss Medicaid rates, with one potential idea being reimbursement that matches the Federal Medicare fee schedule.

PAAW also completed a webcast interview in advance of the AAA State Medicaid Rate Survey being announced.  To listen to the interview with Tristan North, Senior Vice President of Government Affairs for the AAA in Washington DC, click here.

AAA members may log-in to view the 2014 State Medicaid Rate Survey by clicking here.

Source:  American Ambulance Association