Lakeshore Ambulance Lays Off Eight, Ends Advanced Life Support Services

    By on June 18, 2014
    • Lakeshore Volunteer Ambulance is facing problems that have resulted in layoffs and the discontinuation of Advanced Life Support, a far cry from how things looked when Lakeshore purchased new ambulances last summer.

    • George Lockwood, Director of Operations for the troubled Lakeshore Volunteer Ambulance.

    Lakeshore Volunteer Ambulance, which began with such promise nearly a year ago with the purchase of two shiny new ambulances, is now caught up in a web of problems that have brought about the layoffs of eight employees and which prohibits the ambulance service from providing Advanced Life Support (ALS).

    Lakeshore Ambulance, which serves the towns of Wolcott, Butler, Victory, and Huron, missed a June 1 deadline for being licensed to possess and administer narcotics.

    Ross Zastrow, Senior Emergency Medical Care Representative for the Department of Health (DOH) in Rochester, said that as of June 1, the ambulance service lacked a license to administer narcotics.

    “Every agency that provides critical care or above is supposed have a license and be able to administer narcotics or at least be in process by the first of June. They didn’t have it so they can no longer provide ALS,” Zastrow said.

    “They have not been able to obtain that,” Zastrow said of the narcotics license. “They hadn’t even applied for the license.”

    Zastrow cited DOH policy 13-07 regarding Controlled Substance License Requirements for EMT-CC/P Agencies.

    Policy documentation states that at its January 2013 meeting, the State Emergency Medical Advisory Committee (SEMAC) determined that controlled substance medications are a standard of emergency medical care and a necessary part of pre-hospital patient care in New York State.

    SEMAC passed a resolution requiring that all Advanced Life Support (Paramedic and/or EMT- Critical Care) ambulance and ALS-first response services (EMS agencies) be licensed to possess and administer controlled substance medications per regional protocol.

    Zastrow noted that state policy mandates that agencies have a narcotics License by May 1, of 2015, but said the local Regional Emergency Medical Advisory Committee (REMAC), which grants permission in the region for ALS, had the June 1, 2014 deadline for obtaining the license.

    ALS is a level of service for those whose injuries or illness would need to be treated with intravenous fluids and medications. This could apply to people, for example, with serious injuries from a car accident or those who have suffered a heart attack.

    Examples of narcotics needed for ALS are Valium or Versed and Morphine, and possibly Fentanyl, Zastrow said.

    When questioned at Lakeshore Ambulance on New Hartford Street, Wolcott, George Lockwood, director of operations for Lakeshore Ambulance, said the ambulance service will continue working on obtaining the narcotics license, but said he has “no idea” when the ambulance service will have its license.

    Asked why the narcotics license application is late, Lockwood said, “We’re working on it. It’s money issues.”

    He cited funds for ambulance equipment as one issue, and also said the ambulance is busy working out a Medicare provider number issue.

    Lockwood said the ambulance service has turned to Wayne County Advanced Life Support for ALS in the interim.

    Without the approval to provide ALS, the ambulance service can only provide Basic Life Support (BLS), but Lockwood said other agencies are also restricted to BLS.

    Bill Liddle, Wayne County EMS Coordinator, said the county provides ALS as available, with support from surrounding agencies.

    “The appropriate level of services will be provided for the area normally served by Lakeshore,” he said.

    Lockwood Privileges to Practice Suspended

    Lakeshore Ambulance’s ALS problems don’t stop with the narcotics licensing issue. Another issue is that Lockwood’s privileges to practice are suspended in the region, according to Robert Stueber, Program Agency Coordinator of the Finger Lakes Regional EMS council.

    Stueber said Lockwood’s privileges were suspended on March 27, 2014 by Finger Lakes EMS Council’s Quality Assurance Committee and Dr. Jack Davidoff, who is Lakeshore Ambulance medical director and chair of the regional medical advisory committee.

    “It’s a privileged matter, I can’t discuss that,” Stueber said when asked the reasons behind the suspension.

    Stueber said Lockwood can still go on ambulance calls, but is not allowed to provide advanced level care. He also said Lockwood would be reinstated upon completion of remediation.

    Lockwood confirmed he is still on suspension, but declined to say why.

    He said his suspension has nothing to do “with this place,” he said of the ambulance service.

    “There’s nothing that says the director of operations has to do ALS,” Lockwood said.

    Layoffs

    Added to Lakeshore’s woes are the June 7 layoffs of what Lockwood said were eight employees. Those who were put out of work were part-timers and all except one had other employment, Lockwood said.

    Lockwood said there are three paid employees left, but he declined to identify them. He said there are about 10 volunteers, and added they still come on calls when they are available.

    “We’re still answering calls,” Lockwood said. “We’re not closed down like the rumors said.”

    Asked why the layoffs had taken place, Lockwood said the ambulance service is waiting for Medicare to act on its application for a new provider number. He said he has “no idea” when it will be finalized. “That’s up to Medicare,” he said.

    Lockwood said the issue is a delay in receiving reimbursement that could amount to more than $100,000.

    “You have to have a Medicare number in order to bill Medicare,” Lockwood said. “You submit an application to get that and unfortunately they can take up to 180 days.” The 180 days, he said, are up in July.

    The Medicare snafu can be traced to the merger (Lockwood gave a merger date of July 30, 2013) of Wolcott Area Volunteer Ambulance Corps and Red Creek Volunteer Ambulance to form Lakeshore Volunteer Ambulance. The new merged service needs its own Medicare Provider number.

    “That’s why we had to apply for a new Medicare number,” Lockwood said.

    Lockwood said the ambulance service also had to wait on an Internal Revenue Service document before a Medicare application could be completed. “That took until February 6,” he said.

    Once the ambulance service receives its Medicare money, it will go back to full staff, Lockwood said. “It just takes them time to process the application, apparently.”

    MedEx Billing

    MedEx Billing Inc. in LeRoy handles billing for Lakeshore Ambulance. Eric Dodge, Client Relations Executive for MedEx, gave some background on Lakeshore’s situation that pointed to yet another company as the reason behind the Lakeshore delay.

    Here’s how it played out.

    MedEx worked with Lakeshore Ambulance to gather information needed in the application for a Medicare provider number. Information necessary for this included a detailed listing of officers and directors, a list of equipment including ambulances with vehicle identification numbers, incorporation paperwork, IRS paperwork, and state Department of Health documentation. “Anything that can prove to Medicare that the entity is truly in existence and providing services,” Dodge said.

    After some back and forth to clarify minor points, the application was completed and submitted Jan. 29, 2014 by MedEx, on behalf of Lakeshore Ambulance, to Medicare contractor National Government Services (NGS) of Indianopolis.

    Things get more complicated with the addition of NGS.

    “One of the things that’s happened in the last two years is Medicare or NGS required everybody who has a Medicare number to do a complete re-validation. In short, what this means is that everybody who has a medicare provider number needed to pay a five hundred dollar plus fee and submit an entire Medicare application from beginning to end,” Dodge said.

    “When we get notified by NGS of these re-validations, the ambulance companies we represent had to have specific deadlines for these re-validations. Once we submitted these, they would literally sit for months before NGS even began processing them,” he said. “And because of this, any new applications that were submitted, like Lakeshore’s, sat for months. The same people doing the re-validations are also doing new applications, and they are telling us they are overwhelmed.”

    Sometimes, the wait time on new applications, such as Lakeshore’s, can run to eight months.

    Dodge said another problem with NGS is what he called “lack of continuity’ on their end in regard to answering questions.

    “We can call on Monday, get an answer from one person, and call back Tuesday and can’t talk to that same person again. And, we may get an entirely different answer to that same question,” Dodge said.

    “It’s extremely frustrating not only for us but for the ambulance companies who are are waiting for this number so they can begin billing Medicare for payment,” Dodge said.

    As an example of how things go with NGS, Dodge said they were just notified on Friday by NGS that they have found several items that need to be “fixed” in the Medicare Provider Number application submitted in January – like IRS paperwork, and the addition of the word “Inc.” to the bank check, etc.

    “We are notifying Lakeshore about these items today,” Dodge said Monday.

    In short – without that Medicare Provider Number, MedEx cannot bill Medicare on behalf of Lakeshore Ambulance. And, without the Medicare provider number, MedEx cannot apply for a Medicaid provider number, either.

    Dodge calculated that Medicare billings for Lakeshore Ambulance amount to about $60,000, and Medicaid billings total about $48,000.

    The Lakeshore delay isn’t the Ambulance service’s or MedEx’s fault, Dodge said. He said the problem goes back to NGS and Medicare and the re-validation process that has ground the system to a halt.

    All these difficulties have left Lakeshore Ambulance without the funds to pay the eight employees it laid off. Lockwood declined to say what the organization’s fund balance is.

    In the meantime, as Lakeshore Ambulance struggles through its ALS and financial problems, it isn’t above asking for donations. “We’re not going to turn them down,” Lockwood said.

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