Several years ago I had the opportunity to chair a work group to identify any issues that could be barriers to the successful implementation of a cost recovery process for ambulance service from insurance and Medicare. We used a stakeholder input process and listed issues and vetted them out to identify solutions. There were no problems that we identified that we couldn’t find a reasonable solution or adopt a best practice used in other jurisdictions. Those opposed to the ambulance service cost recovery then are the same ones opposed now and each time it has been promoted for implementation. They deny that things have changed and now it is important to find other ways to fund services.

In the 1920s and 30s the fire response system was evolving in Montgomery County and the communities and leaders were focused solely of fire protection. It was a unique community who had emergency ambulance service at that time. Montgomery County was unique in that we did have it. It became an expectation. However that expectation was most frequently an afterthought when it came to funding it. It has never been funded to the level required. I repeat, never has been funded to the level required.

When a tax system was set up in Montgomery County to acquire funding for fire protection it never envisioned the complexity of health care in the future when setting an appropriate mechanism to keep up with growth and increased service demand. That funding mechanism is a separate fire tax on your assessable property value. It is called a Fire Tax not a Fire and Emergency Medical Response Tax. Ambulance and paramedic service is part of a community’s health care system but in Montgomery County it just happens to be delivered by the Fire and Rescue Service.

Montgomery County enjoys the benefit of excellent medical facilities that provide care to our aging population, an aging population that is increase with a surge from the baby boomer generation.  In fact Montgomery County has touted itself a good place to grow old. But as the attracted aging population grows so does the demand on ambulance service. Many of these specific communities and facilities to house and care for the aging population are in dense clusters throughout the County and have become significant service demands for transport to the dispersed hospitals. These facilities account for thousands of calls for service by our ambulances and use a tremendous amount of County tax supported materials, personnel, fuel, etc. By the way, these are big business and they charge their residents (our patients) dearly for their services. But they do not include in that charge for services a funding mechanism for their increased use of ambulances. This demand on services was never imagined and has never been funded to match the purpose or demand. The budget for ambulance and medical supplies has seen little if any increase in years and the cost of equipment and the need for new technology has gone up further eating into these funds. Everyone of those patients have some sort of health care insurance that pays for each of the links in the chain of their care, except one, the treatment by EMTs and Paramedics and the transport of the patient to the hospital. The recovery of those costs is not requested from Montgomery County of insurance and Medicare. This type of institutional demand on emergency service was not planned or anticipated and the unrecovered cost of the ambulance service simply remains with the insurance company while the precious little funding to provide emergency ambulance service supplements these businesses.

Why doesn’t Montgomery County recover those costs of service like so many other jurisdictions? The answer is because there isn’t the will to recognize that things have changed and we deny that it has. Nearly all of the jurisdictions in the Metropolitan Washington and Baltimore areas recover the cost of ambulance service from insurance and Medicare as a standard practice. Furthermore, beyond the suburban areas most of the rural counties in Maryland and Virginia also recover ambulance cost from the insurance companies. In the past the County could absorb the loss of this funding source but with considerably less revenue to pay for services it will soon be necessary to cut service down to the level of the funding. To repeat, this will mean to cut emergency services down to the new level we are being funded at. This makes no sense as Montgomery County continues to grow. Population growth always means an increased demand on emergency services. As a recently retired manager and strategic planner for Montgomery Fire and Rescue Service I can tell you that we are still behind in providing adequate service coverage to match the national standards. Yes I said that we are behind and have a deficit in providing services to the national standard for emergency coverage. If the County is forced to cut more fire and ambulance services as was done already this year we will be even further in the hole. We cannot let that happen.

Vote yes for Question A on the Montgomery County Ballot on November 2, 2010. QUESTION A authorizes Montgomery County to get reimbursed by insurance companies, Medicare and Medicaid for the cost of ambulance service.

On November 2nd, your vote FOR QUESTION A can help keep taxes down by billing the insurance industry for the cost of our local ambulance service. IT WON’T COST YOU A PENNY.

Mike Love

Last weeks inauguration of the president saw an estimated 1.8 million people turn out to see the event in person. What became readily evident is that estimates used to manage the crowds safely were underestimated and as a result of some ineffective entry point operations a significant number of high dollar ticket holders were left holding their purple tickets. As many as 10,000 people may have been stuck for a considerable amount of time with the highly valued tickets (what I would call mosh pit tickets due to the close proximity to the action) were stuck in the tunnel due to some less than adequate entrances (like about 36 inches wide) and some malfunctioning security equipment while other gates let them in at a faster rate.

Nearly immediately with the use of wireless technology the ticket holders began to form a group in Facebook.com called the “Survivors of the Purple Tunnel of Doom.” CLICK HERE for MORE Why is this important? In only a couple of days they had 5,000 members. Also because nearly as immediately as they created the group they were able to influence people in high places and created a very public debate and resulted in the people from Capitol police to spend time through this weekend analyzing the mistakes so they could answer the issues raised by congress. You can imagine that after several months of intense planning and preparation that they would have at least had the opportunity for a break. No, they could not take a break because the scrutiny was too intense.

What began as a network to keep abreast of their classmates as people went their separate ways after college has become a significant and important tool for social activism. From this event the light bulb will go off in many people‘s minds as to the value of this and many of the other internet based news mediums. How will we adopt this medium for useful influence? Have you tested these waters yet?

Mike Love

Mike Love

From: Douglas Alexander [mailto:XXX]
Sent: Mon 1/5/2009 10:12 PM

Subject: Anne Arundel County Adopts residential Sprinkler Ordinance

This is the kind of e-mail I live for. At the Anne Arundel County Council meeting this evening, by a vote of 6 -1, the council adopted requirements for residential sprinklers in all new one and two family homes. CONGRATULATIONS to the Anne Arundel County Fire Service for a tremendous effort!!! This effort began over a year and a half ago and took several educational programs, introduction of ordinances, amending of the proposals, public hearings and so forth. However, the outcome was well worth the effort. Our committee and our partners were able to support the Anne Arundel County folks on many fronts. Dennis Gentzel did a particularly great job in working with the Public Works folks in getting the proper information on the backflow preventer needs, or the lack of need for them I should say. Then the large number of people that attended the public hearing to testify in favor of the ordinance was indeed indicative of the united effort put forth by the fire service in general.

The addition of Anne Arundel County brings our total to 9 of 23 counties with requirements in place. This is a large urban/suburban county that has been added to our number. THE ADDITION OF ANNE ARUNDEL COUNTY IS HUGE toward our effort. What a satisfying “win”.

Again, I want to CONGRATULATE the Anne Arundel County Fire service, Volunteer, Career, Union, and Auxiliaries for their united effort to get this job done!

Doug

You hear people in the fire service frequently say, “I won’t move up because I hate the politics.” But politics isn’t bad you just need to know how to work within in it to be effective. You can learn it through observation and practice just like any of the other knowledge, skills and abilities that we are required to be effective. What Chief Rubin has shown is effective use of many different levels of power and influence; essentials of effective politics. But there is a potential pitfall in all this. You need to know when to throw these trump cards on the table. Do you remember within the last year the fire chief from Massachusettswho criticized personnel cuts after a devastating fire? He lost his job after the very public criticism. This chief still had guts but he was not in an environment that would tolerate that tactic. Dennis Rubin is fortunate to work in an environment where it is not only tolerated its encouraged. Chief Rubin works for Mayor Adrian Fenty. This first term mayor is a turn it on its side kind of aggressive elected official needed to make real change and shake things up. He has made a career as an elected official by being unconventional. His environment is much more open and aggressive. His office is arranged in an open area where all staff has access to each other. No closed off corner office for Fenty. You also may have heard of his school chancellor Michelle Rhee. Not unlike Chief Rubin, Rhee is a get to the heart of the matter and change this now kind of leader. She has said that change to the schools must happen now. The changes Rhee is focused on include cultural, operational and structural changes that are dramatic and not as she puts it “tinkering around the edges.” Wow is she shaking things up to increase performance, improve deplorable facilities and get rid of ineffective staff. She has taken on the union to offer a more performance based approach to compensation, giving the most to those who do the most.  Mayor Fenty appears to like this shake it up and improve things kind of world and surrounds himself with people who work like him.

People like Fire Chief Dennis Rubin are doing good things to improve their departments. These approaches do not work well in all political environments though. So there is a risk. But these are some refreshing reviews of a different type of leadership in action. So stand, watch and learn. You Go Dennis.

Mike Love

I have been running for over thirty years and have run many 10K races. I also wanted to mention that I successfully used my new heart rate monitor during the race. Heart rate monitors are used to help you measure where your heart rate is within your target heart rate. Target heart rate is an indicator that can be used for maximum cardiac output. The monitor I used is a Sportline Solo 925 Click Here which offers an inexpensive monitor that does not require a strap that goes around the chest. It works on the body’s electrical activity that it senses through the watch’s back as you touch a button on the monitor’s face.

Happy Running – Mike Love

‘Errors’ led to firemen’s deaths – Read it HERE

It is unfortunate to hear a survivor of a dead firefighter mentioning that the involvement of firefighters in delivering fire safety education as remotely a root cause to a firefighter’s death. I am convinced that public education is a way to reduce the risk to firefighters. This has been emphasized as one of the areas specified in the NFFF 16 Life Safety Initiatives.

Number 14 says – Public education must receive more resources and be championed as a critical fire and life safety program.

What I do understand is the fact that the effort initiated in the UK to reduce the national fire loss was at least partly a result of the firefighter strike a few years ago that resulted in legislated requirements that all firefighters must be engaged in fire and life safety education. Here is a quote from the article that identifies a union comment about how education should and should not be accomplished.

“The Fire Brigade Union believes firefighters spend too much time in the community teaching people about the dangers of fire rather than learning more about how to tackle fires and other incidents. It wants community education to be carried out by non-operational officers and other groups.”

I am a long time union supporter but here is an example where an organization must be strategic in their comments at the risk that they will put themselves in an unsustainable position.

Mike

What started the epidemic of fire in the South Bronx in the 1960s and 70s?

What stopped the epidemic of fire in the South Bronx?

Could an epidemic of fire like the Bronx occur again?

What would be necessary to create similar conditions for a South Bronx fire storm?

Is there any similarity to the number of catastrophic multiple fatality fires earlier this year to serious epidemics that occurred in the South Bronx?

Who keeps track of trends in fires and would raise concern if trends buck the norm?

How do we know if a significant run of multiple fatality fires has happened before?

What does this year’s run of multiple fatality fires look like as a twenty year trend?

Shouldn’t  we look at these runs of fire deaths as if they were a spreading virus like west nile virus for which the CDC or World Health Organization studies  and tracks?

Mike Love