In a story by Julie Young in this month’s issue, The Municipal visits the problem of EMS being called to treat and transport hospice patients: something Medicare and Medicaid will not pay for unless prior authorization is received from a hospice provider or hospice facility. This is a costly problem for EMS providers because often, when such a call is not paid by Medicare and Medicaid, the ill person does not have the means to pay it himself or herself and the uncollectable bill becomes a write-off.

Most EMS providers are already so financially strained that write-offs are a sore issue. Unfortunately, my understanding is that HIPAA laws prevents solutions such as a protocol for in-home hospice care to contact emergency services and tell them that a patient is involved with hospice. That seemed like an easy solution to me. But then again, even if it were possible, could any significant numbers of patients or EMS services really be served by placing the responsibility on hospice organizations to perform the notification?

In Texas, a voluntary mobile integrated health care program offers a more organized solution and adds accountability and oversight. In situations where that extra layer is not feasible, though, I wish there were another option.

For another article that takes aim at the delicate financial situation balanced by fire and EMS agencies, writer Sarah Wright spoke with two gentleman who have front line knowledge of how much the pool of grant money available to fire service organizations has changed. It’s not negligible, but this sad situation is compounded by the fact that a significant number of departments have become discouraged enough that they’ve simply stopped applying for them.

Certainly, matching grants can be a bit of a challenge; in particular for smaller, rural communities. “Even a 5 percent match can be daunting, especially if a department is doing pancake breakfasts just to put fuel in the tank,” said Dave Finger, chief of Legislative and Regulatory Affairs for the National Volunteer Fire Council.

A recommendation from Jerry Brant, grant writer for FireGrantsHelp and EMSGrantsHelp, is to plan multiple fundraisers to match the grant. Be specific about what the department needs the money for during such efforts, he advised.

Another significant stumbling block is the extensive correspondence of SAM information. Even when a department has the specific information necessary to surmount it, a couple of other unnecessary hurdles are sometimes littering the path. These include taking a global view of their presentation by pulling back and thinking about whether it contains enough background and explanatory information. Too often, inexperienced grant writers forget that the grant review board isn’t familiar with the size of a particular department; its history; situations that limit (or enhance) its function; local weather and geography issues that dictate additional rules of operation; or anything else. As Wright found, departments must keep in mind that the people reviewing a grant application are complete strangers to the particular city, department and situations involved. Without that in mind, a lot of details get left out.

I hope you find Wright’s and all of our articles this month helpful; or at least entertaining, perhaps in the case of the Saltwater Cowboys of Chincoteague Volunteer Fire Service.