June 5, 2018 | View as webpage
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Welcome to the first Fire Chief Leadership Briefing, a bonus to our monthly Fire Chief eNews. We are taking a different approach - bringing you a tightly-curated selection of perspectives and links to address what we feel are the most important topics and trends of the moment in fire and rescue. It’s a newsletter written by leaders, for leaders - all aimed at helping you better understand and resolve the top challenges you are facing within your departments.

The Leadership Briefing will feature Fire Chief editorial board members and FireRescue1 columnists, but will also draw on perspectives from our sister-sites, Police1 and EMS1. Leaders in all public safety disciplines face similar problems with new personnel recruitment, retention of high-performing staff, community and stakeholder education, implementation of new technology, and advocacy with local, state and national legislators.

As this is a new format for us, your feedback is important. I’d welcome you to share this newsletter and email me your suggestions for articles, tips and resources.

Chief Marc Bashoor
Executive Editor, Fire Chief, FireRescue1

In this issue:

By Marc Bashoor

What happened: More than 8-inches of rain fell in a few hours in historic Ellicott City, Maryland on May 27. A confluence of geography and development makes the area, which was waterlogged from recent rainfall, prone to rapid flooding. Video showed fast-moving water rushing over and past the second floor of buildings on Main Street.

Fire and EMS departments, as well as swift water rescue teams, from throughout the region responded. 911 call recordings tell harrowing real-life stories of people stranded on upper floors of buildings, the streets below them a raging river.

This was Ellicott City's second "1,000-year flood" in the past two years. In July 2016, the same Main Street of the historic community was devastated by similar flooding. Parts of town had just finished rebuilding before this most recent flooding.

Top takeaways for swift water response

Flooding has become an increasingly common response for all-hazard fire departments. We need to take a training posture that focuses additional efforts on swift water responses. Learning from Ellicott City's events is a good step to prepare personnel, acquire equipment and improve rescue SOPs.

Fast moving water, 10-feet or deeper, flooded an occupied city street. Swift water and other boat rescue teams need to be fully aware of the underwater terrain they're expected to navigate; remembering that swift water rescues don't always occur in traditional rivers and streams.

HCDFRS Chief Butler's all-hazard reminders

I spoke with Chief John Butler, Howard County (Md.) Department of Fire and Rescue Services. Butler was also the chief during the 2016 flooding incident. Chief Butler reminds us all to:

  • Demand a culture of safety and a culture of learning.
  • Train hard and train always, especially for high-consequence, low-frequency scenarios.
  • Accept that you lead an all-hazards department and train like it.
  • Prepare for the uncomfortable and the unforeseen. Don't only do what you want to do or like to do.
  • Believe rare events will occur under your command. Never be complacent about the likelihood of a 1,000-year flood, 500-year wildland fire or 100-year tornado in your response area.
  • Invest, aggressively and progressively, in your team's training and equipment.
  • Embrace swift water rescue innovation and technology.
  • Learn about shoring, building stabilization, towing, rigging, vehicle recovery from waterways and underwater vehicle searches from other institutions and disciplines.

Ellicott City was nearly destroyed - twice - by flooding. Amazingly, only one person was killed during last month’s flood. As the floodwaters receded, fire and rescue teams continued to help ensure gas lines and electric services were secured and that all affected buildings were searched. Recovery will take years.

Our response preparedness and training must be perpetual.

Additional water rescue resources:

Despite national recognition, widespread access to naloxone, and millions allocated to grants to combat the opioid epidemic, drug overdoses are the leading cause of accidental death in the United States, killing an estimated 60,000 people in 2016.

This series seeks to explore why the fire service is on the front lines of the opioid epidemic, strategies to help protect first responders from fentanyl, empathy and progress in the opioid epidemic and more.

By Kevin J. Fairlie

What you need to know: For the past two years, the Department of Justice, through its local U.S. Attorney offices, along with the Department of Health and Human Services' Office of Inspector General, has been actively investigating fire-based services for improperly billing Medicare for ALS ambulance transports when a BLS level service should have been billed.

These investigations are ongoing across the country and involve all sizes and types of fire-based services. I am personally aware of multiple services under investigation that provide fewer than 100 Medicare patient transports annually.

The issue at hand is that Medicare does not necessarily reimburse at an ALS level despite fire departments responding with ALS-equipped and -staffed ambulances. Medicare billing guidelines must be followed to determine whether Medicare should be billed for an ALS or BLS transport.

However, it is exceedingly common for fire departments to simply bill Medicare at an ALS rate. By doing so, the government is claiming that these fire departments are violating the federal False Claims Act by submitting false claims to Medicare for reimbursement.

Action steps: Work with your billing provider or in-house billing department, as well as an independent third party auditor, to do the following:

  • Determine your ALS-BLS ratio to see if you have a potential billing issue and may be subject to federal investigation. Calculate how often you are billing Medicare for ALS and BLS services. As a rule of thumb, a fire-based service should have an annual Medicare mix of 70 percent ALS and 30 percent BLS.
  • Understand how the government is using Medicare data analytics to find fire services with a high ALS billing percentage. If you have an ALS rate greater than 70 percent, you may have a problem and could become subject to investigation.
  • Hire an independent third-party to audit Medicare claims. I've seen numerous clients who relied on a billing company to submit their claims only to find out the billing company was billing inaccurately. The government expects you to bill correctly and having an independent audit can be critical in defending yourself in an investigation.
  • Make immediate arrangements to refund the overpayments if your audit determines that you have been over-billing Medicare for ALS transports. Medicare's 60-day overpayment rule requires repayment or you will be in violation of the False Claims Act.
  • Ensure you have a healthcare compliance program in place to avoid improperly billing Medicare. In 2003, the OIG outlined expectations from ambulance providers, regardless of their size, for compliance programs. Find this guidance and the requirements on the OIG website.

OIG compliance, billing primer:

3 and out …

3. Be Aware - Get Checked: The 2018 Safety Stand Down highlights the critical safety, health, and survival issues for the fire and emergency services. All departments and personnel are asked to focus on safety and health education and training. Use the materials on the Safety Stand Down website in your department.

2. Get the facts on domestic violence: Intimate partner violence incidents are among the most dangerous for first responders. Share these 10 domestic violence myths, written by Lt. Dan Marcou, Police1.com columnist, with your fire personnel. "The life you save may be your own."

1. Book recommendation: Looking for a book which mixes true crime, compelling storytelling, firefighting and police investigation? Here's a match, "American Fire: Love, arson, and life in a vanishing land."

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You are welcome to share the Fire Chief Leadership Briefing. Forward this email to your command staff or field personnel, print and post in the day room or training lab, or reprint in your organization or regional Fire Chiefs' association newsletter.

Got a leadership tip, management question, commercial use inquiry, or an article idea? Send me an email at marc.bashoor@firerescue1.com.

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