Guam – There is an ongoing crisis within the dialysis community. At least one local medical transport company has been forced to cease services for dialysis patients because the claims contractor for Medicare, Noridian Healthcare Solutions, is refusing to reimburse Medicare claims unless patients are on a ventilator.
The changes have caused mass layoffs and now the Guam Fire Department may be affected too.
On May 12, after four years of medical transport coverage, dialysis patient Rodney Calimlim was informed by Guam Medical Transport that he would no longer be able to utilize transport services to and from dialysis. GMT General Manager Jared Ada says it was an awfully tough decision to make.
Uploaded by pncnews on 2014-05-29.
Ada says that in order for anybody to be able to utilize non-emergency medical transport service, they need to meet the criteria for medical necessity. The criteria, Ada explains, typically requires that the patient either be bed confined or would need oxygen or IV administration during transport; has severe dementia; or requires isolation during transport. All three entail medical monitoring during transport by certified emergency medical technicians.
“Unfortunately all of our patients who meet one or all three of the criteria for medical necessity are still being denied their benefit for medical transport to their life sustaining dialysis appointments. It is a decision that we do not agree with and we are still continuing to take those patients who we feel that if they don’t get to dialysis by us it will be a matter of life and death for them,” Ada says.
“I do qualify with what the qualifications are. Now they’re saying something different, that I have to be on ventilator,” says Calimlim.
Ada notes that because Noridian stopped reimbursing GMT for claims, GMT has had to resort to mass layoffs, letting go of nearly 30 employees. As for the patients who are now without medical transport, Ada says some of the employees who were laid off and some who are still employed have now volunteered services for these dialysis patients.
Granted it’s in their personal car, Ada says it’s still better than not being to make it to dialysis at all. He says GMT treats all their patients like family.
“One of the things that my guys and my ladies of course, have made a commitment to these patients and their families. One of them has done has gone to a patient’s residence and changed her dressings. One of them is actually transporting one of the patients in his own vehicle because he still feels that an EMT must still be present, more especially after dialysis,” Ada says about his employees. “That is the main concern that we have is our patients that have to find another way. I have a patient, from my understanding, that she has to sit in a wheelchair in the back of a pickup truck to get to dialysis. And the last time I checked that is very unsafe,:
Calimlim is one of those who is fortunate enough to still be able to get rides from some GMT employees.
“Sometimes I get nauseous during transportation that’s why some of the symptoms, after dialysis, sometimes I would need, like yesterday I needed oxygen for dialysis and I need some oxygen during transport too,” Calimlim noted, adding that one of the GMT employees brought him home after dialysis yesterday.
Fortunately for Calimlim, he has not yet come across a situation in which his life was on the line since GMT services ceased. But Ada says there have been situations in which lives were saved or prolonged because of this service.
“Recently we did have a patient who did need life intervention and without the EMT personnel present it would’ve just been a bad situation for the patient. But that goes to show you that clearly this patient does qualify for the transport,” he explains.
Guam Fire Department Spokesman Ed Artero tells PNC that since May 12, GFD has gotten calls from at least 3 to 4 patients every week asking for non-emergency transport to and from dialysis. While it hasn’t really impacted the department, it’s a situation that Artero says could potentially get out of control. And Artero notes that they can’t just turn these patients away as they are required by law to provide it regardless of their ability to pay.
“Believe me when I tell you this, statistics in history have shown us that Guam has the highest rate of diabetes and ESRD, end stage renal disease, so when you and I are both gone and our kids who unfortunately [may] have this disease … and need ambulance transport, it will be denied to them, it will be denied now and it will be denied later. And that’s what the issue is, is being able to stand up for what is right. This is not about making money or profit. We made a commitment and we’re gonna do everything we can to stand up and fight for what is right for our people,” Ada says emphatically.
PNC: “What would you be doing without them?”
Calimlim: “Oh man, I really don’t know. Without them, wow, I wouldn’t know, I think my life would be compromised.”
Ada says local officials and Governor Eddie Calvo are looking into the situation to find a solution to the problem.