FP Summary Company and CM Profile – Haiti

February 11th, 2019 Comments off

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IRS 132.5 Assessment: Consulting Services Overview

November 9th, 2018 Comments off

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Taken For A Ride: M.D. Injured In ATV Crash Gets $56,603 Bill For Air Ambulance Trip

October 9th, 2018 Comments off

Credit: www.npr.org All Things Considered https://twitter.com/npratc

Source: https://www.npr.org/sections/health-shots/2018/09/25/647531500/taken-for-a-ride-doctor-injured-in-atv-crash-gets-56-603-bill-for-air-ambulance

It was the first — and only — time Dr. Naveed Khan, a 35-year-old radiologist, ever rode in an all-terrain vehicle.

Khan took the wheel from his friend and drove circles in the sand, on a trail along the Red River in Texas.

“As soon as I turned to the side where my body weight was, this two-seater vehicle … just tilted toward the side and toppled,” Khan recalled. It landed on his left arm.

“I had about a 6-inch-wide exposed flesh gap that I could see below, on my forearm,” he said. “And I could see muscle. I could see the fat. I could see the skin. The blood was pooling around it.”

Khan, feeling lightheaded, tied his jacket around his arm like a tourniquet. He and his friend managed to right the ATV, drive back toward the street and call 911.

When an ambulance delivered him to the emergency room at United Regional Health Care System in Wichita Falls, Khan was surprised to hear a doctor murmur that it was the worst arm injury he’d ever seen.

Khan needed immediate helicopter transport to a trauma center for surgery in Fort Worth, if there was any hope of saving the arm.

Groggy from painkillers, Khan managed to ask the doctors how much the flight would cost and whether it would be covered by his insurer. “I think they told my friend, ‘He needs to stop asking questions. He needs to get on that helicopter. He doesn’t realize how serious this injury is,’ ” Khan recalled.

Flown 108 miles to John Peter Smith Hospital in Fort Worth, the closest Level I trauma center, Khan was whisked into surgery to clean out the wound, repair his shattered bones and get blood flowing to the tissue.

He had a total of eight operations to try to save his left forearm before he finally gave up. After weeks in the hospital, he asked the doctors to amputate, so he could get on with his life.

And then the bill came.

Patient: Naveed Khan, 35, a radiologist and married father of three young children in Southlake, Texas.

Total bill: $56,603 for an air ambulance flight. Blue Cross Blue Shield of Texas, Khan’s insurer, paid $11,972, after initially refusing altogether; the medevac company billed Khan for the remaining $44,631.

Service provider: Air Evac Lifeteam, an air ambulance company that operates 130 bases in 15 states. It’s owned by Air Medical Group Holdings, a holding company that owns four other air ambulance companies and one ground ambulance company. Air Medical, in turn, is owned by the giant private equity firm Kohlberg Kravis Roberts.

Medical service: Khan was flown from the United Regional Health Care System in Wichita Falls, Texas, to the John Peter Smith Hospital in Fort Worth.

What gives: Khan got his first call from Air Evac Lifeteam just three days after the accident, while he was still lying in the hospital. A company representative told him the helicopter ride would most likely cost more than $50,000 and asked him how he planned to pay.

For Khan, rapid transportation to the trauma center was essential since the blood supply to his arm had been cut off, said Dr. Rajesh Gandhi, the medical director for trauma services at JPS Hospital.

“If there’s no blood going that means there’s no oxygen,” he said. “It there’s no oxygen, that means those cells are going to die.” Minutes are precious and the helicopter can get from Wichita Falls to Fort Worth in an hour or less, half the time it takes by ground ambulance, he said.

But complaints about sky-high bills to patients for air ambulance services are common. Since launching the “Bill of the Month” series in February, NPR and Kaiser Health News have received more than a dozen bills from patients like Khan who were charged tens of thousands of dollars for an air ambulance ride even after insurers’ payments.

Air ambulance companies defend their charges.

Rick Sherlock, president of the Association of Air Medical Services, a trade group, said air ambulances require a more highly trained crew than a ground ambulance, because only the sickest or most seriously injured patients need air transport.

AAMS commissioned a study to determine the actual cost of a medevac ride. The report found it takes about $2.9 million a year to run a single helicopter base. Each base handles about 300 transports a year, and the rides cost about $11,000 each, according to the report.

A spokeswoman for Air Evac Lifeteam said the company bills people so much because it is trying to make up for what she said are meager payments from Medicare and Medicaid.

“Our real cost per flight is the $10,200 plus the unreimbursed cost on each flight for Medicare, Medicaid and patients without any coverage,” wrote Shelly Schneider, the company spokeswoman.

The Centers for Medicare & Medicaid Services said it pays an average of $4,624 per ride, plus $31.67 a mile, which works out to an average Medicare reimbursement of $6,556 for helicopter ambulance rides for seniors. Medicaid in most states pays less.

The industry has been advocating hard to get Medicare to boost its reimbursements, Sherlock said. There are bills pending in both the House and Senate that would do so, but there hasn’t been much movement on them.

But others say the industry’s cost estimates are inflated by profit-driven expansion of a lucrative industry. Ground ambulances often carry critically ill patients, too.

Too many air ambulances sit idle much of the time, said Dr. Ira Blumen, a professor of emergency medicine at the University of Chicago and medical director of the university’s Aeromedical Network.

Blumen said the industry — which is dominated by a few companies owned by private equity firms — expanded dramatically in 2002, the last time Medicare boosted its payments. And now there are too many helicopters — 908 as of last year — fighting for patients and profits at the same time.

“The number of helicopters is outrageous for the continental United States,” he said. In the 1990s, most helicopters ran more than 500 flights per year on average. At that rate, the cost per flight today would be less than $6,000.

A BCBS of Texas spokesman said the insurer does have a contracted rate with an in-network air ambulance company, but it is not Air Evac Lifeteam. After initially refusing to pay anything for an out-of-network claim, it agreed to the $11,972 payment.

But in some sense, the reason ambulance companies charge so much is simply that they can: Air ambulances are largely regulated not as health care but as part of the aviation industry. Federal laws prevent states from limiting aviation rates, routes and services.

So many people have been hit with shockingly high air ambulance bills that members of Congress on both sides of the aisle are trying to do something about it. Legislation to reauthorize funding for the Federal Aviation Administration that is moving through Congress now would create a council of industry experts to address balance billing and other issues and set up a complaint line for consumers.

Resolution: Khan has allowed Air Evac Lifeteam to negotiate with BCBS of Texas over the remaining $44,000-plus air ambulance bill. The company has asked him to appeal to the state’s Department of Insurance, and though he first balked at the suggestion, he is now considering doing so. Khan said he doesn’t understand why the helicopter flight, which was an integral part of the emergency medical care he received, is treated differently from his surgeries, nursing care and physical therapy.

“I thought that this was another piece of that puzzle,” he said. “It turns out that this was glaringly different.”

He is waiting for resolution as he gets accustomed to life with his disability. Holding his baby son, he asked in frustration: “How do I hold him while he’s crying and at the same time heat up his bottle?”

Khan, who has had to fight with his insurance company to get coverage for a prosthetic arm, was frustrated when he learns that the air ambulance company expects him to pay far more than the actual cost of his flight.

“It’s unfair,” he said. “It’s random; it’s arbitrary. It’s whatever price they want to set. And to put that onto a person who’s already been through what I’ve been through, I hate to say it, but it’s cruel.”

The takeaway: Most people with health problems serious enough to require a helicopter flight are in no position to ask whether the medevac company is in-network or there’s a choice. But if you or a family member has time to ask, it could pay off.

If you’re faced with a huge bill for a medevac ride, there are a few steps you should take.

First, let your insurer’s process play out. BCBS of Texas first denied Khan’s claim altogether. But he looked closely at his policy and saw that the threat of loss of limb was explicitly covered. He appealed, and that’s when the insurer paid $11,972.

Second, negotiate! The air ambulance company might be willing to negotiate a settlement for a fraction of the bill to avoid turning to debt collectors, who would pay them pennies on the dollar.

Both Sherlock of the Association of Air Medical Services and Schneider of Air Evac Lifeteam said companies will try to determine what a patient can afford. So people with high incomes may find it hard to obtain a substantial reduction for their bill. Still, if patients know the true cost of the service they received, they may be better equipped to negotiate a discount.

Many air ambulance companies offer membership plans that can cost less than $100 a year and guarantee that the company will accept whatever payment an insurance company makes without billing the patient for the rest. But buyer, beware: When people need an air ambulance, they are often not in a position to choose which company will respond to the call.

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National Disaster Risk Assessment for Puerto Rico

September 10th, 2018 Comments off

As the one-year anniversary of Hurricane Maria approaches, Puerto Rico is still struggling to recover. A perfect storm caused by the natural disaster of a major hurricane and a human-made financial crisis has left much of the island not only devastated by recent catastrophe, but also exposed to further risk.

Hurricane Maria, a powerful Category 4 hurricane with 150 mph winds, made direct landfall in Puerto Rico on September 20, 2017, battering the entire island and causing major flooding. The destruction of Maria came less than two weeks after Hurricane Irma, a Category 4 storm, passed just north of the island and left more than 1 million people without power. By the time Maria hit, 60,000 residents were still without electricity. Although Maria was a slightly smaller storm, it was far more damaging. The eye of the storm passed approximately 25 miles away from the territory’s capital, San Juan, which is home to about 400,000 people. According to official government figures, Maria killed at least 1,400 people and caused an estimated $100 billion in damage, making it one of the deadliest and costliest natural disasters ever to strike the United States or its territories.

The overwhelming impact of Maria continues to be felt throughout the island, as the storm led to massive destruction of the electric infrastructure, significant interruptions in telecommunications, considerable damage to highways and roads, and limited access to water and food. In San Juan, there remains broken electrical posts, missing traffic lights, and blue plastic tarps covering damaged rooftops. Short-term power outages across the island are recurrent, and the overall situation remains much worse in mountainous areas.

Rebuilding Puerto Rico is expected to be a long and difficult process, as the commonwealth’s economy is also in shambles. The territory, which has a $103 billion economy, declared bankruptcy in May 2017 with an outstanding debt of over $70 billion. Even though the FEMA Public Assistance program has allocated $2.4 billion in total funding for Puerto Rico, the Stafford Disaster Relief and Emergency Assistance Act passed by the U.S. Congress in 1988 requires power grids and infrastructure to be rebuilt as they were before the natural disaster hit.

The island has also been burdened with major public health problems. Compared to elsewhere in the U.S., Puerto Rico has the highest prevalence rates of premature births, one of the highest incidence rates of HIV, and was a focal point of the Zika virus epidemic. Moreover, the current population drain makes it even harder for the territory to recover. Since Puerto Rico’s economy went into recession in 2006, the island has lost approximately 635,000 residents, and it is anticipated that another half million will leave by next year.

Puerto Rico’s geographic location, along with its high unemployment, low per capita income, rising crime rate, drug activity, and other social problems, renders the island highly vulnerable to natural disasters. The territory faces an array of natural hazards, including hurricanes, earthquakes, tsunamis, landslides, periodic droughts, and flooding. Situated in the middle of the Atlantic hurricane belt, Puerto Rico is ordinarily subject to severe storms in the Caribbean from June to October every year.

Despite Hurricane Maria being the strongest storm to hit the island in 80 years, Hurricane Hugo struck Puerto Rico on September 18, 1989, causing an estimated $1 billion in damage and destroying some five thousand homes. Located near the subduction zone between the North American and Caribbean tectonic plates, Puerto Rico lies in one of the most earthquake-prone regions in the world. While the last disastrous earthquake to impact the island occurred in October 1918, inducing a tsunami that killed many residents and destroyed numerous homes, Puerto Rico experiences frequent smaller earthquakes. Nevertheless, a single major seismically related event has the potential to cause catastrophic damage and numerous casualties.

Though hurricanes constitute the primary cause of flood damage in Puerto Rico, the island also experiences floods and landslides produced by heavy rains unassociated with tropical cyclones. Puerto Rico is among the most landslide-prone areas in the U.S. due to its mountainous terrain and tropical climate. Additionally, post-disaster environmental conditions can be exacerbated due to Puerto Rico’s lack of systematic health and humanitarian relief. Contaminated drinking water and reduced access to safe water, food, and shelter in some areas may create conditions for outbreaks of infectious diseases such as leptospirosis, dengue, hepatitis A, typhoid, vibriosis, Zika, and influenza.

Businesses and nonprofit organizations that currently operate or plan to operate in Puerto Rico must consider the island’s unique geophysical setting and vulnerability and have a contingency plan for disaster preparedness and response in place. Careful and active consideration of the risks and costs associated with the threats posed by natural disasters can help avoid or mitigate loss. In other words, from an organizational perspective, decision-makers and managers should adopt an all-encompassing approach when addressing travel security, asset protection, movement of inventory/convoy protection, and emergency planning. By better understanding the extent of the risks involved and identifying appropriate mitigation strategies, organizations will be better prepared to deal with these disasters and lessen the impact on their businesses.

An early-season analysis of a variety of atmospheric and oceanic conditions led forecasters to predict that the 2018 Atlantic hurricane season would have slightly above-average activity. Although experts are now expecting fewer hurricanes than initially anticipated, now is the time for those in Puerto Rico to begin preparing for the next major storm or other potential disasters.

Partnering with a global security and specialty risk-consulting firm such as FocusPoint International can pro-actively help an organization mitigate risk through the development of business specific strategies, and also provide an effective response capability when faced with a crisis or emergency situation. Our 24/7 crisis response team provides access to reliable and timely sources of weather and other emergency-related information before, during, and after a natural disaster, and is specifically trained in what to expect and how to respond to a major hurricane or severe tropical storm that makes landfall anywhere in the Atlantic basin. Throughout hurricanes Harvey (Texas), Irma (Florida), and Maria (Puerto Rico) in 2017, our firm was heavily involved in providing SAR, asset and convoy protection for several clients, and demonstrated the ability to assist individuals and organizations in preparing for and recovering from the impact of these storms. (Click to view a map that identifies a variety of critical assets in Puerto Rico.) FocusPoint adds overall value by helping organizations develop policies and procedures that promote resiliency, establish business continuity, and ensure requirements are met regardless of location.

Summertime and Travel

May 9th, 2017 Comments off

beach travel

As the summer season rapidly approaches, I think about all the people planning trips overseas. Families taking a special trip to a foreign country, students planning to study abroad and business travelers who may be adding a few days to a business trip to enjoy a ‘mini-vacation‘.  With the current uncertainty in the world, each of these scenarios poses some risk to the traveler whether it is terrorism, political unrest, crime or a natural disaster.  As a security professional, I have been conditioned to assess risk, but I wonder whether travelers have taken risk into account when they plan and book their trips?

Terrorism has unfortunately become a major concern, especially in countries that were once considered safe.  You only need to look at Paris and London to see the very visible increase in police and other security forces patrolling major tourist areas.  Other European cities continue to be on high alert as well.  However, as we know, terrorism can strike almost anytime, anywhere.

Political unrest is an issue that travelers sometimes ignore, that is until they get caught up in a violent demonstration or find their travel plans curtailed due to strikes and other protest actions directed towards governments.

Crime continues to be one of the greatest risks posed to both business and leisure travelers.  Criminals regularly target visitors and identify them at airports, train stations, and hotels.

Natural disasters are also risks that are rarely thought about.  We only need to look at the Italy earthquakes last year that occurred in a major tourist area, just a few hours from Rome.

These risks and others should be considered when traveling.  Pre-trip planning is key.  If your company has a Travel Risk Management program, take advantage of pre-trip information and alerts while traveling.  Ensure you have the number to contact for help in a crisis.  For leisure travelers, speak with your travel company or agent.  They often have programs to inform travelers before a trip and may offer an assistance service at an additional cost.  You can also purchase assistance services online through FocusPoint International.

Wherever you go this summer, get as much security and safety information about where you are going before your trip and practice good ‘situational awareness’ while you are there so that you will not become a victim of crime.  Make sure that if something does happen, you know whom to contact for assistance.  Have a good summer and safe travels.




It is Not Just About Terrorism

April 6th, 2017 Comments off

Business Travel

With the recent incidents in London and Moscow, it seems that almost weekly we are seeing a terrorist act reported in the media.  According to statistics, a terrorist act occurred somewhere in the world every single day in 2015.   These attacks are becoming a growing concern for business travelers, but there are other risks that you should be prepared for when making travel plans.

Crime continues to be a concern in many cities around the world.  Visitors easily stand out, and they are frequently the target of criminals looking to steal bags and purses or pickpocket.

Natural disasters also seem to continue to occur daily.  Earthquakes, floods, hurricanes and other weather-related disasters could occur without warning.

Traffic and other types of accidents frequently affect business travelers, and medical issues can ruin any trip.

Although terrorism continues to be of great concern, it is not the only potential risk to business travelers.

These risks highlight the need for a good travel risk management program.  Giving business travelers information during the planning stages of a trip, informing them of incidents while they are traveling and providing advice and assistance are all critical in ensuring duty of care responsibilities are met by a company or organization.  While being concerned about terrorism is understood, it should not be the only reason for good travel-related security planning.



Should I Go or Not?

March 13th, 2017 Comments off

The statistics have shown that there is an increase in terrorist incidents, natural disasters, kidnappings and many other risks to travelers over the past 20 years. It seems as though there is an extreme weather incident somewhere every day.  I am often asked whether it is safe to travel to Europe, to Israel or even to some cities in the US.  My answer is usually, yes, as long as you have a plan in case of an emergency.

Risk ratings and other pre-trip information are very helpful when deciding whether to travel, but sometimes the trip is necessary for business or other reasons.  Pre-trip planning can go a long way to having more confidence while traveling.  Having a crisis assistance service is critical.  If your company does not have a formal program, you should look at getting one for yourself.  These programs typically provide you with pre-trip information and alerts of incidents before and during your trip.  Most importantly, they can offer 24-hour assistance if an emergency occurs.

Nobody can predict whether you might fall victim to a crime, suffer a medical emergency or be in an area when an earthquake occurs.  These types of things happen every day around the world.  While having information before your trip is helpful, the peace of mind that comes from knowing you can call one number for advice and assistance, and that on-the-ground help is available, is worth it.

You can pretty much travel anywhere safely, but depending on ‘it will never happen to me’ is an enormous risk.

Why Duty of Care Matters

February 16th, 2017 Comments off

With business travel increasing and the way the world is trending, any organization that has people traveling on their behalf should be aware of their responsibilities and the ‘duty of care’ that is required of them.

Management is often unaware of how to address duty of care and can be difficult to find a complete solution.  We at FocusPoint International have developed Crisis Assistance Plus (CAP, a solution that is cost effective and meets duty of care requirements.

CAP™ is a fully funded membership program that provides the critical elements of ‘inform, advise and assist’ to travelers both before they travel and when a crisis occurs.  CAP™ is not an insurance or access program.  It provides organizations and their employees the peace of mind that they will receive assistance both before their trip and if and when a crisis occurs while traveling.

CAP™ is both cost and operationally effective. For an organization, it provides the visibility of a traveler’s location via travel tracking and the ability to immediately contact them to ensure they are informed of any crisis and how they might be affected.  For a traveler, it provides 24-hour consultation services and immediate response in the case of an emergency.  Response services are included in the membership, and there are no claims or additional costs after an incident occurs.

The CAP™ program is comprehensive, providing assistance for 14 medical and nine security related risks, some of which are not typically covered by insurance or other travel risk products.  It was developed to provide comprehensive services with a low barrier to use.  The main differentiator of CAP™ from other travel risk management products is that all of this is included in the membership cost.

All organizations have a responsibility to provide the best possible care to their people who travel.  Duty of care matters.  It is not only a legal requirement, but it is the right thing to do.  Employers should do everything possible to keep employees safe.  Employees should know that if something happens while traveling, someone is there to help.  CAP™ is a perfectly tailored solution to meet those standards and provide real assistance to employees in crisis.

The Experienced Traveler

February 7th, 2017 Comments off

When speaking about travel security and travel risk management, invariably some folks are quick to say, ‘I travel all the time and nothing has ever happened to me’, or ‘our company has thousands of travelers, and we’ve never had a problem’.  The trouble is bad things do happen, crisis situations do occur, and given the way the world is trending, someone in your company will at some point need some help.  The possibility of a medical emergency, the increase in terrorist attacks, the unpredictability of political unrest and the potential for natural disasters all add up to the fact that odds are, you or maybe someone you work with will need some travel assistance in the future.

The idea that ‘it will never happen to me or us’ is not enough.  Companies have duty of care responsibilities for their employees.  They need to inform them of risks before they travel and provide them with assistance if a crisis occurs.  Leisure travelers should consider an assistance product as well.  Nothing ruins a vacation like a medical or security related emergency.  Having an assistance product that covers you during the trip gives yourself and your family some peace of mind.

Experienced travelers can sometimes be at greater risk than a first-time traveler.  As they often travel to the same places, stay at the same hotels, etc., they become complacent and not situationally aware.  This is why a robust duty of care program is so important.  The first step of providing pre-trip threat/risk information is critical and reminds travelers of the security situation at the location they are visiting.  Equally important is notifications of alerts or incidents while on a trip.  These alerts serve to inform and remind the traveler to take caution and be aware of their surroundings.

The experienced business or leisure traveler can be a great asset to any travel risk management program as their on the ground experience can benefit others, but only if they take precautions and remain situationally aware when they are away from home.

Major Event Security

January 18th, 2017 Comments off

With the release of the new movie about the Boston Marathon bombing, I was reflecting on the fact that event security has become more of a concern now than at any time in my career.  Given the most recent attacks in France and Israel where vehicles were used as weapons, any large gathering of spectators and participants, or events of almost any size can be considered targets for an attack that will cause maximum panic and guaranteed press coverage.

Securing large crowds requires constant preparation and participation of both government and private sector security organizations.  Although the media mentions some of the preparations and the number of law-enforcement resources that will be deployed, the amount of planning that goes into the security of almost any size event is often overlooked.

In the coming weeks, we will see a massive security presence at events such as the Presidential Inauguration and the Super Bowl.  What the general public may not be aware of is the amount of time that is required to create an in-depth security plan for these types of events. While smaller local events such as road races, sporting tournaments and others may seem to be less significant; they too require planning and coordination to ensure they can be held safely and successfully.

Event security planning is not easy, especially when resources are stretched thin in local municipalities, but getting started as early as possible, having good coordination between event planners and security resources are essential to ensuring that everything goes well.

Millions of people around the globe will be watching Super Bowl, and I am sure that, just as in previous years, things will go smoothly with regards to security and safety.  What some folks may not realize is that detailed security plans were developed before last year’s event, have been refined and improved over the past year and have involved hundreds of professionals working diligently to protect all who will be attending.

No matter what size event you may be involved in, early planning and coordination are the keys to success.

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