Friday, February 12, 2010
Ambulance contract illustrates healthcare woes
Carlisle Fire Chief David Flannery must balance service time and expense in proposing a town solution for ambulances. It is a very delicate prospect, and real lives hang in the balance.
Emerson Hospital did its own such analysis and cost issues drove its decision to subcontract the ambulance service that it provides to 14 towns, including Carlisle, to Pro EMS of Cambridge starting on February 14. The contract for ambulance service with Emerson will expire in September, and Flannery has until then to decide whether to stick with the new subcontracting model or suggest a better one. And, of course, costs are going up immediately with the updated arrangement.
Carlisle has its own ambulance, but this provides Basic Life Support (BLS), services not Advanced Life Support (ALS) that some patients may require. The Emergency Medical Technicians (EMTs) riding the Carlisle ambulance can provide such things as basic wound care and breathing help to patients. The paramedics riding an ALS transport, however, have the advanced training and equipment to offer intubation, administration of drugs and even defibrillation to patients. The trained Carlisle dispatcher answering an emergency call decides whether to send BLS or ALS support based on a series of questions.
Trying to tabulate the bill
Pro EMS will bill patients with private insurance directly. That could be $1,000 per ambulance call. After reaching a cap of $1,950,000, any additional revenue goes to the towns participating in the agreement. Flannery noted that he is unsure at this time on how Pro EMS would disperse the money fairly.
The town will be responsible to bill patients with Medicare and Medicaid directly. For example, Emerson charged $250 for a Medicare transport in the past. The projected new rate looks to be about $363. As there are many determining factors, such as mileage, the town will see a different number for each patient. Historically, the town has covered portions of ambulance fees uncovered by some people’s insurance or for the uninsured. In the past, however, the private fees exceeded the public costs, and Carlisle realized revenue from ambulance service that goes into a fund to cover costs of its own vehicle and BLS service.
Selectman Peter Scavongelli summed up the fee arrangement: “Private insurance is subsidizing Medicare at present.” Flannery concurred, and noted the local trend that in the past several years the Carlisle percentage of Medicare patients served increased from 16% to 32%. As other towns in the contract have even higher percentages, Flannery expressed a concern that Carlisle was paying out more than its fair share. Furthermore, Flannery said he expects Medicare reimbursement to be reduced 20% over the next two years, thereby reducing revenue further.
“We want to continue to support this [current agreement], but I would like time to evaluate how it’s going for Carlisle,” said Flannery. One of the advantages of the agreement he cited is that there will be two ALS ambulances instead of one providing dedicated service to the group of towns. Towns will be able to view the current location of the ambulances, using GPS and a web-based software program. Flannery hopes response times could come down from 13 minutes as when Emerson provided it from across Route 2 to the desired eight minutes.
Without a workable alternative, the Selectmen unanimously voted to adopt the revised ambulance agreement as recommended by Flannery at its Tuesday, February 9 meeting. Flannery will continue to evaluable solutions being implemented in towns to the West, North, and East of Carlisle. ∆
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