The City Council has decided to postpone voting on a resolution to give a contract for basic life support ambulance service with CarePoint/McCabe Ambulance. The matter became controversial because for decades, the service has been performed by the EMS unit of Jersey City Medical Center (JCMC).
Faced with a protracted conflict over the awarding of the contract, Mayor Steven Fulop withdrew his request to the City Council just prior to last Wednesday’s meeting.
As a result, JCMC asked its supporters not to attend the meeting, and most stayed away. But supporters for CarePoint/ McCabe packed the chamber anyway, brandishing signs supporting McCabe and opposing JCMC. A number of key officials from both CarePoint and McCabe attended the meeting but for the most part agreed not to comment on the contract.
The matter is expected to come back onto the council agenda in January. Most observers on both sides of the issue believe the matter is destined for court, regardless of whom the city selects.
The city’s current five-year contract with JCMC expires on Dec. 31, 2013. In order to continue service, the council voted to extend the contract for the month of January until the legal wrangling over the contract can be decided.
Based on a recommendation by a five-member committee, Fulop asked the council to approve a three-year contract with McCabe Ambulance, which is supported in part by CarePoint Health System, a for-profit company that owns Bayonne Medical Center, Hoboken University Medical Center, and Christ Hospital in Jersey City.
Faced with a protracted conflict over the awarding of the ambulance contract, Mayor Steven Fulop withdrew his request.
Ultimately, only McCabe and JCMC submitted bids.
Performance scoring questioned
In the Dec. 16 council caucus, Councilman Richard Boggiano requested that the issue be delayed because he had questions about how the committee evaluating the bids scored each bidder’s performance. He also expressed concern about the lack of medical professionals on the five person committee.
He and others noted that even though the committee recommended McCabe over JCMC, the scoring in various performance categories showed both companies were very close but with JCMC leading in every area.
The only part of the scoring in which McCabe led was financial. McCabe has offered to reimburse the city for the cost of fire department first responders. In Jersey City, the Fire Department – which has firehouses strategically located throughout the city – sends a unit of its own medically-trained firefighters to each call for an ambulance. This helps reduce overall response time and guarantees that someone is on the scene quickly to begin life-saving measures until the ambulance and paramedics (if needed) arrive.
McCabe also agreed to not charge the city for providing its services. While this was matched by JCMC, during the previous contract period JCMC charged the city almost $20 million over five years.
Councilwoman Diane Coleman asked why JCMC felt it no longer needed the annual $4 million from the city. JCMC officials said the hospital was struggling in 2009, but now is in a better position to provide service without a subsidy from the city.
Questions raised about bid process
Both ambulance companies make their money from patients, whose insurance or other medical coverage pays for all or some of the transport. Paramedics, which JCMC currently provides, are an additional cost, and McCabe would have to subcontract those positions if awarded the contract.
John Lacy, a spokesperson for JCMC, said the city changed the rules in the middle of the process. Lacy said that the city originally proposed a profit sharing arrangement as part of the original bid.
But this, according to Lacy, would be illegal under federal law and might be seen as kind of kickback, since significant fees for transport would come from Medicare or Medicaid. When JCMC pointed this out, the city changed the specifications – which Lacy claims involved a major change in the bid specs.
The change allowed the two services a choice to either pay back some of the cost for first responders, or do away with the need entirely and use first responders of their own. McCabe opted to pay a portion of the salaries for fire fighters who were used as first responders, while JCMC opted to provide a combination of paid and volunteer responders who would serve in this capacity.
Lacy claimed that the five-member committee weighing both bids used JCMC’s choice against the hospital, claiming that the city needed more than volunteers and first responders. JCMC claimed most of those in that role would be paid professionals, and that volunteers would make up only a portion of the group.
Big money is at stake
The core of the conflict for both companies is the financial benefit any provider would get from the contract.
A related issue is where patients would go once they are picked up. McCabe and CarePoint claim that JCMC has for decades bypassed Christ and other hospitals to take patients to JCMC.
CarePoint – which has canceled agreements with nearly all insurance carriers – gets a huge financial benefit from ER admissions. By state law, insurance companies must pay full price for services administered to patients coming in through the ER.
Bayonne Medical Center was recently named the most expensive hospital in the nation partly because of how much it charges for its medical services. CarePoint officials said these charges are designed to push insurance companies into providing lower reimbursement rates.
Awarding the contract to McCabe could guarantee Christ Hospital its fair share of emergency room cases, something CarePoint claims it does not get under JCMC service.
While JCMC has denied bypassing Christ and other hospitals, its policy for EMTs, implemented in 1992 and updated yearly up until 2012, directs its ambulances to bring patients to JCMC unless otherwise directed by the patients or medical need.
JCMC officials say they follow a computer model that dictates which hospital a patient goes to. But JCMC policy pages obtained by The Reporter appear to give McCabe ammunition to make its case.
As the official trauma center for Hudson County, JCMC must get some of the more serious emergency cases anyway – something that would not change regardless of which company gets the contract.
Some believe the loss of the contract could put JCMC, a not for profit hospital, in financial peril, since it also depends on the stream of patients that come through its ER. JCMC has a fleet of about 35 ambulances. Some questioned whether McCabe, which has a fleet of 16 ambulances, can handle the larger volume of calls in Jersey City.
Mikey McCabe, owner of McCabe Ambulance, said his company has already begun to upgrade in anticipation of possibly being awarded the contract, and would purchase additional vehicles if they win the bid.
Bayonne and Jersey City differ
While McCabe has run an ambulance service in Bayonne for more than 40 years, Boggiano said Jersey City is dramatically different in structure and size, and asked how McCabe intend to respond to emergencies quickly.
McCabe said he intended to set up four locations in the city where ambulances would be housed, each able to respond to emergencies quickly.
“Everything is technology these days,” he said, noting that McCabe ambulances are equipped with the latest in navigation devices.
Some residents speaking at the public portion of the Dec. 18 city council meeting expressed concern about relying on technology, noting that JCMC has covered the city for 130 years and its drivers know some of the more complicated parts of the city.
A municipal ambulance service?
By withdrawing the resolution, Mayor Fulop will allow the council to review many of the details of the selection process.
At the Dec. 18 meeting, Councilman David Rivera said he has not yet made up his mind, but suggested that the city might look into developing an ambulance service of its own, operated by the Jersey City Fire Department.
He said two people close to him have died in ambulances, one operated by McCabe, and other by the Jersey City Medical Center.
“People keep talking about this as a loss of life decision, but I’ve already lost two lives,” he said.
While he said he didn’t blame either service, he said it did give him a painful perspective as to how serious a decision this is and how much responsibility the City Council has.
Flooded with emails and phone calls from both sides, Rivera said, “We get it.”
Al Sullivan may be reached at firstname.lastname@example.org.