In one of my recent columns, I encouraged chiefs who do transport services to start talking with the managed care organizations in your area to form a partnership or to at least be included in the bid on a contract for service. Since then, I have received about 20 phone calls from chiefs who have begun discussions where the MCO was receptive and wanted to talk more.
Many commercial (private) ambulance companies have found this lucrative, while still others have seen these this has an opportunity to circumvent a 911 system for increase revenue. Many MCOs or HMOs require their members to call their organization before receiving permission for treatment. If that MCO or HMO has a contract with a commercial (private) ambulance company and have determined one of their members needs an ambulance transport, they will respond the commercial company who they have the contract with. In some cases, such as Portland (OR), when Kaiser Permanente members call their HMO, it rings in the AMR communications center!
Other commercial providers have signed capitated agreements for ambulance services. Capitated agreements usually include giving an organization a set amount of money to handle all ambulance business, rather than a fee for each ambulance ride. As an example, if a service signs a contract for $3 million to provide all ambulance service - any expenses over that you "eat" and anything under that amount is "money in your pocket."
Such was the case with AMR in January when they signed a capitated agreement with Alameda Alliance for Health which serves 130,000 residents in Alameda County, California on Medi-Cal programs. Part of the contract calls for AMR to educate Alliance members on accessing an EMS system, including information on when to call - and when NOT to call 911.
The Galt (CA) Fire Department under the direction of Chief David L. McPherson, Sr. had a managed care agreement with Kaiser Permanente in Sacramento County. After Kaiser approached them, GFD leased a vehicle and hired six additional firefighter/medics to make inter-facility transfers between 17 hospitals and Kaiser HMO facilities. The personnel and vehicle were dedicated between 7:00 a.m. and 9:00 p.m. to Kaiser. However, after 9:00 p.m., the vehicle was located at the fire station, where they were available for Kaiser patients or fire district duty, even while being paid by Kaiser. Kaiser paid $350 per transfer, plus $53 an hour.
Unfortunately, the program was controversial with some department members and was discontinued. Surrounding fire districts are now looking at picking up the contract. McPherson, also a fourth year law student informs me the California Health and Safety Code says they can contract with anyone they like outside their fire district, but the contract must be revenue neutral. According to McPherson, the state is taking money away from fire districts. Chief McPherson can be reached at 209-745-1001.
Marion County (OR) Fire District #1 under Acting Chief Larry Beach and EMS Division Chief Roy Hari have been progressive in the managed care arena. Beginning March 1st, MCFD #1 will begin operating a wheelchair van to augment the service currently provided by their ALS ambulances. Wheelchair vans and convalescent stretcher vans will support operations as demand for fire service transportation grows. The vehicles will be staffed by part-time EMTs, volunteer firefighter/EMTs, and college students who are EMTs as a career builder to the fire service. The entire operation is funded by user fees with no taxpayer money. Either chief can be reached at 503-588- 6529.
Also, in Oregon, hospitals in Linn and Benton Counties have formed an alliance. This alliance has approached the four fire departments in the area that provide ambulance service on managed care issues. Although there are issues that still need to be worked out and finalized, expect a favorable outcome for the FDs.
In essence, managed care represents opportunities for the fire service. Start networking with your MCOs before the commercial providers in your community do.
Gary G. Ludwig is on the Executive Board of the EMS Section and is with the St. Louis Fire Department, responsible for EMS and communications. He can be reached at 314-533-4175; fax 314-289-1977; AOL at GaryLudwig; or LUDWIGSTLFD on ICHIEFS.
(Editor's note: The comments/views presented in these reports are those of Mr. Ludwig and/or the IAFC and may not represent those of EmergencyNet News or the Emergency Response & Research Insitute. They are presented here as a public service to the emergency community. Please feel free to contact Mr. Ludwig, regarding these features, at the address or numbers listed above)