Hospital weighs impact of ambulance decision

By Kirk Johannesen  johannesen@therepublic.com Special projects editor First Posted: June 17, 2012 - 12:37 am Last Updated: June 17, 2012 - 1:40 pm

COLUMBUS, Ind — COLUMBUS Regional Hospital is facing the possibility of losing upward of 80 employees and having to make tough decisions about whether to stay in the ambulance business if Columbus chooses a new primary ambulance service provider for the city.

The city’s decision could have a ripple effect. CRH also provides service to Bartholomew County, which has to award a new contract this year, too.

CRH has provided emergency ambulance service for the city and county since the start of 2006. Before that, it provided two backup ambulances to the city for its Columbus Fire Department Medic 1 unit.

Columbus Mayor Kristen Brown said providing city residents with great ambulance service is crucial, but so is care at a cost that doesn’t hurt taxpayers. She invited CRH, the fire department and four private ambulance companies to submit proposals for the contract.

The city will name its new provider at the July 17 Board of Works meeting.

CRH President and CEO Jim Bickel said the loss of the city contract would have a significant impact on the scale of the hospital’s ambulance service.

“Do we remain in the business? That remains to be seen,” Bickel said. “We have an operation in Brown County as well, and have a contractual obligation there.”

“I think we’re just going to have to evaluate the loss of the city’s business against what our long-term plans would be remaining in the ambulance business,” Bickel said. “That’s to be determined. I don’t know that.”

Bartholomew County Commissioners Chairman Larry Kleinhenz said he spoke with the mayor Wednesday morning and remains optimistic that an arrangement can be worked out so CRH would continue to provide ambulance service for the city and county.

But, he understands the city could deem another provider the best fit for its needs.

“If that were to happen, it certainly would put the county or county residents in an odd or difficult situation,” Kleinhenz said.

“County government has never been in the ambulance business and we really don’t want to be. And, we have always tried and been concerned about making sure there was a competent, professional company to provide those services.”

Brown County has had a contract with CRH for ambulance service since the early 1990s, and the current contract runs through Dec. 31, 2016.

However, the run volumes for Bartholomew and Brown counties are much lower than Columbus. And, the cost to staff an ambulance with an advanced life support unit, which is at least one paramedic and one emergency medical technician, is significant.

Paramedics, who have more training and expertise, earn on average $16.83 per hour, according to CRH. Advanced EMTs average $14.17 hourly and EMTs $8.93 hourly, the hospital said.

CRH has 70 people staffing the four dedicated ambulances for the city and county. An additional 13 cover Brown County.

Bickel said he held a meeting with the ambulance staff on Monday to address the issue of the contract.

“Their concerns are, ‘Gee, when will I know? When will there be a decision? Do I need to start looking for a job? Is the hospital going to find other positions for us within the hospital? Is the new provider coming in going to hire us?’” Bickel said.

Although the city and county pay the hospital for its services, Bickel said financial gain is not the hospital’s primary motivation for wanting the ambulance contracts.

Quality of care, continuity of care and being a good community partner are important, he said.

“I think we’ve done an exemplary service,” Bickel said.

The city and county combined paid CRH $750,000 in 2006, which helped offset money it could not recoup after receiving payments from Medicare, Medicaid, private insurance and patients. Last year, the combined payment was more than $950,000.

However, CRH still recorded operating deficits for its ambulance service in 2006 ($310,114), 2007 ($188,171), 2009 ($189,028) and 2010 ($41,904), largely because of the costs of staffing to meet the contract requirements. CRH’s ambulance service made a profit of about $39,000 last year; 2008 is not counted in the hospital’s records because of the flood.

The hospital’s other lines of services — not the ambulance — have helped its cash reserves grow from $61 million, after the flood in 2008, to $145.4 million at the end of 2011.

“We want to break even. We want to cover our costs to provide (ambulance) services,” Bickel said.

The county challenged CRH to eliminate the annual payment it makes to the hospital. Ideally, the city wouldn’t pay a subsidy, either. Bickel proposed to the county commissioners Monday a way to offset that payment by giving the ambulance provider greater flexibility to perform more non-emergency runs, such as transporting a patient to hospice care, to generate additional revenue.

CRH has a fifth ambulance that performs these runs while also serving as a backup to the other four units, but it doesn’t operate around the clock. And by itself, it doesn’t generate the level of transports needed to offset the city’s and county’s subsidy.

If the hospital doesn’t receive the new city contract, the community could feel an impact in other ways, especially if CRH exits the ambulance business, Bickel said.

CRH’s ambulance personnel live in the community.

“Living here and working here is important,” he said.

Whenever Columbus Police Department’s SWAT team is activated for an incident, a CRH paramedic goes to the scene, said Chris Raaf, CRH’s vice president of professional and support services.

CRH lets Ivy Tech use the hospital and its resources for clinical education for EMT training.

Hospital paramedics also check the defibrillators that are in the local schools to make sure they are functioning properly.

“We have been able to demonstrate that level of commitment to the community,” Bickel said.

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