By Jack Minch
The Lowell Sun
CONCORD, Mass. — Emerson Hospital in Concord is hemorrhaging an average of $209,000 annually operating a regional paramedic service, because Medicare does not cover the entire cost.
The hospital is committed to continuing the service another two years, while it works with the towns it serves to develop a new operating model. But officials say it is very possible the towns will end up operating the service themselves.
For several months the not-for-profit hospital has been working with the Central Middlesex EMS Collaborative, which serves 13 communities including Westford, Littleton, Bedford, Boxboro, Carlisle, Concord and Acton.
"We have discussed paying us a flat rate for (advanced life support) intercept into those communities when it is a Medicare patient," said Bruce Trefry, paramedic manager for Emerson. "So we can recapture some of the revenue lost."
The suggested price is $250 for each Medicare patient, said Westford Fire Chief Richard Rochon. The town of Ayer, which operates its own paramedic service, charges a flat fee of $275 per patient.
Right now fire departments in the collaborative staff ambulances with emergency medical technicians. They rely on Emerson to provide paramedics, who have more training and can give more-advanced care such as intravenous injections and medication.
Emerson provided a groundbreaking service when it started the first hospital-based ALS in 1982, said Littleton Fire Chief Stephen Carter, vice chairman of the collaborative.
Paramedics wait in a central location and intercept ambulances on the way to the hospital when patients have a life-threatening illness or injury.
Of the 5,468 patients that used Emerson's paramedic service in 2005 to 2007, 2,306 of them were Medicare recipients, 42.1 percent, Trefry said.
Should Emerson discontinue paramedic service, cost would prevent individual fire departments from providing service on their own, officials said.
Westford had 363 ALS calls in 2006 and 401 last year. As of September, the most-recent date figures that are available, there were 238 ALS calls, Rochon said.
Many of those calls were canceled before paramedics arrived, because EMTs decided they were not needed.
Comparatively, there were 1,324 calls for basic life-support services from EMTs in 2005, 1,179 in 2006 and 1,318 last year.
Training and hiring paramedics would be costly. The departments are staffed with EMTs, who receive several hundred hours of medical training; paramedics train for 1,500 to 2,000 hours, Rochon said.
The end of Emerson paramedic care would be a sentimental loss but the dilemma offers an opportunity to improve the service, Carter said. Each member of the group brings skills to look at the task of providing care that could be used to modernize the work, he said.
"I'm not going to kid you, there is a lot of work to do in the next two years to figure out a structure for the system," Carter said.
If the collaborative does decide to run the system it would have to settle on participation, training and an operational plan then fold it all into a model that is fiscally sound.
"We're at the table and our ultimate goal is to design a regional EMS system that provides quality (basic life support) and ALS care for the people," said Emerson spokeswoman Bonnie Goldsmith. "The key word is regional."
Saints Medical Center in Lowell also runs a regional paramedic service serving seven towns but is fiscally solvent, said Benjamin Podsiadlo, the chief paramedic and director advanced life support paramedics department.
The systems, economics and business characteristics of the two services are different, he said.
"I would say it's a tale of two systems with nothing in common except some similarities in the model," Podsiadlo said.
Medicare officials could not immediately comment on the agency's reimbursement formula.
Members of the Central Middlesex EMS Collaborative working with Emerson also include Lincoln, Maynard, Stow, Sudbury, Wayland and Weston.
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