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| THOMPSON
CALLS FOR IMPROVEMENTS BEFORE FIRE DEPT. CONSIDERS REPLACING 75 AMBULANCE
SHIFTS WITH VOLUNTARY HOSPITAL AMBULANCES
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Cites Report Demonstrating Voluntary Hospital
Ambulances Responding To 911 Emergency Calls Steer Patients To Their
Own Hospitals - Costing The City's Hospital System $86 Million In
Lost Revenue
City Comptroller William C. Thompson, Jr. has called on Fire Commissioner Nicholas Scoppetta to ensure remedial action is taken regarding serious performance problems of voluntary ambulances before the FDNY considers implementing a plan to replace 75 Fire Department ambulance shifts with shifts staffed by voluntary ambulances in the 911 system. Thompson cited a report released by the Comptroller's Office in June 2001, which found that ambulances operated by voluntary hospitals frequently take insured patients to their own hospitals rather than to the closest hospital, a violation of State regulations and Fire Department rules. Overall, a voluntary hospital ambulance is half as likely as a Fire Department ambulance to bring a patient picked up near a Health and Hospitals Corporation hospital to the HHC hospital, even if the voluntary ambulance has to pass the HHC hospital. The report demonstrates that this practice has cost the city an estimated $86 million in revenue annually. Should the city rely more heavily on the voluntary hospital ambulance system as being proposed, that cost will likely increase. Although Commissioner Scoppetta recently said the FDNY would delay any action to shift services, Thompson wants the Department to use this time to address the problems -- primarily a lack of monitoring -- cited by the Comptroller's Office last year. "As the agency operating the 911 emergency medical system, the Fire Department must take the necessary steps to safeguard patients and end the drain on public hospital revenues from patient steering before increasing the role of voluntary hospital ambulances," Thompson said in a letter to Scoppetta on March 22. "The Department must ensure that all ambulances take patients to the nearest and most appropriate hospitals, not to the hospitals that happen to operate the ambulances. " The Comptroller's Office analyzed 336,482 ambulance trips from May to September 1999. The study analyzed where ambulances took patients picked up in the same zip code. It focused on 11 zip code areas containing an HHC hospital, but also looked at other areas. Since FDNY ambulances have no financial stake in where patients go, they were used as the benchmark to evaluate the performance of the voluntary ambulances. State and City regulations require ambulances to take patients to the nearest hospital under all but two circumstances: when a patient requires special care and when a patient requests a specific, nearby facility. It is not possible to say whether any patient was actually harmed by the patient steering identified in the report, but if a large number of patients traveled longer than necessary to a hospital, there was risk of harm. The study found that:
"I am requesting that Commissioner Scoppetta direct his staff to implement the recommendations contained in our report because increased reliance on voluntary hospital ambulances under the current system will clearly exacerbate these problems," said Thompson. Irrespective of the Commissioner's decision to implement this plan, the Comptroller is urging the Fire Department to develop a system to track whether ambulances are steering patients. The Department could, for example, program its computer-assisted dispatch system to identify the nearest and most appropriate hospital for each patient. A copy of Comptroller Thompson's letter to Commissioner Scoppetta is below. # # # March 22, 2002 Commissioner Nicholas Scoppetta I am writing concerning the Fire Department's recent decision to delay its cost-saving plan to replace 75 Fire Department ambulance shifts with shifts staffed by voluntary hospital ambulances in the 911 system. Last year, the New York City Comptroller's Office issued a report, "Where Do 911 System Ambulances Take Their Patients? Differences Between Fire Department Ambulances and Voluntary Hospital Ambulances." I am enclosing a copy of the report for your information. The report identified serious problems in the performance of voluntary hospital ambulances and the Fire Department's oversight of that performance. The Fire Department must take remedial action before implementation of its plan, since increased reliance on voluntary hospital ambulances under the current system clearly will exacerbate these problems. The biggest problem described in the report is that ambulances operated by voluntary hospitals often steer patients to their own hospitals and away from competing public and private hospitals, particularly when the patients have medical insurance. Patient steering violates State regulations and Fire Department rules requiring ambulances to take patients to the closest and most appropriate hospital and potentially harms patients. For example, the report identified voluntary hospital ambulances that took trauma patients to hospitals that do not have trauma centers. Patient steering also costs the City money; when the report was issued in June 2001, the Health and Hospitals Corporation lost an estimated $86 million per year in net hospital inpatient revenue as a result of patient steering. One of the main recommendations of the report was that the Fire Department should monitor voluntary hospital ambulances more closely. Disturbingly, the report found that the Fire Department does not have a method for adequately determining whether or not voluntary hospital ambulances are complying with the rules prohibiting steering. In fact, the Department could not enforce these rules because it generally did not know when they were being violated. Although the Fire Department does investigate patient complaints, it is not sufficient to monitor compliance only on the rare occasions when someone complains. The Fire Department should regularly collect and analyze aggregate statistics that would reflect whether ambulances are steering patients. As discussed in the report, the aggregate statistics show a clear pattern of steering, which is not always evident in isolated cases. As the agency operating the 911 emergency medical system, the Fire Department must take the necessary steps to safeguard patients and end the drain on public hospital revenues from patient steering before increasing the role of voluntary hospital ambulances. The Department must ensure that all ambulances take patients to the nearest and most appropriate hospitals, not the hospitals that happen to operate the ambulances. I believe that the Fire Department would do a better job monitoring the voluntary hospital ambulances if it implemented the recommendations contained in the report. I am requesting that you direct your staff to do so before adding more voluntary hospital ambulance shifts. I look forward to learning your views on this important matter.
William C. Thompson, Jr. WCT:brs |
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