Five Questions With: Jeff Behm on the End of MONOC

On January 23, 2020, Jeff Behm, president and CEO of New Jersey’s prominent Monmouth Ocean Hospital Service Corporation (MONOC) ambulance service, announced in a letter to his employees that the service would close on April 1 due to “a challenging financial environment caused by declining reimbursements and increasing payor restrictions.” EMS World interviewed Behm about the details.

EMS World: The state of New Jersey has a unique way of delivering EMS. For those who don’t know how this works, can you explain the hospital partnerships?

Behm: We have a two-tiered EMS system in New Jersey, providing basic life support (BLS) and advanced life support (ALS). By statute the provision of ALS care is hospital-based, through a certificate of need by a Mobile Intensive Care Unit (MICU)-licensed provider who is authorized by the New Jersey Department of Health. MONOC provides this care for our patients on behalf of three healthcare systems: CentraState Healthcare, Hackensack Meridian Health, and RWJBarnabas Health. In its existence MONOC has provided EMS with BLS, ALS, air medical, and critical care transport, but our core provision of services is with the MICU program.

Can you give us the relevant statistics for MONOC? How many employees do you have, what is your call volume, and how big is your service area?

In 2014 MONOC reached a peak of 800 employees. We serve an area of approximately 1,800 square miles with a population of about two million people. We run about 150,000 calls a year. Since 2014 we have reduced our size based on the fact that our member hospitals have had less of a need for MONOC to provide EMS and medical transport services. Clearly, fewer calls for service means less reimbursement, and this has made it harder to cover the costs of the operation. Our hospital cooperative recognized this two years ago when MONOC was facing financial challenges, and they stepped up and provided us a subsidy. But that subsidy will end after the first quarter of 2020.

MONOC is well-known throughout New Jersey and has served the community for 40 years. What will happen to MONOC employees on April 1, when service ends?

As we head toward April 1, MONOC is providing its employees with information about other employment opportunities. The good news for New Jersey EMS providers is that there is a shortage of paramedics in the state and no shortage of jobs available. All the clinicians are represented by a union, and MONOC will meet with the union to discuss employee benefits. This is a process we must go through by talking with the union’s leadership.

What are some things you would like people to know about MONOC’s achievements as an organization?

I’m so proud of the excellent clinical work MONOC has provided in taking care of the community. I believe our clinicians are the best in the state of New Jersey. These communities and agencies will still benefit from these providers as they move on to other companies.

The greatest memory for me as a MONOC employee was on 9/11. It was an uncertain day in all our lives; we are so close to New York City, and we were all together that day, wondering what else was going to come out of the sky. All our off-duty employees came in that day and tried to get together and offer help. Of course, the sad fact is that the day ended without any help needed from us.

Jeff, you’ve spent 28 years at MONOC. This must be a difficult time, and you must have a lot of emotions surrounding its closing.

I’ve wanted to be a paramedic ever since I saw Johnny and Roy on TV. I am fortunate to have lived my dream. I am very proud of being able to say that as a kid, it was something I wanted to do, and I did it.

I educated myself with an MBA after starting with associate and bachelor’s degrees. Through the course of my career, I think I have left my mark on this company. I helped formalize our orientation, improved our clinical competencies, and helped with the regional dispatch system, among other things. I’ve been here a long time, and I love this company.

I care about the employees very much, and for me what has helped is that I came from the same place and worked my way up in the company, and so I understand it. I hope all our providers, medics, EMTs, nurses, and administrative staff all land safely and move on to other great journeys.

MONOC’s Letter to Employees

January 23, 2020

Dear MONOC Employees:

Over the last several months, our board of directors has been reviewing their individual corporate strategic plans and the diminishing synergies represented by their membership in MONOC. They have also been analyzing the company’s financial outlook and sustainability, while considering recommendations provided by MONOC’s senior management team.

As you know, MONOC has experienced a challenging financial environment caused by declining reimbursements and increasing payor restrictions, while the costs of running a high-quality, high-performance EMS and medical transport program continued to rise over the last few years. In 2018 our member hospitals, for the first time in over 25 years, began paying a subsidy to MONOC to assist with our financial shortfall.

We have seen a decline in service participation from our members. As these healthcare systems grew and acquired their own EMS programs, the need for MONOC to serve them diminished. While we have focused on our core business of the MICU program, a hospital cooperative model such as MONOC cannot survive with reduced participation.

With that said, the MONOC board of directors has voted unanimously to dissolve MONOC and transfer the MICU program to the patron hospitals. This will ensure continued viability of MICU services in all of Monmouth and Ocean counties, as well as the designated municipalities within Bergen, Essex, Hudson, Passaic, and Union counties currently [served] by MONOC.

On April 1, 2020, the MONOC MICU program will close, and Hackensack Meridian Health and RWJBarnabas Health will assume full operational and administrative responsibility of the program. The CentraState Health System MICU region will be covered by RWJBarnabas Health. The northern region will become the responsibility of RWJBarnabas Health with the exception of Clifton and Passaic, which will become a Hackensack Meridian Health operation. There will be no disruption of MICU services, and every current MONOC paramedic will have the opportunity to seek employment at either or both of the health system’s MICU programs.

In addition, our remaining SCT responsibilities will be transferred to the RWJBarnabas Health-Mobile Health Services (RWJBH-MHS) by April 1, 2020. RWJBH-MHS will be offering employment opportunities to our SCT nurses and EMTs.

Our control center employees who provide a mission-critical service to MONOC will also have the opportunity if interested to apply for positions at RWJBH and HMH. Hackensack Meridian Health and RWJBH-MHS are accepting applications for employment with their organizations for dispatchers, call takers, and flight followers.

To our administrative staff, we will discuss the timeline for closure of MONOC and other opportunities for you to consider. Although the clinical operations will close on April 1, 2020, many administrative functions will continue for several months, as we do not expect MONOC as a company to close before December 31, 2020.

After 40 years of service to our member hospitals and their surrounding communities, we will prepare to say good-bye to our incredible employees who have worked so hard and dedicated themselves to the mission of MONOC for so long. To our friends in the EMS community and to the new MICU programs that will launch throughout our catchment area, we turn the torch over to you and expect you to carry it forward with reverence for the high quality of service we provided. It is certainly a sad time for those of us who collectively form the MONOC family, but we know new opportunities await us, and we are comforted by the knowledge that we set the tone and led the way in EMS in New Jersey for decades.

Thank you!

Jeff Behm

President & CEO

Hilary Gates, MAEd, NRP, is the senior editorial and program director for EMS World. She is a volunteer paramedic in Alexandria, Va., and teaches in the School of Education at American University in Washington, D.C.