York Hospital president: Regionalization of EMS is key

Aug. 19--YORK, Pa. -- WellSpan's York Hospital lost about $1.6 million last year on emergency medical services.

And that number is no anomaly.

Each year, the health system subsidizes other services to the community at a financial loss, including behavioral health and dialysis.

"If it was the money, we would have made this decision years ago," said Keith Noll, president of York Hospital, referring to an announcement last week regarding the impending discontinuation of WellSpan's EMS services.

"It's time to make a change in the system."

That system, Noll said, is fragmented.

In lieu of coordination at a higher level -- as it is done by other states -- individual municipalities in Pennsylvania decide how to provide emergency medical services, including advanced life support from paramedics.

"The ALS resources are not necessarily placed strategically throughout the region," Noll said. "They're placed opportunistically based on each municipality's desire to provide that service."

The decision to discontinue hospital-based EMS has been in the works for two years.

WellSpan, Noll said, voluntarily started offering advanced life support 30 years ago, contracting with municipalities to provide direct service through paramedics that follow ambulances in "chase trucks."

The original intention, he said, was to discontinue the service after three to five years. Currently, WellSpan's medics are

stationed in Stewartstown, Red Lion and Dover.

Over the last five years, the call volume for those units has decreased by 50 percent, Noll said.

"There are many more providers that can provide ALS coverage and therefore, they've been shifting volume away from us," he added.

The chase truck model of EMS, Noll said, isn't as efficient, either.

The newest model, the Mobile Intensive Care Unit, is the new way of doing things.

In a MICU, a paramedic rides on an ambulance equipped with more life-saving technology, including medications and IVs. Care is coordinated through one vehicle, instead of two vehicles trying -- sometimes futilely -- to arrive at a scene at the same time.

"The MICU model is a more expedient service to provide for the patient's care and quality," Noll said. "To us, that's where we need to move."

Yoe Ambulance Service and White Rose Ambulance have already adopted the MICU model.

Between training and equipment, the costs are steep, said James Arvin, president of White Rose Ambulance.

"Any service running less than 2,000 calls a year is going to have trouble moving forward," he added.

Running a MICU around the clock costs about $500,000 a year -- expenses small emergency medical services won't be able to afford on their own, Arvin said.

The cost alone, he added, could push a lot of the EMS services to combine into a regional entity once WellSpan pulls its services from the community.

A similar situation occurred in Lancaster in 1996, he said.

There, the advanced life support of St. Joseph Hospital (now Lancaster Regional Medical Center) and those of Community Hospital of Lancaster consolidated to form the Lancaster EMS, which served 18 municipalities across Lancaster County, according to its website.

Since then, smaller organizations joined the consolidation, including Strasburg Community Ambulance Association and Providence Township Ambulance Service.

"I think some of these organizations are going to have to do things outside their current comfort level," said Ted Hake, Yoe EMS chief.

Yoe operates its own MICU. Hake said the EMS group wants their neighbors, Jacobus and Red Lion, to make the transition, too.

"A lot of people are thinking about this now," Hake said. "If nothing else, this has been a catalyst for positive change."

WellSpan intends to help, where needed, with barriers to regionalization, Noll said, including equipment and start-up funds that groups might need.

"We aren't saying, 'You're on your own,'" Noll said. "We believe there's a better model and we're interested in participating in the development of that model, but it has to be community based."

EMS staff

About 100 people -- some part-time -- are employed by WellSpan's EMS services.

Not all the positions are being eliminated, said York Hospital President Keith Noll.

"Some will remain at WellSpan in different positions, we believe," he said. "We have opportunities that arise all the time in which we can use people's skill sets."

Some EMS providers, he said, have already spoken to WellSpan about employing the paramedics they currently lease from the hospital.

Leasing paramedics

WellSpan began leasing paramedics to EMS providers in the community about five years ago, Noll said.

"They trusted that we could provide good quality people," he said. "It was a way to help staff with a high quality product."

Acting as a staffing agency for EMS personnel, Noll said, is "not our core competency."

Some of the services that lease paramedics from WellSpan previously employed their own, he added.

"They are considering whether or not to take that service back over again," Noll said. "We're not telling them to do that. They need to make that decision."

lboyer@ydr.com; 771-2062

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