York County Council, PMC consider changes in ambulance response standards

jzou@heraldonline.comNovember 9, 2013 

ANDY BURRISS — aburriss@heraldonline.com

  • Other county EMS systems: York County

    Population: 235,000

    Type: Hospital contract

    Operator: Piedmont Medical Center

    Response time standard: (under current contract*)

    Eastern: 12 minutes

    Western: 20 minutes

    Clover/Lake Wylie: 18 minutes

    City of York: 12 minutes

    Call Volume: 35,000

    Total Ambulances: 15

    County Cost: $0

    Sources: York County Department of Public Safety Communications, Piedmont Medical Center

    * The proposed contract will change response times to countywide targets based on medical urgency, similar to Charlotte-Mecklenburg's system. See below.

    Spartanburg County

    Population: 289,000

    Type: Hospital contract

    Operator: Spartanburg Regional Medical Center

    Response time standard: 9 minutes countywide

    Call Volume: 44,000

    Total ambulances: 20

    County cost: $2.1 million

    Source: Jimmy Greene, EMS Director

    Lexington County

    Population: 270,000

    Type: County

    Operator: County

    Response time standard: 11 minutes countywide

    Call Volume: 30,000

    Total Ambulances: 15

    County cost: $11.3 million*

    Source: Brian Hood, EMS Coordinator

    * The county anticipates it will collect $6 million in revenue from EMS patient transports, which will go into general funds.

    Charlotte-Mecklenberg County

    Population: 970,000

    Type: Joint county and hospitals

    Operator: Medic 911

    Response time standards:

    Priority 1 (life-threatening): 11 minutes

    Priority 2 (emergency): 13 minutes

    Priority 3 (non-emergency): 20 minutes

    Call Volumes: 115,000*

    Total Ambulances: 30-40

    County cost: $13.1 million

    EMC

    * This number refers to Medic 911’s total call volume, which includes fire dispatches as well as non-emergency, scheduled, patient transfers.

    Notes:

    1. County statistics provided by specified sources rounded to nearest thousand for fiscal year 2013.

    2. Response times refer to goals set by county or operator agency.

    3. Populations from 2012 U.S. Census Bureau estimates and rounded to nearest thousand.

When someone calls for an ambulance in York County, the response time depends on where the caller lives.

Under current standards, urban residents in Rock Hill and Fort Mill can expect medical help at the door within 12 minutes. But people in the rural areas of western York County such as McConnells or Bethany can wait up to 20 minutes for the same care.

The disparity – allowed under the county’s current agreement with Piedmont Medical Center – has become a lightning rod for the York County Council. The council members are working on new agreements with PMC and two volunteer rescue squads with the goal of eliminating geographic considerations in response time standards.

PMC’s Emergency Medical Services and the rescue squads operate at no cost to county taxpayers, but the agencies must meet county standards or risk penalties.

While the council is pushing for a heightened, uniform standard, questions about control, competition and efficiency continue to plague ongoing debates about the proposed changes.

Some have claimed that the county’s proposed agreement with PMC isn’t the same as the proposals being considered for rescue squads. Some council members also worry the new contracts will not improve response times. Others are worried that drawn-out negotiations will further delay a needed update to ambulance care. The county has been negotiating contracts with both the hospital and the rescue squad for more than eight months.

The council is set to take a final vote on the contracts on Nov. 18 in York.

Moving Past Geography

Currently, average response times for rural communities in western York County such as Hickory Grove are among the county’s longest, exceeding 16 minutes, according to recent data by the Department of Public Safety Communications. Meanwhile, response times in urban centers such as Rock Hill and Fort Mill clock in at little more than nine minutes. The response times are within the standards established by the county’s current agreement with PMC. Other standards include 18 minutes in the Clover/Lake Wylie area and 12 minutes in the city of York.

York County Council member Joe Cox, who represents western York County, has led a council committee that has worked with PMC and the rescue squads to hammer out new contracts. Cox pointed out that while the response times meet current expectations, the standards don’t take into account patient severity, resulting in unequal service for thise in western York County.

Under the proposed changes, the county would abandon geographic standards for a tiered system prioritized by medical urgency. Under the new standards, life-threatening calls such as cardiac arrest should be answered within 10 minutes, while less serious cases such as high blood pressure will be allotted 15 minutes. Non-emergency calls for slips and falls will have a 20-minute standard.

All agencies will be expected to meet those standards on 90 percent of calls.

While no federal regulations on ambulance response times exist, emergency agencies throughout the U.S. have typically aimed for response times of 8 minutes or less.

Piedmont Medical Center, the county’s primary ambulance provider that accounts for more than 90 percent of all transported patients, said that while response time is important, it is just one aspect of patient care. Response times “are increasingly not viewed as the primary point of interest to assess the performance of an EMS system,” said hospital spokesperson Amy Faulkenberry. She pointed to other indicators such as national survival rates for cardiac arrest, which she said PMC currently exceeds.

According to a 2011 report, the hospital shaved off a minute and 16 seconds in its response times in western York County and has maintained the reduced time for the last two years. The hospital also spent more than $700,000 in the last two years to purchase two ambulances. The hospital also must insure the vehicles – all without a dime from county taxpayers.

“We are providing a valuable service at no cost to taxpayers and doing it in such a way that has demonstrated constant improvement,” Faulkenberry said.

A Matter of Compliance

Cox and fellow County Council member Bruce Henderson, who represents the Clover area, said setting compliance for tiered times at 90 percent doesn’t give PMC an incentive to improve response times in rural areas.

According to a 2013 report, western York County accounted for less than 8 percent of the hospital’s dispatches from June 2012 to May 2013. Comparatively, eastern York County made up almost 73 percent of total calls.

Cox said those numbers show residents in western York County do not make up a large enough percentage of calls to affect the hospital’s compliance. He said he and other council members argued for a 95 percent compliance rate, but the hospital pushed back.

PMC representatives have been hesitant to discuss some details of the proposed contract, citing confidentiality concerns and murky legal territory. While negotiations for both contracts have been simultaneous, discussions between Cox’ committee and the rescue squads were held in public meetings while discussions with PMC’s representatives were held behind closed doors - or in executive session - at the recommendation of county attorney Michael Kendree.

“All matters discussed in executive session should be treated with the confidence in which they were assumed to be held,” wrote Faulkenberry, adding that “as we do not want to risk fines or jail time, we cannot comment on this and assume the council members have been given the same guidance from the county attorney.”

Council members have been willing to discuss some details of the negotiations with Piedmont. York County Council member Michael Johnson said that when the committee pushed the hospital to increase compliance from 90 to 95 percent, he was told by representatives that an improvement would require subsidies of at least $1 million annually.

Unlike many counties, no York County taxes are spent on ambulance services. In Spartanburg County, $2.1 million in tax revenue was allocated this year to the local hospital for EMS services. Some other counties pay the full cost of county-owned systems, which can amount to $5 million or more. York County Council Chairman Britt Blackwell said a similar payment in York County is out of the question.

Faulkenberry of PMC denied that taxpayer subsidies were formally considered. In order for PMC to consider a 95 percent compliance rate, Faulkenberry said, hospital officials would first need to see evidence showing 95 percent would result in better clinical outcomes for patients.

She also noted that “the cost to meet the same standard county wide with our current road systems would increase exponentially.” PMC’s goal will remain to arrive “on scene in a timely manner with trained, qualified personnel to assist those in need,” Faulkenberry said.

Representatives from the county’s two rescue squads, River Hills/Lake Wylie and Fort Mill, have supported increasing the county standard to 95 percent.

Hindering Competition

Johnson, a member of Cox’ committee who also has led negotiations, confirmed that talks with PMC stalled when stricter provisions such as the 95 percent rate were suggested.

Despite being “unhappy” with the current draft, Johnson was one of five council members who voted to push the contracts through a preliminary approval in October. Only Cox and Henderson voted against sending the contracts forward.

Johnson added that there was no arguing with a “900-pound gorilla” such as PMC, which is a top county employer. “The county has to make a contract the hospital is willing to sign,” he said.

The county’s current contract with PMC took effect in December 1980 when Tenet Healthcare Corp. bought and renamed York General Hospital. The contract is binding until July 2045.

A provision in the new proposal calls for possible revisions to be made every five years, but only with the consent of county council and PMC. The last set of changes were made in 2006.

Henderson said he also is concerned about the contract because he believes it is anti competitive. It has an “atmosphere of monopoly” by making it harder for outside agencies to create an ambulance service and for existing rescue squads to add ambulances. Under the proposed contract, an outside agency can’t add ambulance service unless the existing providers fail to meet standards for six months. The rescue squads also cannot ask to add an ambulance unless they fail to meet standards for six months. On the other hand, PMC can add or subtract ambulances as it sees fit.

Gary Loflin, director of the Department of Public Safety Communications, said the provision was added to ensure the county dispatch system can keep track of ambulances and agencies.

Both rescue squads have retained lawyers and recently hinted at legal action because of what they see as an anti-competitive contract.

Jie Jenny Zou •  803-329-4062

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