February 21, 2007
Hughson Firm Says Rival Will Not Play Fair: Ambulance Company: Calls From Memorial Dwindling
By Ken Carlson, The Modesto Bee, Calif.
Feb. 21--A new arrangement for handling nonemergency ambulance calls out of Memorial Medical Center of Modesto has at least one ambulance provider crying foul.
He further charges that Cotati-based ProTransport-1 is "cherry-picking" patients, that is, taking the patients who are well-insured and giving uninsured patients to its competitors.
ProTransport denied the allegation Tuesday.
Memorial formerly used any of three ambulance firms -- American Medical Response, Priority One or Hughson Ambulance -- when a patient needed transfer to another hospital or a convalescent facility.
But that changed when Memorial awarded a contract to ProTransport, which moved into the Stanislaus County market after the city of Modesto approved its permit request late last year.
Since December, Memorial's dispatch center has forwarded transport requests to the Cotati firm. ProTransport either sends an ambulance for the patient or gives the call to a competitor.
The new system relieves nursing supervisors of the task of arranging for ambulance transportation and has become the model at other Sutter Health hospitals in Sacramento and the Bay Area. Sutter is affiliated with Memorial.
Crowder said last week that he has experienced a sharp drop in call volume out of Memorial.
"They only call us for patients they don't want to transport," he said. "We can't make up the loss with the percentage of patients we are getting who have insurance."
Hughson Ambulance said it received 21 calls for Memorial patients in January, compared with 142 in October.
According to Crowder's figures, more than half were Medi-Cal or Medicare patients (five and seven, respectively). Six patients were insured by Secure Horizons (a Medicare health plan), and the others had HealthNet, United Healthcare or Blue Cross insurance.
Crowder said Medi-Cal does not come close to covering his costs, and Medicare pays about 40 percent of an ambulance bill.
He expects to lose more than $200,000 in business from Memorial, but also claimed the arrangement is not good for patients.
The Sutter-ProTransport deal is supposed to be for patients at Memorial and Sutter Tracy Community Hospital who have Sutter doctors through managed-care plans, but the hospitals are referring other patients to ProTransport when they need transfer, according to Crowder.
He contended that those patients should have a choice because ambulance companies charge different rates. He said his company charges $200 per trip less than what ProTransport charges.
Another ambulance provider, Priority One, expressed concern in November about the newcomer's application for a permit to serve the area. Priority One said there wasn't enough service demand and that the new company would weaken the emergency medical services system.
Jim Karras, vice president and general manager for Priority One, said Tuesday that it's too early for him to evaluate the Memorial-ProTransport deal, although it does raise questions about fair competition.
"This is a model where one competitor has the ability to affect the business of other competitors," he said. "It is relatively new and I am sure there is a learning curve. The hospitals have assured us they will be monitoring this."
ProTransort gets Sutter contract
Anita Talkington, a spokeswoman for Memorial, said the decision to change the arrangement came out of Sutter's corporate offices in Sacramento.
She said Sutter's purchasing division invited other ambulance companies to bid on the contract but Hughson Ambulance did not respond.
ProTransport was awarded the contract based on the merits of its proposal, and Priority One, which also submitted a bid, was chosen as backup, she said.
As far as she knew, she said, the system was running smoothly.
According to ProTransport, the company passed 198 of the 331 calls in January to other providers, including 110 to American Medical Response, 17 to Priority One, 22 to Medivan, and seven to Manteca Ambulance in San Joaquin County.
ProTransport said its records show 42 calls to Hughson Ambulance.
Company officials said it provides a similar service for Sutter hospitals in the Bay Area. Because the goal is improving response times for patients, it regularly uses other ambulance providers.
Spokesman Gabriel Ferreira denied that the company is cherry-picking patients.
"It isn't possible," he said. "We don't know who the payers are until the call is already run."
Under the agreement with Memorial and Sutter Tracy, ProTransport has first priority for calls and notifies other providers if it has no ambulance available.
Priority One is next in line, followed by AMR and Hughson, Ferreira said.
He said Hughson Ambulance is lower on the list because it doesn't have a contract with Sutter. He had no explanation why Priority One got only a handful of calls in January, but said it should get more in the future because it contracts with Sutter.
Elena Whorton, the company president who founded ProTransport in 2000, said the company has tried to have discussions with Hughson Ambulance about its complaints.
"Every time we called them, they are upset and want to bring it back to their claim of unfair business practices," she said, adding. "We try not to come in like a predatory company."
Policies allow for competition
Tuesday, an AMR spokesman said it had no evidence of improper activity under the new arrangement.
Steve Andriese, executive director of Mountain Valley Emergency Medical Services Agency, which regulates ambulance service in Stanislaus County, said the local ambulance companies aired concerns before the new agreement went into place.
Because regional policies allow for competition among providers for nonemergency calls, the agency only made sure that ProTransport was properly staffed and equipped before signing off on the agreement.
Crowder said it isn't true that ambulance companies are unaware of the patient's insurance before taking nonemergency calls.
He said his office has asked for and received that information from ProTranport when calls were given to his company.
In his view, Memorial should go back to using other ambulance companies to transport patients who are not covered by Sutter's managed-care agreements.
To comment, click on the link with this story at www.modbee.com.
Bee staff writer Ken Carlson can be reached at [email protected] or 578-2321.
Copyright (c) 2007, The Modesto Bee, Calif.
Distributed by McClatchy-Tribune Business News.
For reprints, email [email protected], call 800-374-7985 or 847-635-6550, send a fax to 847-635-6968, or write to The Permissions Group Inc., 1247 Milwaukee Ave., Suite 303, Glenview, IL 60025, USA.