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Extensive Revamping of County's Advanced Life Support Services Proposed
Cost savings basis of recommendations
by Margaret Sternberg
Clearly appalled by the escalation of costs associated with the Advanced Life Support ("ALS") services Putnam County has contracted with Empire State Ambulance to provide, freshman Legislator Anthony Fusco proposed a series of specific, yet broad-based, changes that, he maintains, will help save the County possibly hundreds of thousands of dollars annually on outside ALS services.
Fusco dominated the 3 ½-hour March 6, 2008 meeting of the Legislature's Protective Services Committee, standing at the podium for over two hours as he outlined numerous issues with the current service itself and its monitoring by the County's Office of Emergency Medical Services, making recommendations for corrective measures while also discussing new initiatives.
Fusco's proposals include the County obtaining a Certificate of Need ("CON,") an action that would enable the County to, in effect, become the umbrella under which an ambulance service would act as a subcontractor. The action would enable a number of ambulance services, who are currently ineligible to bid for the county contract, to bid, thereby increasing competition and potentially lowering the cost to the County. Employees of any ambulance service hired under a CON would not be county employees. Several legislators voiced concern that the county would become enmeshed in medical billing, but Fusco said that there exist companies that can be hired specifically to do billing.
Fusco also suggested that the County "reorganize the fire-ambulance services in an effort to facilitate the capture of lost revenue from health insurance billings." Fusco later said that he was hoping to ensure that revenue would be recaptured in instances involving transport of patients. Ambulance services run by fire departments are not permitted to bill for their services; however, volunteer ambulance services, such as those operated by Philipstown, Cold Spring and Putnam Valley, Fusco said, would not be affected since they are able to charge for their services.
He also called for an audit of Empire State Ambulance in order to ascertain that the County was "getting what it pays for." Fusco maintained that according to his calculations Empire State responded to calls within the contractually mandated 10-minutes or less response time only 17.62 percent of the time (Empire State agreed to make 75 percent of the calls within that timeframe,) and he called for the institution of the 10 percent financial penalty allowed by the contract for not meeting that goal.
On Monday EMS Director Robert Cuomo rebutted Fusco's claim of an average response time of 17 minutes, asserting that Fusco's figures were inaccurate. Cuomo said that "based on raw data you can't just extrapolate numbers. Our numbers don't match Tony Fusco's, and we don't know how he came to his numbers." Cuomo said that he has checked the data from Empire State regularly and that the "numbers [Cuomo has] been getting all along are lower."
Frequently castigating Bureau of Emergency Services Commissioner Robert McMahon for not complying with his repeated Freedom of Information Act requests for data, a charge that McMahon denied, Fusco also criticized fellow legislators for having re-negotiated the contract with Empire State Ambulance, when they threatened to cancel the contract with the County, which resulted in more than doubling the County's annual payment from the initial $485,000 quoted to $980,000.
McMahon noted that the County had, at that time, received quotes from two of the other three providers eligible to operate in the County, and the bids were 1.8 million and 1.9 million, adding that they felt "Empire was doing a very reasonable job for us, and their price was worth paying." Their contract ends in October, at which time companies will be invited to bid via Request for Proposals.
Committee Chairman Terry Intrary angrily took issue with Fusco's accusation that the Legislature had failed - "at best" - to do due diligence, adding that the Legislature had responded to numerous calls and letters from community members and local official demanding that the ambulance service be continued. Intrary said that he took affront with being "thrown under the bus…This body worked like hell to do our due diligence…I make apologies only that this community wanted ALS, and they didn't [care] how much it cost…If we were malfeasant in your mind for allowing this project to go by, that's the suggestion you're making…That's not true."
Fusco said he was not accusing the Legislature, but that he was suggesting "the ball was dropped. If anyone specifically in here feels that they've dropped the ball, then let them feel that."
The Committee decided to focus on the resolution of the questions surrounding Empire State's service and develop an RFP based upon several of the issues raised by Legislator Fusco. There was no immediate decision reached on the county obtaining a CON or dealing with fire-ambulance services that are prohibited from charging for their services.
The date for the April meeting of the Protective Services Committee will be posted on the PCN&R's website as soon as it becomes available.
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