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Ron Tamaccio: Greenville EMS Discussion Must Put Patients First




Ron Tamaccio|| By RON TAMACCIO || Should Greenville County transfer its award-winning ambulance service (EMS Department) to The Greenville Health System (GHS) by creating something called a “Mobile Integrated Healthcare Practice (MIHP)?” To save money, the Greenville County Council is currently considering making just such a change on October 1, 2015.

Greenville EMS has been operating at a loss for years. Some believe a big part of the solution may be as simple as correcting the process the county uses to seek reimbursement from insurance companies, Medicare, Medicaid, and “out-of-network” patients. Nevertheless, the county has been looking for ways to reduce the cost of providing ambulance service to the community. Last year, (GHS) proposed a plan to take over and operate the ambulance service.

Under that plan, the county will relinquish control of its entire EMS Department and only retain the “dispatch” function. The county has to keep that because ambulance service is a part of the 911 system for dispatching police and fire units.

There are several troubling aspects in the details of this 64-page proposal. Unfortunately some members of County Council seem to be willing to accept these shortcomings without any further due diligence. Obviously, that’s irresponsible. All concerns, and all potential conflicts of interest, must be resolved before the Council votes to approve any changes to the current system.

Here a few examples:

*There is a high probability that patient choice will suffer, because this agreement creates a “monopoly” for GHS. It makes no provision for the County’s other large healthcare provider- Bon Secours St. Francis Health System – to participate in the MIHP.

*The proposal provides no mechanism for direct citizen input via the County Council, because EMS will no longer be a part of Greenville County administrative responsibilities.

*The broken promises of Obamacare are likely to trigger patient “trepidations” with this new arrangement, because it creates a monopolized EMS system controlled by a very large public healthcare delivery system – GHS. “Control” should remain with Greenville County Council, because it is directly accountable to the voters.

*The proposed cost-savings estimates are unverified. Therefore, they may be grossly exaggerated.

*The county is obligated to subsidize GHS $1.5 million annually for “operating support.” This amount automatically increases by $50,000 annually after just two years.

*All EMS assets, equipment, supplies, facilities, and employees will transfer to GHS without any compensation to the county. These things have intrinsic value; perhaps as much as $2 million.

*The county must replace all 22 ambulances currently in-service with new ambulances during the first four years of the agreement. This alone will likely cost more than $2 million.

*The county must provide dispatch services to GHS free of charge.

*If GHS’s costs for providing ambulance services to the county exceed expectations, they have the option to renegotiate their annual subsidy.

*Although the contract is a ten-year commitment for the county, GHS can renegotiate its compensation after just three years.

*At termination, GHS is only required to return the ambulance fleet to Greenville County. There is no provision for an orderly transition of the EMS services back to the county.

*GHS could “steer” patients to its own hospitals, and away from other providers like Bon Secours St. Francis

*Washco & Associates, a leading healthcare-improvement consulting firm, hired by the County, recommended five options, including privatization, for improving Greenville’s EMS system. The Council ignored most of those options.

*GHS is a respected provider of healthcare services to the community. Up to now, EMS was not a part of those services. “Healthcare” and “EMS” are not the same thing!

In conclusion, EMS operators must handle calls to 911 with utmost care to insure a prompt and proper response to the needs of the patient. This should be the paramount concern of Greenville County Council.

Ron Tamaccio is retired and lives in Greenville with his wife, Patricia.

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