Competing Hospitals Stake Claim to Providing Paramedic Services in Camden

Andrew Kitchenman | June 12, 2015 | Health Care
Legislation would let Cooper, with its Level I Trauma Center, take over coverage from longtime provider Virtua

ambulance paramedic
Two hospitals serving Camden are at odds over a proposal to give facilities designated as Level 1 trauma centers control over local paramedic services.

A bill, S-2980/A-4526, would give hospitals classified as Level 1 trauma centers exclusive authority to provide advanced life support (ALS), or paramedic, services in the municipality where they’re located.

The legislation would basically affect Camden, where Cooper University Health Care could potentially gain control over ALS, since the state’s two other Level 1 trauma centers – University Hospital in Newark and Robert Wood Johnson University Hospital in New Brunswick – already operate the local paramedic services.

But it would wrench away these services from Virtua, the health system that’s provided ALS coverage in Camden for 38 years. Virtua operates three hospitals: Virtua Marlton Hospital in Voorhees; Virtua Memorial Hospital in Mount Holly; and Virtua Voorhees Hospital.

Cooper has become a powerful force in southern New Jersey healthcare, in part because hospital Chairman George Norcross is a major powerbroker in the region. Norcross, who’s also chairman of insurance firm Conner Strong & Buckelew, led the effort to build Rowan University’s Cooper Medical School and supported efforts to reshape Camden’s schools and police.

A Cooper representative said the measure would allow for more seamless, efficient care, as the hospital could integrate local paramedics into other services it provides in the city.

New Jersey’s ambulance system is currently divided into ALS, which includes paramedics, and basic life support, which doesn’t. Municipalities select BLS providers individually, while the state Department of Health determines ALS providers on a countywide or regional basis. University Hospital and Robert Wood Johnson University Hospital provide both ALS and BLS coverage in their respective towns.

As a legacy from its days as a part of the University of Medicine and Dentistry of New Jersey, University Hospital also operates BLS ambulances in Camden, but is reportedly looking to get out of the business in a city that’s 90 miles from its Newark base of operations.

Combined with the proposed legislation, this would allow Cooper to consolidate ambulance services in the city – which some deem a potential advantage to the bill, since some emergency calls currently require two different emergency vehicles – both ALS and BLS – to respond.

Virtua Assistant Vice President Scott Kasper said city residents benefit from the fact that Virtua provides paramedic services throughout Camden County. He said passage of the legislation would fragment services, add to healthcare costs, and duplicate existing services.

“Operationally and clinically, there is no rational reason” for the bill, Kasper said.

Virtua has been providing high-quality ALS service for both Camden and Burlington counties for nearly 40 years, he noted. “That type of expertise can’t be duplicated,” he said.

The state intentionally regionalized services because it would lead to the best health outcomes for patients, Kasper said. He also said having a regionalized service provides the best way for paramedics to gain experience with the rare but severe cases that require paramedics and leads to lower costs due to efficiencies from the size of the operation.

Kasper added that since Virtua’s paramedic system was built to include both the city and the rest of the county, removing Camden from its coverage area could affect service in the county.

“There’s no evidence to suggest that simply because a provider is part of a Level 1 trauma center, that they provide better care,” Kasper said. He added that Virtua works closely with local BLS ambulances.

Finally, Kasper said, Virtua is the only mobile intensive care unit in the state that can provide a service used in some emergencies — rapid sequence intubation — without getting a direct order from a doctor. Kasper said this saves time that can be critically important in saving lives.

Cooper’s case rests on a different basis – as the largest hospital in the city, it could potentially integrate paramedics into the other services it provides.

For example, they could follow-up with patients that they treated. The hospital already employs some paramedics to staff its helicopter, but would need to hire more if it took over citywide services.

“This legislation is designed to improve the quality of care and the efficiency of care,” in the city, according to Christine Stearns, a lawyer with Gibbons PC’s Trenton office who has worked with Cooper on issues related to the bill.

Stearns said the bill would give Camden the best possible emergency medical services (EMS), by leveraging Cooper’s resources and better integrating ambulances and paramedics with the hospital.

She added that the hospital intends to work closely with Lourdes Health System, the other hospital operator in the city, to implement the EMS system.

While Camden would be most affected by the bill, it could also affect paramedic services in Hamilton in Mercer County. That’s because the measure would require state health officials to conduct an “expedited” review if a hospital that’s part of a system that includes a Level 1 trauma center applies this year to operate paramedic services in its municipality.

Robert Wood Johnson University Hospital-Hamilton could apply to operate paramedic services in the municipality, since it’s part of the same hospital system as the New Brunswick Level 1 trauma center.

Like Virtua in Camden County, Capital Health System and its predecessors have provided paramedic services throughout Mercer County for decades.

Capital Health opposes the proposed legislation, said Vice President Dennis Dooley. He said losing Hamilton would have a ripple effect, since the privately insured patients in that township and other suburbs help subsidize the paramedic services that Capital Health provides in Trenton, which has a larger population of uninsured patients and Medicaid recipients. Without those patients from Hamilton, the paramedic system would operate at a loss for the hospital.

“At the end of the day, any institution has to be able to sustain itself economically,” Dooley said.

He noted that whichever hospital provides paramedic and ambulance services, they must take patients to the nearest appropriate hospital.

“We’re solving a problem that doesn’t exist,” Dooley said. “I don’t see any clinical advantage whatsoever.”

The bill is moving very quickly. The Senate version was introduced Monday and the Assembly version was introduced yesterday. There will be hearings on the bill before the Senate Health, Human Services and Senior Citizens Committee and the Assembly Health and Senior Services Committee.

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