Hospital won't quit life support

Hospital still offers advanced life support

Many hospitals have stopped providing emergency response advanced life support, or ALS, ceding the job to local fire departments or private ambulance services.

But not Emerson Hospital. Bucking the trend, the 177-bed facility is working to make sure its own emergency team is ready to answer the call for residents of Concord and the dozen communities closest to it - despite the heavy financial burden as reimbursement from health insurance companies has dramatically declined.

To help carry that burden, the hospital has formed a consortium of fire chiefs from 13 communities - Acton, Bedford, Boxborough, Carlisle, Concord, Lincoln, Littleton, Maynard, Stow, Sudbury, Wayland, Westford, and Weston - along with leaders from the hospital. The consortium will meet quarterly to discuss approaches to emergency medical care and ways to keep costs down - all with the goal of maintaining Emerson's 26-year-old ALS program.

"The first step in the short term is to look at how we can improve revenue and keep moving forward," said Bruce Trefry, Emerson's manager of ALS/EMS (emergency medical systems). Trefry said a subgroup of fire chiefs and hospital representatives are looking at the current system's structure and seeking ways to meet future community needs.

Kevin Whitney, Emerson's vice president of patient care services, said the challenge is that insurance reimbursement for ALS care is decreasing, which puts the financial burden on the hospitals. Typically, the town that provides the emergency transport receives the portion of the reimbursement deemed "basic life support" and the hospital is paid the ALS premium beyond that.

To provide more parity between the hospital and the local fire departments that provide emergency transport, one short-term solution that the consortium has come up with is having towns pay a flat fee for the ALS care of Medicare patients, but the longer-term goal is to ensure that taxpayers don't end up having to absorb an untenable financial burden for this service.

Trefry says there are compelling reasons to keep ALS teams active at Emerson.

"A significant call volume is necessary in order for our paramedics to stay proficient in their skills and assessments," he said.

As opposed to EMTs, who provide basic first aid and can administer oxygen, paramedics are qualified to place IVs, insert tubes to maintain open airways, and administer medications. Those who work out of Emerson receive 1,500 hours of training and meet monthly with an emergency department physician to review cases. Of the approximately 3,600 ambulance calls that Emerson receives per year, slightly over 50 percent require a paramedic response.

"There's a better quality of care if you have a small team covering a large area," because of the repetition, Trefry said.

Concord Fire Chief Kenneth Willette, a key participant in the consortium, says local fire departments need to be sure that they have the resources to make up for any shortfall caused by Emerson's wide reach.

"When I became Concord's fire chief in November of 2003, discussions were already underway about expanding the availability of ALS in this region," he said. "Emerson Hospital has one truck on call 24 hours a day and a second one 12 to 15 hours a day. Local fire chiefs reasonably question whether that is sufficient."

Still, Willette emphasizes that the very existence of the consortium represents progress.

"Five years ago, we weren't in a climate where we could discuss these concerns," he said recently. "The reality is that fire chiefs would like to be assured of greater ALS availability and Emerson Hospital would like to be assured of sustaining their revenue stream."

"One step we could decide on as a group, for example, is to elevate the training of emergency staff in the fire departments to an intermediate level, which would take some of the burden off the hospital's paramedic staff," he said. "Because we've formed this consortium, both sides are really listening to one another and paying attention to what our shared needs are."

The consortium faces a large task as it analyzes ways to reduce costs to towns, according to Whitney, but everyone involved agrees that it is a priority.

"Other hospitals have discontinued this service," he said. "But at Emerson, we believe it's an important part of our mission."

Nancy Shohet West can be reached at nancyswest@msn.com.