Ambulances, Politics, and Money

What defines a best-in-class ambulance and EMT service?  The Journal of Emergency Medical Services (JEMS) has an answer: the Jersey City Medical Center (JCMC).   What is the most expensive hospital in the United States?  The NY Times has an answer: Bayonne Medical Center, owned by CarePoint Health.   So…why is Jersey City looking to sever its EMS contract with JCMC and instead do business with CarePoint Health / McCabe Ambulance?

Let’s get civic and break this down.  First, let’s look at the players involved:

  • Journal of Emergency Medical Services (JEMS). An independent journal that reports on EMS systems nationwide and a source for verifiable, objective information about JCMC and McCabe Ambulance.
  • Jersey City Medical Center (JCMC): Hospital on Grand Street in Jersey City that spun off from the city in 1988 to become a standalone non-profit.  Works with a fleet of 40 ambulances & support vehicles. JEMS reported in 2012 that JCMC logged 91,336 annual responses and 43,155 annual transports.
  • CarePoint Health. Formerly known as “Hudson Holdco” and current owner of Bayonne Medical Center, Hoboken University Medical Center, and Christ Hospital in Jersey City.  Aspiring to become a statewide player in the healthcare market according to the Jersey Journal.
  • Bayonne Hospital. The most expensive hospital in the United States, per the NY Times. Owned by CarePoint Health.
  • McCabe Ambulance: Private ambulance provider located in Bayonne.  Responds to an average of 10,000 emergency calls a year within Bayonne and 22,000 calls a year in greater Hudson County.

Background on JCMC

From its inception as a non-profit in 1988 until 2006, the JCMC entered into a series of 3-year EMS contracts with Jersey City at no cost to the city. But by 2006, both the JCMC and its EMS service were operating at a deficit. From 2006 through 2012 – a period spanning two 3-year contracts – the JCMC received multi-million dollar subsidies from the city.  During this same time period, the JCMC underwent a remarkable transformation; JEMS characterized it as “the epitome of an American success story…they [JCMC] addressed every adversity, whether external or internal, redesigned their entire EMS system and became nationally recognized in five major specialty areas, the first in the nation to achieve all five in just three short years.”  By 2012, the JCMC was no longer operating at a deficit and JEMS cited the following accolades attributed to JCMC:

  • 100 best places to work in healthcare, ranked nationally by Modern Healthcare Magazine
  • State-designated regional trauma center
  • Recognized by the American College of Surgeons for “Excellence in Trauma”
  • CHF Bronze Award from American Heart & Stroke Association
  • State-designated regional neonatal intensive care center for diagnosis/treatment of critically ill newborns

In November 2013, the JCMC submitted its bid for a new 3-year contract, with the subsidies now removed; it was reverting back to its no-cost arrangement with the city.  But this time around, the city decided to go with another provider: CarePoint Health and McCabe Ambulance.

Background on CarePoint Health & McCabe Ambulance

CarePoint Health owns Bayonne Medical Center, which was cited in the NY Times in May 2013 as the most expensive hospital in the United States.  As the NY Times details, Bayonne Medical Center was founded in 1888 but by 2007 was losing nearly $1.5 million per month, whereupon it filed for bankruptcy.  It was then acquired in 2008 by “a consortium of buyers” that included Vivek Garipalli, formerly of the private equity giant Blackstone Group.  By 2011, Bayonne Medical Center was operating at a profit.  The profits, according to the NY Times, were due to the following changes in strategy:

  • Converting Bayonne Medical from a nonprofit to a for-profit hospital
  • Severing existing contracts with large private insurers to make Bayonne Medical an out-of-network hospital for most insurance plans.
  • Related to bullet #2 above, the NY Times explained how Bayonne Medical gamed NJ law to maximize profits, stating that (bold added for emphasis): “Under NJ law, patients treated in a hospital emergency room outside their provider’s network have to pay out of pocket only what they would have paid if the hospital was in the network. But an out-of-network hospital can bill the patient’s insurer at essentially whatever rate it cares to set. While the insurers can negotiate with the hospital, they generally end up paying more than they would have under a contractual agreement.”

The NY Times article further stated that Bayonne Medical Center offered no greater quality of care to accompany the higher costs, and that, “in a 2011 state hospital quality report, Bayonne Medical scored only in the top 50 percent.”

McCabe Ambulance is an independent, “for-hire” ambulance service in Bayonne, per JEMS. There was not a lot written about the company itself in JEMS; more was written about the owner and director, Mickey McCabe, and his personal accomplishments in the field of EMS.

So…Why Switch EMS Providers?

According to the Jersey Journal, the city’s reasoning for switching providers is “JCMC has been charging the city $3.8 million annually for ambulance service over the last three years. But CarePoint/McCabe offered to pay the city for the contract.”

A vendor paying the city for a contract?

Let’s Get Civic

Upon learning all of this, I came up with some basic questions that I think need to be answered before this new EMS contract is voted upon by the City Council:

  1. Why does the city want to walk away from the JCMC after it has undergone such a remarkable transformation as detailed in JEMS?  If it is now best in class, why sever ties?
  2. Why does the city want to contract with a healthcare conglomerate that operates the most expensive hospital in the nation, and is characterized in the NY Times as gaming NJ insurance law to hype profits?
  3. How is it good for Jersey City residents to switch from JCMC, which currently logs 91,336 annual responses and 43,155 annual transports, to McCabe Ambulance, which currently responds to 10,000 calls per year? How will McCabe Ambulance adjust up to this new level of demand?
  4. Why is CarePoint Health offering to pay Jersey City $2.6 million for the rights to this 3-year EMS contract?  If the short-term gain to the city is $2.6 million, what is the long-term gain to CarePoint Health / McCabe Ambulance?  And if there is a long-term gain to CarePoint, what is the long-term cost to Jersey City?
  5. CarePoint Health is on record in the NY Times of severing contracts with insurers to hype out-of-network related profits.  Will CarePoint Health exercise the same type of strategy if and when it takes over the EMS contract in Jersey City?

I believe the public needs to understand these issues before this Wednesday, December 18, 2013 because on that date, the City Council will vote this new 3-year contract into existence.

Call to Action:

  1. Email your city council representatives (contact info below) and ask if they support the city’s decision to switch EMS providers from JCMC to CarePoint Health / McCabe Ambulance.  If they do support the city’s decision to switch, ask them what the rationale is.
  2. If you believe the JCMC should continue to be the EMS service provider for Jersey City, sign the petition here to support the renewal of the JCMC contract.
  3. Attend the next City Council meeting at City Hall on Wednesday, December 18th at 6:00pm. The City Council will vote on the EMS contract during this meeting and you will have an opportunity to address the City Council with your concerns.

Contact information for city officials:

  • Mayor Fulop: info@stevenfulop.com, (201) 547-5200
  • At-Large Councilman Rolando Lavarro: RLavarro@jcnj.org, (201) 547-5268
  • At-Large Councilman Daniel Rivera: DRivera@jcnj.org, (201) 547-5319
  • At-Large Councilwoman Joyce Watterman: jwatterman@jcnj.org, (201) 547-5134
  • Ward “A” Councilman Frank Gajewski: FGajewski@jcnj.org, (201) 547-5098
  • Ward “B” Councilman Khemraj “Chico” Ramchal: KRamchal@jcnj.org, (201) 547-5315
  • Ward “C” Councilman Rich Boggiano: RBoggiano@jcnj.org, (201) 547-5159
  • Ward “D” Councilman Michael Yun: MYun@jcnj.org, (201) 547-5485
  • Ward “E” Councilwoman Candice Osborne: COsborne@jcnj.org, (201) 547-5315
  • Ward “F” Councilwoman Diane Coleman:  DColeman@jcnj.org, (201) 547-5338
  • Council Secretary Pam Andes: PAndes@jcnj.org, (201) 547-5053
  • Council Clerk Desire Marte: MarteD@jcnj.org, (201) 547-5204
  • Council Clerk Jasmin Gonzalez: JGonzalez@jcnj.org, (201) 547-5204

Revised December 17th to include:
McCabe Ambulance responds to 22,000 calls a year in greater Hudson County (which includes 10,000 calls within Bayonne)

6 Comments

  1. McCabe Ambulance posted this on their Facebook page today: “The City of Jersey City has notified McCabe Ambulance that on January 1, 2014, we will become the 9-1-1 EMS agency for the City.” So I just emailed Candice Osborne and the at-large council members to why the city would have notified McCabe if the City Council had yet to vote on the contract.

  2. Thank you very much for breaking everything down so clearly. I am very concerned about what is going to happen on Wednesday vote. I emailed my council woman Candice Osborne, and so far, dead silence. I hope she does right by her Ward on Wednesday.

  3. Ok, so JCMC got 3.8 mil for the last 3 years and put it back into the service as far as state of the art life saving equipment and response vehicles, making them an acclaimed emergency response service, one of the best in the nation, as judged by an independent source. Now they go back to zero pay. But you dump them now? That makes no sense. You now lose all that equipment and advantage to a START UP, who doesn’t even have enough ambulances or staff in place 2 weeks prior? Wow, BIG MISTAKE

  4. I know someone who personally works as an EMT down there. Why fix something if it is not necessary? After everything that was noted above it does not seem like there needs to be a switch and everything seems to be running smoothly now. After knowing many EMTs personally they run on a routine that they each know based upon their town/squad. It does not seem logical to change that and all their procedures.

  5. Maybe they should fix the attitude problem inside that hospital instead of mucking with pre-hospital care. Something must be mighty interesting in the sky because that (many, not all) staff always has their noses facing up. Personally, I think a course in chairside/bedside manner would be something this citizen of JC would be willing to pay into. I’d much rather deal with the ambulance crews than the staff in there. I do agree, I would like to have the EMTs/company that are used to handling such volume but I’m sure there is a lot more to this that we are being told (if any).

  6. Pingback: Post from Civic Parent BLOG | SAVE OUR EMS

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