Much has been written about Mayor Fulop controversial plan to contract with CarePoint/McCabe Ambulance as Jersey City’s new ambulance provider as well as the vote on the issue which has been delayed by Jersey City City Council until the end of the month. This move would alter the current status quo of Jersey City Medical Center maintaining its 130 year contractual arrangement with the city.
At the Heart of the Debate, a Money Trail
Ambulance carriers are simply a conduit to transport patients from point A to point B. Why this issue has ignited such a firestorm in Jersey City is not so much which ambulance service provides the best service (even though there’s dispute there as well), but more so which hospital ends up being the point B that actually admits those patients.
The request for proposals was posted by the city on Sept. 27, 2013. CarePoint/McCabe and JCMC both submitted bids. JCMC provided the ambulance service at no cost to the city from 1998 to 2007, but fiscal needs prompted them to charge the city approximately $4 million per year to subsidize their costs and allow them to make upgrades and modernize its fleet with new technology.
CarePoint/McCabe incentive to the city involves its willingness to reimburse the city about $2.6 million for use of the Fire Department as first responders.wholesale jerseys from china The bid specifications gave the bidder the option to pay the cost of the Fire Department or supply their own first responders. JCMC decided to provide its own at no cost to the city after January 1, 2014.
To Profit or Not to Profit, That the Question
In essence, this heated debate boils down to whether or not to award this contract to a for profit or not for profit health system.
Jersey City Medical Center holds a non profit hospital status, which is not required to pay local, state or federal income taxes. By law, it considered a charity providing certain community benefits in accordance with state and federal guidelines.
JCMC raises funds for medical improvements and enhancements through fund raising, government funding, subsidies and re investing its earnings back into the facility. CarePoint is a private investor owned hospital group that operates as a revenue producing enterprise. Yet the reports highlighted that most expensive hospital in America [was] not set amid the luxury townhouses of New York Upper East Side, but instead eleven miles south of Midtown Manhattan in Hudson County.
Comparisons were drawn in these reports. One example matched up the treatment for the respiratory aliment known as COPD, or chronic obstructive pulmonary disease costing $7,044 at New York Lincoln Medical Health Center, whereas a patient at the Bayonne facility faced a bill more than ten times the amount, or $99,690, for the exact same treatment.
More defined data on comparison costs across the board for most health procedures and surgeries can be found in a massive federal database of national health care costs made public as part of the Obama administration effort to make the health care system more affordable and transparent.
The database released by the Centers for Medicare and Medicaid Services lays out for the first time how much the vast majority of American hospitals charge for the 100 most common inpatient procedures billed to Medicare. More than a snapshot, the resulting spreadsheets highlight the varied fluctuation of pricing that appears extremely random versus being hinged to any set of standard guidelines.
charge masters are totally irrational, Robert Laszewski, former health insurance company executive/current consultant for health care companies, wrote in an email to The Huffington Post.
So how does changing an ambulance contract follow this money trail? Critics who are pro and con as to who should win this bid proposal point to the hospitals they serve.
Those who are CarePoint/McCabe supporters (and generally support shaking up the status quo, following Fulop lead) suggest that patients transported by JCMC did not have a choice of hospitals. They were either directed to the JC Medical Center or its parent organization, the Barnabas Health Center in West Orange. And the reverse has been said of those opposing this plan that is they believe patients will be transferred to one of CarePoint three hospitals in either Bayonne, JC or Hoboken if CarePoint/McCabe secures the bid.
Jersey city resident Dan Levin who served one month on Fulop transition committee back in June, 2013 is not a proponent of the mayor plan. am all for putting contracts out to bid, but in this situation it does not look like it is apples to apples and the RFP does not appear to ask for proposals that match the EMS service that is currently in place in Jersey City. Also, the process has not been open and transparent looking like a deal, even announced to the public and going on the council agenda before any type of outreach or discussion in a public venue. Roots Growing for JCMC
Outreach in the community is supportive of maintaining the status quo. Kuzas is a concerned Jersey City citizen who has motivated a team of forty volunteers to spread the word at the grass roots level. Described on their website as with JCMC, CarePoint, McCabe or Jersey City government, the group believes its crucial to the EMS with JCMC. admits the issue is and react differently, dependent on their affiliation and personal connection to the issue. In her case, she is a advocate because (she) has a son with a chronic illness and personally had to navigate through the health care system. However, her group is purely volunteer driven, where she has personally paid for the website and invested her time to further the cause, on a gratis basis.
Responding to questions about the $4 million annual subsidy that has benefitted JCMC, which may be the one obstacle to sway the Council’s vote in CarePoint/McCabe favor, Kuzas explains that the subsidy from the city was contractually only for four years, terminating at the end of 2013. never got a subsidy before that, and isn getting a subsidy as of January 1. then councilman Fulop and the city gave the contract to JCMC four years ago, JCMC was the only company that offered to do it all, but only if the city could offset some of the costs because they were losing so much money back then, notes Kuzas. Mickey McCabe response declined to attend by letter [addressed to community advocate Joanna Arcieri] stating: we greatly appreciate your invitation, we must decline (as) we have been participating in the process outlined by the city government. . . and we look forward to the Council upcoming full public meeting at which we will happily answer all questions, said McCabe.
In fairness to CarePoint and McCabe to provide them the opportunity to include their side of the story in this post, several email requests for interviews with the principals were sent over a five day period.http://www.big49erssanfrancisco.com As of this writing, we have not received any type of response to provide feedback of any sort.
While neither CarePoint nor McCabe have contributed directly to Fulop run for mayor, some critics question if the current administration is overstepping the city pay for play regulations. Senator Robert Torricelli (D), who serves as a lobbyist for CarePoint.
Torricelli, who was instrumental in helping the purchase of the CarePoint Hospitals, donated $5,000 to Fulop, and $2,500 to the Fulop team.
While the city government has chosen not to add this contractual item to Council January 15th agenda, based on their need for a legal review, the next opportunity for a hearing would be January 29. However, there are still a lot of unanswered questions to be addressed from both sides. Issues pertaining to response time, the cost of first responders, the necessity for first responders, the number of ambulances required to handle the demand in Jersey City, predatory billing and the actual ambulance costs for the uninsured are just a few that need to be brought into the equation.
The Congressional Budget Office (CBO) found that «on average, nonprofit hospitals provided higher levels of uncompensated care than did otherwise similar for profit hospitals. However, on average, nonprofit hospitals were found to operate in areas with higher average incomes, lower poverty rates, and lower rates of un insurance (sic) than for profit hospitals.»
Nonetheless, following the money trail in Hudson County might just set the precedent for decisions made on the national level. What done here and now by the power brokers and citizenry in this state may just be the determining factors as to whether non profits or for profit heath facilities become the leading business model to be emulated for healthcare facilities in the future.