Greenville EMS proposal raises hackles

07/31/2014 8:34 PM

07/31/2014 8:40 PM

A proposal that could turn Greenville County EMS over to Greenville Health System has drawn sharp criticism from Bon Secours St. Francis Health System, which says the arrangement would unfairly favor one of the county’s two hospitals over the other.

St. Francis CEO Mark Nantz told The Greenville News that he heard that a deal is imminent. But County Councilman Butch Kirven said he isn’t aware of any deal in the making.

Greenville County announced a year ago that it was looking for ways to restructure its Emergency Medical Services department, including possibly letting another entity, like GHS, run it.

At the time, County Administrator Joe Kernell said the 202-person department needed $15.5 million a year to operate, about $4 million a year more than it collects in fees. But the county hadn’t begun formal discussions with any entity yet, he said.

A study by Washko & Associates for the county looked at five possible new models for delivering EMS, including privatizing the service, a public/private partnership, and a public utility model where a quasi-governmental organization is developed to oversee and run the system. Such a shift has the potential to improve service and reduce costs, the study concluded.

Nantz said that about three weeks ago St. Francis heard the county was getting close to a deal for GHS to assume control of EMS.

Kirven said he doesn’t know of any deal being close.

Kernell couldn’t be reached for comment Thursday. But County Council Chairman Bob Taylor said that while the matter has been discussed, a decision hasn’t been reached about what to do.

“There has been a study done of different models,” he said. “But no decision has been made at this time.”

Kirven said the review of EMS is continuing.

“The goal is to explore potential changes that could dramatically improve EMS for citizens as well as provide significant cost savings to the county,” Kirven said. “And if we can find a way to do that, it’s something we ought to consider doing.”

Under the current system, EMTs generally ask patients which hospital they want to go to, except in certain circumstances, like serious traumas, when they would be taken to GHS.

Nantz said he is concerned that if EMS workers become employees of GHS, they would be more likely to take patients to the hospital that provides their paychecks.

Nearly 17 percent of St. Francis’ admissions come through the ER, he said, and a reduction could impact the hospital’s bottom line. The choice of health care provider also could be limited under the arrangement, he said.

“Once people become employed with another organization, that objectivity, that choice, has a significant chance of being impaired,” he said.

GHS issued a statement saying that what’s important is innovative approaches that benefit the community.

“It’s not about competition between hospitals — it is about how to provide the best emergency services for all patients regardless of where they receive their care,” said Dr. Angelo Sinopoli, chief medical officer.

“Greenville Health System has been working with community partners like EMS for years and has provided medical management for EMS for more than 30 years.”

Taylor said the EMS staff wouldn’t necessarily be employees of GHS. That’s just one model, he said. It’s possible that the county would retain the employees and devise an agreement whereby GHS could use them, he said.

In any case, a patient’s choice of hospital is “something that would be built into any agreement,” he said.

Kirven said he can understand Nantz’s concern, but that’s not the intent at all.

“We want to do as EMS does now, go where the patient wants,” he said. “The various entities have their own interests they’re looking after. Greenville County is looking after interests of the citizens.”

Nantz also criticized the process, saying that discussions have been conducted “in the cover of darkness and without transparency.”

“We don’t feel our voice has been heard or that the needs of the St. Francis organization and its patients are being considered at all in this,” he said.

Kirven and Taylor said the discussion has included both GHS and St. Francis. Nantz said that’s only been at St. Francis’ insistence. But Kirven said council members and Kernell would be happy to meet with anyone who has an interest in the situation.

Nantz also said the issue should be discussed in public, with input from residents and stakeholders.

“It’s a public service and one we expect to be independent and objective, and that honors patient choice and is not locked into one hospital or another,” he said.

“It’s too important for this to be a contract that comes up signed before the public knows what’s going on with it.”

Taylor said there is nothing to put before the public yet.

“Right now, we just had somebody do a study of the options and we’ve had some discussions,” he said. “There’s really nothing to talk about yet.”

But Nantz said that from St. Francis’ perspective, the study appears to outline how EMS can be taken over by GHS.

Kirven said that was one recommendation by the consultant.

“We ought to put out some of the results of the consultant’s study ... so people can see there is nothing secret going on here,” he said.

But Nantz said that if the county wants to get out of the EMS business, all the stakeholders should work together and equally share the burden.

“We offered to come in to create an organization with the county and GHS where we would all work together ... And really, they patted us on our head and told us to go away,” he said.

“It’s patient choice, independence and the lifeblood of our organization that we feel is at risk. As one of the county’s largest employers, we don’t feel this is the way we should be treated.”

Kirven and Taylor said there is no timeline on making a decision.

“The county is being very deliberate in addressing all the concerns of the stakeholders and that will be considered prior to any decision being made,” Kirven said. “But we haven’t finished the review of it. No decisions have been made on anything at this point.”

“We are not going to go out on a limb and do something without council having approved it,” Taylor said.

Kirven said that at some point a decision will be made and that his goal is “for it to be a decision that’s mutually beneficial and agreeable with everyone involved.”

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