By Ron Leir
The Town of Harrison has a new tenant occupying its Cleveland Ave. firehouse.
Kearny Emergency Management Services (EMS) has vacated the space and, as of New Year’s Day, it’s been replaced by Monmouth- Ocean Hospital Service Corp. (MONOC) EMS, based in Wall Township.
Mayor Ray McDonough and the Harrison Town Council voted Dec. 19 to accept the bid submitted by MONOC to provide emergency medical service coverage – basic life support provided by EMTs – for Harrison and East Newark. MONOC says it will also provide medical 9-1-1 call intake, pre-arrival instructions and dispatching.
The town is paying nothing for the service and, in fact, will be collecting $1,500 a month rental fee from the new vendor for stationing of a MONOC ambulance at the Harrison firehouse and for sleeping quarters for MONOC staff, according to Town Attorney Paul Zarbetski.
Zarbetski said that the agreement with the new provider is for one year with a provision for possible two one-year extensions.
Zarbetski said that under the contract terms, MONOC will handle all billing with patients. The vendor will accept payments through third-party insurance firms, including Medicaid and Medicare, he said.
The town won’t be on the hook for any deficits that may be experienced by the vendor, he said.
On its website, MONOC describes itself as a nonprofit hospital cooperative with affiliated member hospitals around the state, including Clara Maass Medical Center, Belleville, which is part of the Barnabas Health network.
If MONOC’s ambulance is on the road responding to an emergency and another call is received by a dispatcher, then Harrison will deploy one or both of its two backup ambulances, as needed, Zarbetski said.
Zarbetski said MONOC was the only firm to submit a bid on Dec. 17, the date designated by the town for receiving proposals for emergency services. “Kearny didn’t bid, which was surprising,” he added.
It was also puzzling for Harrison Public Safety Director Harold Stahl, who said that during the past two and a half years that Kearny provided the services – responding to about 1,600 calls a year – “we were working well together.”
Kearny EMS, which operates independently of the Town of Kearny, has been an “interim provider” of the services since July 1, 2011, after Harrison – with prodding by the state Dept. of Community Affairs – opted to end a longstanding practice of having its Fire Department, whose members are trained as emergency first-responders, handle ambulance runs.
With a depleted fire personnel roster, Harrison officials felt the town – and neighboring East Newark – would be better served by delegating that service to another entity. At the time, DCA encouraged the town to solicit bids but, instead, the town elected to go with the Kearny squad on a trial basis. Kearny EMS operated from the Cleveland Ave. firehouse with a Harrison ambulance.
In mid-October last year, Kearny EMS President/CEO Harry McNeill wrote to Mc- Donough, serving notice that the squad would “terminate its services as interim EMS provider … effective Dec. 31,” pending Harrison bidding out the service, “… in which Kearny EMS may submit a bid for contract.”
But Kearny didn’t follow through, because, according to Kearny Mayor Alberto Santos, “it was not a cost effective service.”
Although the mayor couldn’t provide figures to back that up, he said the Kearny squad “did an analysis” of the operation and concluded the revenue from the Harrison enterprise wasn’t sufficient to cover costs.
Santos said that the squad did receive monthly compensation from Harrison to cover “labor costs” but nothing for administration overhead or for gaps in uncompensated insurance coverage. “Only about one-third of the patients the squad transported were insured,” he said.
“Acute care service is a very competitive industry these days,” Santos said. “With medical conglomerates swallowing up smaller hospitals and hospitals merging, with hospital stays tending to be shorter and more medical procedures being done in outpatient clinics, ambulances are being used to direct patient traffic to those hospitals they’re affiliated with and those ambulances will get subsidized by the receiving hospitals. The Kearny squad has no hospital affiliation agreements and, as required by state protocol, takes patients to the nearest appropriate [medical] facility.”
Without the assurance of a hospital subsidy, “it does not add up” for the squad, Santos said, “unless you make [the deficit] up elsewhere.”
So if an ambulance ends up taking an emergency case to an affiliated hospital, Santos added, “the question then arises, is that the best outcome for the patient?”
While its base is the Jersey Shore area, MONOC isn’t exactly a stranger to this area. In June 2011, the firm was contracted to provide EMS dispatch to Hudson County, meaning that its staff received 911 EMS calls from the county sheriff’s office and, in turn, relayed information to guide first responders – including paramedics, fire or police, if needed – to the correct location. And MONOC currently provides Advanced Life Support paramedic emergency service to the West Hudson region.
MONOC, founded in 1978 “to improve health care and reduce [hospital] members’ costs,” comprimises 15 acutecare New Jersey hospitals from Meridian Health System, Robert Wood Johnson Health Network and Barnabas Health System spread among five counties, the closest being Essex. Its website says MONOC “employs over 700 staff and operates a fleet of over 100 ambulances and works within a $61 million annual budget.”
Affiliated Essex hospitals listed by MONOC are: Clara Maass Medical Center in Belleville, Newark Beth Israel Medical Center, St. Michael’s Medical Center (now owned by the California-based forprofit chain Prime Healthcare Services) and St. Barnabas Medical Center in Livingston.
In 2004, then-Assemblyman James Holzapfel (R-Ocean) questioned MONOC’s billing practices after receiving complaints from Monmouth and Ocean county patients about allegedly excessive bills for paramedic service. Holzapfel couldn’t be reached during the holiday period to learn what, if anything, resulted from his inquiries.
More recently, while Kearny EMS was providing BLS services for Harrison/ East Newark, Santos said that MONOC would periodically send him letters asking that Kearny share insurance fees the squad received for providing BLS service in connection with ambulance calls to which MONOC also responded – a request that, Santos said, Kearny consistently rejected. He said the cooperative threatened to sue but never did.