December 19, 2014

Elyria
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City to LifeCare: Show us lots of your paperwork

ELYRIA — City officials want LifeCare Ambulance Inc. to provide them with paperwork — and a lot of it.
City officials, in their continuing quest to run a fine-tooth comb through the 17-year-old emergency medical services contract with LifeCare, have asked the private company to submit more information to them than does any other city that works with LifeCare.
Bruce Shade, the assistant safety service director in charge of public safety, is requesting documentation on every advanced life support call LifeCare responds to in Elyria going forward as well as in the previous six months.
“The intent is not to ask LifeCare to spend a lot of time generating reports,” Shade said. “They’ve got a very sophisticated system where they can extract data into a simple report. I don’t think it will be very hard.”
LifeCare President Pete de la Porte said he received the request in writing Friday, and while he will comply, he also knows it will be additional work.
“We will give them whatever they request and will answer all of their questions as much as we can, but this will no doubt be a lot of additional work for us,” he said. “We absolutely have that information in house, but it will add a lot of work to what we already do.”
LifeCare answers not just calls in Elyria, but also Lorain, Amherst, South Amherst and Carlisle Township. Elyria averages 400 calls a month.
The information the city is requesting includes the date, time, address and nature of every advanced emergency the company responds to; the time for when the call was received; ambulance dispatched; ambulance arrival on scene and arrival at the hospital; what work paramedics provided; and what fees were charged to the medical insurance provider and/or patient.
Shade said the request is about accountability.
In EMS contracts across the country, a slew of accountability and assessment provisions are spelled out, but in Elyria’s contract that dates back to 1996, there are few. Elyria can ask to see paramedic certifications to ensure trained help goes into neighborhoods, analyze response times to make sure help comes within a reasonable time and scrutinize what fees LifeCare charges Elyria residents and their insurance companies.
“I tried to make sure the items asked for were within the body of the contract and we have a reasonable right to ask for them,” Shade said.
Mayor Holly Brinda defended the information request as an intricate part of the contract review process the city has to take because the agreement with LifeCare has not been updated since it was signed.
“Absolutely this is part of the review process, and we are more than hopeful LifeCare will respond to our information request because we have not made a decision on what will happen going forward,” she said. “We are reviewing the contract and opening up dialogue with the company, but until all information is received I can’t say what will happen in the future.”
Brinda said it will be her, not Council, who will determine the next step, which could include keeping LifeCare with an updated contract or issuing a public request for proposals that opens the process to both LifeCare and other ambulance companies and getting the best deal for the city in a more competitive process.
Brinda said a third scenario also could come into play now that University Hospitals is taking steps to take over EMH Healthcare. With different protocols employed by UH, which will likely come into place, the integration of the two hospitals could be a game changer the city can’t anticipate right now, she said.
That development likely would become more apparent by the end of the year.
Beyond de la Porte, others also are questioning this latest request for information, which comes on the heels of Council unanimously passing a resolution calling for a Brinda to back off LifeCare.
“It is apparent she continues to press forward despite Council’s resolution for her to stop,” said Councilman Vic Stewart, D-at large. “We all said we support reviewing the contract, but this level of scrutiny appears to just be in response to Council’s commitment to LifeCare and comments that have been made public by both sides.”
Councilman Mark Craig,
I-4th Ward, also has been outspoken, urging the Brinda administration to step away from efforts that could be seen as trying to squeeze LifeCare out of Elyria in favor of letting the Fire Department take over.
“I think it’s an attempt to create an onerous burden and make it difficult for LifeCare to do business in the city,” he said. “We are not even talking about a periodic review, but so much work we will have one employee — Mr. Shade — pretty much devoting all of this time to reviewing paperwork from a private company.”
Craig said he wonders when Shade will have time to form the Ambulance Review Board, which is stipulated in the contract but hasn’t been used.
“The one thing the city is supposed to do, it hasn’t done and instead we have someone investigating this issue that should not be an issue,” he said. “We have a resource worth $77,000 — because that is what we are paying Mr. Shade — that is wasting time researching a company that provides an exemplary service when there are so many other things the city should be focused on. Economic development comes to mind for me.”
Shade said the request will not be too much work for him, and LifeCare is not a target, he said.
“We have a private company we have a vendor contract with and basically what they do and how they do it should be available to the view of the public,” he said. “We are also looking at all first-responder calls — response times and quality of care. It’s not that we are just looking at LifeCare. The Fire Department is the other side of this and we want to make sure we are being as efficient as possible and our resources are being used wisely.
“Really the goal is how we can make the service better for patients,” Shade said.
A similar request for information was made to Fire Chief Richard Benton, Shade said.
“I don’t suspect we will spend a lot of time on this every month,” he said. “Identifying those anomalies that fall outside the terms of the agreement will be easy to spot. My expectation based on what I have seen so far is those anomalies are not going to be too often.”
Still, Shade said there are areas he has to look over based on provisions in the contract. First, if LifeCare transports a patient and charges them for advanced life support at $738 a run versus $383 a run, there needs to be documentation to support the higher level of care.
“The benchmark there is theoretically a company or community could provide advanced life support merely for the purpose of charging at the hiring rate,” Shade said.
Second, Shade said a provision in the contract stipulates a 10-minute or shorter response time. Beyond that, LifeCare cannot charge patients or their insurance company for the run.
“Naturally, that was probably put in the contract to assure the public they would have reasonable response times,” Shade said. “When we are talking about critical cases like cardiac arrest, response times need to be within the 4- to 6-minute window if you want a good patient outcome.”
De la Porte said he welcomes the scrutiny if it means concerns will be put to rest.
“At the end of the day, we do a real good job for the city. We have 6-minute response times and we comply fully with the contract,” he said.
Contact Lisa Roberson at 329-7121 or lroberson@chroniclet.com.