Squads will take patients to closest hospital

By Gracie Hart
Review Staff Writer
Published: November 20, 2008

Where the ambulance takes you in the case of a non-serious, non-life threatening emergency may no longer be up to you.  Local emergency medical service staff and volunteers used to allow citizens to choose which hospital they were transported to.  Last week, the board of supervisors voted to begin taking patients to the geographically closest facility in non-life threatening cases.
Previously, patients could choose between any of the four hospitals that the rescue units transport to including: The University of Virginia Medical Center, Martha Jefferson Hospital, Culpeper Regional Hospital and Mary Washington Hospital. 
“[In the past] we’ve transported people to the hospital of their choice for various reasons in the spirit of community service,“ Director of Fire & EMS Jamie Clark said.  “It is not always the closest facility.“
According to Clark, Medicare states that, for billing purposes, patients should be taken to the nearest appropriate hospital.  Appropriateness is determined by the medical need.  In some cases, acute conditions dictate the facility EMS personnel recommend.
“People with heart attacks, strokes, burns, trauma and ill pediatrics would be taken to the hospitals that have those specialties,“ Clark said.  “You’re talking people who break ankles, etc-non- life threatening emergencies.“
According to Clark, the issue of where people are transported is a sensitive one.
“It’s a very touchy issue,“ he said.  “Lots of people have strong feelings about what facility they’ll go to.“
He said that there is a draw on the system because of this and the department moves units around within the county to accommodate the requests.  Not traveling long distances could save on fuel costs and the wear and tear on the vehicles.
“Each time we transport to UVA, we are taking [a unit] out of the county in the far end,“ District 5 Supervisor Lee Frame said.  “It should be a medical decision where people should go.  We are trying to be responsive to the citizens throughout the county and give the ambulance people the cover to say ‘I know you want to go to UVA but this sprained ankle can be taken care of in Culpeper.‘ “
Currently, EMS charges patients’ insurance a transport fee based on the distance that they are transported which, while medically appropriate and legal, does not cover the total cost of the transport.
“Last year, we received 65 percent back from insurance for transport,“ Clark said.
Because Medicare suggests taking the patients to the closest geographical location, doing so may cause the EMS department to receive more money back from insurance companies. 
“Out of 2,800 transports a year, there is a 60:40 ratio of people being transported to Charlottesville, instead of the closest hospital,“ Clark said.  “Out of the 50-60 percent that go to Charlottesville, 25 percent of them could go elsewhere.“
Chairman Mark Johnson brought up the question about where to transport a person who has a chronic problem with records at one hospital but who calls for medical transport regarding a non-related problem.  He also questioned whether a person would refuse medical transport if their preference of hospital was denied.
“[The County of Orange Fire and EMS operational medical] director understands for someone that is really hurting there is a psychiatric reason to take them where they are going to be most comfortable,“ Frame said.
Clark agreed, saying: “The director is conservative.  My feeling is that he wouldn’t deny people transport because of hospital preference.“
The board voted 5-0 to allow the operational medical director to form a policy which would have the department of fire & EMS transport patients to the geographically closest facility that is clinically appropriate based on the EMS provider’s assessment of the patient.