After a lawsuit settlement with McCabe Ambulance Service, Inc. was approved by the Jersey City Council last week, a “grid protocol” has been implemented that could send residents to one of three different hospitals.
By John Heinis/Hudson County View
In a 16-page lawsuit filed in Hudson County Superior Court on December 8, 2014, McCabe, an affiliate of CarePoint Health Systems, alleged that the City of Jersey City improperly awarded a Basic Life Support Emergency Ambulance Services (BLS EMS) contract to the Jersey City Medical Center.
The suit claims that in December 2013, the city’s request for proposals (RFP) committee recommended that the contract be awarded to CarePoint. However, the proposal was allegedly pulled for “legal reasons” and sent to the Office of the Inspector General for review.
Rather than waiting for the review to be complete, the city rejected all bids and started the process over in June 2014.
The Jersey City Medical Center was ultimately awarded the BLS EMS contract in a unanimous vote of the council in November 2014.
“We’re the only triple E accredited EMS service in Hudson County, we’ve been providing this service for over 100 years … we really wanted to demonstrate to this community that we deserve this contract,” Jersey City Medical Center-Barnabas Health CEO Joe Scott told us moments after the vote.
“And I think the evaluation committee, actually on every single indicator, voted us higher than the competitor.”
Then-CarePoint Health Services CEO Dennis Scott said at the time he expected the vote to go the way it did and accused the JCMC of planting false information.
“Regarding some of the things we heard tonight, they were just blatantly false and I’m sure they came from our competitor, planted that information. For example, if you’re in network with us and visit one of our facilities, you don’t get balance billed,” he stated.
“The charges are irrelevant. The bottom line is the one thing they point to is our charges and the reality is Medicare sets our payment schedule that we actually get. And if you look at the State of New Jersey, all of our hospitals, throughout the state, the average revenue for each admission coming into the hospital is $12,230.”
In recent years, CarePoint has come under funding for exorbitant billing costs, at least part of the reason why state lawmakers are planning to crack down on out-of-network medical bills (h/t NJ Advance Media).
The lawsuit also says that the city passed on being reimbursed $2,663,245.91 from McCabe, further claiming that the Jersey City RFP evaluation committee suddenly decided to use 10 separate evaluation criteria, as opposed to the standard six-point criteria that had always been used prior.
Furthermore, the results of the review from the Office of the Inspector General were never released. A Jersey City spokeswoman did not return an email seeking comment on the OIG’s report.
Jersey City Council Vote
At the July 20 meeting of the Jersey City Council, a settlement agreement between the city and McCabe, CarePoint and JCMC was approved by a vote of 5-1(2), with Ward C Council Rich Boggiano voting no and Ward E Councilwoman Candice Osborne and Councilman-at-Large Daniel Rivera abstaining.
Councilwoman-at-Large Joyce Watterman was absent.
“If you call for an ambulance, I’d rather have the [Jersey City] Medical Center respond than CarePoint. There’s so much politics going on with CarePoint right now it’s ridiculous … what I think is going to happen here is there’s going to be a lot of lawsuits down the road,” Boggiano said over the phone this morning.
“Politics rears its ugly head everywhere in this city. I wish Christ Hospital was Christ Hospital again because that was a great facility.”
The 2014 EMS contract vote has come under fire in the aftermath of CarePoint Health Co-Founder Vivek Garipalli being revealed as the mystery $1 million donor to a super PAC linked to Jersey City Mayor Steven Fulop’s expected gubernatorial run next year.
In December 2013, Fulop advocated giving the EMS contract to McCabe, but the council ultimately selected the JCMC.
Back to last Wednesday’s approved resolution, which says “the main purpose of McCabe’s lawsuit was to gain clarity as to which hospital would be the closest to any given BLS transport,” a “grid system” has been implemented “to identify the closest public facility for medical transports.”
It is also important to note that the City of Jersey City and the JCMS “deny the allegations in the lawsuit, and deny that they or any of their subsidiaries, agents, or successors are liable for any claims raised in the lawsuit.”
Provisions of the New Grid Protocol
“All three medical facilities designated in the Grid Protocol currently possess the specialties to treat patients with symptoms of stroke or myocardial infarction,” the resolution says.
“If any of those facilities should subsequently lose the specialty to treat such symptom(s), then transports to that facility for such symptom(s) will be an exception to the grid protocol.”
A city spokeswoman did not respond to an inquiry this morning asking for an explanation of the grid.
However, multiple sources, who spoke under the condition of anonymity, said that incidents that occur in the blue area will be taken to Christ Hospital in Jersey City, patients picked up in the purple area will be taken to JCMC – Barnabas Health and the green area relates to incidents reserved for the Bayonne Medical Center.
Both Christ Hospital and the Bayonne Medical Center are owned by CarePoint Health and the yellow and orange areas, according to sources, indicate areas of overlap where an on the spot judgment call would have to be made.
The grid protocol also says that JCMC EMS personnel cannot influence a patient’s decision on which facility they’d like to be taken to. This is an exception to the grid protocol, as are cases involving a physician directive or sexual assault.
The initial six months will serve as a trial period, where the overlap areas can be redesigned. During this same time frame, an independent auditor will randomly select two times to audit the JCMC’s EMS transports.
The independent auditor will also provide “HIPPA-compliant quarterly reports to the city.”
Additionally, if patient drop-offs decrease by at least 10 percent at Christ Hospital in any six-month period during the first year the grid protocol is in effect, McCabe can choose to have JCMC terminate the grid protocol.
JCMC will also provide monthly reports regarding emergency patient transportation. Should they violate, and then fail to correct, any terms of the contract, their EMS contract with Jersey City can be terminated.
Mark Rabson, a spokesman for the JCMC, declined comment on the new grid protocol, citing a confidentiality agreement contained in the lawsuit settlement.