Paramedics seek ability to transport patients

Emergency responders say they are caught in a financial crunch


Staff Writer

 "I don't want anyone to suffer when minutes count in an emergency. We can all work together as a community. We want to keep paramedic units up and running."  - Sen. Ellen Karcher “I don’t want anyone to suffer when minutes count in an emergency. We can all work together as a community. We want to keep paramedic units up and running.” – Sen. Ellen Karcher Residents in the area may soon feel the impact of an emergency response crisis affecting Mobile Intensive Care Units (MICU) in the state.

MICU operations have long been strained by Medicare billing regulations and outdated state laws, according to Vince Robbins, president and CEO of the Monmouth Ocean Hospital Services Corporation (MONOC), and it is beginning to take its toll.

“Over the past few years, MICU operations have sustained heavy financial losses as a result of these regulations and we are left with no choice other than to reduce services or begin billing Medicare recipients directly,” Robbins said.

Closing some units completely and severely limiting the operations of others is currently on the horizon for MONOC, which provides paramedic services in support of local first aid squads. A MICU based in Marlboro is one of four locations that are affected at the present time, according to David de Simone, an attorney and vice president of administration for MONOC.

Units in Marlboro, Lacey Township and Belleville will all be taken out of service. The MICU in Kearny will only offer limited service, according to MONOC.

What does this mean for area residents?

The impact of this situation may mean nothing or it may mean everything if an individual is the person calling for an emergency unit to respond for himself or for a loved one.

Until now, the process has always been that if a person calls a first aid squad, the Emergency Medical Technician (EMT) who responds is responsible for providing the patient with first aid treatment and transporting that individual to a hospital if necessary.

EMTs are trained in Basic Life Support (BLS). This training includes first aid and cardiopulmonary resuscitation, among many other things.

But EMTs are not licensed to give medication, intravenous therapy or any other invasive treatment. When a call comes into a first aid squad that involves certain acute illnesses, conditions or injuries, first-aiders trained in BLS will defer the responsibility of the care of the patient to an MICU worker or paramedic who is trained in advanced life support treatment. When medical emergencies are of a nature that involve cardiac problems, breathing problems, serious injuries and excessive bleeding – anything that may require a more advanced level of medical training – MONOC is called to respond.

For years now, paramedics who have received advanced lifesaving training have worked side by side with volunteer first-aiders. According to a new Web site,, “To preserve the valuable role of volunteer municipal services, regulations were imposed by the New Jersey Department of Health and Senior Services to allow only basic ambulance services, which were mostly volunteer at the time, to transport a patient.”

This was done in 1996, according to de Simone.

However, in recent years volunteer first aid squads in some communities have given way to paid ambulance companies. Under Medicare’s single billing rule, only one entity, the transporting unit, can receive payment for a single incident. The cost of this shift has fallen squarely upon the paramedics, according to the Web site.

According to de Simone, Medicare patients make up a significant number of the emergency response calls for MONOC. This means if MONOC interfaces with local first aid units, Medicare will pay only one entity and since the program favors the unit that transports the patient, the first aid squad will be the entity to get paid.

According to de Simone, the standard emergency fee is currently $400. MONOC receives that $400 check and sends $335 of it to the first aid squad. MONOC can only claim $65 of it, he said.

The lowering of the standard fee for a MONOC response from $800 to $400 has already changed the financial face of the agency. Taking away much of that fee is only making matters worse, according to de Simone.

Add to that reduction the fact there are more municipalities being forced to employ a paid first aid squad due to a decline in first aid squad volunteers and there is what some people are calling a crisis beginning to show itself.

So where does this leave residents who count on the fact that in an emergency some trained professionals will not be very far away? Maybe in a serious situation.

When medical emergencies arrive, they usually come with a time frame

According to, paramedic providers are unable to make ends meet under current regulations. Their ability to continue rendering service in New Jersey is threatened, compromising the lives and well-being of people in need.

According to the Web site, “the lives of families, friends and neighbors are at risk.” The site claims residents in some areas of New Jersey are already unable to receive paramedic services and states that the availability of these services will continue to decline unless immediate action is taken.

One concern being expressed by emergency care providers is that seniors living on a fixed income worry about unexpected expenses and will be less likely to dial 911 for help if they are afraid of being billed for paramedic services.

The solution, according to de Simone, is four-fold and involves the following:

• Urging representatives in Trenton to support legislation which would allow lifesaving providers to transport Medicare patients directly to a hospital, eliminating costly existing arrangements.

• Supporting local volunteer squads which work productively with paramedics.

• Supporting the creation of a fund to fairly compensate paramedic units.

• Advocating for changes to Medicare’s single billing rule.

A bill introduced by state Sen. Ellen Karcher (D-Monmouth and Mercer) proposes permitting hospital service cooperatives to operate MICUs that may transport patients to hospitals under certain conditions. At the present time, an MICU is not permitted to transport a patient to a hospital. In certain situations, however, a responder from the MICU may accompany and treat the patient en route to the hospital in the first aid squad ambulance.

The bill (S-2302, introduced on Nov. 13) states that an “MICU operated by a hospital service cooperative as authorized … to provide advanced life support services may transport a patient needing advanced life support to a hospital: If the vehicle utilized to transport the patient is licensed … as an ambulance; If the patient is, or appears to be, covered by federal Medicare program; The basic life support provider with which the MICU interfaces bills for its services.”

In an interview, Karcher said she was approached by officials from MONOC soon after taking office in 2003.

“We saw this thing happening down the pike when we met with MONOC officials. I was made aware of the significant role paramedics play in emergency care,” she said. “They provide a higher level of services that are separate and distinct from first aid, Basic Life Support responders.”

Karcher said many people she represents who live in adult communities such as Greenbriar and Covered Bridge have come to rely on this care.

“Not only is the viability of MONOC at risk, but their relationship with their clientele is also at risk,” the senator said.

Karcher said her bill does not take away from the care provided by BLS responders.

“It is no comment on their type of care. It is just that MONOC provides an advanced level of care and has advanced life-saving equipment as well,” she said.

Karcher said she is trying to move the bill forward in the legislative process.

“I don’t want anyone to suffer when minutes count in an emergency,” the senator said. “We can all work together as a community. We want to keep paramedic units up and running.”

The issue becomes more complicated because some ambulances bill insurance companies and Medicare and some do not, according to Scott Kasper, director of MICU and South Star, and president of the New Jersey Association of Paramedics Programs. He said just because a first aid squad is volunteer does not mean it will not bill an insurance company or Medicare for its services and just because a first aid squad is a paid squad does not mean it will automatically bill for its services.

The people who are serviced may not be billed, but insurance companies will get billed, he said, adding that he cannot support Karcher’s bill in isolation.

“The bill presents a potential solution for MONOC. On the other hand, it also has the potential to present other related effects throughout the state that would be damaging to other MICU programs and possibly first aid squads as well,” Kasper said.

The bill is one solution but it does not fix the problem, according to Kasper. It needs to be part of a group of solutions to a multifaceted problem.

Even though more and more first aid squads are moving to become paid squads, according to Kasper, whether or not a squad is paid or volunteer is irrelevant. The issue is more of whether a squad bills for its services.

Kasper said he will refrain from commenting any further until he meets with members of the association on Dec. 14. He said he is looking forward to the meeting and to a “very interesting debate