Patient Transfer Changes Continue -- Boon or Bust for EMS?

Another LHIN-based initiative to restructure  "non-urgent patient transfers" is underway. 

Non-urgent transfers are ambulance-like transfers for patients from hospital to hospital, from hospital to long-term care, or from hospital to home. While the cost of these transfers often simply come out of the hospital budget, austerity has made this more difficult.  

The latest restructuring project is in the North East  -- and is funded by the North East LHIN.

Earlier this year, the government strongly endorsed a LHIN-wide plan for the South West.   As in the South West LHIN, the North East project is supposed to develop a standardized approach to the delivery of non-urgent transportation services throughout the LHIN.  

While EMS had provided much of the inter-facility transfers in the past, over the last 14 years that has changed, after the Mike Harris Progressive Conservative government introduced legislation in 2000 allowing hospitals to use for-profit "patient transfer" companies rather than ambulances to move patients between hospitals or long-term care facilities if the patient was in stable condition.

In many locations around the province, hospitals developed their own poorly coordinated systems of non-urgent transfers, creating quite a number of private providers. Reports from the CBC and the Ombudsman have shown that problems abound. 

In the North East, there are some differences from the South West restructuring, at least initially.  Instead of turning the work over to one provider for the entire LHIN, geographically based pilot projects have been established three parts of the LHIN: [1] Manitoulin-Sudbury, [2] Sudbury, and [3] Temiskaming.  

Large parts of the LHIN remain unaffected by these three pilots, (e.g. North Bay, Hearst, Sault Ste. Marie) but given the enormous size of this LHIN, that is unsurprising.

Another difference from the South West restructuring is that currently almost all of the 24,000 non-urgent transfers in the North East LHIN are being done by public EMS providers, which are highly unionized and pay reasonable wages.   CUPE represents many of the paramedics in the North East.   As noted, in most of the rest of the province, private transfer companies have already made significant inroads into the patient transfer industry, creating many problems and leaving workers in the industry with poor working conditions. 

Interestingly, two of the pilots in the North East are using public EMS staff, while the third uses a private company, according to a June report.  The Sudbury pilot project uses the public EMS employer, modified and designated EMS vehicles, and EMS paramedic staff (although some other transfer work continues to go out to a private company) .  Likewise, the Sudbury-Manitoulin pilot also uses the public EMS employer,  modified and designated EMS vehicles, and EMS staff -- but the staff are not paramedics. 

“From my perspective, I didn’t want someone coming in and assuming responsibility for a service that I’m currently providing,” said Manitoulin-Sudbury EMS chief Mike MacIsaac. 

In contrast, the Temiskaming pilot uses a private company.

In the past, a major problem for EMS patient transfer was that the transfer might be  stopped when too many emergency calls came in.  Creating modified, designated EMS vehicles means that the trucks will not be pulled off to do emergency work while doing transfer work. 
  

The project began in March 2013 and is supposed to be completed by the spring.  Participants in this project include all 25 hospitals in the North East LHIN, 41 long-term care homes, 8 municipal social service managers, 12 EMS providers, ORNGE, 5 Central Ambulance Communication Centres, and the EMS base hospital.

Here is the official plan for the period ahead:

•          Two more project advisory committee meetings will be held in early 2014 to review the options for solutions and recommendations on governance, funding and operational improvements.   
•          A final round of consultations with hospitals and EMS in February 2014.
•          A project report to be submitted to the North East LHIN by early spring 2014. 
•     The report will assess the current non-urgent transfer system in the North East and make recommendations for a future model for the services including costs, partnerships and funding options.

The government had promised over two years ago to regulate the largely privatized patient transfer industry, which has been plague by scandal and bad service.  With no sign of that, LHIN-wide restructuring of the industry may be the only substitute on offer, for now.  

Restructuring has come to the patient transfer industry. This latest project is suppose to test different approaches to delivering non-urgent inter-facility transportation using a common set of evaluation measures. 

We will see if this opens the door to more privatization, or to bringing some of the work back into the public sector.

Photo: Instant Vantage