YORK COUNTY, S.C.-- When you hear the term “ambulance chasing,” you might associate it with the word “lawyer.”
But in at least one South Carolina county, the ambulances are chasing each other, chasing patients and chasing health care dollars.
This is the tale of two ambulance companies, one town and the fight for health care dollars.
The companies: Piedmont EMS – operated by the for-profit Piedmont Medical Center, a Tenet hospital in Rock Hill, SC, and the non-profit, largely volunteer Fort Mill Rescue Squad.
Under policy set by the York County Council, emergency dispatchers at the county’s 9-1-1 center send both ambulance companies to every call 24/7 – one from Piedmont EMS and another from Fort Mill Rescue Squad.
And, as they say in racing, they’re off.
The first ambulance to get to the patient, gets the patient.
And the ambulance company that gets the patient gets paid.
“It is the transport that generates the bill,” says Piedmont CEO Charlie Miller.
Is it a race to the scene? “Some would call it that,” says Miller.
But when asked if his employees are the ones doing the racing, Miller answers a flat “No.”
Fort Mill Rescue Assistant Director Tim McMichael says his ambulances are not racing either. “Occasionally there might be a little drafting going on but we’re definitely not swapping paint,” says McMichael.
There is another downside to competing ambulances: patient choice.
As a matter of policy and practice, McMichael says Fort Mill Rescue Squad asks each patient an open ended question: “Which hospital would you like to go to?”
But Piedmont EMS policy dictates that patients are not offered a choice of emergency rooms.
“They’re told we’re going to take you to Piedmont emergency,” says Miller.
But the CEO says patients know they can always tell the driver to take them to a different ER.
“All you’ve got to say is ‘I’d rather go to Pineville,’” says Miller. “If it takes more than fifteen seconds I’d be stunned.”
Piedmont’s EMS Director sent out a memo to staff in February noting, “Competition in health care… can threaten the livelihood of each and every one of us….”
In that context he wrote, “Once a decision is made for transport to the emergency room, your response should always include, ‘I will be taking you to Piedmont Medical Center.’”
The NewsChannel 36 I-team checked the numbers, obtained under a Freedom of Information request to York County.
In the last year on record, Piedmont EMS took 68% of their Fort Mill area patients to Piedmont Medical Center.
In the same year, Fort Mill Rescue Squad took only 42% of their patients to Piedmont.
The rest went to Charlotte area emergency rooms at Carolinas Medical Center or Presbyterian.
Asked about the disparity in destinations for ambulances serving the same Fort Mill area, Piedmont CEO Charlie Miller responded, “We have reason to believe the staff at Fort Mill Rescue work hard at making sure the patient goes somewhere other than here.” Miller said, “They view us as adversaries.”
Fort Mill’s McMichael responded, “I’d like to say that perception is not accurate, but I do think enhanced competition in this area may cause some animosity.”
McMichael stressed that at the street level, paramedics from competing services are both friendly and cooperative.
But if there is animosity it’s because in the last two years Piedmont has doubled its number of ambulances assigned to Fort Mill – from two to four – in effect “double teaming Fort Mill’s largely volunteer squad and threatening to take away business.
“That’s not the reason we’re doing it,” says Miller, noting that Fort Mill’s population has boomed and Piedmont is trying to keep response times in the area low.
“We’re a business and yes it is about market share, but we also look at response times,” says Miller.
That fight for market share is not limited to ambulance service.
If Piedmont treats the patient in the ER or the hospital, they obviously stand to earn more.
But at Fort Mill Rescue Squad, McMichael says, “We have no vested interest in transporting patients to a particular hospital.”
Piedmont is also working hard to raise its profile in Fort Mill as it competes for a state permit from South Carolina to build and operate a hospital in Fort Mill.
“I think there’s some marketing going on,” says Cotton Howell, York County Emergency Management Director, who is charged with overseeing the county’s ambulance contract with Piedmont.
Howell says the County Council should resolve the competition between the two ambulance services.
“This has to be addressed because it's not – ‘fair’ may not be the word - it's not practical,” Howell says.
But with five of seven York County Council members being replaced in this fall’s election, the Council is not likely to resolve the question soon.
So while Piedmont fights for a new hospital and Fort Mill rescue fights for patients to support the squad’s budget, the chase is on.