By Richard Sullins | richard@rantnc.com

The Lee County Board of Commissioners is set to decide Monday whether Central Carolina Hospital or FirstHealth of the Carolinas will provide emergency medical services locally for the next several years.

Central Carolina Hospital has had the county’s EMS franchise since the late 1990s, but the county opened up a bidding process and a series of public hearings – the first was held on Aug. 2 – because more than one vendor expressed interest. The current contract expires on Sept. 30.

An EMS advisory committee appointed by the county voted 3-2 in July to recommend commissioners award the contract to FirstHealth. The divided committee’s recommendation was that FirstHealth was better positioned to meet the county’s needs because of their extensive fleet of ambulances and large staff to provide round the clock coverage; an existing paramedic academy through which it hires, trains, and graduates employees; and its track record of success in the neighboring counties.

The advisory committee’s recommendation has proven to be controversial. About 20 supporters of Central Carolina Hospital’s EMS service attended the first public hearing. Among them was Sanford resident Millie Johnson, who asked the commissioners “if another county takes over our EMS, would this not potentially cause a loss of jobs, of sales tax revenue, and perhaps even our local hospital?”

Speaking on behalf of the FirstHealth proposal at the August 2 meeting was Chief Operating Officer Brian Canfield, who said “we at FirstHealth stand ready to serve Lee County with the same high level of service that we are offering in our other service counties and are happy to address any issues or concerns that you or any of the good people of Lee County may have.”

The second public hearing will be held at 6 p.m. on Monday at the Dennis A. Wicker Civic Center. A vote is expected to follow.

Proposals Differ in Scope, Costs

The two EMS proposals lay out competing visions to provide the types of response that will be necessary as the county continues to grow with new industry and jobs, and commissioners must decide which of them most closely aligns with where the county wants to be in five years.

The Rant has obtained copies of the proposals for service that were submitted by Central Carolina Medical Center and FirstHealth of the Carolinas, and a comparison shows the differences in vision the commissioners will have to choose between.

SERVICE AREA: Central Carolina EMS operates within the boundaries of Lee County, an area of 242 square miles with a population of approximately 60,000. FirstHealth provides EMS services in Moore, Montgomery, Richmond, and Chatham counties, approximately 3,200 square miles and a population of 241,000.

NUMBER OF CALLS: The Lee County EMS system received 9,662 calls during 2020. Central Carolina EMS projects that 9,800 calls will be received during the first year of the new contract, with 5,500 of those calls resulting in transport. FirstHealth’s proposal projects 7,750 total 911 dispatches during the first year, with approximately 6,190 of these requiring emergency care and transportation.

LOCATIONS: Central Carolina EMS operates from a base located at the hospital on Carthage Street, with a substation based at Jimmy Kellam’s Towing on Hal Siler Drive to reduce response times in the southern portion of the county. It is evaluating new potential base locations at Carolina Trace, Deep River, and Lemon Springs. FirstHealth proposes to operate from 3 locations, including its current facilities on Beechtree Drive and others in downtown Sanford and Broadway. It has indicated that, if selected, it intends to work with the county for consideration of the current EMS facility used by Central Carolina EMS. FirstHealth already owns property near that location that could be converted to that purpose, and it has expressed interest in talking with fire departments to see whether some would consider leasing space for an ambulance and crews.

RESPONSE TIMES: It is estimated that about 70 percent of the current calls for EMS assistance originate within the city limits of Sanford. Central Carolina EMS says that its median response time to emergencies within this area ranges from 7 to 8.5 minutes. In areas outside the city limits, Central Carolina estimates response times between 12.9 to 13.6 minutes. While having no actual experience within the county, FirstHealth says that it is “committed to a goal of having advanced life support assets on the scene within 9 minutes or less 90 percent of the time.”

USE OF FIRST RESPONDERS: Getting trained help to the scene of a medical emergency saves lives. Both proposals speak to the importance of engaging with first responder units in the county in greater ways than ever before, particularly in working with training for fire departments and encouraging them to participate on calls when they occur.

COSTS: Comparing costs for medical services is difficult for many reasons, not the least of which is government regulation. As with all medical services, Medicare and Medicaid have limitations on what they will pay for emergency medical costs. In the same way, commercial insurers also place limits on what they consider to be reasonable costs for services. As a result, patients who receive the same services will rarely pay the same costs, based on the type of insurance coverage they have. Still, EMS transport agencies establish their own base rates and it is from these figures that their ultimate reimbursement is calculated. An examination of these rates as provided in the proposals indicates that categories of proposed EMS transport rates for Lee County by FirstHealth are anywhere from 14 percent to 76 percent higher than fees listed in Central Carolina EMS’s proposal.

For example, a Basic Life Support (BLS) emergency call is one where no advanced procedures of any sort are performed, such as a lower extremity fracture or a transport to another sub-acute facility. Central Carolina EMS’s rate for such a transport is $440.60 and FirstHealth is $721.49. For an Advanced Life Support (ALS) call that is staffed by a paramedic for patients who require a higher level of medical monitoring, the Central Carolina EMS transport rate is $528.72 and FirstHealth is $933.34. The rate for a Specialty Care Transport – hospital-to-hospital transports of critically injured or ill patients by ambulance – is $1,413.96 with Central Carolina EMS and $2,077.37 with FirstHealth.

Both vendors are clear in their proposals, however, that all patients are treated regardless of their ability to pay for any treatment that is provided.

FLEET: Central Carolina EMS has 10 vehicles, all of which are operational, with service and maintenance performed by various local dealerships and shops. FirstHealth has 45 ambulances, with 7 undergoing maintenance at the time of inventory in May, and 4 vehicles awaiting delivery. FirstHealth has its own capabilities for vehicle maintenance and repair.