COASTING TO A STOP
Remember that crisis brewing regarding local ambulance service in the greater Bishop area? Symons Ambulance called it quits. The local government officials scrambled. An emergency RFP (Request for Proposals) was floated. An outside company, Coast2Coast Public Safety, stepped in to handle EMS services.
Crisis averted, right?
Hardly.
At the Inyo County Supervisors regular meeting on Tuesday in Independence, a discussion item regarding an update on EMS services revealed that Coast2Coast is seeking government subsidy to continue operations, as a company spokesperson Sarah Morris said Coast2Coast has been running a $30,000 monthly deficit.
Further, it was revealed that Coast2Coast can check out of the Hotel Bishop California AND leave this Monday when its contract expires.
*Late-breaking news. Coast2Coast will continue on for 30 more days while the County floats another RFP. The County will pay a $25,000 subsidy over that span. Coast2Coast Owner Jason Villa said the company will not be an applicant for that RFP and plans to leave the area.
The reasons why Villa is leaving (namely, Northern Inyo Hospital and Sierra Lifeflight are stacked against him) will become evident as you read further.
So now the City of Bishop and Inyo County are in the tenuous position of trying to work together to figure out the issue – but also strategizing to take care of their own constituents.
Bishop City Manager Deston Dishion told Supervisors bluntly, “No one can sit here and bleed money forever … I feel like I’m right back to where we were in March.”
He expressed frustration that the County is futzing around with an “EMS Study” while what it really needs to do is push the EOA (Exclusive Operating Agreement) process.
An EOA allows an operator like Coast2Coast to count on certain business (e.g. medical transports to the Bishop Airport or distant hospitals with greater resources) which makes it more feasible to operate in a place like Bishop (and not require government subsidy).
Currently, there is no EOA in place. And there are a lot of regulatory hoops (state, federal) to get there.
It also appears like the new guy (Coast2Coast) is getting passed over on a lot of calls in favor of REACH Air Medical Services, which operates Sierra Lifeflight out of the Bishop Airport.
Particularly on transports from the hospital, which Villa said is worth between $75,000-$150,000 per month. “That was Symons’ bread and butter,” echoed one insider.
Villa says the typical hospital-to-airport transport pays $1,600.
Allison Partridge, who serves as Northern Inyo Hospital’s Interim Chief Operations Officer, insists NIH isn’t giving REACH the reach-around.
She said the decision to transport a patient via ground v. air is left up to the physician.
Factors which play into that decision, she said, include duration of transport and level of need.
Problem is, it seems like every call is going to REACH. Even one call (referenced by multiple sources) where a person with a broken ankle (hardly a life-threatening situation) was air-flighted from Lone Pine to Bishop versus calling Coast2Coast for the transport.
Partridge had assured Supervisors all air transports had been “critical.” Hmm. Morris also disputed a statement made by REACH Medical’s Mike Patterson that she paraphrased as, “Mike said if a patient could have been driven, REACH charges that patient ground prices … there’s no way corporate would allow that.”
“We have never gotten any flight transports,” she added.
“The County needs to stop catering to this other company that’s not playing nice,” said Villa, who added coincidentally that over half of the Hospital’s ER staff also works at Sierra Lifeflight.
The matter of a potential subsidy elicited a lot of feedback.
Supervisor Matt Kingsley warned that subsidy is dangerous. A Pandora’s box. The rest of the county has never relied on subsidy, he said.
Big Pine Fire Chief Damon Carrington said EMS has been going downhill for more than a decade. “We’ve all predicted this,” he observed. But if subsidies are going to be bandied about, his department is certainly going to get in line.
REACH Medical’s Mike Patterson said if subsidy is on the table, “you may get different bidders” the next time an RFP is floated.
Which is rich, given that during the initial RFP process, Patterson (who did not respond to an interview request), according to Supervisor Scott Marcellin, claimed he did not have time to submit a bid. Three companies found the time.
In reality, Marcellin said GMR, REACH’s parent company, is a huge conglomerate. Which is not interested in advancing its ground ambulance business.
And why bother if the status quo is that the Hospital serves up transports to REACH’s ambulance on a silver platter – which are then handed off to REACH’s even more lucrative lifeflight operation?
The Sheet spoke to Marcellin post-meeting on Wednesday. He was still annoyed. He feels like his own staff (Marilyn Mann and CAO Nate Greenberg) are stonewalling, leaving his District 3 constituents, and Trina Orrill’s District 1 constituents, in the dark.
“I don’t know whether it’s Marilyn or Nate, but someone’s dropping the ball,” he said.
And he scoffed at Mike Patterson’s suggestion that Supervisors rely on the EMCC (Emergency Medical Coordinating Committee), an advisory committee that meets quarterly.
Patterson serves as chair of the EMCC.
Villa had kinder words for the efforts of County staff, but said County staff doesn’t have the ability to stop REACH from using its size and local influence to exploit the absence of an Exclusive Operating Agreement (EOA).
Call statistics provided by Coast2Coast at Tuesday’s meeting indicate that 85% of call volume is split fairly evenly between the City and outlying areas with the remainder of the calls from the Bishop Paiute Reservation.
Dishion said that during the RFP process, one company came forward with a quote of $35,000/week/ambulance. Which essentially equates to $300,000/month running two ambulances.
If Coast2Coast goes toast, REACH would be left as the last local provider on wheels.
From the Northern Inyo Hospital Board meeting Wednesday …
In May, Northern Inyo Hospital lost $1.2 million net.
CEO Stephen DelRossi said year-over-year, NIH lost $12.3M in FY 22-23, down from $15.8M in FY 21-22. DelRossi optimistically said, “We are slowing the bleed … but there may be more surprises.”
Board member Jean Turner chimed in about the improved “trajectory.”
Which was like saying the plane had been nose-down heading for the tarmac, but now is pointing down at a seventy-degree angle.
Still doesn’t portend a soft landing.
During the meeting, there was a lot of talk about various cost-saving initiatives and revised contracts.
Lunch translation: Further angle reduction to 66 degrees.
A front page story on distressed hospitals which appeared in the July 6 issue of the Wall Street Journal framed the crux of the problem as follows:
“Salaries and benefits amounted to more than 58% of the net revenue that hospitals collected from serving patients in 2022 according to Merritt data. That is the highest share in three decades except for 2020, the first year of the pandemic. Meanwhile, hospitals are reporting that revenue available to cover debt payments is at its lowest level in 30 years, except for during the 2008-2009 financial crisis … and the cash crunch is coming as lenders are less forgiving.”
