Meadville Tribune

Local News

January 22, 2014

Meadville Medical Center's turns to outside company to bolster emergency room services

Facility's patients shouldn't notice major changes

MEADVILLE — Beginning Feb. 1, medical services in Meadville Medical Center’s Liberty Street emergency department will be provided by EmCare, a subsidiary of the Colorado-based Envision Healthcare.

Patients coming to the facility, however, shouldn’t notice major changes.

“There will be no change in the service provided to the public in the emergency department — except that we will have more providers,” MMC President and Chief Executive Officer Philip Pandolph told the Tribune. “Everyone will be treated regardless of ability to pay — we’re just trying to make the emergency department better with more doctors.”

Speaking from his Philadelphia-area office, Dr. Russ Harris, chief executive officer of EmCare’s North Division, agreed that EmCare’s first task will be to simply augment the emergency department staff. “The current physicians are working very, very hard,” he said.

The current physicians agree.

In a written statement submitted to the Tribune, Dr. Kevin Kraeling, D.O., of Meadville Emergency Physicians, P.C., which he describes as “an independent company that has been providing professional emergency department staffing services to Meadville Medical Center since the mid-1990s,” described the current situation.

“Due to recent unanticipated staffing events MEP has been unable to provide continued coverage to meet the increasing patient volumes experienced at Meadville Medical Center,” Kraeling wrote. “Within a matter of months we have had a provider resign due to personnel issues, another take an extended medical leave and lastly a provider accept a position at another hospital. For the record this has been no fault at all of the hospital’s but rather just the perfect storm, so to speak, of circumstances.

“Therefore,” Kraeling continued, “Meadville Medical Center has looked, as it rightfully should, to a larger ER staffing firm which in this case is EmCare. I am pleased to have the hospital’s continued support to provide patient care services at Meadville Medical Center as an employee of EmCare. Both myself and Dr. Lawrence Newhook are excited about the positive opportunities EmCare will bring to the hospital as well as the community.”

Because Meadville Emergency Physicians has been operating for approximately two decades under a contract with Meadville Medical Center to provide emergency department medical services and EmCare will provide emergency department medical services to MMC under the terms of a contract, the fundamental arrangement isn’t changing. “This is no different than the current group of local providers,” Pandolph said. However, he noted that the hospital’s new partnership with EmCare will provide access to more physicians as well as additional best-practice protocols and emergency department performance tools.

As for the immediate future, “the transition will be seamless because we’ve asked all the current providers to stay,” Harris said. “We will augment, but we’ll make sure that it’s a seamless transition.”

Moving ahead

One of the first things that will happen, Harris explained, is that a nurse specially trained to look at every aspect of care from the perspective of maximum efficiency will be brought in to take a close look at current procedures. “Within the first three to six months, we’ll be looking at processes resulting in delays — and looking at what we have to do to make them more efficient,” Harris said.

Pandolph and Vice President of Clinical Operations Valerie Waid shared a recent emergency department communication describing the approaching transition.

In the written statement, Pandolph explained that all existing emergency department staff and management will remain in place and employed by MMC.

“We anticipate that the current physicians in the emergency department will continue to provide service under this new arrangement,” Pandolph wrote. “A new Limited Liability Company will be formed and operate as PA Liberty St. Emergency Physicians, LLC. This aspect of the arrangement with EmCare was a key provision for MMC as we wanted to ensure that the current physicians and nurse practitioners in the emergency department, which have served our organization tremendously well, have an opportunity to do so for years to come.”

EmCare’s recruiting efforts are already under way. “We believe very shortly we should have a new medical director responsible for clinical oversight in the department,” Harris said, noting that while plans call for more physicians to be on hand by the first of February, some may be assigned on a temporary basis while permanent hires are being made. “We have as many as 200 licensed physicians in Pennsylvania currently working with us,” he added. “We hope to mobilize some of them.”

In additional to the new medical director, six additional emergency medical physicians are scheduled to be added to the hospital’s emergency department. “We hope for eight physicians,” Pandolph said, noting that when the emergency department was fully staffed in the past it included a total of five physicians, although that number has recently fallen to two.

As for whether the increased staffing will add to the medical center’s overall cost of doing business, Pandolph said that after examining the current patient volume and demographic, EmCare advised MMC that as long as the volume doesn’t go down, the hospital should not be asked to provide a subsidy for the added personnel. Because billing for emergency department activities is part of the contract, Pandolph said he doesn’t have access to exact figures about revenues generated by the department.

The short-term recruitment challenge they’re facing, Harris explained, is that physicians typically make moves during the summer months. However, he added, they’ve already found a few very good people who are interested in coming on board.

Moving in

Physicians, Harris stressed, are being recruited to live in the community. “We’re looking forward for our providers to get acquainted with the community,” he said. “We don’t want our doctors to be EmCare physicians. We want them to be Meadville doctors.”

They will also be emergency doctors. “The difference for us is that emergency department doctors need to know about everything,” Harris explained. “We really have to have some training in many fields to take care of emergencies that occur in those areas.” In the emergency department, holding off on answers until a follow-up appointment simply isn’t an option. “We need to operate within a very small window — three to four hours — to figure it all out,” he said.

“For those of us who do it, it’s a lot of fun,” Harris added. “You find a lot of folks who really thrive on the energy of the time-specific nature of things. And for a lot of our physicians, when they go home, they’re done, while physicians in other fields can get called back out at any time. That’s a benefit for many.”

EmCare’s job, he added, “is to provide the doctors with the financial resources, benefits and infrastructure so they can provide cutting-edge, high-quality emergency care in a time-sensitive, efficient way.”

In December, The Denver Post described Envision, headquartered just south of Denver and currently on track for $4.5 billion in annual sales, as “already the country’s largest private ambulance provider and a leading manager of hospital emergency rooms” through its American Medical Response and EmCare subsidiaries. In the article, the Post noted that Envision, which re-emerged as a public company in August after going private in 2011, has recently established Evolution Health — a third subsidiary focusing on the five percent of the population accounting for “half or more of all health care dollars spent.”

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