Mon May 24, 2004
Physicians contemplate MAST's future
By Matt Hackworth
KANSAS CITY – MAST and ER docs
Kansas City is poised to re-structure its ambulance service. The City's council will soon decide what system will replace MAST ambulance. The ambulance service faces audit reports of mismanagement, and operated for some time at a deficit. Kansas City leaders hope changes in structure will improve MAST's financial picture but emergency room physicians are anxious to see how the changes may impact service. K-C-U-R's Matt Hackworth reports.
On the first floor of Research Medical Center's sprawling hospital, Dr Hillary Chollet shows off his workplace.
"This is our trauma room we keep this room nice and warm, at least 80 degrees."
The trauma suite sits just off of the hospital's busy emergency room. It's where patients who've had the most severe of accidents are brought for treatment.
"EMS identifies if our entire trauma team needs to respond or if a lower level response is necessary."
These days, Chollet and other emergency physicians rely more on the paramedics and EMT's who shuttle patients to the hospital than they used to. No longer is an ambulance just a ride to the hospital. Emergency crews make decisions about what care a patient may need, and serve as eyes and ears for doctors who communicate by radio. But MAST ambulance has an uncertain future Dr Chollet says the ambulance service's problems come at a tough time in medicine, too.
"The problem of MAST of MAST relates to the problem of liability, the stability of trauma centers, the presence of neurosurgeons, the presence of very good specialists. It's all related and it all has to do with finance and it has to do with expectations with people who live and work in our area."
MAST ambulance's finances have been shaky. Reductions in federal Medicare payments, billing problems and funding requests that were way too low pushed the ambulance service to near insolvency. Kansas City pays MAST's ambulance largest subsidy, which at $10 million, more than doubled last year. The City's council asked a consultant for recommendations on how to fix the system. The option seemingly favored by most council members involves re-structuring MAST's administration to include stronger financial oversight. Kansas City Health Department Director Dr Rex Archer says he doesn't anticipate a major overhaul in management of Kansas City's ambulance system.
"It's important every few years to take a comprehensive look at an issue or system. We really hadn't done that with the full city council, the full public process since the beginning of MAST."
The consultant's other options include making MAST a city department, absorbing MAST into the fire department or having the city pay a contractor directly to provide service. Right now, MAST serves as an independent organization. It provides oversight of one of the most praised ambulance systems in the country, when it comes to providing care.
In the busy University of Kansas Hospital emergency room, nurses and doctors dodge one another as they make rounds, treating patients. Trauma department director Dr Michael Moncure says he and other emergency physicians are watching what will happen at MAST.
"Obviously there's concern with all the different issues they're having to work with. There's worry if they'll be able to maintain the clinical excellence and maintain the history of what they'll be able to accomplish. We'll be watching that very closely but thus far, I've not noted anything that would lead me to believe that excellence would fall short of what's been in the past."
Doctors Moncure and Chollet both say the topic of what will happen in MAST's management frequently comes up in conversation among Kansas City's emergency physicians. Doctor Chollet says he's confident changes won't affect patient care but the likelihood of change makes him a bit apprehensive.
"As a trauma surgeon, we will have a zero tolerance for setback I terms of EMS. We want to assure that the fine care they're offering our patients will continue so that we can ensure the lives of as many people as possible."
Physicians say the ambulance service's management shakeup hasn't affected care in MAST ambulances. Kansas City's budget and audit committee will make a recommendation for change in the coming weeks, an adjustment that preserves care but ensures more financial security for the future.