American Medical Response will dedicate ambulances and staff to the Town of West Hartford at least through the end of 2025.

West Hartford Fire Department medic units utilize lighter intercept vehicles rather than the large apparatus. Photo credit: Ronni Newton

By Ronni Newton

The West Hartford Fire Department has had a continuous partnership with American Medical Response (AMR) for many years, both before and after the department began providing its own paramedic service in 2016, and a newly-executed contract with the provider will streamline services and improve overall patient care, Chief Greg Priest said.

Effective March 7, AMR has two staffed ambulances dedicated to West Hartford during daytime hours, and one at night.

“We have a certain number of ambulances, and two are now in the Town of West Hartford. They stay here,” said Chris Chaplin, AMR’s regional director for Connecticut.  “I am very confident that the resources dedicated to the Town of West Hartford will improve the quality of care and the patient experience,” he said, noting that there is no extra cost to the town under this new contractual agreement.

Brandon Bartell, an AMR supervisor, said the deployment of the units is split between the north and south parts of town, but they rotate locations rather than just remaining in one parking lot.

West Hartford Assistant Chief Hugh O’Callaghan has been instrumental in working out the specifics of the program, Priest said. It is designed to AMR units to the scene within 8 minutes in 97% of the town, and there is a contract performance metric for the town to monitor and receive reports to ensure appropriate response times.

When the West Hartford Fire Department took over the paramedic responsibility as of Aug. 1, 2016, staff became responsible for providing Advanced Life Support (ALS), while AMR provided transport and necessary Basic Life Support (BLS) during that transport. Depending on the nature of the call, West Hartford paramedics may accompany a patient to the hospital.

“This has been a long time coming,” Priest said of the new arrangement, which will further improve patient care, response time, and will be a cohesive system with defined reposnsibiltiies.

As the town’s paramedic program has evolved, there have been structural changes. Emergency dispatchers now categorize the calls and determine the resources needed. Many of the medical-only calls are no longer “apparatus based,” he said, but rather with the smaller intercept vehicles.

For most medical calls – other than perhaps those requiring “lift assist,” AMR crews are dispatched. The West Hartford emergency dispatchers are responsible for controlling the dedicated ambulances. West Hartford Police continue to respond to serious medical calls as well as other incidents as needed.

Through a two-way CAD link, AMR staff also sees the calls that come into the town.

Firefighters are also responsible for fire protection and suppression, and paramedics, along with other staff, provide mutual aid as well. The nature of the work is unpredictable, and a quiet day when all units are available can suddenly be transformed as the call screen lights up – as was the case the day of this interview.

A quiet morning at the West Hartford Fire Department turned busy in moments with multiple calls coming in and all units being dispatched to various location. Photo credit: Ronni Newton

Responses by the department’s two medic units – those who travel in the intercept vehicles – are generally equally split among the units on both ends of town, Priest said.

According to Chaplin, AMR has 33 ambulances in this region. If those assigned to the town are occupied on other calls, they have other resources that can be brought in.

The new contract with AMR will also streamline billing, Priest said.

Having two different organizations involved in the care and transport has created an issue with billing of Medicare patients. Medicare will only pay one bill, and the town was unable to charge the federal payor for calls that also involved AMR. Priest reported to the Town Council’s Public Safety Committee at its March 2 meeting, however, that under the new contract, bundled billing with AMR has been negotiated.

“This was money that was being left on the table,” Priest said. “It wasn’t being billed.”

Under the new agreement with AMR, one bill will be sent to Medicare, that will include ALS. Chapin confirmed that AMR will send out the bill, and will then pay the town for its costs.

“The system that is in West Hartford with this new contract is really the gold standard,” Chaplin said. “It’s a top tier system.”

“Really what we’re doing is improving patient care, so all responsibilities are clear,” Priest said of the new AMR contract. “With this move we’ve really solidified the EMS system,” he said.

Priest said the department will be tracking the billing carefully.

Earlier this week Connecticut Attorney General William Tong and U.S. Attorney Leonard C. Boyle announced a $601,759 civil settlement with AMR resolving allegations that the ambulance service over-billed the Connecticut Medicaid program.

The investigation found cases between Jan. 1, 2014 and Dec. 31, 2019 where AMR had billed Medicaid for ALS services when they had only provided BLS. Those cases included situations for which the West Hartford Fire Department, and local fire departments that also provide ALS, had also billed Medicaid.

“Officials with American Medical Response of Hartford (‘AMR’) can confirm that the company has resolved a billing misunderstanding related to Advanced Life Support (ALS) transports completed 2014-2019 in the state of Connecticut. As part of the resolution, the company has implemented a new service agreement with a public partner and AMR has also agreed to a settlement with both the state and federal governments without any finding of liability. The new service agreement with the public partner will streamline joint operations going forward,” Chaplin said in a statement Wednesday responding to a question regarding the settlement.

“AMR-CT billed the state for Advanced Life Support services that local fire departments had already provided. In addition to the significant financial penalty, AMR-CT has entered into a strong consent agreement to ensure this unacceptable overbilling never happens again. Working in coordination with our state and federal partners, our office is prepared to take aggressive action against anyone who abuses our taxpayer-funded healthcare programs,” Tong said in a statement.

“We hold ourselves to high standards for both medical care and the practices surrounding billing. We hope and strive to ensure that the patient experience is positive both in the field, at the hospital and beyond,” the West Hartford Fire Department’s webpage on the town’s website states. Complete details about the department’s EMS, including regarding operations and billing, can be found there.

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