A Packet Publication
19 September, 1986
Fate of New Jersey litemobile program being decided
By Joseph Dee
While the cry for a fourth lifemobile rings throughout the county, the state and federal officials who control the program are absorbed in an issue that holds the fate of the statewide program in balance.
Many municipal governments as well as the .county Board of Chosen Freeholders have.. passed resolutions urging the state Department of Health to secure a fourth Mobile Intensive .Care Unit for Mercer County. The freeholders sent telegrams this week to New Jersey’s two U.S. senators — Bill Bradley and Frank Lautenberg — as well as U.S. Reps. James Courter and Christopher Smith, asking them for help in the matter.
“We are distressed that another lifemobile will not be supplied to Mercer County,” said Freeholder President Anthony Cimino.
On the local level members of area volunteer rescue squads also cite the need for an additional unit.
Despite the chorus of pleas, a state official involved with the program said the county will not get another vehicle. Dr. Leah Ziskin acknowledged that recent communication with the federal agency that holds the purse strings included a commitment to leave unchanged the current lifemobile setup.
That commitment, which was part of an application for a waiver extension, eliminates any chance of augmenting the state’s current fleet of 60 life-mobiles, according to Dr. Ziskin, the assistant commissioner of the Local and Community Health Division of the Department of Health.
“We’ve asked for an 18-month waiver extension. We would have to maintain the number of life mobiles at 60 and continue the same reimburse-ment methods for the length of the extension,” Dr. Ziskin said. The current waiver expires Oct. 31, she said.
She said if municipalities in Mercer County want a fourth lifemobile, “they would have to find another way to finance it.” She added the Department of Health would review any such proposal to assess the need and would, also monitor any maverick unit so that it would comply with department protocol.
Mark Reading, who is an adminstrator of the lifemobile program in Mercer County, said he met with state officials. “They talked about the 60-vehicle cap and the waiver,” he said. “But the concept of a fourth unit is not dead. We’re looking at possible 3ther reimbursement structures for a fourth unit here.”
The waiver under which the state lifemobile program now operates in-volves the transport of patients to the hospital. Federal law stipulates that in order for the lifemobiles to receive reimbursement when they serve a Medicare or Medicaid patient, the lifemobile must transport the patient to the hospital.
Only about five of the 60 lifemobiles in the state are equipped to transport patients. In all other cases, local volunteer ambulances take the patients to the hospital, Dr. Ziskin said.
The federal Health Care Finance Administration granted New Jersey a waiver from this requirement three years ago, and is now deciding whether or not to extend it, according to Judith Willis, who heads the administration’s demonstration project unit.
She would not say if New Jersey was likely to get the extension. Ms. Willis added that her office is now collecting data on how the joint-response system of volunteers and paid paramedics works in New Jersey.
“We’re looking at it to see if it is a good system. Is it cost-effective? And we’re looking at the care provided,” she said.
Dr. Ziskin said about 55 percent of the approximately $20 million annual operating budget comes from federal reimbursement.
“If we don’t get (the extension), it would appear that the government wouldn’t reimburse us.” That, she said, “would have a devastating impact.”
In that event, she said one possible solution would be to convert the life-mobiles to be capable of transporting patients.
“But I don’t feel that’s reasonable or do-able,” she said. Princeton First Aid and Rescue Squad member Mark Freda sees other dangers in such a conversion. ”
If they went to transport vehicles, they are in essence eliminating the need for volunteer squads. Then how are three vehicles going to respond to all the calls in the county?” he said.
“They’re insane to tamper with the structure of the volunteer’ squad,. They’re such a bargain to the towns. The A-number-one thing is we’d like to see a fourth vehicle added,” he said.
He said the current setup of both local ambulances and paid paramedics responding to calls works fine.
Edward Van Hise, a Hopewell Township police officer who serves on the Union Rescue Squad in Titusville, agrees with Mr. Freda. “(The phid units) are definitely doing the best they can, but they need at least one more,” he said. “There are delays — not too often — but sometimes it can happen at the worst possible time.”
Cindy Lipton, president of the Twin W First Aid Squad in Princeton Junction, said the system has worked well.
“We’ve had no problems working with the paid units.”
She added that squad members “have never really sat down to think about the joint-response setup, and whether it should be changed.”
But that’s exactly what Gov. Kean is doing with an advisory council he is now forming, Dr. Ziskin said. “We don’t have all the answers. The goy-emor called for this council to try to see what would be best for New Jersey.”
A waiver would keep the program funded until state officials come up with a plan, Dr. Ziskin said. “That’s what we’re asking the feds for — some time.”