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The Dripby Brew Editors9:08 amJan 4, 20230

Hart to Heart defends higher ambulance rates

Based on lower volume, the higher unit prices for ambulance trips did not result in a higher overall contract price, the Harford County firm says in response to an Inspector General report

Above: Hart to Heart provides non-emergency ambulance services for Baltimore City. (flickr)

The following letter was submitted by Jason Skidmore, owner of Hart to Heart Transportation Services, regarding The Brew’s coverage of a report issued by Baltimore’s inspector general, Isabel Mercedes Cumming.

The December 12 report questioned price increases approved by former city purchasing agent, Erin Scher Smyth, for Hart to Heart’s ambulatory, wheelchair van, basic life support, emergency room releases and other rides for Medicaid patients.

The upward revisions – made a day before the contract went into effect in January 2019 – resulted in the city Health Department paying “$3,543,056 more than it would have if the prices had remained fix for the initial contract term,” the IG report concluded. The report also questioned a $122,400 software fee approved by Smyth.

The Brew reported those findings, then followed up with a copy of the letter showing the original prices approved by the Board of Estimates and the prices and software fee – submitted by Hart to Heart – that Smyth subsequently authorized.

Emails and a phone message to CEO Skidmore were not answered at the time of publication. This letter was received last week:

In response to the articles contributed by Mark Reutter earlier this month, our workforce of nearly 300 team members takes extreme exception to the manner with which Hart to Heart Transportation (H2H) was characterized.

H2H offers the highest quality in transportation and health care services in Maryland, providing safe, reliable, and timely assistance delivered by highly trained and caring healthcare professionals and transportation specialists. We are incredibly grateful for the thousands of patients, and their families, who annually depend on our team.

Specific to the articles, it was suggested that H2H is filling its coffers to Baltimore City’s detriment during a contract modification. Nothing could be further from the truth.

There are very accessible public documents which support that the volume numbers confirmed by the City after H2H’s contract award decreased by 48% compared to the those provided in the RFP.

This means that despite the negotiated per trip rates being higher for ambulatory, wheelchair and ALS services, the total anticipated cost to the city over five years, based on the revised volume provided by the city, decreased by almost $5 million.

“We followed the rules and were granted an economic modification by the City’s purchasing agent based on their requirements”  – CEO Jason Skidmore.

Basically, the city changed the rules of engagement after the award was given, which impacted H2H’s ability to efficiently perform to scale. As with any business, there are many baseline costs to consider when significantly scaling operations up or down, particularly in healthcare.

Perhaps the most misleading issue in the article is that the reported numbers were based on the new (negotiated) rates measured against the old (RFP) volume numbers.

H2H’s initial bid was projected to total $33,424,490 over five years; however, the new rates times the new volume brought the negotiated total to $28,621,860 over five years. That is $4,802,630 less over the life of the contract.

The city is well aware that this is a fee-for-service contract, so the amount billed is based on the number of actual transports provided. This fact alone shifts the abilities and business model of any similarly situated vendor. For clarity, H2H bid on an initial scope of work that Baltimore City dramatically changed after the award was made; therefore, H2H was compelled to appropriately modify its fee structure.

While there are other issues with the reporting, the bottom line is H2H is the most economically and operationally efficient transportation option for Baltimore City. When H2H was notified of the dramatic volume/scope changes, we, like many businesses, requested a change within the appropriate channels outlined by Baltimore City.

We followed the rules and were granted an economic modification by the City’s purchasing agent based on their requirements. To suggest anything different is misleading and simply untrue. H2H remains committed to serving the citizens of Baltimore. 

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