With medical air transport services running into financial trouble around the country, why does Salt Lake City have two such services - each with its own retinue of planes and helicopters?
Officials of Intermountain Health Care - which operates LifeFlight - raised the question during the recent skirmish over the dissolution of the University of Utah Hospital's Neonatal Transport Team - an arm of the U.'s AirMed transport service.IHC officials argue costs could be cut if the two transport services leased the same pool of equipment, eliminating the need for so many costly planes and helicopters.
But U. officials believe savings from such a joint venture would be minuscule. They also cited sharply different philosophies between the two organizations about how a transport system should be run.
So, drive past the University of Utah and Primary Children's hospitals and you will see two helicopter pads, a helicopter poised for take-off on each one. The pads are a half-block apart.
LifeFlight officials say they lease four airplanes and two helicopters for their transportation service. AirMed leases two helicopters and three airplanes for its service. For the most part, LifeFlight takes its patients - infants to adults - to IHC hospitals. AirMed now takes its patients to the U. Hospital.
Both services are costly. Patients pay anywhere from $250 to $700 just to get a helicopter in the air, plus around $20 for each mile it flies. Planes aren't much cheaper.
"Primary's concept of the ideal world would be to have common vehicle pool that we could access on a first-come, first-served basis. That would be the very lowest cost possible," said Don Poulter, administrator of Primary Children's Medical Center, an IHC facility."That has to translate into less costs to the consumer and that's what we are concerned about," he said.
U. Hospital spokesman John Dwan doesn't agree. He said a recent study by the financial officers of LDS, Primary and the U. hospitals showed that using the same aircraft would save less than 2 percent of the total costs.
The U. is also fearful of running afoul of federal antitrust laws.
"Public policy and law now dictate that hospitals compete. Our first concern is antitrust considerations. If we are supposed to be competing, we have to compete," Dwan said.
Doctors at both institutions say the competitive need to "keep up with the Joneses" also gets in the way of joint leasing arrangements that might cut costs.
Dr. Randall J. Olson, chairman of the U.'s ophthalmology department, called it the "me, too, syndrome," a competitive drive that prompts hospitals to duplicate much of each other's equipment.
Dr. Michael A. Simmons, medical director of Primary Children's Medical Center, wants to go beyond a joint vehicle pool to one, community-based medical transport system.
"It would be by far wisest to have an integrated, community-based transport system," he said.
But the transportation of critically ill patients is so politicized that attempts to forge cooperation between the two systems have failed.
"People in seniority have tried to negotiate a common system in good faith. But it failed," said Simmons, who is also chairman of the U.'s department of pediatrics.
He characterized the problem as the "Red Baron Syndrome" - the fact that "everyone loves to fly."
But he favors air transport as a last resort, calling flight "unconscionable if you can do it by ground."
One area of cooperation between the two systems - the U.'s neonatal transport team that serviced both the U. and Primary - went out of business Friday.
Primary's new neonatal team started up the same day, replacing the U.'s 20-year-old, nationally renowned team.
As of Monday afternoon, eight flight nurses from the U.'s team had signed on with Primary's team, according to George Belsey, U. Hospital administrator. Five will continue to work at the U. in other capacities 75 percent of the time and be available to fly with Primary's neonatal team at least 25 percent of the time.
Primary's fee for transporting babies by helicopter and plane will be considerably higher than what the U. charged Primary to fly babies there.
Primary Children's officials Monday listed several reasons for the increased charges. Chiefly, Primary's higher charges will reflect the actual cost of running the neonatal transport system, they said.
The U.'s charges were so low that the system operated at a loss, said Richard Smith, assistant administrator at LDS Hospital, the base for the LifeFlight system.
Primary subsidized the U. service by paying the full bill on every flight, but collecting only part of that money from patients, insurance companies and federal programs, Poulter said. Primary officials believed they could run their own system with less cost to the hospital.
Dwan agreed that the U.'s transport charges were often below costs. But he said it's worth it to the U. to lose money flying patients there because the loss is made up by the patients' hospitalization charges.
"We feel that based on the revenues that are brought by the AirMed patient, that we make money," Dwan said.
Even though Primary's flight charges are higher than the U.'s, Primary argues it will save patients money by using air transport less frequently than the U. did.
"We would transport the maximum amount possible by ground because that's less expensive," Poulter said. He estimated that 40 percent of critical newborns transferred to Primary Children's will come by ambulance under the direction of the new transport team.
When the U. operated its team, only 20 percent of the transports were ground transports, he said.
Simmons argues that his tiny patients will be safer on the ground than in the air. "In a helicopter, you can't hear a thing. You can't see," he said. "Most of the skills (a team) needs to use with critically ill babies disappear. In fact, there are times when you have an emergency, you have to land. An ambulance is very different. You can do anything in an ambulance.
"A helicopter is the most dangerous form of transportation man knows," he said, mentioning the crash of an AirMed helicopter behind the U. several years ago that killed the pilot.
Dwan objected to the implication that the U. transferred newborns by air unnecessarily. "The University Hospital's track record in neonatal care speaks for itself. We feel that we have and do provide the very finest, very highest quality of care here," he said.
A comparison of current charges for transporting a baby by AirMed helicopter and Primary Children's LifeFlight ground ambulance as determined by Primary's price list.
Hospital Miles U. AirMed Primary ambulance
Jordan Valley 35 $1,140.00 $552.54
Cottonwood 20 $ 986.00 $464.54 *The listed charges include use of a helicopter by AirMed, an ambulance by LifeFlight, round-trip mileage and team costs for two team nurses. The charges do not include the cost of any medical equipment, which varies from baby to baby.