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It baffles me to no end how city planners and leaders can justify their numbers when talk of privatizing EMS rolls around! If a fire based EMS system is already in place and is healthy and thriving, why mess with a sustainable money making machine? My friend and boss Bobby Halton said it best when reviewing this submission; stupid is, is stupid does! Forrest Gump is a genius compared to many city (and state) leaders!

What are your thoughts and/or experiences with losing EMS to private ambulance services?

 

 

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Comment by Jason Myer on April 15, 2011 at 1:28am
correction... No that was NOT a all inclusive thing, that was a take your BP while transporting you to the hospital thing... and at the time minimum wage was around 7.00 a hr.
Comment by Jason Myer on April 15, 2011 at 1:19am
Okay I have to argue that idea jsut from having been on both sides... as a 12 year BLS provider on ambulances and engines, to run all medics BLS only winds up commiting engines and medic units to extended duration of call commitment, cause at best your gonna loose 1 medic to the ambulance for a als call, and at worst your engine isnt staffed enough to respond and adhere to the 2 in 2 out rule on a fire. IF were gonna compete with Private enterprise on level of care then we have to be able to provide ALS Medic Units. What we have to be able to do is operate efficiently, and proficiently.  And bill and cost control properly and proactively. Lots of private ambulance charge a lot more for hourly time for personnel then what they pay. WHen I worked in private ambulance I got paid min. wage, no benefits. The company I worked for charged 30 dollars per hour, with a time minimum, for BLS CARE.  and no that was a all inclusive thing, that was a jsut for me taking your blood pressure while transporting you thing.  We can bill more accurately cost wise which is a benifit to our customers, and still become closer to self supporting. With the feds I had to go to a class called fire business management. Well maybe that is how we should look at it now. We have private EMS AND FIRE AGENCIES (and yes that is structural fire)  trying to show that they can do it for a lower cost to the local government. Well instead of just relying on the studies that said Fire should be inherently governmental, lets get out there and try to get to being self supporting... Lets bill for wildland and structure fires, when it is not the result of a accident but can be proven through investigation that carelessness or disregard for due safety is involved. lets put some costs of cut and rescues on insurance companies, get criminals to have to pay part of costs for times when we have to respond to the results of a criminal act and suppress fire or treat a patient. Staffing levels are a problem, but one that we have to tackle the same way we always have, and that is to try to push through it till the economy gets better or we do enough good to prove the need for staffing.  Near miss reporting that can involve loss of civilian life, that could have been avoided with proper staffing levels. the stories are coming up almost daily about tragedy fires and near misses  that could have been adverted if not for staffing level cuts. Well IF were billing for 75% of our calls and getting paid for 25% of our calls that is still 25% more income for the department. Public EMS and ESU should do the same...If we treat and transport, then bill. We don't have to charge the same as private to provide the same. Im all for the private enterprise way of life in america, but when it comes down to whos treating my family, whos responding to put out my house while IM on duty, who is on the big (Fill in the color) Engine and Medic unit I see responding when Im on vacation or what ever, I like knowing that for the most part we are trained to the same level and held to the higher standard.  I know there was a time when Senior ranks said "we don't need medical qualifications, were firefighters", just the same as later came "I don't want that ambulance in my Fire house, were firefighters!" Well the truth of the matter is were problem solvers. When everythign is goingbad, and someone is some how in a world of hurt...the fire service gets the call...(except when it requires law enforcement...Ill stage and wait for the all clear thank you very much). The way i kinda see it is we can be proactive and supplement our income by billing for certain services, or try to get a new higher tax passed through, or sit back and watch our jobs go by the way side to private enterprise. Heck, who knows maybe we can even get enough to not face staffing cuts...not face empty firehouses or units that are on "revolving black out shifts". Granted I am jsut a lowly firefighter, but that is my view...again nuff said, end of the rant...
Comment by THOMAS D HORNE on April 14, 2011 at 9:14pm

If you can provide EMS at a lower cost for the actual delivered service then that is a good thing.  To me that means doing it with the existing staff OR fully justifying any increase in staffing.  One fatal mistake I think many fire service EMS systems are making is to tie up medics on non advanced cases.  One way to avoid that and get increased staffing on Engines is to get medics out of the transportation business.  If the medics only staff engines then they won't be pressed into service on routine transports accidentally.  If the only assigned staffing on ambulances is EMT-Bs then the new gall/guys get to start out on the routine calls and you don't burn out medics with them.  If the new gall/guy wants off the ambulance then he/she will work their butt off to qualify as a medic and become too valuable to tie up on a transport unit for routine transports.  Check the figures and you will find that the closest government owned vehicle to any citizen on average is an engine. 

 

Thinking of insurance reimbursements as a cash cow will blow up in your face.  Insurance companies do not take multimillion dollar hits and not adjust premiums to compensate.  When the law changed to prevent insurers from limiting psychiatric care more than medical care premiums went up to cover increased costs.  When the ambulance allowance in their policy gets used more their premiums will go up.  They will blame you.  There is no such thing as free money!  

Comment by Robert Freitas on April 14, 2011 at 3:42pm

What the public sector tends to forget, though, is that the fiscal side of the equation is an important to factor into justification for providing services.  Many departments jump onto the EMS bandwagon through paramedic staffing or transport services without a solid cost/benefit analysis in place.  We cannot expect the public (either through increased taxes or insurance premiums) to support these higher level of services unless we can justify WHY its better for us to do it then private industry.

 

While we can all agree that more services are better, we cannot leave out the follow-up question of, "Yeah, but is it worth it?"

Comment by Jason Myer on April 14, 2011 at 9:53am
sorry guys read the chiefs posting and agreed, and had started forming a comment in my head already... wasn't trying to jump on his band wagon...oops... guess all I really did was reiterate everything he said. Good job though chief and thank you for at least letting me know that I wasn't just in some little dream world with my thoughts..
Comment by Jason Myer on April 14, 2011 at 9:37am

It has always amazed me how most Fire EMS systems are just "thrown in" with the tax base for Fire. I understand in some areas this tax base is some what substanstial and so it proves and provides further affirmation on why the budget and tax for the fire service is needed. But in may areas the amount of the tax base that goes to a Fire Department is measly compared to other public services...eg water, waste, parks and rec. Why shouldn't publicly funded EMS operations, in and out of the Fire Service beable to bill for their services, just the same as a private company does. It seems that when the budget isnt in that bad of shape and civic leaders wish to show that their in control of the budget, cutting private EMS for a Fire Based service looks like justification of why to have a paid fire department. But when budgets are bad, its easier to cut EMS back out of the FD and not have extra training costs, vehicle maintenance costs, and of course the almighty price of Diesel. We're already there staffing the station, with provided protection areas, aka first dues... I like also how the city of Dallas, Tx has as I think they're called "peak hours" medic units that are staffed during the peak hours of response providing extra response abilities to the areas that have high call and transport volumes. we can be easily self sustaining to bill for these charges. Either way we have to keep our qualifications up cause a engine goes to medical calls in most jurisdictions anyway. We have to buy the supplies to keep on these engines for when we beat the private ambulance coming from across town to the scene and start providing treatment. The people are going to still expect to see a engine to come to the call jsut " as it always has" even in areas that only recently ( in the past 10 to 20 years) started providing Fire based EMS. So I figure its going to be a lot easier for us to bill and get paid by insurance, government health care ( mediCal, medicare etc) then it would be to try to raise the taxes to provide theses services. Also, correct me if I'm wrong but in some areas, ( of course not all) but some areas went to Fire based EMS because of failing levels of service provided by private companies. Anyone really want to hear that at their City Commissioners meeting from the public? And as said by the other commenter, we have been letting insurance and some private companies get a "free ride" for other areas. Cut and rescues, Fire suppression, hazardous condition standbys (power lines down can wrap up several companies for a extended duration as we all know...) I think its time that for SOME of our services we stop just trying to "float the note" and prove that publicly provided services not only are still the most affordable by our customers the citizens, but that dollar for dollar we can provide the most efficient service in the most proficient manner.... Nuff said...end of the rant.

Comment by Paul Combs on April 14, 2011 at 9:27am
Chief Murphy: Sound off any time you please! :)

Jeff: Great to have you on here! I know you and I talked about this in length at FDIC - unfortunately the people making the decisions are not listening!
Comment by John K. Murphy on April 14, 2011 at 9:22am

The trends towards fee for service in the fire departments are changing but in many areas of the country it’s a “cultural thing” and many departments won’t event talk about it. In many parts of the country, fire departments do not charge for EMS services although that revenue is available from the patients’ Medicare coverage or private medical insurance. The selling point to municipalities from the private sector is by marketing a self sustaining service to the community, elected and appointed leaders are seeing more dollars for other projects and less for Fire based EMS. Private EMS has been charging Medicare and the insurance companies as a way to stay in business. The reality is that in some areas, private EMS becomes a “business partnership” with the municipality. This may mean a marginal subsidy by the municipality to the private sector which in the long run lowers the municipality’s cost for this essential service. In other larger service areas (think major cities), there is a ROI in the form of a “cash back” arrangement from the private sector to the municipality. This becomes a revenue stream potential that the municipalities are craving. If public Fire and EMS can get on the same business page as the private sector and convince the municipality that we can do the job effectively, efficiently and create a profit in the EMS arena, then the Fire Service can compete head to head with the private sector. Fortunately, there is a trend by Fire/EMS in becoming a fee for service provider. This paradigm change is difficult for many fire departments as they derive much of their current operating costs from property taxes and other special levies. The Fire Chief’s question is, “will fee for service cut into the tax subsidy?” A solid business plan will answer that question. Another potential untapped revenue source for fire suppression activities are the insurance companies. We need seek fee recovery for fires and other events involving insured structures. Insurance companies have been getting a free ride for our services. I postulate that we have not adopted a business model that appeals to the “elected leadership” who are generally business people. As an industry, we need to get on the same page as our elected leadership like the private sector. We are in a fight for survival and the fire service needs to take the gloves off. Is the next threat the privatization of Fire Protection services? I shudder at the thought.

Great illustration and thanks for letting me sound off.

Comment by Jeff Betz on April 14, 2011 at 9:19am
Great point Paul. Better yet, look at how many of us are trying to ask to provide fire-based EMS, only to be given an emphatic NO! We would provide better service (at least in my city) with the added bonus of stabilizing a bleeding budget. I could go on and on, but for the sake of my mental health, I better just bid you a good day, and well done!

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