Worried? Will Your City, County, Private, EMS Job Survive?

[MSBMEDIC]

get ready fire gods a communist city like san fran wanting competitionThe San Francisco Chronicle (California)

San Francisco's public health director has decided to invite additional private ambulance firms to help the Fire Department cover 911 emergency medical calls on the city's streets.

The decision by Dr. Mitch Katz to establish a "nonexclusive zone" for emergency ambulance services follows a recent state ruling that advised the city to put those services to competitive bid.

But the health czar has balked at preparing a bid package for 911 medical services, a move that experts warned could create logistical problems and lower the quality of services, with private firms vying to serve neighborhoods where there are fewer homeless and uninsured patients.

"This is the worst of all the solutions they could pick," said Richard Narad, a professor of health and community services at Chico State University who is an expert on California ambulance law.

"You will have a system that will cost more, that will be less accountable and provide a lower level of service. And I don't understand why Katz would decline to put it out to bid, which would result in a provider who meets county standards and is accountable to the public and is likely to cost less."

Narad said such competition for patients creates a highly expensive dispatch dilemma of determining which ambulance is closest, and will also result in an increasing number of ambulances flooding into the system - which will lead to higher costs that will be passed on to consumers.

But Katz said dispatching the closest available ambulance to 911 calls will help reduce response times, especially in outlying areas that are not close to a fire station.

On July 31, the state's Emergency Medical Services director, Dr. Steve Tharratt, ruled that San Francisco's 911 ambulance services, which have been dominated by the Fire Department since 1997, do not qualify for antitrust protection from the state because of a lack of competition among the city's emergency ambulance providers.

Tharratt said private ambulance firms handle fewer than 2.4 percent of the city's 911 ambulance services.

The state ruling has sparked consternation among Fire Department administrators, fire and paramedic union leaders and two private ambulance firms that already provide backup emergency ambulance services in the city.

"Effective immediately, San Francisco will no longer maintain an exclusive ambulance zone," Katz wrote in an Oct. 3 letter to Fire Chief Joanne Hayes-White. "If there are additional EMS providers who meet the requirements for advanced life support ambulance services, we will welcome them into our system ... Having additional providers may enhance our system by providing additional capacity."

Katz said in a telephone interview Monday that the city was in "a weak position" to challenge the state's ruling. He also said that, with his creation of an open system for qualified ambulance providers, the state has no grounds to require a competitive bid process.

"Providing pre-hospital care is part of our core mission, and we're devoted to it," Hayes-White said. "We're not going to change the way we do business at all."

David Nivens, president of the California Ambulance Association, said that he was unaware of another urban area in California that has successfully operated a nonexclusive zone for emergency ambulance services. But, he added: "I would think that San Francisco would be an attractive market ... It's small and there's a large population there."

David Andersen, a quality improvement expert in 911 ambulance services who worked previously for the San Francisco Fire Department, said that private ambulance firms may resort to "cream skimming" - only responding to calls in neighborhoods where patients are more likely to afford these services.

John Hanley, president of firefighters union Local 798, questioned the qualifications of outside ambulance firms and the impact Katz's decision will have on the city's revenues.

"We have extremely high standards on patient care," he said. "Do the ambulance companies that will be doing this work have our standards on patient care?"

Private ambulance firms were skeptical about Katz's latest move.

"We'd hate to go back to the ambulance wars of years gone by," said Jerry Souza, general manager of American Medical Response, which already provides backup 911 ambulance services in the city. "Ultimately, we're concerned about quality and a dilution of levels of competencies by new providers who might come in."

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[Dustdevil]

David Andersen, a quality improvement expert in 911 ambulance services who worked previously for the San Francisco Fire Department, said that private ambulance firms may resort to "cream skimming" - only responding to calls in neighborhoods where patients are more likely to afford these services.

John Hanley, president of firefighters union Local 798, questioned the qualifications of outside ambulance firms and the impact Katz's decision will have on the city's revenues.

Zero. The city currently refuses to run the "cream" runs that pay anyhow, so there currently is no profit for the city. The privates are already "cream skimming" and not having to give back to the EMS system. The concern is completely invalid, and in fact, the opposite of reality.

"We have extremely high standards on patient care," he said. "Do the ambulance companies that will be doing this work have our standards on patient care?"

"We'd hate to go back to the ambulance wars of years gone by," said Jerry Souza, general manager of American Medical Response, which already provides backup 911 ambulance services in the city. "Ultimately, we're concerned about quality and a dilution of levels of competencies by new providers who might come in."

Why? If the privates can be regulated out of the system, they can just as easily be regulated within the system. Easier, even. Simply establish standards for medics, just like they do for the FD medics? What the Hell is the difference?

Are these people really this stupid, or are they simply manufacturing false concerns to avoid doing what needs to be done?

[spenac]

We have to keep watch on the markets. Many agencies have funds tied to the markets. We also have to watch foreclosures, because those that get money from taxes will lose 2 ways. Foreclosed properties will have no one paying taxes. Empty houses also mean property values will drop, thus the amount collected from those that pay will be less. That is just two ways your check could come into question.

So who gets cut? At some point all non required services will start feeling the pinch, so goodbye EMS and Fire.

[spenac]

bump as similiar topic just started

[Richard B the EMT]

In no particular order, EMS, FD, Police/Sheriff's Department, Sanitation (garbage), Sewer and Water Departments are ALL essential services, but all must look on how to "cut the fat" when they are already claiming they are "cut to the bone".

[spenac]

In no particular order, EMS, FD, Police/Sheriff's Department, Sanitation (garbage), Sewer and Water Departments are ALL essential services, but all must look on how to "cut the fat" when they are already claiming they are "cut to the bone".

Actually EMS is not considered an essential service. In fact in Texas for example the only essential service, that is the only required service is one sheriff per county. Cops, EMS, fire etc are optional. So in theory if budget cuts were made which would be the least likely to stir up the blue hairs? EMS because we are not thought of as heros like cops and fire. No one sees us saving lives like they see in news of FF's and cops. So guess what they can drop us claim hay we still have cops and ff's everythings alright.

[crotchitymedic1986]

Well I think EMS/FIRE/PD would rank higher than most departments on the evolutionary chain, whether you want to call them "essential" or not. The problem is, as noted by someone else, most departments have been cutting for a long time now, and may not be able to cut any further without closing down the department all together. So those "more essential" services may have to start sharing the pain.

[Richard B the EMT]

Considering that I say it so often, I must have forgotten to mention that EMS in NYC is not a "Third Service", and never was, even before we were forced into the merger with the FDNY.

[Jworobe]

Since most EMS services are fire based they should be able to survive all types of economic situations.

Not sure where you get your information from. I am the Deputy Director of a five county EMS Region that has 9 ambulance service providers, only one of which is fire service based. By my rather small sample population, only about 10 percent are fire service based.

Another factor to consider is state funding for augmentation of EMS services. In this state, our augmentation has been cut 10% this year with a potential for more cuts in the near future. Add to this, the current augmentation has not been increased for over 10 years, and EMS Regions in this state (and by extension services provided to manage EMS Systems) is working on about 21 cents to the dollar.

[WolfmanHarris]

Oh don't mind Jbangas. He was a troll and never replied to direct questions anyways. He's gone now.