# Martin County can realize significant cost saving by privatizing ambulance service



## MMiz (May 31, 2010)

*Martin County can realize significant cost  saving by privatizing ambulance service*

As part of its mission, your taxpayers association seeks to work with public officials by proactively suggesting ways to save or use tax revenue more efficiently. Since personnel costs are by far the largest portion of the county’s operating budget, outsourcing of county services presents a major opportunity.

One such opportunity is the Fire Rescue Department. For years, your taxpayers association has warned public officials and taxpayers that yearly, double-digit wage increases and accompanying fringe-benefit increases in this department were unsustainable. We have nothing against the Fire Rescue Department. But in the past 10 years — 2000 through 2009 — total salaries and fringes have increased more than threefold. With significantly decreasing tax revenues, the Fire Rescue Department is now a major contributor to Martin County’s deficits.

*Read more!*


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## medic417 (May 31, 2010)

Bravo for them.  It only makes sense that at some point all these mandatory pay raises etc would bust the budget.  A private can come in and private equal or better care for less.  Time to get off the recliners and look for a job.  Hope they paid off or stayed out of debt as I see a drastic pay cut in their very near future.


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## atropine (May 31, 2010)

Outsourcing for cheaper labor, cool and all, but I guess thats why private wages are stuck where they are.


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## jjesusfreak01 (May 31, 2010)

atropine said:


> Outsourcing for cheaper labor, cool and all, but I guess thats why private wages are stuck where they are.



Well, probably because people are willing to work for way less than they should. EMS is skilled labor, but some medics don't seem to think that way.


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## FLEMTP (May 31, 2010)

Bringing in a private EMS agency will only hurt the residents of the county. You get what you pay for when it comes to public safety.  

Rural Metro will come in, hire people because they're breathing and have a Paramedic cert. 

Not to mention they want to "save" the county money....by taking away the revenue from transporting patients, yet still want the Fire Rescue to do paramedic first response on every 911 call...

So let me get this straight... you're going to _save_ the county money by making them still go to all the calls as they do now, but not get the revenue from the transport of the patient?

yeah.. cuz THAT makes sense 

Now, a couple more things I'd like to point out

The salaries for Martin County are in line with other Fire-Rescue Depts across the state

from the Martin County Human resources website
http://www.martin.fl.us/web_docs/adm/web/aid_hr_docs/02_2010_Pay_Plan.pdf

a FF-EMT's salary range is     43,118 to 73,746
a FF-Medic's salary range is   49,915 to 85,370

This is not an obscene amount, and these amounts are acceptable should Martin County Fire-Rescue want to remain a competitive employer



> So, the taxpayers association searched for an acceptable private company outsourcing alternative and found Rural/Metro Corp. (www.ruralmetro.com). For more than 50 years, Rural/Metro Corp. has been a leading provider of emergency and nonemergency medical transportation services, fire protection and other safety-related services to municipal, residential, commercial and industrial customers in 400 communities and 22 states. Current Florida customers are Altamonte Springs, Kissimmee, Orange County, Orlando, Osceola County, Sanford, Seminole County, and Sikorsky Aircraft in West Palm Beach.



Rural Metro is a provider at this point in time for ONLY the City of Orlando, which that contract is set to expire and be taken over by AMR. I'm not sure about Sikorsky Aircraft... but where is the author of this article getting his information from?




> It must be pointed out that the taxpayers association is not specifically promoting Rural/Metro Corp. or any other private provider, but wants to counter, up front, any arguments and make it clear to our readers that there are reputable, capable and reliable private companies able to provide needed services.
> 
> Rural/Metro was provided with the Fire Rescue Department’s operating goals and costs, and requested to provide an operating scenario and quote that would not compromise the level of service Martin County residents expect. Rural/Metro responded with the following: “After careful analysis of the material you provided, we have developed a model which would present significant cost savings to your community. Based upon the financial and operational data made available, we believe Rural/Metro could provide emergency ambulance service and transportation for the residents and visitors of Martin County with no government subsidy and at a conservative cost savings to the county of $3 million annually.




First of all any time you go to a private EMS provider, they will ALWAYS tell you they can realize a cost savings for your government. Thats their business... to undercut the goverment and make money for their investors. Thats like going to a car salesman and asking him if his car will be cheaper than the guy down the street.. he's ALWAYS going to say yes.

What will end up happening is that RMA will come to the commissioners and begin demanding a "subsidy" claiming they are not collecting the revenues they thought they would based on the numbers provided to them by Martin County Fire-Rescue.. so they'll end up with no savings, and a redundancy of services by a private provider, at the cost of the quality of care.




> For this to succeed we would need the latitude to operationally deploy our resources to meet an acceptable performance standard. We would suggest a partnership between Martin County and Rural/Metro with Fire Service first response at a paramedic level, and Rural/Metro Paramedics providing a continuum of care and transport to the hospital.”



Read between the lines: We want to do it our way, but we still want you to respond to all the same calls you do now... but we want the money for the transport



> Emphasis has been added as we interpret the above to mean that Martin County paramedics would continue first response so there would be no deterioration of current service levels, but the county would still realize a net savings of $3 million annually.



Id be curious to see how they achieved that 3 million a year number..the only cost savings would be on vehicle fuel and maintenance by them not transporting, since they would still be required to respond to all the 911 calls as they do already



> This information was presented to county commissioners who, as reported by the News, voted unanimously April 27, to “examine proposals for a public-private partnership for emergency services” that would include other providers along with Rural/Metro.
> 
> Your taxpayers association lauds the commission for courageously voting to proceed in this direction and urge county administration and management to move rapidly in pursuing this significant cost-saving opportunity and to expand their investigations to include other county services.
> 
> Your taxpayers association also suggests the city of Stuart, the School Board, Martin County’s constitutional offices and other entities seek similar privatization cost savings opportunities, as tax increases are not acceptable while these opportunities have not been seriously evaluated.



Yeah.. thats smart.. farm everything out to private entities... that way the government has very little control over how critical government services are provided.. heck, while we're at it.. lets fire the sheriff's office, and replace it with Wackenhut!


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## DrParasite (Jun 1, 2010)

FLEMTP said:


> Yeah.. thats smart.. farm everything out to private entities... that way the government has very little control over how critical government services are provided.. heck, while we're at it.. lets fire the sheriff's office, and replace it with Wackenhut!


Actually, that would save millions.

For most public safety agencies, the #1 budget item is salaries and pensions.  Outsource EMS, Fire, PD, and DPW, and the city doesn't have to pay those salaries, esp if the contracted price is lower than the original budget.

THIS IS STILL A BAD IDEA!!!!!!!!!!!

outsources is cheaper.  however, you lose any and all revenue from billing insurance companies.  you tend to have poorer paid employees, with lower levels of morale.  pensions disappear, turnover is high, and the quality of service deteriorates.  The citizens are the one who end up suffering (just look at OCP and the movie RoboCOP), but as long as it costs less, politicians are often in favor of it.

Politicians need to stop looking at dollar figures as the end all be all.  look at the overall service, including the employees themselves.  many places have outsources their EMS, only to realize after the switch how much they wish they had their own agency, and now would be very expensive to switch back.


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## JPINFV (Jun 1, 2010)

You know what's always funny when it comes to arguments like this. Government run EMS is good because the government can provider a higher level of service, however government run health care is bad because it costs too much money and is government run. 

A few points.

1. Private ambulance with fire first response is stupid. Similarly, fire departments do stupid things like running the EMS system, but farming out just the transport. If you want to run an EMS system, then provide the whole enchilada. 

2. Regional systems are going to be more efficient than non-regional systems. It doesn't make a whole lot of sense to have, based on need, 3 ambulances in one town and 3 ambulances in a neighboring town (by "neighboring" I mean towns that have grown to the point where you wouldn't be able to tell the city limits except for a sign), but only 5 ambulances if you combined the area. Additionally, a regional design would mean that you wouldn't need a separate complete disaster response system for each individual town. I'd argue that, similarly, every city having their own SWAT team is just as inefficient. It's easier for this to be accomplished by private companies through a competitive bid process because moving from a city service system to a regional system requires the city chiefs to give up their own little fiefdoms.


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## rescue99 (Jun 1, 2010)

JPINFV said:


> You know what's always funny when it comes to arguments like this. Government run EMS is good because the government can provider a higher level of service, however government run health care is bad because it costs too much money and is government run.
> 
> A few points.
> 
> ...



The need for fewer full time FF will reduce overhead a lot and off-set the cost of a private contract. As FF retire the staffing glut can also be reduced to a more fiscally prudent number of men and women. No one has to lose a job if it's done right. It's simple mathmatics. Private is cheaper and the overall quality of care is historically better. Work in a large metropolitan area very long and the quality of patient care is noticable between the two responding entities.


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## WolfmanHarris (Jun 1, 2010)

rescue99 said:


> It's simple mathmatics. Private is cheaper and the overall quality of care is historically better. Work in a large metropolitan area very long and the quality of patient care is noticable between the two responding entities.



If the math is simple, please present it. How many County staff are close to retirement, such that attrition alone can cut staffing costs? At what rate is the County growing which would increase required staffing for suppression? The fact is, the math on these decisions is going to be variable with the municipality.

Also, using evidence that's not anecdotal and can be applied beyond a local setting please justify the quality of care comment. 

Now I'm against private EMS, but I'm also against privately funded or two tier health care, and while we're at it I'm against Fire-based EMS, the combination of the stable IFT industry with EMS, poor education standards, and drowning kittens. But that's neither here nor there. The issue should be looked at rationally, free of the baggage we all carry to the discussion.


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## medic417 (Jun 1, 2010)

Heck if any of these people were doing it for the right reason they would just give up the pay and do the job for free.  They have no real passion.  They are in it just for the money.


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## atropine (Jun 1, 2010)

Weii, first off, what are the right reasons, and second who the hell works for free?


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## Shishkabob (Jun 1, 2010)

atropine said:


> Outsourcing for cheaper labor, cool and all, but I guess thats why private wages are stuck where they are.



If someone truly wants a cost effective EMS system, it is NOT with the fire department.





FLEMTP said:


> Id be curious to see how they achieved that 3 million a year number..the only cost savings would be on vehicle fuel and maintenance by them not transporting, since they would still be required to respond to all the 911 calls as they do already



Fallacy.


Many places that do Private/Third service EMS with fire first response only dispatch fire to life threatening calls, and not EVERY 911 call.


FW for example.  Priority 1 is life threatening, 2 is potentially life threatening, and 3-5 are not life threatening.  MedStar goes on all calls.  Fort Worth Fire only does priority 1-2.


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## medic417 (Jun 1, 2010)

atropine said:


> Weii, first off, what are the right reasons, and second who the hell works for free?



Sadly lots of FF's and EMS people.


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## atropine (Jun 1, 2010)

Linuss said:


> If someone truly wants a cost effective EMS system, it is NOT with the fire department.
> 
> 
> 
> ...


Well what happens if the call comes in at a  3-5 and when medstar gets on scene it's a 1 or 2?


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## atropine (Jun 1, 2010)

medic417 said:


> Sadly lots of FF's and EMS people.



Yeah, where and what are these reasons you speak of?


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## medic417 (Jun 1, 2010)

atropine said:


> Yeah, where and what are these reasons you speak of?



What reasons do you speak of?  As to where look at almost every community and you find volunteer fire and EMS.  Heck most fire in the USA is Volunteer.  Why?  Because there is so little need for fire in our day and age.  So they get to have the light and act like a hero.  

As to why people give away their EMS services?  Don't get me started.


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## medic417 (Jun 1, 2010)

atropine said:


> Well what happens if the call comes in at a  3-5 and when medstar gets on scene it's a 1 or 2?



They take care of the patient w/o the fire fighters getting in the way.  Actually better that way.


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## Shishkabob (Jun 1, 2010)

atropine said:


> Well what happens if the call comes in at a  3-5 and when medstar gets on scene it's a 1 or 2?



Most FWFD engines are EMT engines only.  There are only a couple of engines in the entire city that have a Paramedic on board and they tend to be in the outer areas.

MedStar is Medic/Basic.


The medic on the ambulance will be able to handle a priority 1/2 without 4 extra EMTs if need be.  Really the only time you need the extra hands is in a cardiac arrest.  Everywhere else, they're nice to have but not a necessity.


And, from my experience, as soon as it's deemed to not be a cardiac arrest, the Medic on the ambulance tends to send the engine back home anyhow.


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## mycrofft (Jun 2, 2010)

*One and two...(not "five is four")*

1. What do you think subsidizes a decent sized FD nowadays? *EMS runs*, the number one in quantity of run categories.

2. FLEMT sounds like he's been there and seen that, I've seen that and I'v seen it done with jail medical. Lowball the estimate, get in, then start weasling out of the budget restraints and find ways to avoid doing all your work as promised. Sort of like my landscaper. Or Lockheed aircaft.


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## FLEMTP (Jun 2, 2010)

mycrofft said:


> 1. What do you think subsidizes a decent sized FD nowadays? *EMS runs*, the number one in quantity of run categories.
> 
> 2. FLEMT sounds like he's been there and seen that, I've seen that and I'v seen it done with jail medical. Lowball the estimate, get in, then start weasling out of the budget restraints and find ways to avoid doing all your work as promised. Sort of like my landscaper. Or Lockheed aircaft.



Yes, I have.. and unfortunately.. I've been on both sides of that situation.. 

My personal belief is if you want the best care available and you want the most bang for your buck, you go third service municipal EMS. ( or even a well ran not-for-profit EMS agency) If thats not an option, the I'd prefer to see a Fire based EMS agency, with separate EMS/Fire Divisions... if thats not an option.. then dual role EMS...whether it be LEO/EMS or Fire/EMS... followed lastly by private EMS. 

As far as I'm concerned... when you try and run a for-profit EMS agency.. in the end.. no one wins.


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## BLSBoy (Jun 2, 2010)

I had a response, but its not worth fighting this battle. 

I hope you all have lots of insurance on your property.


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## Hal9000 (Jun 2, 2010)

FLEMTP said:


> My personal belief is if you want the best care available and you want the most bang for your buck, you go third service municipal EMS. ( or even a well ran not-for-profit EMS agency)



I won't really get into the whole discussion on economic black holes, early retirement, etc., but I will note that the two most responsible EMS agencies I have seen were each from one of the quoted categories.  Of course, that's just an anecdotal experience.


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## Focallength (Jun 12, 2010)

The company I work for dosent handle 911 calls, however we handle calls from numerous hospitals and SNF. That being said when the SNF or the hospital has an emergency they dont call 911 they call our dispatch. Fire never shows up unless we call them, we handle all aspects of the call, not just transport. The average ALS call day is up to 40 calls in a 24 like wise for BLS. We provide better care than AMR and fire, we handle just as many calls as fire. AMR runs a fraction of our calls. We deal with pediatrics, Mental health, Geriatrics as well as calls from prisons. 

yes wages are lower than they should be, butin all reality thats our fault (the employees) we shoot ourselves in the foot when we as fresh faced green EMT's are willing to take any job because its a job, so they pay minimum. You dont like it, well theres 100 other new recruits that will take your job and be happy about making $8 an hour. So if EMS went private, you would see the smaller companies getting bought out by the bigger, and hopefully unions would be formed. Thats where the major fault is I believe, Im not a pro union guy but there are benefits. Up here AMR is union and a green EMT will start at $15 an hour.


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## FLEMTP (Jun 12, 2010)

Focallength said:


> The company I work for dosent handle 911 calls, however we handle calls from numerous hospitals and SNF. That being said when the SNF or the hospital has an emergency they dont call 911 they call our dispatch. Fire never shows up unless we call them, we handle all aspects of the call, not just transport. The average ALS call day is up to 40 calls in a 24 like wise for BLS. We provide better care than AMR and fire, we handle just as many calls as fire. AMR runs a fraction of our calls. We deal with pediatrics, Mental health, Geriatrics as well as calls from prisons.
> 
> yes wages are lower than they should be, butin all reality thats our fault (the employees) we shoot ourselves in the foot when we as fresh faced green EMT's are willing to take any job because its a job, so they pay minimum. You dont like it, well theres 100 other new recruits that will take your job and be happy about making $8 an hour. So if EMS went private, you would see the smaller companies getting bought out by the bigger, and hopefully unions would be formed. Thats where the major fault is I believe, Im not a pro union guy but there are benefits. Up here AMR is union and a green EMT will start at $15 an hour.




Maybe I'm missing the point of your post.. but...how does any of this pertain to Martin County Fire Rescue or the Martin County Commissioners considering a privatization of services?


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## jgmedic (Jun 17, 2010)

Focallength said:


> The company I work for dosent handle 911 calls, however we handle calls from numerous hospitals and SNF. That being said when the SNF or the hospital has an emergency they dont call 911 they call our dispatch. Fire never shows up unless we call them, we handle all aspects of the call, not just transport. The average ALS call day is up to 40 calls in a 24 like wise for BLS. We provide better care than AMR and fire, we handle just as many calls as fire. AMR runs a fraction of our calls. We deal with pediatrics, Mental health, Geriatrics as well as calls from prisons.
> 
> yes wages are lower than they should be, butin all reality thats our fault (the employees) we shoot ourselves in the foot when we as fresh faced green EMT's are willing to take any job because its a job, so they pay minimum. You dont like it, well theres 100 other new recruits that will take your job and be happy about making $8 an hour. So if EMS went private, you would see the smaller companies getting bought out by the bigger, and hopefully unions would be formed. Thats where the major fault is I believe, Im not a pro union guy but there are benefits. Up here AMR is union and a green EMT will start at $15 an hour.



Seriously? Wait, you mean you deal with peds, geriatrics, mental health, AND prison calls. I'm sure AMR and Fire never do that sort of thing. You run 40 calls in 24 hours? Are all your hospitals 2-3 min away and your turnaround time less than 10 min? Come on man, I'm glad you're proud of where you work, but this was a bit much.


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