# Rural Metro's ambulance contract with Santa Clara County



## AlphaTech (Apr 29, 2013)

"Cause for alarm: A year and half after taking over 911 calls for Santa Clara County's 14 cities and vast unincorporated areas, Rural Metro ambulance has violated its contract by failing to meet response times, paid more than $4.7 million in fines for contract violations and faces the threat of the first paramedics strike in recent "


Full Article
http://www.mercurynews.com/breaking...tens-yank-rural-metros-ambulance?source=email

So who's next if Rural loses there contract? AMR again? Or do you guys think they won't lose their contract?


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## PotatoMedic (Apr 29, 2013)

Didn't Falck just start operations in that area?  My guess it will go to them if they want it.

EDIT: After a little more research they would need to get a county license but they are already in the area.   Not too farfetched.


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## AlphaTech (Apr 29, 2013)

FireWA1 said:


> Didn't Falck just start operations in that area?  My guess it will go to them if they want it.
> 
> EDIT: After a little more research they would need to get a county license but they are already in the area.   Not too farfetched.



Yeah they've only been responding to 911 for 1.5 years. 

County license?


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## TheLocalMedic (Apr 29, 2013)

Falck has a corporate office in Sonoma County and I heard that they now either have or are planning to have an office in Alameda County.  They just recently bought Verihealth ambulance and are making a move to come up big on the west coast.  

I think Falck would be very interested in moving into Santa Clara...


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## Aprz (Apr 29, 2013)

TheLocalMedic said:


> Falck has a corporate office in Sonoma County and I heard that they now either have or are planning to have an office in Alameda County.  They just recently bought Verihealth ambulance and are making a move to come up big on the west coast.
> 
> I think Falck would be very interested in moving into Santa Clara...


I don't know how this all works, but I heard rumor that they had the opportunity to take over Santa Clara County, and they turned it down. *shrugs*


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## socalmedic (Apr 30, 2013)

TheLocalMedic said:


> Falck has a corporate office in Sonoma County and I heard that they now either have or are planning to have an office in Alameda County.  They just recently bought Verihealth ambulance and are making a move to come up big on the west coast.
> 
> I think Falck would be very interested in moving into Santa Clara...



when I spoke with Falck about coming on board as a supervisor they stated that they had no intention of operating 911 on a large scale anytime in the near future.


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## PotatoMedic (May 1, 2013)

socalmedic said:


> when I spoke with Falck about coming on board as a supervisor they stated that they had no intention of operating 911 on a large scale anytime in the near future.



Makes sense.  911 is not where the money is at.  Better to get established before you get in a sector of ems that really does not pay all that well.


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## csa819 (May 1, 2013)

Oh, Falck's interested in the 911 markets, especially Rural/Metro contracts. The US president of Falck left Rural/Metro on rather interesting  terms involving multiple litagations. In Massachusetts they are involved in intellectual property disputes with AMR over a few thing's. 

But this is classic  Rural/Metro, over promise and then under deliver.


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## gclol (May 1, 2013)

Sounds like a certain company in Alameda county


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## PotatoMedic (May 1, 2013)

csa819 said:


> Oh, Falck's interested in the 911 markets, especially Rural/Metro contracts. The US president of Falck left Rural/Metro on rather interesting  terms involving multiple litagations. In Massachusetts they are involved in intellectual property disputes with AMR over a few thing's.
> 
> But this is classic  Rural/Metro, over promise and then under deliver.




You make it seem like there is bad blood between him and rm. 

Again it will be interesting to see what happenes in the future.  Either way.  911 pays like crap if at all.


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## csa819 (May 1, 2013)

*hmm*



FireWA1 said:


> You make it seem like there is bad blood between him and rm.
> 
> Draw your own conclusion...
> google heffner vs.rural metro


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## TheLocalMedic (May 2, 2013)

Falck has invested millions in building offices, purchasing ambulances and equipment, and has just bought a profitable ambulance company that has been getting involved in the 911 game in both Sonoma and Mendocino counties.  I only foresee further growth for them on the west coast.  

And while running a "911 system" isn't the most profitable, if they can secure transfer contracts and agreements by taking over a county, then I don't see why they wouldn't at least throw in a bid.  Transfers are where the money is at, and if securing 911 contracts will open the door to them to control the transfer market, then why not go for it?

The money they have already thrown into this area is more than enough evidence for me to conclude that they are already invested in the idea of coming up big on the west coast.  I wouldn't be surprised if they made a run at Santa Clara, Contra Costa, Alameda, Napa, Sonoma, Mendocino and Yolo.  Watch out for them, THEY'RE COMING!!


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## DPM (Jul 4, 2013)

The Contra Costa 911 contract is up for review soon, and Falk has an IFT operation in Concord, I'm interested to see what happens there.

As far as R/M in Santa Clara goes, I'm hearing worrying things about the county... County EMS being worried that R/M might cut their losses and call it a day. 

Hopefully it doesn't end up like another Westmed.


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## Amberlamps916 (Jul 4, 2013)

DPM said:


> The Contra Costa 911 contract is up for review soon, and Falk has an IFT operation in Concord, I'm interested to see what happens there.
> 
> As far as R/M in Santa Clara goes, I'm hearing worrying things about the county... County EMS being worried that R/M might cut their losses and call it a day.
> 
> Hopefully it doesn't end up like another Westmed.



What happened with Westmed?


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## DPM (Jul 4, 2013)

Westmed won the Monterey County 911 back in 2004 when they underbid AMR. Unfortunately they couldn't afford to run at the rates that they had negotiated, so they ended up having to lay people off, take out loans to afford payroll, running the county at low levels because they couldn't afford to have the units up... eventually they split the company to save their assets and filed for bankruptcy. (In 2005 I think). It messed things up in the county for a while and AMR ended up getting the contract back and having to pick up the pieces. 

If (and it is an if) R/M is having similar financial difficulties then things could end up going the same way.


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## Amberlamps916 (Jul 4, 2013)

Santa Clara, Monterey, and Alameda counties prove that you shouldn't mess with a system that has been working fine.


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## gclol (Jul 4, 2013)

Pplus has lost just as much in Alameda county gonna be interesting next few years


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## DPM (Jul 4, 2013)

gclol said:


> Pplus has lost just as much in Alameda county gonna be interesting next few years



Aint no one in Oakland pay for no amber lance!


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## Akulahawk (Jul 5, 2013)

AlphaTech said:


> "Cause for alarm: A year and half after taking over 911 calls for Santa Clara County's 14 cities and vast unincorporated areas, Rural Metro ambulance has violated its contract by failing to meet response times, paid more than $4.7 million in fines for contract violations and faces the threat of the first paramedics strike in recent "
> 
> 
> Full Article
> ...


I remember a time when AMR had essentially the same issues that R/M has now. I've run _many_ 911 calls as an EMT-1 because AMR wasn't able to handle the load and weren't meeting the terms of their contract. I was on a BLS ambulance for about 18 months, running typically 1-2 911 calls _every day_ that I was working. Just about every BLS company in business got multiple 911 calls every day... They didn't do much about it on either side because there was ambulance coverage, AMR was paying the fines, and the contract was almost up. After the new contract went into effect, I went from running 1-2 911 calls per day to 1-2 911 calls per month, if that! Same thing happened to the other BLS providers. 

I'm quite reminded of those days just from reading the article, just that the contract is in it's early stages, not the end... If R/M doesn't get it's act in gear, they're going to have trouble keeping that contract.


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## Aprz (Jul 5, 2013)

When I did my ride along with American Medical Response (AMR) in Santa Clara County (SCC) in 2010, I don't recall seeing them having mobile data consoles (MDCs). Maybe my memory is fuzzy. I thought they received the map book page and location on their pager, and they used The Thomas Guide to the Bay Area Metro, or the custom made one for SCC (they removed unnecessary pages from the Thomas Guide to the Bay Area Metro). County Ambulance (operated by Rural/Metro) has Panasonic MDCs, which will provide dispatch information, route their to their call, and they can update dispatch on their status.

I thought AMR also did posting by zones, and usually posted in or near the same area frequently. I cannot find a picture of the zones online. I think County Ambulance started using system status management (SSM) via Mobile Area Routing and Vehicle Location Information System (MARVLIS) (scroll down to page 26 of the PDF), which predicts where future calls will be based on when and where previous calls were, and post them in that predicted spot.

The brought over mostly the same staff from AMR, and hired more to staff I believe up to five additional ambulances.

You'd think with MDCs, SSM, and more ambulances, they'd have quicker response times, and wouldn't be late. I think the primary problem in regard to meeting response time is with SSM though; it takes several years of collecting data before it more accurately predicts calls and saves "a little bit" of time. I also think it could slightly be because crews aren't as familiar with the roads they are responding and transporting on. Some of the hospitals in the area (eg Valley Medical Center (VMC)) are notorious for making prehospital personnel wait for a bed ("wall hug?"). <somewhat jokingly>They probably would have better response times too if they hired me there.</somewhat jokingly>

From what I've been told, the fines are also a lot more severe. After AMR lost the contract, the county seems to have gone crazy with rules and regulations. Interfacility transfer only ambulance companies are required to have new 5.11 jackets (also look at SCC EMS - EMS Personnel Markings & Protective Gear - Policy 613), and I've been told there is a hefty fine if a crew wears the jacket when they are not in the system. The crews are also suppose to have a personal helmets. That means every prehospital personnel, County Ambulance or not, has a personal 5.11 jacket and a helmet.

They recently started requiring all prehospital personnel to have Hazmat First Responder Operations (FRO) (SCC EMS - Prehospital Training Standards - Policy 214). They offered the class for free for awhile, but now a lot of EMTs have to pay out of their own pocket to continue working as an EMT in SCC if their company doesn't pay for it.

I don't think County Ambulance / Rural/Metro is awesome, but I don't think they are as bad as people make 'em seem. With all the rules, regulations, and fines that SCC EMS has, I think they are doing a fairly good job. The county is crazy.


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## DPM (Jul 5, 2013)

MDT's are great, but their system status management is still worse than when AMR was in the county. The things you've listed are good for the providers, but they were also very expensive (include the brand new fleet, new monitors etc) and SCC has become a very expensive contract for them. 

I'm not saying everything is R/M's fault, but they agreed to this contact. If they're having trouble staying profitable they have no one else to blame.


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## Akulahawk (Jul 5, 2013)

SCC's Policy 613 got started when I was last working there. It's undergone some revisions since I left. One of which was the county purchasing/designating the standards for PPE. The original PPE requirement didn't get as specific. IIRC, they were also getting ready to start those HazMat, and the other courses as requirements for working there. 

If I were R/M, implementing an SSM plan, I'd probably wildly overstaff and closely watch usage patterns from there, slowly backing down on the staffing until maintaining somewhere near 92% all the time, to allow for a very few incidents where a greatly unusual surge in calls occurs.


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## DPM (Jul 5, 2013)

Akulahawk said:


> SCC's Policy 613 got started when I was last working there. It's undergone some revisions since I left. One of which was the county purchasing/designating the standards for PPE. The original PPE requirement didn't get as specific. IIRC, they were also getting ready to start those HazMat, and the other courses as requirements for working there.
> 
> If I were R/M, implementing an SSM plan, I'd probably wildly overstaff and closely watch usage patterns from there, slowly backing down on the staffing until maintaining somewhere near 92% all the time, to allow for a very few incidents where a greatly unusual surge in calls occurs.



The problem is, they agreed to charge X amount of money for their services (X being an amount less than AMR did.) So while AMR managed to run a busy system with a less than ideal reimbursement rate R/M is having trouble staffing the necessary number of units to stay compliant and also remain profitable. Raising the cost to the consumer would put R/M in breach of their contract so they're stuck trying to do the same as AMR with less $$.


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## Akulahawk (Jul 5, 2013)

DPM said:


> The problem is, they agreed to charge X amount of money for their services (X being an amount less than AMR did.) So while AMR managed to run a busy system with a less than ideal reimbursement rate R/M is having trouble staffing the necessary number of units to stay compliant and also remain profitable. Raising the cost to the consumer would put R/M in breach of their contract so they're stuck trying to do the same as AMR with less $$.


Unfortunately, I'm not at all surprised that R/M is doing this... AMR was having trouble as well... but at least they were able to somehow make do. It just isn't easy to make money or even break even on 911 calls because of the number of people that don't have insurance or can't pay, even in that county.


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