Dead horse, new article

[SanDiegoEmt7]

http://www.msnbc.msn.com/id/42609378/ns/business-tax_tactics/

 

[Aidey]

I just saw this too. I couldn't help but wonder how much IAFF paid for that.

 

[usalsfyre]

Interesting how they focused on R/M being investigated but failed to mention the ongoing investigation of Dallas FD over an alleged $40 million in Medicare fraud.

This has Harry Schaitberger written all over it.

 

[Aidey]

What is scary are the comments. It really shows how ignorant the general public is about anything EMS, no matter who is running it, and if they are union or not. A few people have tried to point out how certification works and such and they are getting trampled.

 

[terrible one]

Note 70% of the nations FD are volunteer, there are 1000 applications for one opening, yet in CA FF/PM get paid almost double the national average.

With unemployment near 12% cities cannot nor should they be paying full benefits and 90% pay for retired city employees, including public safety

 

[Zodiac]

The comments are almost comical but with people who already think they know everything, there's really no changing their minds no matter how much evidence anybody presents to them.

 

[firetender]

Who carries the load?

http://www.msnbc.msn.com/id/42609378/ns/business-tax_tactics/

Here's what bugs me most...

Last June, AMR suggested it take over part or all of the job, according to a proposal submitted to the city. One of its arguments was that the pay differential could be up to 50 percent less for private employees than fire department EMS workers who have more generous wages and pension plans.

The FD wants to hold on to what they have, understandably. It's all about keeping those contracts.

The privates, on the other hand, are just as contract-driven, aren't they? They are essentially saying you give US the contract and we can get THEM (that's YOU folks!) to work for cheap.

Neither side is talking improving the system or patient care. EMS needs to be separate from private, separate from Fire; the relentless pursuit of vested interests is killing us!

 

[PotatoMedic]

Personally I never want to see a system primarily run by private EMS. Private EMS companies are out to make money. Tri-med, a private EMS company in the PNW, has fired EMT's for requesting Paramedics. Why? Because the paramedics transport the patient who needed paramedic care and tri-med gets no money.

Where I live I like the fire based EMS system I have. Other places I would not want to see a firefighter even put a bandaid on someone. But I don't think EMS should be privatized. I feel it should be a municipality.

 

[Veneficus]

People have been saying this for years.

Public vs. private, in some surreal sense, private might be the better answer.

Most hospitals are private, and the private sector does respond to changes much better than the municiple sector.

I think with the inevitable decrease in payment for transport, the fire service is not going to be able to adapt. They already cannot handle the call volume in many major cities.

As such, multiple private providers will have to compete with each other. Sure the game has been to cheapen the cost like a trucking company ths far.

But you can only cheapen so much before somebody starts to go the other way and offer superior service. Which I think will have to happen becase nobody will be able to make money off of transports.

As for the pay, municiple firefighters in the US are way over paid. Not to be mean, but no other skilled laborers make nearly the amount firefighters do in pay and benefits with such little training.

Union strong arming might not be enough anymore. The "fiscal conservatives" have convinced the little guys that high taxes, government spending, and government benefits are evil.

The people have bought into that and the trend will continue.

The fire service has also been squandering all of the public good will. You can only call yourself a hero so long and not deliver.

 

[abckidsmom]

People have been saying this for years.

Public vs. private, in some surreal sense, private might be the better answer.

Most hospitals are private, and the private sector does respond to changes much better than the municiple sector.

I think with the inevitable decrease in payment for transport, the fire service is not going to be able to adapt. They already cannot handle the call volume in many major cities.

As such, multiple private providers will have to compete with each other. Sure the game has been to cheapen the cost like a trucking company ths far.

But you can only cheapen so much before somebody starts to go the other way and offer superior service. Which I think will have to happen becase nobody will be able to make money off of transports.

As for the pay, municiple firefighters in the US are way over paid. Not to be mean, but no other skilled laborers make nearly the amount firefighters do in pay and benefits with such little training.

Union strong arming might not be enough anymore. The "fiscal conservatives" have convinced the little guys that high taxes, government spending, and government benefits are evil.

The people have bought into that and the trend will continue.

The fire service has also been squandering all of the public good will. You can only call yourself a hero so long and not deliver.

People still buy it, though. The fire service is going to get a resurgence once the 1o-year 9/11 stuff starts up. That will help next year's budgets across the country.

Whatever the fad emergency of the moment will always boost the fire service- our local newspaper had a huge front page article about how super prepared our department is for nuclear emergency after the Japanese earthquake.

Personally, I like a really well-supervised Public Utility Model that privates will compete for. I never saw anyone come close to AMR in bidding for the Richmond, VA contract, and the city is doing an OK job since they took out the private ambulance service, but there's typical government inflation in that system since it's no longer private.

 

[usalsfyre]

I hadn't been able to access the comments until today, all I can say is the misinformation out there is frightening....

 

[Medic2409]

Me personally, I've been so badly burned by Private EMS that I'm considering getting out of the field altogether. I've been put into a position that is causing me to reevaluate what I am and where I'm trying to go.

I could go into detail about the rigs, etc. etc, but it's no use, really, since all that Admin cares about is making a profit. Good luck to all of you who are still willing to fight the fight, maybe someday EMS will be valued for what it is and the potentials will be realized.

Who know's, maybe I'll even be able to continue on, someday, but today ain't that day.

 

[46Young]

People have been saying this for years.

Public vs. private, in some surreal sense, private might be the better answer.

Most hospitals are private, and the private sector does respond to changes much better than the municiple sector.

I think with the inevitable decrease in payment for transport, the fire service is not going to be able to adapt. They already cannot handle the call volume in many major cities.

As such, multiple private providers will have to compete with each other. Sure the game has been to cheapen the cost like a trucking company ths far.

But you can only cheapen so much before somebody starts to go the other way and offer superior service. Which I think will have to happen becase nobody will be able to make money off of transports.

As for the pay, municiple firefighters in the US are way over paid. Not to be mean, but no other skilled laborers make nearly the amount firefighters do in pay and benefits with such little training.

Union strong arming might not be enough anymore. The "fiscal conservatives" have convinced the little guys that high taxes, government spending, and government benefits are evil.

The people have bought into that and the trend will continue.

The fire service has also been squandering all of the public good will. You can only call yourself a hero so long and not deliver.

If reimbursement rates drop, how is a private provider going to cut a profit, w/o contributions from the municipality? That defeats the purpose of outsourcing, doesn't it?

 

[46Young]

Yeah, you guys are right - instead of those EMS positions being fire based, or perhaps third service with decent benefits and a liveable wage, those positions should instead be ten buck an hour jobs, pulse and a patch hiring standards, with maybe a 401k and six days vacation a year if you're lucky. That's much better.

 

[JPINFV]

Oh, I'd love to see the IAFF and other fire service agencies come out in support of 3rd government service agencies. I'm not, however, holding my breath.

However, you're right. I'd much rather die in a fire because the local fire engine was standing around on a medical aid call or die in a car accident because the fire department ambulance was playing at a structure fire.

 

[46Young]

Oh, I'd love to see the IAFF and other fire service agencies come out in support of 3rd government service agencies. I'm not, however, holding my breath.

However, you're right. I'd much rather die in a fire because the local fire engine was standing around on a medical aid call or die in a car accident because the fire department ambulance was playing at a structure fire.

We were talking about private takeover of EMS. If they're claiming to be less costly than FD EMS, then they'll also claim to be less costly than muni third service EMS. Either way, people are going to lose their jobs, the same as when a FD takes over EMS. Either way, putting someone out of work is wrong. I've said it several times before.

When I worked single role EMS in NYC, and SC as well, we were always dispatched as standby for a box alarm. Same where I work now. How is that playing? We're there to treat victims, or FF's that get injured inside.

I wonder how much lower the median income nationwide for EMT's and medics would be if privates dominated 911 EMS. Maybe 18k/25k a year? It will also suck when the few people who do want a career in EMS are forced to change employers every few years, or move across/out of state for another job, when these privates bump each other out for the contract, or up and leave when they run in the red. FD EMS are, for the most part, the only ones who pay well, followed by some third services. Even if they don't pay well, at least they have decent benefits. I could care less about anything else unless those needs are satisfied first. This is how I pay the bills.

 

[JPINFV]

We were talking about private takeover of EMS. If they're claiming to be less costly than FD EMS, then they'll also claim to be less costly than muni third service EMS. Either way, people are going to lose their jobs, the same as when a FD takes over EMS. Either way, putting someone out of work is wrong. I've said it several times before.

The article specifically discussed FD vs private though. Also, the arranging the deck chairs is an unfortunate side effect of competition. The question then is, what fields, if any, should be free from any competition, even if it's intergovernment competition (say, regional departments vs city based departments)?

When I worked single role EMS in NYC, and SC as well, we were always dispatched as standby for a box alarm. Same where I work now. How is that playing? We're there to treat victims, or FF's that get injured inside.

So fire departments never involve their ambulance crews with suppression tasks? What about departments that run paramedic assessment engines, especially in regions where the paramedic assessment engines are the designated 911 paramedics?

I wonder how much lower the median income nationwide for EMT's and medics would be if privates dominated 911 EMS. Maybe 18k/25k a year? It will also suck when the few people who do want a career in EMS are forced to change employers every few years, or move across/out of state for another job, when these privates bump each other out for the contract, or up and leave when they run in the red.

The question I've always found interesting is why aren't both the service providers, and the employees of those services, doing more to expand beyond a limited transport only role? EMS, unfortunately, has pigeonholed themselves as a one trick wonder, and I don't see the fire department expanding much into other aspects of health care. At a minumum, the private and third service agencies mission can much more easily be adapted into the greater health care community than the fire department can. The only question, now, is will they?

Also, you're ignoring the issue of supply vs demand. Is any field important enough to be shielded from market influences? If medicine was as easy to get into and oversaturated as EMS is, then you wouldn't see physicians making several hundred thousand dollars a year like we do.

FD EMS are, for the most part, the only ones who pay well, followed by some third services. Even if they don't pay well, at least they have decent benefits. I could care less about anything else unless those needs are satisfied first. This is how I pay the bills.

Of course it's also easier to pay more when you can demand money at the end of a gun, like any tax supported agency can.

 

[46Young]

The article specifically discussed FD vs private though. Also, the arranging the deck chairs is an unfortunate side effect of competition. The question then is, what fields, if any, should be free from any competition, even if it's intergovernment competition (say, regional departments vs city based departments)?
Leave the third service alone, and leave the FD/EMS alone. The FD's shouldn't absorb existing muni EMS, and FD's shouldn't be made to give up EMS, at least not the ones who have been doing it for decades already. As far as regional vs city, each jurisdiction needs to run it's own. Mutual aid agreements should be put in place, and state aid given to the more rural areas. In EMS, profit and adequate staffing/deployment/pt care/working conditions/salary/benefits are in conflict.

So fire departments never involve their ambulance crews with suppression tasks? What about departments that run paramedic assessment engines, especially in regions where the paramedic assessment engines are the designated 911 paramedics?
Departments are wrong to commit an ambulance crew to suppression ops. It's not the way to make up for staffing and deployment issues. There's nothing wrong with the crew helping to hook up to a hydrant, throw ladders, or deploy a crosslay, so long as they monitor their radio and drop what they're doing for pt care. As far as ALs engines, they could just as easliy be running an alarm bell. Good departments plan well for spikes in call volume.


The question I've always found interesting is why aren't both the service providers, and the employees of those services, doing more to expand beyond a limited transport only role? EMS, unfortunately, has pigeonholed themselves as a one trick wonder, and I don't see the fire department expanding much into other aspects of health care. At a minumum, the private and third service agencies mission can much more easily be adapted into the greater health care community than the fire department can. The only question, now, is will they?
I'm sure that most FD's would be happy to stay in EMS transport and leave the community outreach to a hospital based service. I asked if there was any community outreach like we sometimes discuss here, while at orientation at my new per diem hosp. based job today. The hospital says that they do some degree of followup with pts, and would like to do much more if reimburement changes and compensates for that. A FD would be happy to let area hospitals do that sort of thing, since it's not compensated currently.

Also, you're ignoring the issue of supply vs demand. Is any field important enough to be shielded from market influences? If medicine was as easy to get into and oversaturated as EMS is, then you wouldn't see physicians making several hundred thousand dollars a year like we do.
The conflict of interest with for profit EMS in 911 is well known. I feel that 911 EMS ought to be shielded from the privates, for that conflict of interest and also to provide a liveable wage and retirement. Yes, I know it's artificial, but the alternative is to be a $10/hr welfare case, with no retirement, and deplorable working conditions. We missed the boat on education unlike other countries, so it's either stack the deck in your favor, or look for another field.


Of course it's also easier to pay more when you can demand money at the end of a gun, like any tax supported agency can.

If that wasn't the case, I would have been a PA or BSN by now. If things become untenable in the future, I can still do that and be okay. It baffles me why people attack those with a decent standard of living and a good retirement when instead they should be asking themselves how they can get that for themselves. The corporations took away their defined benefits (because it's cheaper for them, not better for the employee), and now they want everyone else to lose out as well.

If EMS was 100% private, do you think there would ever be anything better than patch factories? No one's going to get a degree to work for ten bucks an hour with no benefits and a lousy work environment. The turnover's fine, since they won't need to give raises. Community service? Not happening. There's no profit in that. The average tenure for an employee would be a year. If anything, the privates have more of an interest in keeping barriers to entry low than what people say the fire service does. I would absolutely like to keep EMS shielded from private industry. The average crew has probably three years experience between the both of them; they're overworked and disgruntled; the equipment is the bare bones minimum, cutting corners whenever possible; staffing and deployment are reduced to the bare essentials; the hiring standards are the lowest of any form of EMS out there; pt steering occurs if the private provider is contracted by a hospital, as is the case in NYC with Transcare and AMR; no medical director is going to allow anything past cookbook medicine with the type of employee that such a work environment will attract. That's what we can look forward to with a mass takeover by private EMS. Just hope that they don't fold or leave town suddenly if their profits are down, leaving the municipality scrambling to put something else in place.

 

[terrible one]

Yeah, you guys are right - instead of those EMS positions being fire based, or perhaps third service with decent benefits and a liveable wage, those positions should instead be ten buck an hour jobs, pulse and a patch hiring standards, with maybe a 401k and six days vacation a year if you're lucky. That's much better.

Privates should not be providing 911 emergency care. Let them deal with interfacility transfers because those pay. 911 care should be delievered by a third service entity separte from the FD. One that is able to provide a decent wage, benefits, and retirement.
This will never happen nationally though

 

[46Young]

Privates should not be providing 911 emergency care. Let them deal with interfacility transfers because those pay. 911 care should be delievered by a third service entity separte from the FD. One that is able to provide a decent wage, benefits, and retirement.
This will never happen nationally though

They seem to do pretty well in Texas, from what was said in this forum. There's places like Wake Co. in NC, but they only start you somewhere n the 30-40k range. Doable if you're single and renting, but that's about it. I'm way past the point in my life where I'm doing the job only because I enjoy it, compensation be damned. That happened at about the time my wife became pregnant with our first child. I follow the money. If my combined service were to split, I'd just have to choose a side, whichever offers better pay and more career advancement opportunities.

Does anyone have any evidence of a trend towards privatization of EMS? Studies by local politicians, actual takeovers, etc?