Good example of how for profit EMS is a job killer

FLMedic311

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After reading this, I guess I am left wondering what it is you are trying to say regarding this situation?? How does this relate to job killing? This seems more like a power struggle between two groups about who can provide better service..
 

luke_31

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After reading this, I guess I am left wondering what it is you are trying to say regarding this situation?? How does this relate to job killing? This seems more like a power struggle between two groups about who can provide better service..
Exactly. I was wondering the same thing. I got that two services were competing against each other and nothing more out of it.
 

VentMonkey

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Agreed with both posters above me. Can you elaborate, and defend your stance, OP?
 

DesertMedic66

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#allEMSshouldbehandledbyfire...
 

Tigger

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This (from a systems perspective) is a bizarre story. Everything I read made it seem like the transition was quite abrupt and no one really knows why the state made it happen.
 

DrParasite

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#allEMSshouldbehandledbyfire...
yeah, because there aren't examples of horribly run FD based EMS systems....

#AllEMSshouldbehandledbymuniciple3rdpartyEMSAgencies
 

DesertMedic66

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yeah, because there aren't examples of horribly run FD based EMS systems....

#AllEMSshouldbehandledbymuniciple3rdpartyEMSAgencies
Name one, I dare you! Hahaha
 

DrParasite

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surely you must be kidding.......
 
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DrParasite

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@FK911: I don't get it, both entities are hospital based EMS systems, IIRC, both are not for profit, and they have created more jobs than they have killed.

What exactly are you trying to say?

BTW, of course Cooper's response times are less.... they have a much smaller coverage area than virtua, and have more dedicated units within that coverage area. More units -> shorter response times per call, it's pretty much common sense.
 

NysEms2117

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Gotta love detroits 25 minute response times :)!!!!
 

DrParasite

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Although in their defense, many of their units are in the shop, and that is an decrease from their former standard of 45 minutes from time of 911 call until the ambulance showed up.
 

VentMonkey

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While I don't work for a public provider, and admittedly all of my experience is with the private for-profit sector, wouldn't it be safe to assume public (third) service agencies may be profit-driven in their own rights?

Doesn't fiscal responsibility play any role in allocations for their respective services?

I can't imagine there are no profits to be made in spite of their reasons for them, even in the public sector. Again, I'd like the OP to share his viewpoints since he's the one who, thus far, has posted such a somewhat misleading thread topic.
 

Tigger

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While I don't work for a public provider, and admittedly all of my experience is with the private for-profit sector, wouldn't it be safe to assume public (third) service agencies may be profit-driven in their own rights?

Doesn't fiscal responsibility play any role in allocations for their respective services?

I can't imagine there are no profits to be made in spite of their reasons for them, even in the public sector. Again, I'd like the OP to share his viewpoints since he's the one who, thus far, has posted such a somewhat misleading thread topic.
As my chief says, there's no such thing as a non-profit. Though we are tax supported (~60% of the budget), we are always looking to turn a profit. Without his attitude we might not have survived the recession.
 

DrParasite

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While I don't work for a public provider, and admittedly all of my experience is with the private for-profit sector, wouldn't it be safe to assume public (third) service agencies may be profit-driven in their own rights?
in a word? no.... hence the term non-profit.
Doesn't fiscal responsibility play any role in allocations for their respective services?

I can't imagine there are no profits to be made in spite of their reasons for them, even in the public sector. Again, I'd like the OP to share his viewpoints since he's the one who, thus far, has posted such a somewhat misleading thread topic.
When I worked in NJ, for an urban city, we hemorrhaged money. we spent decent money on our system (decent equipment, decent salaries, jobs besides field provider, grant funded special ops equipment, etc), and we constantly came back in the red. much of our population was on medicaid, or had no insurance, or was undocumented, so we would have to expend funds to treat and transport them, but we would never recoup those losses. Thankfully we were attached to a semi profitable hospital, so we were able to balance out our books. But there was no way we could survive on transport revenue alone (and could have used 4 more units to assist with the call volume, but I digress).

profit driven means you need to take a bunch of your money out of your budget and put it towards someone's profit center. money that could be spent on salaries, on equipment, on additional staffed units, etc. When you get tax payer funding, it's more money you can count on to use for operational expenses, and means you don't have to worry about if patient a has good insurance or bad insurance (or nothing at all).

Think of it this way..... would your boss rather spend 100,000 on putting an additional (non-required) unit in service, or taking that 100,000 as additional profit for a year well done?
 

EpiEMS

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in a word? no.... hence the term non-profit.

I would disagree, in answer to @VentMonkey 's question ("wouldn't it be safe to assume public (third) service agencies may be profit-driven in their own rights?"). The main difference between a for profit and a not for profit entity is not their goal - it is the distribution of net income (and also some things about how their can raise capital, but that is secondary). If I'm a not for profit service CEO, sure, I might be OK with providing some more uncompensated care (for example) or maybe even spending a bit more on equipment (maybe) than a for profit service CEO would be, but the reason is because of who I answer to. A for-profit answers to shareholders (who want capital appreciation and dividends), a not-for-profit answers to...well, a bit of a broader group, say, a board of trustees of community leaders, and perhaps, if you like to think of it this way, to the community they serve. That's not to say that for profits are "worse" or "better" than not for profits, they're just different. And everybody needs to turn a profit (or at least break even), because if you don't, you know, you're just not viable in the long run. Municipal services are a whole other beast, but they've got stakeholders more like a not-for-profit.

profit driven means you need to take a bunch of your money out of your budget and put it towards someone's profit center. money that could be spent on salaries, on equipment, on additional staffed units, etc. When you get tax payer funding, it's more money you can count on to use for operational expenses, and means you don't have to worry about if patient a has good insurance or bad insurance (or nothing at all).

The story of cross-subsidization in healthcare is a very complicated one, and while the story you tell is not wrong, per se, it is oversimplifying the matter. And in emergency care, ability to pay is irrelevant (at the hospitals, by EMTALA, and for EMS, usually by state law).

As my chief says, there's no such thing as a non-profit. Though we are tax supported (~60% of the budget), we are always looking to turn a profit. Without his attitude we might not have survived the recession.

@Tigger, I love this answer - and I think it's true even for municipalities!
 

DesertMedic66

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in a word? no.... hence the term non-profit.
All of the non-profits I am familiar with are still profit driven. If they are not profit driven and do not work to get paid then they will go under pretty quickly. You still need money to operate in a non-profit company.
 

DrParasite

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And in emergency care, ability to pay is irrelevant (at the hospitals, by EMTALA, and for EMS, usually by state law).
While that is true to a point, the money needs to come from somewhere. ERs also routinely run in the red, because they have to offer the expensive services to save your life, but there is no guarantee that they will be paid for services rendered. And while the hospital can make up those losses at other departments, EMS doesn't always have the luxury. yes, services need to be rendered regardless of the ability to pay, no argument there, but big picture wise, it's a poor business model to spend $500 on a patient who is going to pay you maybe $15, and you can't get any more out of them (yes, that is a gross exaggeration with made up numbers, but i hope you get the point)

maybe i should clarify my previous statement..... all businesses strive to be in the black (and are profit driven), but non-profits are allowed to be in the red when they calculate revenue vs expenses, and if they are too much in the black, they need to distribute the funds, often back into their internal infrastructure or to their employees.
But the goal of a non-profit is not to make a profit; they might want to maximize their profit to minimize being in the red, but it's not their reason for existence. a for profit company's goal is to turn a profit, an return said profit to it's owners/shareholders.

And yes, I am over simplifying a little bit.
 

EpiEMS

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but non-profits are allowed to be in the red when they calculate revenue vs expenses, and if they are too much in the black, they need to distribute the funds, often back into their internal infrastructure or to their employees.

In general, sure, I think this is true - and you're not wrong that, again, in general, the money does need to come from somewhere. EMS certainly doesn't have the immense ability to cross subsidize that hospitals have*, but we do have some - think IFT or wheelchair vans, those probably have thicker margins than 911.


*Not that they do, necessarily - there is evidence for and against this proposition
 

VentMonkey

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would your boss rather spend 100,000 on putting an additional (non-required) unit in service, or taking that 100,000 as additional profit for a year well done?
My boss in particular is quite peculiar based off of the fact that as for-profits stand, he wholeheartedly invests tons of money into the reputation of his company, its service model, and in turn, it's image; we literally have gotten a fleet of new ambulance all but 1(?) year since I've been here. He would be the (thankfully) rare former, and not the latter.

Either way, good stuff guys, thanks for the insight. This is definitely not my strongest area, the "business" side of prehospital healthcare. I think it's good for people to know and learn this sort of stuff because it helps foster less resentment, misguided concepts, and perceptions. Hopefully it provides more education and understanding that this is in fact a business for others as well.

Also, has anybody seen the OP?:confused: He may stand to gain a few pointers, and some insight as well.
 
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