Money issues:
A lot of uninsured patients who won’t/can’t pay.
Insurance reimbursement rates are crap.
all very true
We are not funded through taxes and can’t add in a new proposition for more money.
everyone wants something for nothing, and then *****es when they don't get the server that they don't pay for fast enought
We pay the county money in order to keep our contract (in the millions of dollars).
this is actually bad business, especially in a field like 911 that tends to lose money on a regular basis. however it seems to be the norm in many areas, and also contributes to why a different private takes over 911 EMS every so often when the predecessor say it can't function without enough money. it's a vicious cycle, really.
We have late fees if we don’t make our scene times and we also have hardly any exceptions (max single fine is $10,000 per call).
now that's impressive. you would think that the solution to not making scene times is more units..... but that's a different story.
By having the county contract the county also put in that we have to transport all 5150 (psych holds) and will probably not get paid for them.
sounds like someone didn't negotiate right, or was willing to accept this loss to get the contract
All new ambulances must be type 1 or 3 even though we ordered 10 brand new type 2s.
that's your company's stupidity for ordering 10 new ambulances that you can't use. blame a stupid manager/administrator, not the system.
All major equipment must be replaced every 5 years (radios, MDTs, computers).
this is actualy a really good thing: if this rule wasn't in place, we both know there would be some company that would be using ambulances from the 1990s, and barely functioning radios (and we both know that MDTs and computers wouldn't exist). Remember, the less money a company has to spend, the more it's profits are.
We must do X amount of no cost things for the county.
goes back to something for nothing
We must have additional certs over any other responder in the system.
do you pay for that or does your company? because my agencies have always exceeded the bare minimums.
The biggest problem I see in private, for profit, EMS is you are doing everything you can to make money, without spending any money unless you absolutely have to, in an industry where you must provide service to 100% of the population with a 0% guarantee that you will ever get paid for the services rendered. And then you throw in the bribes that you need to give (oh, we will pay your town/county XYZ amount of dollars if you will select us as the provider the service, to be surprised, I'm surprised the mob hasn't gotten into private ambulance service), and rely on the revenue from the people who you need to serve but don't need to pay for the services, and you see where issues arise.
For example, many town contracts require just one dedicated ambulance (usually double ALS). If a 911 call comes in for any psych-related emergency, that can sometimes tie up resources for way too long.
it doesn't matter what happens; if a 911 call comes in for anything, it ties up that ambulance. what happens when a second call comes in? or a third? the contract calls for 1 dedicated ambulance, but the agency is the 911 provider for the town. What happens if the primary call is for a drunk person who needs to go to the hospital, and while they are transporting, a 2 year old stops breathing and the responding units have an extended ETA? the town blames the ambulance company, since they are the contracted provider, goes to the media and press blaming them, even other public safety agencies say "we called for EMS, they took a long time." the fact that the company followed the contract is lost to the general public; because this public relations nightmare (and the incident that caused it) was totally the fault of the town's leadership.
you want to fix EMS? follow these steps:
1) for any given area, you have as many BLS ambulances as you have staffed fire engines; you have as many ALS ambulances as staffed ladder companies and heavy rescues
2) ems need guaranteed money to function, so they should be tax supported, just like FD and PD, which spends millions every year, and are known black holes for money. this ensures EMS has the funding for new equipment, new trucks, and decent salaries for their staff
3) change the perception that EMS is a get something for nothing service. if you want quality service, you need to pay for it. if you don't want to, than expect crappy service. you get what you pay for.
4) take private EMS out of the 911 system. it doesn't make money, unless you short change something (often the employees). they can handle all the IFTs they want, where they can guarantee payment before the services are rendered. It's also harder to regular private IFTs, compared to government or quasi government agencies, at least when it comes to hiring standards, background checks, and QA/QI. There are exceptions, but we ALL know of private EMS agencies that will hire anyone with a card and a pulse, and the pulse is optional.
the EMS system, in general, is so broken, that people don't even realize it; they just accept it as the norm.
