What do you guys think about this?

[Amberlamps916]

After 40 Years, County Supes Open Up Ambulance Contract to Bidding

Firefighters eye AMR’s exclusive $20 million contract.

www.independent.com

One of the last great EMS systems in California has the potential of changing for the worse.

 

[NPO]

They're trying to avoid the lawsuits that Kern County is fighting regarding EOAs and no competitive bidding.

 

[Amberlamps916]

They're trying to avoid the lawsuits that Kern County is fighting regarding EOAs and no competitive bidding.

Oh yeah? Can you fill us in on that? I haven't heard much regarding the situation over there.

 

[NPO]

Oh yeah? Can you fill us in on that? I haven't heard much regarding the situation over there.

It's moving at iceberg speed. Essentially Kern County is divided into several EOAs (Exclusive Operating Areas). Hall Ambulance has several of them, Liberty Ambulance has two, and Delano Ambulance has one. For the most part they were grandfathered into those EOAs when they were created in 1981.

The issue is that Hall Ambulance acquired several of the EOAs through purchase of other ambulance companies or taking over after a company ended service without there being a competitive bid process after 1981. It is these EOAs that are being contested.

The state says that since they changed hands after the 1981 law, there needs to be a competitive bid process. Kern County disagrees.

None of the big hitter EOAs are at risk. They are the EOA covering Wasco and Lost Hills, one EOA in the desert around California City, and one of Liberty Ambulance's EOAs from their acquisition of CARE ambulance in the Lake Isabella area. If the state wins, it opens up new companies to bid on these EOAs.

While not a direct threat because they are low volume/low earning EOAs, it's causing concern because Hall Ambulance has been failing to meet several contractual response time standards for several years. If a new company was in the county, they could have an opportunity to unseat the incumbents and that was cause big headaches for everyone, including KCEMSA.

 

[Jn1232th]

I never have been a fan of fire based EMS. From my experience in LA/OC, most fire medics are medics because it got them the fire job not because they like to practice medicine. Of course not saying all fire medics are like that but it’s a pointless system that none of Northern California or other states use. Hopefully AMR can keep this contract, seems like last decent division behind Palm Springs/hemet from what I’ve heard.

 

[DrParasite]

After 40 Years, County Supes Open Up Ambulance Contract to Bidding

Firefighters eye AMR’s exclusive $20 million contract.

www.independent.com

One of the last great EMS systems in California has the potential of changing for the worse.

As a non-Californian, can someone explain how the local fire departments, where FFs make 100k+ a year, do the job at a cheaper level than a private ambulance company, where a single role paramedic might make $75k a year with OT?

 

[DesertMedic66]

As a non-Californian, can someone explain how the local fire departments, where FFs make 100k+ a year, do the job at a cheaper level than a private ambulance company, where a single role paramedic might make $75k a year with OT?

Cheaper for who?
AMR is not funded through city/state taxes so all of their revenue must come from insurance companies. So there is a cost to the patients who utilize the service.
Fire is funded through taxes and a decent number of fire departments are now also charging individual patients for services rendered (although at a lesser of cost than AMR).

 

[Tigger]

Ambulance rides are too expensive the citizens bemoan! Well compared to what exactly... EMS is small pennies compared to much of healthcare. This argument kills me. If you don't want to pay out of pocket for ambulance service, then subsize it with taxes. It isn't just going to magically cost less.

 

[FiremanMike]

As a non-Californian, can someone explain how the local fire departments, where FFs make 100k+ a year, do the job at a cheaper level than a private ambulance company, where a single role paramedic might make $75k a year with OT?

Because the citizens are currently paying taxes to fund both agencies instead of just 1... FD's would likely start by cross manning, then eventually increase manpower.. Either way when you have two separate departments, you have two separate administrations, two separate sets of overhead, etc..

I realize FD based EMS is pretty universally hated around here, but you asked how it'd be cheaper and I answered.

 

[DrParasite]

Because the citizens are currently paying taxes to fund both agencies instead of just 1... FD's would likely start by cross manning, then eventually increase manpower.. Either way when you have two separate departments, you have two separate administrations, two separate sets of overhead, etc..

I agree that it would be cheaper up front, provided you cross man apparatus.... in my experience, that only works until you raise manpower levels to have dedicated personnel assigned to the EMS units, as well as the suppression units, at which point, the costs far exceed that of a standalone EMS agency.

and for a small EMS agency (less than 3 ambulances), I would agree with you. But when an EMS system gets to be no longer a small agency (think a county wide or busy city, more than 3 ambulances), having EMS administrative staff begins to make a lot of sense from an operational perspective.

I realize FD based EMS is pretty universally hated around here, but you asked how it'd be cheaper and I answered.

Fire based EMS isn't universally hated, however the IAFF and fire-based propaganda is. Having an 80/20 split of EMS to Fire calls, as well as an 80/20 split for Fire to EMS funding is hated, as well as having the EMS providers in the Fire based EMS system be treated like redheaded ******* stepchildren who aren't given the tools, staffing, or funding to do the job well, yet their suppression counterparts have a wish list that they get every year. That type of stuff makes pro EMS people people not look favorably on fire based ems, especially when FFs get hired, and immediately start counting the days until they get off the ambulance....

There are exceptions, and based on what you have said about your department, your department is one of them, but that is definitely not the norm.

 

[FiremanMike]

I agree that it would be cheaper up front, provided you cross man apparatus.... in my experience, that only works until you raise manpower levels to have dedicated personnel assigned to the EMS units, as well as the suppression units, at which point, the costs far exceed that of a standalone EMS agency.

and for a small EMS agency (less than 3 ambulances), I would agree with you. But when an EMS system gets to be no longer a small agency (think a county wide or busy city, more than 3 ambulances), having EMS administrative staff begins to make a lot of sense from an operational perspective.

I'd still be inclined to believe that even with a 25% increase in salary for the line level employees, the reduction of two complete sets of overhead and administration to one would be cheaper (overall).

Fire based EMS isn't universally hated, however the IAFF and fire-based propaganda is. Having an 80/20 split of EMS to Fire calls, as well as an 80/20 split for Fire to EMS funding is hated, as well as having the EMS providers in the Fire based EMS system be treated like redheaded ******* stepchildren who aren't given the tools, staffing, or funding to do the job well, yet their suppression counterparts have a wish list that they get every year. That type of stuff makes pro EMS people people not look favorably on fire based ems, especially when FFs get hired, and immediately start counting the days until they get off the ambulance....

There are exceptions, and based on what you have said about your department, your department is one of them, but that is definitely not the norm.

My department is far from Eden, but we (for the most part) don't dismiss EMS as a tertiary activity. With that said, there are some advantages that I've observed when comparing public service FD programs to private EMS prorgrams, namely in turnover and equipment.. Never forget that private EMS agencies need to operate at a profit where as FD programs don't care.

 

[DrParasite]

With that said, there are some advantages that I've observed when comparing public service FD programs to private EMS prorgrams, namely in turnover and equipment.. Never forget that private EMS agencies need to operate at a profit where as FD programs don't care.

I happen to think that private EMS is substantially worse than Fire based EMS, for the exact reasons you listed. But you are wrong on one part: FD don't operate in the red, per se, they just make up those losses with an influx of taxpayer funds.

Personally, I'm in favor of a taxpayer funded municipal or county EMS agency, paid well, where they have the tools to do the job on their own without needing another agency to hold their hand. There are good ones that have good equipment, minimum turnover, and enough resources to do the job; but they tend to be expensive to run (which leads to higher salaries and better equipment, which is why people rarely leave, and provide for EMS careers, not just jobs).

 

[DesertMedic66]

Because the citizens are currently paying taxes to fund both agencies instead of just 1... FD's would likely start by cross manning, then eventually increase manpower.. Either way when you have two separate departments, you have two separate administrations, two separate sets of overhead, etc..

I realize FD based EMS is pretty universally hated around here, but you asked how it'd be cheaper and I answered.

Citizens are only paying taxes to support the fire department. Private ambulance companies are not funded through taxes.

 

[FiremanMike]

Citizens are only paying taxes to support the fire department. Private ambulance companies are not funded through taxes.

The money comes from somewhere. I'm sure AMR isn't covering that area of the country solely out of a sense of pride and duty..

 

[DesertMedic66]

The money comes from somewhere. I'm sure AMR isn't covering that area of the country solely out of a sense of pride and duty..

The money comes from billing insurance. AMR will place bids to the county to run 911 services in order to bill patients. They will place multi million dollar bids in order to run services in specific areas. Once a bid is accepted the county and AMR agree on a contract. Aside from government medical insurance, really the only time AMR gets money from government is FEMA.

Also the article is talking about Santa Barbara county which is known for being very high class. High class = private insurance = higher payments.

 

[DrParasite]

Also the article is talking about Santa Barbara county which is known for being very high class. High class = private insurance = higher payments.

Just imagine how much money Santa Barbara County could make by running it's own 3rd service EMS agency, with as many ambulances as fire engines, especially if it was funded by transport billing and supplemented by taxpayer funds.....

 

[Tigger]

The money comes from somewhere. I'm sure AMR isn't covering that area of the country solely out of a sense of pride and duty..

AMR will pay municipalities for the right to run 911 in their area if the payer mix is right and it keeps competition out of the local transport market.

 

[FiremanMike]

Sorry then for speaking out of turn, this type of setup is foreign to me and not seen in my area at all...

I would have to imagine the working conditions as a line medic in such a place wouldn't be that great.. Every trip has to make money, every time..

 

[DesertMedic66]

Just imagine how much money Santa Barbara County could make by running it's own 3rd service EMS agency, with as many ambulances as fire engines, especially if it was funded by transport billing and supplemented by taxpayer funds.....

Ehhh, not sure if I agree. In CA, fire departments are not know to make the city a lot of money. Instead they are usually very costly for the city. Adding on EMS to that is likely to just add to the costs while not offsetting it.

 

[NPO]

Just imagine how much money Santa Barbara County could make by running it's own 3rd service EMS agency, with as many ambulances as fire engines, especially if it was funded by transport billing and supplemented by taxpayer funds.....

SBCoFD already has ambulances. They'll never make their own third service, the FD will just do it. It's a losing proposition. FF/Medics are expensive to hire, and labor is the highest cost in EMS even when we only pay "low" single role medic wages.

Cambria Ambulance is one of the few (or only, idk) third service ambulances in California independent from any other department. Yet they're drowning in debt and can barely keep their necks above water.