Which is better: public or private EMS?

[Tnaemt94]

Some counties and municipalities have their own EMS departments. Some are in conjunction with fire departments.

Other counties contract private companies, like RuralMetro, to provide EMS services for their jurisdiction.

Which do you find to be the best approach?

 

[Ewok Jerky]

It depends

 

[TransportJockey]

I have worked for a third service that sucked and I have worked at private for profit and nonprofits that blew it away. So... Ig depends

 

[teedubbyaw]

They're both led by political ********.

 

[46Young]

If you want to stay with one employer for your entire career, I would go with municipal. With municipal, you can typically get a DB (pension), or a DB/DC hybrid at the least (half pension, half 457). Most privates are only 403b or 401k. Just look through this forum, there are many posts about privates - who's losing a contract, who's getting taken over, who is losing part of their business to the local FD. How would you like to spend 14 years in a company then suddenly be forced to look for a new employer and/or be forced to relocate, perhaps out-of-state? A company can always be forced to relocate, or can go out of business altogether. For example, anyone who worked in NYC EMS for Cabrini, the SVCMC chain, or Victory Hospital had to look for new jobs. A 401k or 403b is portable, so if you don't mind moving far away for another job, employer stability may not be an issue for you. Just start putting away at least 10% of your pay 100% in equities from day one, and you should be okay for retirement in 35-40 yrs. Definitely don't wait to start aggressively funding a 401k/403b if that's they way you're looking to go instead of a municipal employer.

Having said that, some privates and hospitals can provide better schedules and other working conditions than a municipal employer, and in some cases better pay and medical benefits. If you're doing EMS as a temporary thing while you go for a degree, or even if you want to get a degree to climb the corporate ladder in EMS, your best bet is working for hospital-based EMS, as they're more apt to assist people with schedule changes to accommodate a class schedule. Second would be the privates, and the worst would be municipal. A rotating schedule, whole shift holdovers, mandatory recalls and having to be on-call can quickly derail and educational aspirations, unless you're doing something that is mostly distance learning.

 

[Underoath87]

Private EMS is usually the inferior option for employees.

 

[SandpitMedic]

Best for whom? Patients or us?

 

[Tnaemt94]

Here is my opinion on the matter

I believe EMS should be a local government service (county ran or affiliated with a fire dept):

EMS involves collaboration with public safety entities in a general public setting through a variety of complex and intricate situations. This needs uniformity that ultimately falls into the same organizational leadership for better regulation. Ex. County Board of Commissioners, Mayor, etc.

Also, with for profit ambulance companies, the root cause is the mighty dollar. We have seen buy outs (AMR buying or merging with R/M) that can affect organizational structure, contract terms established with governments, and overall structure and operations.

Also during emergency scenes out in the field, actions due to faulty training or protocols can have a detrimental effect on other agencies and can indirectly cause harm to crime scenes or other operations. Putting EMS in the hands of for profit companies puts very little control of the overall EMS operations in the local government's hands and can cause a wedge between other involved agencies.

Also, with a public ran EMS system, this eliminates the battles on who wins ambulance contract. Because the government can put their foot down and say "we are the primary EMS service of this county and we call the shots."

 

[Tigger]

Also during emergency scenes out in the field, actions due to faulty training or protocols can have a detrimental effect on other agencies and can indirectly cause harm to crime scenes or other operations. Putting EMS in the hands of for profit companies puts very little control of the overall EMS operations in the local government's hands and can cause a wedge between other involved agencies.

While generally speaking I agree with most of your post, there is no reason that municipalities cannot maintain tight control over the ambulance contractor. I work for a large private service that is required by local regulation to follow county medical protocols. We are also subject to total control by the on scene fire company (vomit). We have the same medical direction with a unified QA process. The city has near total control over ambulance operations.

 

[Tnaemt94]

While generally speaking I agree with most of your post, there is no reason that municipalities cannot maintain tight control over the ambulance contractor. I work for a large private service that is required by local regulation to follow county medical protocols. We are also subject to total control by the on scene fire company (vomit). We have the same medical direction with a unified QA process. The city has near total control over ambulance operations.

But have you ever heard that saying, "if you want something done the way you want it just do it yourself"?

What I am saying is that when you have for profit weighing in on the decisions of their company along with government officials trying to weigh in on how they want the for profit ambulance company to perform to their standards, it makes everything more complicated. Versus if you have a government organization that ultimately reports to a local board of commissioners it breaks the structure down to scale and puts more control into the hands of the local gov and the public

 

[Tigger]

But have you ever heard that saying, "if you want something done the way you want it just do it yourself"?

What I am saying is that when you have for profit weighing in on the decisions of their company along with government officials trying to weigh in on how they want the for profit ambulance company to perform to their standards, it makes everything more complicated. Versus if you have a government organization that ultimately reports to a local board of commissioners it breaks the structure down to scale and puts more control into the hands of the local gov and the public

Such things cost money that the municipality may not have. Meanwhile, large corporations will actually pay municipalities franchise fees for the "privilege" of operating in their area. While perhaps not the ideal setup, it's tough to argument that this does not benefit the municipality. While it might take more effort to maintain control over the contractor, a cool few million dollars might make that worth it.

When we talk about service delivery models, it's usually in regards to patient care or crew satisfaction. The pros and cons for the government actually providing the service are often left out.

 

[Underoath87]

But have you ever heard that saying, "if you want something done the way you want it just do it yourself"?

That would be: "If you want something done right, do it yourself".

 

[Tnaemt94]

That would be: "If you want something done right, do it yourself".

Same concept just a different variation

 

[Tnaemt94]

Such things cost money that the municipality may not have. Meanwhile, large corporations will actually pay municipalities franchise fees for the "privilege" of operating in their area. While perhaps not the ideal setup, it's tough to argument that this does not benefit the municipality. While it might take more effort to maintain control over the contractor, a cool few million dollars might make that worth it.

When we talk about service delivery models, it's usually in regards to patient care or crew satisfaction. The pros and cons for the government actually providing the service are often left out.

Although, EMS services can be self sufficient. Yes there are startup costs associated with it. But once you get a department established it can sustain itself. One benefit I noticed with a public department versus a private service (I worked for both) is that the money earned by a public service goes to improvement of the department such as better equipment. With a for profit service, the priority is just that, profit.

Also, when I worked for a private company, I had to be extra cautious as to how I address patients. I couldn't tell them the obvious.

When I worked for a government service, I could tell it like it is. If I thought a patient was abusing the system and being problematic, I can be blunt and straight forward and be as stern as I wanted. Because in the end, I work for the government and whether they are pleased as to what I said or not, it would have no bearing as to whether or not I keep my job.

 

[Tigger]

Although, EMS services can be self sufficient. Yes there are startup costs associated with it. But once you get a department established it can sustain itself. One benefit I noticed with a public department versus a private service (I worked for both) is that the money earned by a public service goes to improvement of the department such as better equipment. With a for profit service, the priority is just that, profit.

Also, when I worked for a private company, I had to be extra cautious as to how I address patients. I couldn't tell them the obvious.

When I worked for a government service, I could tell it like it is. If I thought a patient was abusing the system and being problematic, I can be blunt and straight forward and be as stern as I wanted. Because in the end, I work for the government and whether they are pleased as to what I said or not, it would have no bearing as to whether or not I keep my job.

If only if only.

EMS services are rarely self sustaining. There are two ways to have a chance, either have a payor mix of mostly private insurance patients, or run transfers. The former usually only happens in wealthy suburbs, the latter is not something that most municipalities engage in with great frequency. Certainly there are third services and fire departments that do hospital to hospital transfers, but they are not marketing themselves within the healthcare network as a transfer agency. In the ambulance industry, money is made doing transfers and possibly special events. There is no money in 911 calls, especially with the ACA dramatically increasing the Medicaid population, which pays perhaps a few cents on every dollar billed by EMS.

 

[Tnaemt94]

If only if only.

EMS services are rarely self sustaining. There are two ways to have a chance, either have a payor mix of mostly private insurance patients, or run transfers. The former usually only happens in wealthy suburbs, the latter is not something that most municipalities engage in with great frequency. Certainly there are third services and fire departments that do hospital to hospital transfers, but they are not marketing themselves within the healthcare network as a transfer agency. In the ambulance industry, money is made doing transfers and possibly special events. There is no money in 911 calls, especially with the ACA dramatically increasing the Medicaid population, which pays perhaps a few cents on every dollar billed by EMS.

Yes, and that is why the government EMS department I work for does a combo of both 911 emergency response and BLS convalescent services.

But in the end, if you think about it, with the normal cost of a transport, the department would get its money worth. Because the goal would not be to make profit but to pay for the expenses of the equipment used and regular salaries. The main difference is that you don't have higher up executives making millions and having a special vehicle for each personal activity he does in his life (like the president of the private service I once worked for). Instead of a lot of money going to his private multimillion dollar mansion, it can go to improving the department and maybe to other public services.

 

[Tigger]

Yes, and that is why the government EMS department I work for does a combo of both 911 emergency response and BLS convalescent services.

But in the end, if you think about it, with the normal cost of a transport, the department would get its money worth. Because the goal would not be to make profit but to pay for the expenses of the equipment used and regular salaries. The main difference is that you don't have higher up executives making millions and having a special vehicle for each personal activity he does in his life (like the president of the private service I once worked for). Instead of a lot of money going to his private multimillion dollar mansion, it can go to improving the department and maybe to other public services.

You are greatly oversimplifying how EMS budgets work.

The goal is never to make ends meet, that's how agencies fail. Even government agencies look for profit making strategies, that's how they remain sustainable. These days, it is nearly impossible to recoup the cost of transport. Even transfers are not particularly profitable, it's the contracts that agencies hold that are profitable. Relying on patients and their insurance for reimbursements is a recipe for failure absent an alternative funding strategy (taxes).

 

[Tnaemt94]

You are greatly oversimplifying how EMS budgets work.

The goal is never to make ends meet, that's how agencies fail. Even government agencies look for profit making strategies, that's how they remain sustainable. These days, it is nearly impossible to recoup the cost of transport. Even transfers are not particularly profitable, it's the contracts that agencies hold that are profitable. Relying on patients and their insurance for reimbursements is a recipe for failure absent an alternative funding strategy (taxes).

It may be a profit strategy, but the revenue obtained go towards the department itself. It is not going into the pockets of CEOs and corperate executives to buy themselves multimillion dollar homes. Of course you have to pay your employees and even the supervisors must make ends meet. But the main objective with a public service is the public and not for personal profittable gain.

Now, I believe private ambulance services should exist, but they should never hold a monopoly over a jurisdiction where civilians have no choice as to who responds to their 911 calls. For example, if you call 911 where I live for a medical emergency, there is only one service they will send that is contracted by the county. Patients have no choice in the matter.

I believe primary EMS services shall be a basic government service such as police and fire. At least I believe for profit EMS shall never hold a primary function but rather a supportive role.

 

[Tigger]

It may be a profit strategy, but the revenue obtained go towards the department itself. It is not going into the pockets of CEOs and corperate executives to buy themselves multimillion dollar homes. Of course you have to pay your employees and even the supervisors must make ends meet. But the main objective with a public service is the public and not for personal profittable gain.

I guess I really do not see the issue with that, so long as the quality of care and service is maintained. I have worked for some pretty excellent private companies that treated their employees decently, provided quality care, and saved municipalities money. The executives of these companies were rewarded with compensation. Welcome to business...

Granted I would still prefer to see municipalities understand that EMS is something that needs to be paid for just like fire and police services, but I realize that change is a ways off in many places. The city I live in right now is in absolutely no position to afford its own EMS service, but AMR pays them to operate and somehow despite all rich executives, the system works just fine. It could be improved no doubt, but the money just doesn't exist to do that right now.

 

[Tnaemt94]

I guess I really do not see the issue with that, so long as the quality of care and service is maintained. I have worked for some pretty excellent private companies that treated their employees decently, provided quality care, and saved municipalities money. The executives of these companies were rewarded with compensation. Welcome to business...

Granted I would still prefer to see municipalities understand that EMS is something that needs to be paid for just like fire and police services, but I realize that change is a ways off in many places. The city I live in right now is in absolutely no position to afford its own EMS service, but AMR pays them to operate and somehow despite all rich executives, the system works just fine. It could be improved no doubt, but the money just doesn't exist to do that right now.

I am still under debate as to whether or not EMS is considered public safety like law enforcement and fire is classified, but I can say this.

EMS personnel work very closely in conjunction with fire and leo's in uncontrolled atmospheres (the field). In collaboration, they work together to resolve emergency situations while protecting the patients. EMS personnel serves a presence in the general public and serves as a liaison between occurances in the field (scene) and the receiving end (hospital). While EMS personnel are resposible ultimately to the patient, while law enforcement and fire are responsible for everyone as a whole, there is still close collaboration and interaction between all in critical moments. EMS personnel must have an established relationship with many fields of work, including public safety personnel and other healthcare providers. To maintain this relationship, there must be organizational stability and trust. With for profit companies competing for contracts and the potential of one company moving in after the other, it creates a come-and-go atmosphere. With a government service, they can plant their roots and remain solid.