City officials are reviewing the Three Rivers Ambulance Authority after making an emergency declaration this year, but an expert said Fort Wayne’s system isn’t the only one in need of an overhaul.
Nate Metz, president of the Indiana Emergency Medical Services Association, said all of Indiana’s EMS systems, including the one in Fort Wayne, are outdated and it’s time to get back to the drawing board.
Most trips made by EMS are non-emergency calls, Metz said, and the demands are different in today’s world.
“The idea that an ambulance is only paid for when the wheels are moving is crazy – absolutely crazy,” he said. “Indiana is still sitting on an archaic business model that no one else will touch.”
The city created the Three Rivers Ambulance Authority in 1983 to save taxpayer dollars. Prior to that, local residents had Fort Wayne EMS, which was a division of the city that handled emergency medical services.
Like other city departments such as the police and fire department, Fort Wayne EMS had a budget to pay its employees and operate the department. But while seeking to raise taxes to support EMS services, former Mayor Win Moses Jr. heard of a way to operate EMS services where it wouldn’t be a municipal service and cost people a dime. taxpayers – the public utility model.
The utility model was introduced by the late Jack Stout, economist and EMS expert, in 1980 through a series of articles in the Journal of Emergency Medical Services. In a utility model system, a government entity creates an ambulance authority that serves as a purchaser of emergency medical services from a contractor. Emergency services are paid for with a user fee.
Since the model was included in the ordinance, no other ambulance company can operate transport of stretchers in the city. Gary Booher, executive director of the Three Rivers Ambulance Authority, said she has followed the same rules ever since.
The Fort Wayne Fire Department proposed in 2016 to take over emergency medical services entirely, dissolving the Three Rivers Ambulance Authority. Ron Schwartz, president of the authority contractor, PatientCare EMS Solutions, said a change was not necessary, in part because the city’s contract includes a maximum duration of 8.5 minutes, which l ‘authority “has never failed to uphold in 33 years of existence.
The state of the ambulance authority in 2021 is different. Councilor Russ Jehl alerted the public in July that the board of directors of the Three Rivers Ambulance Authority had approved a declaration of emergency without notifying the council or the public. This is because the contractor was not in compliance when it comes to turnaround times since August 2020.
Public utility model
The public service model makes the ambulance authority a “competitive monopoly,” Booher said, because the authority always seeks the highest efficiency at the lowest cost when asking for offers.
The ambulance authority has a council made up of four people appointed by the mayor, four appointed by the county commissioners and the chairman of the EMS Foundation medical control board. The authority handles billing and the contractor manages operations, from hiring employees to maintaining their ambulances.
Although the ambulances are called TRAA, the ambulance authority does not own them. The ambulances are owned by PatientCare EMS Solutions, a Tyler, Texas-based company that has been the city’s contractor since 2009.
PatientCare operates emergency medical services in six other communities across the country. The ambulance service is known as what the community wants it to be called, as Sunstar Paramedics in Pinellas County, Florida.
The ambulance authority has employed four contractors in its 38-year history, Booher said. Contractors can be a private company like PatientCare or other types of agencies, like the city fire department.
Fort Wayne EMS was funded primarily by taxpayer dollars, but Three Rivers ambulance services are fully funded by user fees, whether they come from patients, private insurance companies, or Medicaid or Medicare.
Some ambulance authorities receive tax money, but this was not part of the 1983 agreement.
“Whatever the rules, we’ll work by the rules,” Booher said.
Even if an ambulance is late, Fort Wayne firefighters with advanced resuscitation training should be there within minutes, said Fire Chief Eric Lahey.
Fort Wayne firefighters were only required to have basic life support training until about five years ago, he said. Lahey has not commented on anything directly relating to the ambulance authority since he is a member of the board of directors, but he did share information on firefighter training with The Journal Gazette.
He played against the ministry when he offered to take over emergency medical services in 2016. Lahey suggested the change because he would keep the annual budget of $ 900,000 in Fort Wayne rather than going to a business. from Texas.
Schwartz said the change could cost lives since fire department workers were not trained to the paramedic level. He added that the fire department would not be allowed to get the contract from the ambulance authority due to lack of training.
After reaching an agreement with the ambulance authority, all firefighters in Fort Wayne are now trained as paramedics.
Fire stations are strategically placed around town so they can do three minute response times, making them ideal first responders. Firefighters can board an ambulance if a paramedic is not present and paramedic care is suddenly required.
Even with ambulance staff issues, Lahey said, the level of emergency care Fort Wayne residents receive has not changed.
“We are all committed to saving lives in the communities in which we serve,” he said.
Hold him accountable
One of the functions of the ambulance board is to ensure that the contractor is in compliance with the agreement reached 11 years ago when PatientCare became the city contractor. One measure is that 90% of calls are needed for doctors to arrive within the 8-and-a-half-minute window provided for in the agreement.
PatientCare has been out of compliance since August and has since been fined over $ 575,000.
Mike Bureau, operations manager for the ambulance authority, said the bleeding from employees continues.
The shortage of paramedics and emergency medical technicians is a national problem, Booher explained, and the board has taken steps, such as switching to a system in which paramedics with advanced resuscitation are no longer available. sent only on life-threatening calls. The two-tier system is expected to reduce the need for mandatory overtime.
The board’s only other option, Booher said, is to find the defaulting contractor.
“But where does the fault leave us? ” he said. “It just shifts the problem.”
No other city or county in Indiana has emergency management services through a utility model, Booher said. It is a rare model used in the country today.
Several agencies that were known to use the model are now what Booher calls “old utility models”. The ambulance authority still exists, but it functions as its own contractor.
This is the case with emergency medical services in Richmond, Virginia; Oklahoma City and Tulsa, Oklahoma; Reno and Washoe County, Nevada; Fort Worth, Texas; and Little Rock, Arkansas.
Booher’s example of another system using the utility model is Pinellas County, Florida, as there are no others in the state. Its contractor is also PatientCare.
Booher said many utility systems receive some type of subsidy, even if it’s not in cash. In some cities, the city buys ambulances, which reduces the costs paid to the contractor. The Three Rivers Ambulance Authority has not applied for a grant in the past, but Booher told the council in July that he may see a request in the future.
Emergency medical services are performed differently in different cities. Many, like the Muncie department, use a two-tier system that reserves paramedics for calls requiring advanced resuscitation training, similar to the one Three Rivers is currently implementing.
In Indianapolis, at least six emergency medical services companies compete. South Bend has the largest firefighter-based emergency medical services system in northern Indiana, according to its website.
A statewide problem
Many rules for Indiana emergency medical services were created in the 1970s, Metz said, and agency demands have changed since then.
“When you call 911, an ambulance comes,” he said.
But that is not the reality of providing emergency medical services in 2021. Metz said a large majority of calls are non-emergency trips, and a large portion of doctors’ time on calls is spent on emergency medical services. patients with chronic diseases.
Metz imagines a world of ambulance agencies working with nonprofits, grants, and other funding sources unrelated to Medicaid and Medicare. Perhaps then, doctors’ salaries could compete with unskilled jobs created by private companies, he said.
Calls have recently increased by 44% statewide, Metz said, and this is handled by short staff and doctors working mandatory overtime.
Metz said he had been raising awareness about the problem for about eight years and hadn’t seen much change.
“Just know that those who answer the calls, they are the ones who decide to stay in there,” he said. “They are tired, they are overworked and what we need from the community is that we need support and patience right now more than ever.”