The Vancouver Fire Department returned to Monday’s City Council workshop to continue discussion of the proposed “Stop the Clock” ambulance agreement, which would add a few minutes to emergency response time and cut back on hours that ambulances are staffed.
Vancouver Fire Chief Joe Molina and Clark Regional Emergency Services Agency manager Doug Smith-Lee made a request to amend the emergency services contract with American Medical to add two minutes to allowable emergency response time, increasing it from seven minutes, 59 seconds to nine minutes, 59 seconds. They also want to reduce hours that ambulances are staffed by 12 hours a week for an estimated annual savings of $262,780.
Currently, the contract to provide ambulance services states that an American Medical Response ambulance must respond to an emergency call within seven minutes and 59 seconds. This proposed change allows them to subcontract with other paramedics to meet the timing window. For instance, fire department paramedics arriving on scene within the time frame would be allowed to count toward meeting American Medical Response’s contract. American Medical Response would then have an extra two minutes to arrive, creating the 9 minute, 59 second window.
Molina and Smith-Lee defended amending the contract, saying it is driven by finances but in the end the process of reviewing the system improves efficiencies.
Redefining ‘first responder’ shares cost savings with fire department
American Medical Response faces an increasing number of people in the county requiring service who are underinsured or uninsured, along with decreased Medicare reimbursements. This creates a business environment for the ambulance provider that’s rife with financial difficulties.
If rates are simply increased it wouldn’t necessarily resolve the disparity between cost and revenue stream. When a patient can’t pay the higher bill, the unpaid bill is sent to collections, which adds to the cost of doing business.
The team acknowledged that the city faces similar financial difficulties. Sales and property taxes are bringing in less revenue, so the city is in no position to underwrite ambulance service shortfalls. Also, getting a levy on the ballot for emergency services “would not be seen as favorable by the community,” said Smith-Lee.
Improvements to the system have contributed to better coverage and better efficiencies. The two entities, American Medical Response and the Vancouver Fire Department, now work with an integrated call system that sends the nearest unit – which in some cases may not be the nearest station.
Counting the “first responder” – even if when it happens to be the fire department – allows American Medical Response to reduce staff hours. The resulting costs savings would be shared with the fire department when it is the first responder.
So instead of asking for more money on the contract, this arrangement has the potential of refunding money to the city.
The overall review of the current system to come up with the contract amendment also brought Molina and Smith-Lee to take into consideration the patient’s experience. Up until now the only measurement used was whether emergency personnel arrived on time. Now, the patient’s journey is being assessed.
“You can get there on time, but what is the patient’s experience?” said Molina.
City Council asks ‘why now’
City Council questions ranged from whether this would alter when the Fire Department showed up on scene, who had the responsibility to turn the patient over to transport, and what factor determines when the ambulance or the fire department leaves the scene.
The council was told that some changes would result by working more closely together. Decisions on transport and leaving the scene are all “situational” but would not alter when the Vancouver Fire Department showed up.
Subsequent to this proposal, about 4,000 low-level priority calls have been eliminated from the fire department’s responsibility. When asked to give an example of the lowest priority call Smith-Lee said someone “complaining of an earache or a stubbed toe.”
Councilmember Bill Turley asked when the clock starts ticking – when the call comes in, or the call is assigned. Molina answered, “When the call is assigned.”
Council member Jeanne Harris pressed several times to have her question answered, “Why do we have to make this change right now?”
For American Medical Response to continue its current role the system requires more than a “few tweaks,” said Molina. Expanding the response time two minutes “buys us that critical time to figure out what the system will look like beyond 2014,” when the contract comes up for renewal. He said they are juggling “a lot of moving parts” due to the new call system, closing a station and opening a station.
“You (American Medical Response) sign a contract and halfway in you come back and say you can’t do it? Now is not the time to change the contract, now is the time to review protocals,” said Harris.
Councilor Jeanne Stewart said, “I’m considering it a stopgap measure. We need to maintain safety and cost reduction in the case of duplication.”
Molina summed up, “I really think it will improve performance.”
In 1987 Clark County created an emergency management services district called District #2, which currently provides services for about 80 percent of the county.
In 1991 the City of Vancouver was sued in Federal District Court by Buck Ambulance, which demanded 50 percent of the ambulance calls. Had Buck’s suit prevailed ambulances would have been dispatched much like tow trucks, “which isn’t a good idea because you’re not always sending the closest ambulance,” said Smith-Lee.
After the suit was settled, interlocal agreements were put in place in 1992 with the seven cities in Clark County, Battle Ground, Camas, La Center, Ridgefield, Washougal, Yacolt and Vancouver to group purchase or contract for annual services. They also established uniform pricing and other regulations within the district.
The contract for District #2’s emergency services is approved by county commissioners, who appoint a board to oversee the district’s contract. The Emergency Management Services Board incorporates citizen volunteers with expertise in finance, business, healthcare administration, insurance and law and is appointed by the county.
Any time the board exceeds what would be considered normal oversight that creates a fundamental policy change, the recommendation returns to the seven cities for approval.
At the earlier workshop the council raised a number of questions in order to understand how the dispatch system works and how the proposed change would affect the city.
According to Molina, all the other cities involved have signed off on the agreement