Re: MedStar

[Guest guest]

This seems to be an ongoing problem with Rural/Metro as well as other private

EMS providors. staffing is a major problem, but as long as the wages are

what they are, this is going to be a PROBLEM. I understand that there is a

budget with which R/M has to operate, but if you can not staff an ambulance

service to meet compliance without being in the red, then dont bid on the

contract. It seems that alot of EMS services is having a employee shortage.

The BOTTOM line is, that as long as the wages are what they are , then this

is going to be a problem...............

Gene

[Guest guest]

Just wanted to comment on Genes post.

More and more municipal departments are " upping the annie " so to speak on the

pay. There are several county and city services that have entry level

positions starting in the 40's. They also offer generous benifit packages as

well as municipal retirement systems. (Benefit) something like that} Anyway -

The " privateers " employ many outstanding talents so they will loose out to

this trend. I also know of many central texas are privateers that start

paramedics at 7 to 8 dollars an hour. Funny thing is - they can drive an

extra 40 or 60 miles and make more than twice that amount and enjoy a the

perks of a municipal system.

H Tate

[Guest guest]

Number one:

Subsidize EMS on an equal basis as fire and police. What do you expect when

you give EMS 1/10th the funding and they are making 10 times the responses?

In a message dated 11/1/00 7:33:37 PM Central Standard Time, joby@...

writes:

<< How many folks saw the Channel 5 News piece on MedStar tonight? Of those

of you that did, what do you think it would take to alleviate the situation?

For those of you that did not view the piece it was in reference to

compliance problems and not making the 90% requirement on priority 1 calls. >>

[Guest guest]

More staffing, more units? Why is it that even AMR had problems meeting the

requirements?

Jay

[texasems-L] MedStar

How many folks saw the Channel 5 News piece on MedStar tonight? Of those of

you that did, what do you think it would take to alleviate the situation? For

those of you that did not view the piece it was in reference to compliance

problems and not making the 90% requirement on priority 1 calls.

Joby Berkley

[Guest guest]

Mr. has hit all of the points regarding MedStar's 'failures' to

date. I want to add something as an outsider. I am an outsider in that I

have worked alongside an AMR run operation while volunteering in Dona Ana

County, NM but was never employed by AMR (I didn't pass the test... I also

shot my mouth off to a supervisor...not a good combination) or Rural/Metro

(whom I have never applied with). I most likely will NEVER work for either

so I have no fear of saying what I am about to say (paycheck damage wise at

least).

I was my experience in DAC that AMR employee's were, for the most part,

competent, skilled, and dedicated. They also made poopy wages. The average

life-span was something like 3-5 years. By then they had either moved on to

a higher paying position with AMR (ie: Las Vegas), left AMR for R/M or a

municipal provider, or become RN's (PA's, MD/Do, etc). Why? AMR tries hard,

but it IS a for-profit organization. That means that, no matter what, the

share-holders MUST be kept happy. How do you keep the share-holder happy?

Make money, keep the price of the stock up, give higher dividend's, and all

that other Wall Street stuff.

Does this mean that the local EMT's and the Medical Director don't care

about patient care? No. Does it mean that AMR/Rural Metro are evil? No. Does

it mean that the path of least resistance to profit will be followed? Yes.

Does that mean patient care will suffer? Probably. Does this mean that your

EMT's are going to burn out? Yes. At least they will if they give a damn

about doing the right thing.

We need to face the facts, EMS is NOT a money making operation. Anyone who

gets into this line of work or starts a company based on this expecting to

make a profit better be ready to only break even (if they are lucky). Right

now AMR and R/M are barely keeping their heads above water. Why? They got

too big. AMR and R/M are like a dinosaur, they have to eat all the time

(earn money) or die. Huh? You ask? Simple, for every hour I have to pay a

crew $18 (10 for the medic, 8 for the EMT), plus my share of their taxes

($3), plus my share of their benefits ($1), plus the cost of maintaining the

unit ($7 per hour last I heard was the government cost = fuel, maintainence,

truck cost, taxes, etc). That means that I am spending about $30 per hour,

per unit to have my system up and running. Multiply that by 100 and you get

$3000 per hour.

I would need to make 6 $500 transports/runs PER HOUR to pay this. Not all

that hard...but wait, I have to keep in mind that you only collect about 33%

of what you bill...so now I need to make 18 runs PER HOUR to make this cost.

Still no big deal with 100 units, right? Oh yeah, I also have to pay for

advertising (so people know who to call for non-ER stuff), the cost of my

office, my dispatcher, the insurance PER EMT and PER UNIT if I am sued.

Okay, let's make that 30 runs per hour to BREAK EVEN. That means that 1/3 of

my service must be EARNING MONEY each hour to break even. One law-suit and I

am going to have to increase that to more like 1/2 of my units running to

pay that off and still break even. Now lets add in that 'dedicate EMS' unit

I have to have. Okay, I need $30 per hour to do this. But the other guy will

charge $29 per hour and beat me out. So I come in at $28 per hour on the

assumption that I will make up for it in volume with my other units

(accountants hate it when you say, 'I will make it up in volume')

Starting to see what this can run into? Yes, these figures can be picked

apart, they aren't intended to be factual, just to give you and idea of how

much you are biting off when you start a service. Am I surprised that AMR &

R/M are having financial troubles? No. Am I surprised it took this long?

Yes. They must have some dedicated individuals working for them to have held

things together this long.

Webb, LP

FLW EMS, MO

These are my opinions, if you don't like the, block the sender.

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[Guest guest]

There is no doubt there is a problem in Ft. Worth, but the greatest danger

is that someone in authority will have a knee-jerk reaction and impose a

solution that is worse than the disease. I also am not prepared to blame all

this on Rural/Metro. I think its a system problem. First lets look at what

we have on the plus side.

Medstar is one of very few major EMS services in Texas that employs

full-time, professional paramedics that are not required to also be experts

in another, totally unrelated field. They have historically had fairly high

standards for the paramedics they employ. They have over 40 ambulances that

can be put in service and have a very well developed infrastructure that

supports their operations throughout their service area. They have a very

sophisticated regulatory mechanism that makes them more directly answerable

to the local medical community than is true for any other major city in our

area. It also handles all the non-emergency transport functions for the

area. This means this important medical function is properly integrated into

the medical transport system and is equally answerable, instead of being a

separate operation that must be separately regulated and is vulnerable to

abuse by fly-by-night operators. By no means is MedStar a failed system that

doesn't work and should be replaced with something else, say a fire

department system. It is a well-thought-out design that needs some

adjustments.

What are the negatives? MedStar has historically been staffed by for-profit

companys that asked for less money than is necessary to adequately cover the

EMS needs of the territory covered. To a degree, this is built into the

system. Consequently, the service has had to cut costs whereever possible.

The most obvious way this has been done has been to pay poor salaries and to

utilize system status management to try and stretch resources. One result of

this has been a consistent failure to meet required response times through

most of the service's operating life. SSM is a false concept that almost

never works in practice and MedStar is proof. Another result is that, due to

the combinations of poor salary and poor working conditions (what you

inevitably get when you mix SSM with a busy EMS system), the provider has a

recurring problem staffing up to full strength. This means trucks must be

staffed by personnel on OT at higher cost or that trucks can't be staffed at

all, stretching the system even thinner and wearing out existing medics even

more. Notice I haven't cited high hiring standards as a contributing cause.

That is a factor on the plus side and I hope they don't lower their hiring

standards in an effort to put more red patches on the street.

So, then, what does the problem boil down to? First, Medstar has a problem

because it uses a utilization plan that does not work effectively, never

has, and never will. The system status management system that has been used

from the first has not made available resources go farther or be more

efficient. All it has done is make working conditions less comfortable for

medics, increase employee turnover, and cause some qualified candidates to

go elsewhere. Second, funding for the service is not, and never has been,

adequate to properly support the service. Fire and police receive a yearly

allocation up front because they are not really expected to make money. The

same attitude should prevail, to a point, with EMS. It must be realized and

accepted by the authorities that, because of insurance and medicare factors,

to say nothing of the fact that the heaviest users of the service are those

least likely to pay an ambulance bill, a 911 service for a metropolitan area

cannot stand on its own revenue-producing potential. The funding has to come

from the same source that funds the fire, police, and other municipal

services. If I were the god of EMS assigned to the Tarrant County area,

here is what I would do to correct the problem:

1. Do a detailed analysis to answer the following:

a. What is the response time that needs to be maintained based on

known medical considerations? Clue: it ain't no 9 minutes!

b. What minimum number of ambulances needs to be in service and

placed at fixed locations to meet that response time under typical average

conditions on any given day.

c. What is the actual cost of operating the service with that number

of ambulances plus three with a typical salary for medics equivalent to that

paid by Austin- County EMS. This factor would not include any profit

for the managing company.

d. Besides contracting with a private company, what other management

options are available, given that the service must remain an autonomous

entity? (for example, could the Ft. Worth Health Department manage it?)

2. Redesign the base system as follows:

a. eliminate the roving-truck SSM system currently used in favor of a

set number of station locations plus a small number of 8-hour floating

units. Not all stations would necessarily be manned on every day. This would

be the only variation based on utilization statistics.

b. alter the bid specifications to require the medically-appropriate

response time and to require a minimum salary for medics as stated above.

Allow EPAB to specifiy minimum criteria for candidates for hiring.

c. Plan to pay the management contractor a yearly sum equivalent to the

minimum operating cost estimates derived in the above analysis. I'm not

talking subsidy here any more than a fire department or a police department

gets a subsidy. I'm talking about paying for the service that is needed by

the citizens. In other words, participating cities will pay up front for the

basic costs of operating the service, the equipment, and the salary costs of

the medics. Note these costs are for 911 only. The management company must

agree to handle non-emergency and the exclusivity rules will remain, but

they must pay for that out of their percentage of collections (see next

item)

d. Potential management contractors will bid on the basis of what

percentage of the collections from citizens for EMS services they will keep

and how much will be returned to the ambulance authority to defray the costs

of the system. A management service's profit, if any, will be derived from

collections for EMS service. The basic operation of the service will not

depend on collections, although collections may help to reduce the costs to

the taxpayers after the fact. Management salary costs (cost of anyone whose

office doesn't have the potential to make an EMS response) will come from

the percentage of collections kept by the managing company. Vehicle

maintenance personnel are paid as part of the base operating cost money

provided by the cities.

What will such a modification do? First, it will eliminate most of the

controllable reasons for medic staffing problems (poor salaries, bad working

conditions) and will insure that the actual operations of the 911 service

are not affected by the vagaries of fee collection. It protects the vital

aspect of the system, a functional, high quality 911 service staffed by

well-paid, professional paramedics. Second, it eliminates the motivation of

potential contractors to increase their profits or reduce their losses by

scimping on operational expenses like maintenance, unit staffing, or medic

salaries. It gives them a better chance for profit by guaranteeing them a

certain percentage of collections up front. If they want to scimp on

salaries to boost profit, the only salaries that can be affected are those

of the suits and management staff, not the medics. The winning bidder is the

one whose management staff efficiency is such that they can make a good

profit from a lower percentage of all collections and who, thus, can turn a

larger portion of collection proceeds back to the ambulance authority. This

should somewhat reduce the the tendancy for bidders to underbid to get the

contract because it reduces the potential ways they can cut costs at the

expense of the system. The major downside (and that depends on how you look

at it) is that the cities will actually have to pay what it really costs for

the level of service they seem to want instead of depending on the voodoo

economics they always have in the past. The greatest upside is that the many

positive aspects of the MedStar system can be retained.

Okay. This is a fairly simplistic analysis of the problems in Ft. Worth.

There's probably a lot of things I can't possibly know that need to be

factored in. There are probably a lot of problems with this idea (other than

an unwillingness on the part of the cities to pay for it. That is a problem

on their end, wanting something for nothing). I posted this thing just to

express some of my pet ideas and to generate some discussion beyond the

point-the-finger-of-blame type of post. I hope that discussion will now

commence and that a lot of the ideas will come from the folks who actually

work in the system over there. By the way, in case you are wondering, my

vested interest in all this is the fact that my parents live in Ft. Worth

and, from the EMS standpoint, I think they are much better off than they

would be if they lived in, say, Dallas. I want to keep it that way and I

want to see them even better off in that regard. If you got to the end of

this without hitting the bye-bye key, thanks for reading it.

Dave

[texasems-L] MedStar

> How many folks saw the Channel 5 News piece on MedStar tonight? Of those

of you that did, what do you think it would take to alleviate the situation?

For those of you that did not view the piece it was in reference to

compliance problems and not making the 90% requirement on priority 1 calls.

>

> Joby Berkley

>

>

>

[Guest guest]

How long ago was this. MedStar just raised their base pay to $28,000 from

$24,000.00

[texasems-L] MedStar

>

>

> How many folks saw the Channel 5 News piece on MedStar tonight? Of those

of you that did, what do you think it would take to alleviate the situation?

For those of you that did not view the piece it was in reference to

compliance problems and not making the 90% requirement on priority 1 calls.

>

> Joby Berkley

>

>

>

[Guest guest]

I saw it twice. I really wish that the news stations would have had the

information regarding the pay scale. Most people do not realize that EMS is

paid so low. They all think that EMS personnel are very well paid. When they

were talking about the 18 medic shortage I believe that they should have delved

into why there is a shortage. I did my medic clinicals with MedStar (anyone

remember Etheridge, Terrell). I rode with this crew most of my

clinicals as well as with a few other great ones (Wayne Day and some others

whose names escape me) and thought that I would like to work at MedStar,

however, when I found out what the starting pay was, I gasped big time! I

couldn't afford to drive from Denton to Ft. Worth on what they wanted to pay and

I didn't want to work 40 hours OT to make it worth my while. So I went back to

school and am now an LVN as well as a Licensed Paramedic. I also believe that

concessions should be made to the ambulance services in regards to what they are

reimbursed for and the initial contracts should be at alevel that can provide

for enough service for the area.

ita Diamond

[texasems-L] MedStar

How many folks saw the Channel 5 News piece on MedStar tonight? Of those of you

that did, what do you think it would take to alleviate the situation? For those

of you that did not view the piece it was in reference to compliance problems

and not making the 90% requirement on priority 1 calls.

Joby Berkley

[Guest guest]

This was back in '95 and '96 - how many hours is required for the base pay?

JD

Re: [texasems-L] MedStar

How long ago was this. MedStar just raised their base pay to $28,000 from

$24,000.00

[texasems-L] MedStar

>

>

> How many folks saw the Channel 5 News piece on MedStar tonight? Of those

of you that did, what do you think it would take to alleviate the situation?

For those of you that did not view the piece it was in reference to

compliance problems and not making the 90% requirement on priority 1 calls.

>

> Joby Berkley

>

>

>

[Guest guest]

Almost everyone works 48 hour work weeks. There are two units that are 24

hour trucks.

[texasems-L] MedStar

> >

> >

> > How many folks saw the Channel 5 News piece on MedStar tonight? Of those

> of you that did, what do you think it would take to alleviate the

situation?

> For those of you that did not view the piece it was in reference to

> compliance problems and not making the 90% requirement on priority 1

calls.

> >

> > Joby Berkley

> >

> >

> >

[Guest guest]

But keep in mind, that $28K is base for primary

paramedics. EMT's and I's are still basing at just

around $20k

__________________________________________________

[Guest guest]

Lake Country Estates

Mark Hull, LP

[Guest guest]

Ok, one 24-hour-unit is in Burleson, where is the other one? Just curious!

Take care, stay safe, and practice mercy, ya'll!!

Jana

FW,TX

[texasems-L] MedStar

> > >

> > >

> > > How many folks saw the Channel 5 News piece on MedStar tonight? Of

those

> > of you that did, what do you think it would take to alleviate the

> situation?

> > For those of you that did not view the piece it was in reference to

> > compliance problems and not making the 90% requirement on priority 1

> calls.

> > >

> > > Joby Berkley

> > >

> > >

> > >

[Guest guest]

Boat Club Road

Re: [texasems-L] MedStar

Ok, one 24-hour-unit is in Burleson, where is the other one? Just curious!

Take care, stay safe, and practice mercy, ya'll!!

Jana

FW,TX

[texasems-L] MedStar

> > >

> > >

> > > How many folks saw the Channel 5 News piece on MedStar tonight? Of

those

> > of you that did, what do you think it would take to alleviate the

> situation?

> > For those of you that did not view the piece it was in reference to

> > compliance problems and not making the 90% requirement on priority 1

> calls.

> > >

> > > Joby Berkley

> > >

> > >

> > >

[Guest guest]

Boat club truck

[texasems-L] MedStar

> > > >

> > > >

> > > > How many folks saw the Channel 5 News piece on MedStar tonight? Of

> those

> > > of you that did, what do you think it would take to alleviate the

> > situation?

> > > For those of you that did not view the piece it was in reference to

> > > compliance problems and not making the 90% requirement on priority 1

> > calls.

> > > >

> > > > Joby Berkley

> > > >

> > > >

> > > >

[Guest guest]

The wages at MedStar are 2nd in the state for a private. The staffing

situation parallels all medical professions in that there are simply not

enough paramedics to go around. Of course many are going to municipals and

hospitals for more money. Is this the contractors fault? I don't think so.

MedStar is now offering a higher starting salary plus bonuses. But you can't

pay air ... if there's no one out there and it now takes longer to train, the

staffing shortage is only going to escalate. So the solutions are elsewhere.

The solution at MedStar and in many other systems around the nation is to

look at the system and make some modifications. With funding the way it is

and with the change in the new fee schedules for MCare and MCaid, all systems

will need to re-evaluate their structure. This isn't all about money, this

is about this industry changing and NOT being " business as usual " .

my 2 cents

[Guest guest]

Still not much to raise a family on

[Guest guest]

Who would oversee the Authority and mandate that they have acceptable

response times? Seems dangerous. That is the very reason for a PUM.

[Guest guest]

The information came from a study that was done by a consulting firm. This

study was not done for a private service and was independently done. However,

this study was done a few months ago. But, please consider when you are

quoting from posts that you have seen, you only see starting pay and bonuses.

The study considered pay across the board for current and starting pay.

[Guest guest]

I'm curious. If R/M should lose the Ft. Worth contract and the Ambulance

Authority has to take over directly, why does it have to be only a temporary

thing? For what reasons would the member cities and the Authority NOT want

direct management of the system and employment of the medics to be

permanent. It seems to me that is the surest way not to have yet another

management company come in and underbid the real costs of the contract. I

realize they probably don't have the staff at the moment, but that could be

changed if need be. Can someone in the know educate me on this issue?

Dave

[Guest guest]

To me it all boils down to $$$$$$$$$$$, it's as simple as that. Why do some

cities, counties, hospital districts, and feds contract with private EMS

providers? Over 50% cost savings than running it yourself, vicarious or very

little liability, the notion by government officials that a professional

company can handle the 'ambulance woes', and tax money can be spent on other

things.

Mike

Dave wrote:

> I'm curious. If R/M should lose the Ft. Worth contract and the Ambulance

> Authority has to take over directly, why does it have to be only a temporary

> thing? For what reasons would the member cities and the Authority NOT want

> direct management of the system and employment of the medics to be

> permanent. It seems to me that is the surest way not to have yet another

> management company come in and underbid the real costs of the contract. I

> realize they probably don't have the staff at the moment, but that could be

> changed if need be. Can someone in the know educate me on this issue?

>

> Dave

>

[Guest guest]

I'm not sure where the information on MedStar's pay

being second in the state came from, but that cant be

right. Just look back at some of the job postings that

have been placed here for private services. There are

3 that I know of, just in the D/FW area, that have

higher starting scales. We all know that the pay is

not the main issue with MedStar, but once again,

misinformation is being disseminated, which does

nothing but steer the discussion at hand in the wrong

direction.

__________________________________________________

[Guest guest]

Three years ago I applied, tested, and was offered a job with Medstar. Of

course, then it was AMR, but they wanted to start me at 16k base/year. And of

course, I didn't take the job.You can't hire and keep people for that amount of

money. It's no wonder why THEY(AMR) had problems.

Eddie on, EMT-P

Re: [texasems-L] MedStar

> I'm not sure where the information on MedStar's pay

> being second in the state came from, but that cant be

> right. Just look back at some of the job postings that

> have been placed here for private services. There are

> 3 that I know of, just in the D/FW area, that have

> higher starting scales. We all know that the pay is

> not the main issue with MedStar, but once again,

> misinformation is being disseminated, which does

> nothing but steer the discussion at hand in the wrong

> direction.

>

> __________________________________________________

>

[Guest guest]

Dave,

Unless it has changed, the interlocal agreement that created the

Metropolitan Ambulance Authority specifically forbids the authority from

permanently operating the service. The only provision is for a temporary

takeover until a new RFP can be let.

If memory serves, the City of Fort Worth was insistent that they did not

want to be in the ambulance business. Thus the language was drafted to

specifically preclude a permanent takeover by the authority

Mike Carr, JD, LP

> I'm curious. If R/M should lose the Ft. Worth contract and the Ambulance

> Authority has to take over directly, why does it have to be only a

> temporary

> thing? For what reasons would the member cities and the Authority NOT want

> direct management of the system and employment of the medics to be

> permanent. It seems to me that is the surest way not to have yet another

> management company come in and underbid the real costs of the contract. I

> realize they probably don't have the staff at the moment, but that could

> be

> changed if need be. Can someone in the know educate me on this issue?

>

> Dave

>

>

>

>

>

[Guest guest]

Thanks, Mike. I've always wondered about that. All is now clear. Have a

good, if somewhat damp, weekend.

Dave

RE: [texasems-L] MedStar

> Dave,

>

> Unless it has changed, the interlocal agreement that created the

> Metropolitan Ambulance Authority specifically forbids the authority from

> permanently operating the service. The only provision is for a temporary

> takeover until a new RFP can be let.

>

> If memory serves, the City of Fort Worth was insistent that they did not

> want to be in the ambulance business. Thus the language was drafted to

> specifically preclude a permanent takeover by the authority

>

> Mike Carr, JD, LP

>

>

>

> > I'm curious. If R/M should lose the Ft. Worth contract and the Ambulance

> > Authority has to take over directly, why does it have to be only a

> > temporary

> > thing? For what reasons would the member cities and the Authority NOT

want

> > direct management of the system and employment of the medics to be

> > permanent. It seems to me that is the surest way not to have yet another

> > management company come in and underbid the real costs of the contract.

I

> > realize they probably don't have the staff at the moment, but that could

> > be

> > changed if need be. Can someone in the know educate me on this issue?

> >

> > Dave

> >

> >

> >

> >

> >

>

>

>

>

>