City ambulance service not a solution, AMR says

December 14, 2001

The Cleburne Times-Review

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City ambulance service not a solution, AMR says

By:Rob Fraser,Times-Review Writer December 13, 2001

Any move by the city to institute its own ambulance service would be

a mistake, according to American Medical Response's Cleburne Operations Manager

Dan Brunner.

American Medical Response (AMR) ambulance service operates three

24-hour ambulances in County. Brunner said Wednesday afternoon two of

the ambulances are in Cleburne and one is stationed in Alvarado. On " high volume

days " -Fridays, Saturdays and Mondays-a fourth ambulance is on duty with

part-time staff.

Annually in County, AMR makes 7,500 ambulance runs, Brunner

said.

The full time staff, including administration and field medics,

totals 21, and about 12 part-time staffers.

During the workshop session of the city council meeting Tuesday

night, City Manager Chester Nolen told the council Fire Chief Clint Ishmael was

putting together a report outlining some ambulance service options for the city

and suggested that once the report is ready a workshop be held. One of the

options would be the fire department taking over the ambulance service.

AMR's response time was questioned and Ishmael was asked " Are you

happy with them? " He responded, " No sir. "

Nolen said there have been several situations where volunteers from

the ambulance services in Keene and have had to respond to calls in

Cleburne because AMR didn't have any available ambulances. " They are at level

zero quite often, " he said.

Brunner agreed and said the service hits level zero frequently,

" When we do not have an available ambulance. "

When that happens Keene or responds to provide service.

Brunner said as far as level zero is concerned, about 25 percent of

AMR's calls are outside " of our contract service area. " These are calls to

, Keene and Grandview. They have a volunteer staff and sometimes " they can

get a crew and sometimes they can't. "

Since there is that unknown, he said, virtually every time a call

comes in from one of those cities they " attempt to dispatch them and dispatch us

simultaneously. " So there are two ambulances responding to the same call if the

volunteers can get a crew together. " That contributes to us being level zero. We

are helping out the other cities in the county. "

Walls Regional Hospital has the contract with AMR, Brunner said.

Back when the county and the Hospital System negotiated

closing up the county hospital on North Main Street and building a new facility

out by the lake, part of the agreement was that the hospital would continue to

shoulder the responsibility of providing ambulance service.

Brunner said he answers to the hospital. In addition, the service is

governed by Cleburne city ordinances, governed by the Texas Department of Health

and then there are federal and state laws.

The three ambulances for County is what the " revenue that we

generate will allow for, " he said.

" If you go and talk to any first responder in County and ask

them if there are enough available ambulances in this county the answer is

'no,' " but this is " what we have to work with. "

Brunner said a recent case of a patient having to wait 30-plus

minutes for an ambulance was an extremely rare occurrence, but " there are times

when there are delays of 20 minutes or more. Obviously that's a very serious

concern for us and we have been very pro-active working to improve the system. "

Brunner said, " It's a bad situation. "

On paper, he said, there are five ambulance providers in the county

and there is a " pool of revenue from user fees for ambulance services so it's

diluted (the amount of money) by five and it's very inefficient. "

In January of 2000, Brunner said, AMR recommended to County

Commissioners hiring a consultant and doing a study to develop a county-wide

ambulance service so all that revenue could be consolidated and it would be more

efficient. " We believe it (a county-wide system) would allow enough ambulances

to be on the street with little or no taxes, and as you recall we do not receive

any taxes from any city or county government at this time. "

" The citizens of Cleburne and County are getting an

excellent deal right now, " Brunner said. " The only ones that pay for ambulance

service are the ones that use it. It's quite a bargain. "

The Balanced Budget Act of 1997 began to seriously decrease the

amount of compensation from Medicare. In this service area there is a large

percentage of Medicare patients so that has an impact, he said. In Texas,

Medicare compensation has traditionally been very low compared to the rest of

the nation. " On the east coast or west coast Medicare pays quite well. "

There was supposed to be a national fee structure by January of

2000, but it has been delayed for a variety of reasons. There has been a lot of

lobbying by the American Ambulance Association to have that figure readjusted.

If the proposed fee schedule goes into effect, say in New Jersey, according to

Brunner, that state will be in crisis as many of the ambulance providers will go

under. " There's no question about it, " said Brunner.

There's legislation before Congress that will adjust that fee

schedule to where people wouldn't be losing money every time they made a run, he

added.

" So with that on the horizon, that looks very good to us, " he said.

AMR's billing has been done out of the Denver office from 1998 until

September of this year; prior to that it was done in Dallas and the collection

rate was good. When it went to Denver that turned out to be ineffective, so it's

back in Dallas, where " we have seen an improvement in the collections. "

Brunner said AMR is under contract to Walls Regional Hospital and in

the event AMR decides to leave this area AMR has to give the hospital 180 days

notice. " If we don't do that we forfeit $100,000. "

Brunner said, " The City of Cleburne doesn't have to worry about

finding themselves without an ambulance provider. If AMR makes the decision to

leave Cleburne and County, I have financial backers lined up where I

could buy the business. We are going to be here. Whether the trucks say AMR or

Dan's Ambulance we are going to continue to provide high quality emergency

medical services. "

Brunner said his medical staffers have clinical expertise and

quality of care is superior. " Our protocol is more sophisticated than what you

will see in Fort Worth, " he said. " We are doing a very good job with very little

to work with. I'm very proud of the job our paramedics do, " he said.

If the city enters the ambulance business, he said, " it will take a

bad situation and make it worse. "

" We already have five providers sharing that revenue pool and a

sixth would even dilute it further, " he said.

Right now the bulk of the money goes to AMR and to Fort Worth with

the MedStar system in Burleson.

If Cleburne enters the business, he said, it appears that it would

no longer be financially feasible for us to continue to operate under these

conditions. What would be left over if you exclude Burleson, Cleburne, Keene,

and Grandview? What do you have? You have unincorporated areas. A large

geographical area with limited population and that makes it difficult and

expensive to serve. "

Having five ambulance providers, he said, also creates some

coordination issues. The inefficiency of multi-units going to the same call; if

you have a disaster situation there's no plan to coordinate five or six

ambulance services with 14 fire departments; and, the standard of care is

different in many areas and can vary.

One of the things that illustrates the need for a county-wide

system, Brunner said, is if, for example, you live 100 yards outside the

Burleson city limits on East Renfro and if you need an ambulance there is one

less than eight minutes away, but it's not going to come. It's contracted to the

City of Burleson and is not to leave the city limits. So the ambulance that

person needs comes from Alvarado or Cleburne. Again there's not enough volume in

that area to support an ambulance. But if Burleson was part of a county-wide

system, there would be a couple of ambulances there.

Another part of the coordination is the efficiency, he said. How

many ambulances will the city put on? and if they are all busy will they ask

or Keene to respond? and then will they respond to those cities when

needed?

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