Hitting where it hurts

| January 16, 2013
The Fire Department and mayor are open to new approaches.
The Fire Department and mayor are open to new approaches.
- Kirsten Akens

When you're having a heart attack, you don't care if the paramedic works for a private company or the local fire department. You just need help.

But when the bill comes, you might care a lot.

Colorado Springs Mayor Steve Bach is considering changing how patients are transported, and both options he's said to be mulling could increase ambulance charges.

Since the mid-1990s, the Emergency Services Agency, a regional agency with 27 members (including El Paso County and the city) has overseen a regional emergency ambulance contract. It competitively bids the contract at certain intervals; the current one with American Medical Response will expire on Dec. 31, 2013. The city has refused to approve an extension.

County Commissioner Sallie Clark met with Bach on Dec. 19 and reports he's looking at the Colorado Springs Fire Department taking over ambulance transport. City Councilor Merv Bennett says, however, that Bach considers that "only an option"; another would be for the city to charge its service provider, whether AMR or someone else, a franchise fee of up to $2.4 million a year. That's more than 10 times the $200,000 AMR currently pays the ESA for contract oversight.

Details are scarce, largely because the city refuses at this point to release information. In response to the Independent's questions about operational costs, collection rates, start-up expenses, legal liability and staffing, its communications staff issued this response: "The City is in the process of evaluating all of its options and will share our findings with the community once the analysis is complete."

The unknowns

Springs firefighters responded to only 802 fires in 2011, the most recent data available. That's 29 percent fewer than the 1,127 fire calls in 2002. But during that same decade, medical calls jumped by 14 percent, to 34,995.

Firefighters respond to those calls along with AMR and provide initial assessment and treatment, but don't transport except in certain circumstances. They clearly occupy a support role, so much so that if they use any medical supplies on a call, AMR restocks those supplies.

The last time the city studied a Fire Department takeover was 2005. It was a different world then, as evidenced by the study's allusions to a "promising" economy and a "robust" home construction industry. In fact, AMR general manager Ted Sayer says the study is simply "no longer relevant," what with declining government reimbursements and rising expenses, including an 83 percent fuel-price hike since 2005.

But with no new figures coming yet from the city, the '05 numbers provide perhaps the best ballpark figures for what it would take to start this kind of operation. Besides $5 million to buy ambulances and equipment and modify fire stations, the '05 plan called for 70 new hires — most of them civilians, to dodge paying higher firefighter salaries.

The city would break even each year, the study predicted, once it collected more than 42 percent of its billed charges. That's hardly a given; Sayer says AMR's collection rate sits at 33 percent to 40 percent.

Then there's liability. The city could be sued if something went wrong during a transport. And billing can lead to issues: The city of Dallas paid a $2.47 million fine in 2011 because its collection agency overbilled Medicare and Medicaid. Dallas then switched to a different company, whose collections were $8 million below projections.

Manuel Navarro, who was the Colorado Springs fire chief in 2005, in an interview recently labeled the takeover idea "marginal at best."

"If revenue fell short, we would still have the employees," notes Navarro, who worked for AMR as an executive between his tenure in the Springs and his current job as an assistant chief in California's Bay Area.

Covering the shortfall would likely mean raising rates on the public.

Given such problems, it's no wonder that Steve Williamson, who runs the Emergency Medical Services Authority in Oklahoma City and Tulsa, Okla., says fire departments are moving away from providing ambulance service.

"People who think this is a revenue source for cities to get into the business are crazy," says Williamson, an American Ambulance Association board member. Referring to the decline in Medicare and Medicaid reimbursements, he adds, "There isn't revenue there to make it smart for cities to take it over, because it's just going to get more restrained in the future."

Not that it's impossible to make it work. The Phoenix Fire Department, which handles emergency transport, is doing fine, says spokesman Tim Kovacs. Rates are set by the state — currently it's an $850 base rate for advanced life support, and $750 for basic life support. (AMR's charges are $709 and $529, respectively.)

"Our rates cover all of our costs, and we have one of the highest collection rates in the state, and we don't aggressively beat people's doors down," Kovacs says.

A hidden tax?

Bach's other idea is to have AMR pay the city for firefighters' time spent responding to medical calls, estimated at $2 million to $2.5 million a year, as a franchise fee.

The fee seems to adhere to a 2004 federal Inspector General's advisory opinion that cities won't violate an anti-kickback law if their franchise fees reimburse for a service — in this case, firefighter first responses. Still, EMS attorney and consultant Doug Wolfberg of Harrisburg, Pa., considers franchise fees a "pay to play" arrangement and a hidden tax or cost shift, because they drive up rates for insurers and private-pay patients.

Wolfberg says most franchise fees hover around $500,000; he calls the city's figure "outside the norm." Ambulance companies run on a tight margin, he says; without a significant rate increase, they might not make money.

"The fees ambulance services get from Medicare and insurance companies are simply not sufficient for them to subsidize municipalities that have holes in their budget," Wolfberg says, citing two federal studies that found that government reimbursements provide "barely a break-even proposition" for contractors. Franchise fees, he says, drive up rates.

Most emergency ambulance companies supplement their income by handling non-emergency transports, such as between nursing homes and hospitals. Fire departments don't usually handle those calls.

Bach and Fire Chief Brown are due to report on the matter to Council in late February, Bennett says.



Comments (18)

Showing 1-18 of 18

I wonder if the folks that worked for STF Ambulance in July 1992 that now are on CSFD think of what it felt like that day when they lost their jobs.

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Posted by Mary Beth on 01/17/2013 at 8:35 PM

Mayor Bach ran on support of private business in our city ...even visited AMR to support him for Mayor...passed out yard signs ha...now many hard working dedicated people.. their jobs are threatened! So many families at AMR will be affected! AMR has provided great care and support to our community since 1992..why fix something if it is not broken??? There is no reason for this.. why put so many out of work at this time...how will this help our community? Do we not already pay taxes for the fire departments services?? After the Waldo Canyon fire and this year another dry fire season...would it not be better to have CSFD using all their resources to fight fires???? Very sad...

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Posted by Mary Beth on 01/17/2013 at 8:44 PM

Government should support businesses, who in turn provide money to the system, including taxes to the government.

Private business will always be able to do a job for lower cost, because competition keeps them lean. Bureaucratic agencies have nothing to keep them from becoming ever-larger.

Also, if the city does this, there is no reversing it. Even if it is an abysmal money losing black hole, you will never see the Fire Department get out of the business. Once the mechanism are in place they will put tentacles throughout the government, so that they cannot be removed. The city will just have to keep paying more and more money to prop up a losing Fire Department ambulance service that cannot and will not go away. That means ever higher ambulance bills from the Fire Department, and increases in taxes to help pay for the agency's losses.

The Fire Department will run the ambulance service, but the paramedics and EMT's who staff them will be non-sworn public servants, who will be paid significantly less than sworn firefighters, and ambulance people will always be treated as second class members.

Many jobs will be lost, and so will tax revenues.

Costs will go up, and quality and accountability will go down.

AMR provides a lot to the community which the Fire Department will not, including free education to all ESA agency EMT's and paramedics, including CSFD. Continuing education for certification renewal can cost $300-$500 every two years if done elsewhere, and it is free through AMR

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Posted by Mary Beth on 01/18/2013 at 7:35 PM

Awareness and frustration! What is very frustrating is Mayor Bach and CSFD Fire Chief Rich Brown decided this for our community without ANY community awareness or input ..I think this is wrong a scary!!!! Too much power not balanced!!! It is our tax dollars!!! OUR COMMUNITY!!! If it is not broken why fix it??? AMR has provided great service to this community for over 20 years..the Paramedic's and EMT's live in our community are raising families here and the 200 some employees are part of our community!!!! Their wages and benefits do not come close to that of the CSFD but they LOVE what they do! Last summer CSFD voted with the ESA Board to extend AMR's contract then abruptly late fall changed their minds and decided to go another route with Mayor Bach!!! NO VOTE by the citizens , the ESA Board or city council just Mayor Bach and CSFD Rich Brown. When it comes down to it whether there is another private ambulance company or AMR that is so much better for the community then CSFD transport. With the horrific summer we had with the Waldo canyon fire and this summer promises to be another DRY and HOT summer why is CSFD not concentrating on more manpower to fight wild fires???? So many other agency's were called in to help CSFD understandably! While CSFD was fighting that fire AMR was handling all 911 medical calls and AMR folks came in to help evacuate folks from nursing homes etc. but we do not hear those stories about AMR. Why with our economy with the way it is would the Mayor do such a thing? What about private industry? "

"The city is struggling just pay new firefighters to staff all of their stations. It took a two year $2 million grant from the Obama administration to fully staff the new Fire Station 21 without pulling crews from other fire houses.

"I think there's a concern that things have kind of been done behind closed doors, the ESA really feels that this needs to be a transparent process," said El Paso County Commissioner Sallie Clark. "

Please be aware of what is going on in our backyard!!!

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Posted by Mary Beth on 01/19/2013 at 7:50 AM

I guess the missing piece to this since all seem so eerily quite Mayor Bach, CSFD Rich Brown, and AMR. There is nothing fourth coming from all three no coverage by news media no communication no PR..silence! Sometimes the truth hurts maybe AMR has made a deal with CSFD that would provide jobs for AMR street crews...alas this is a possibility..If this is so... then thank goodness there will be some jobs...so there is nothing else to say

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Posted by Mary Beth on 01/19/2013 at 8:46 AM

Dear Mayor Bach, CSFD Fire Chief Rich Brown, and AMR,

Please, if you are planning the force of CSFD city ambulance transport, which might involve some layoffs of crews from AMR be merciful, be fair, to these hard working individuals at AMR let them know ahead of time. AMR communicate with your people... the stress they and their families are dealing with of wondering is so hard. CSFD how can you with ease look at these crews day by day in the eye when you will be taking their jobs. Mayor Bach you visited AMR you asked for the crews vote based on your belief in private enterprise..you passed out yard signs. What do you stand for? Rumor has it no one can even get you on the phone. Is this true? What are you and Rich Brown and maybe AMR doing to our city? Why would you potentially layoff employees during this dismal time?

A Friend Of The Community,


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Posted by Mary Beth on 01/22/2013 at 10:32 PM

Dear Mayor Bach,

We elected you..as did many that work for AMR ...you spoke to them and asked for their vote. You told them you supported priviate business. Where do you stand with the jobs of all at AMR Ambulance? Why have you given CSFD Rich Brown your ear and not close to 200 dedicated hard working Paramedic's and EMT's that work for AMR Ambualnce. What do you know about the medical skills overall of CSFD and the Paramedics and EMT's at AMR? Sadly I would not want most CSFD Paramedics to attend any of my family. Before you shove CSFD fire transport down all of our throats have you yourself checked the abilitys of the CSFD Will you yourself ..YOURSELF personaly before you make this happen for our city will YOU know how well medically CSFD will preform? Speaking from experience did you know that Rich Brown was always considered at best a mediocre Parmedic but you are using him as your expert for medical care in this city...you need to be open to medical input from other parties before you hand over the key to peoples lives?

Your Kind Friend Of Our Community,


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Posted by SILENT DOGOOD on 01/23/2013 at 7:07 AM

Dear Mr. Mayor,

Your comment on public transit http://www.csindy.com/IndyBlog/archives/20…

Why are you speding the money for CSFD to transport when our city already has an ambulance service that does this? Why not spend the time and energy to fight for public transit instead?

Friend Of Our Community,


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Posted by SILENT DOGOOD on 01/23/2013 at 8:18 AM

These are the people Mayor Bach and CSFD Rich Brown you to replace..why?

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Posted by SILENT DOGOOD on 01/23/2013 at 8:32 AM

These are the people Mayor Bach and CSFD want to replace..YOU TELL ME?

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Posted by SILENT DOGOOD on 01/23/2013 at 8:35 AM
Posted by SILENT DOGOOD on 01/23/2013 at 8:37 AM

For all our local Paramedic's and EMT's that work for AMR..THANK YOU! Thank you for your outstanding service to our city! I wish I could have done more for you!!! I wish I could have helped in some way..I wish our coummunity could have helped you more...helpless! Pain's me to think so many may be laid off...I think CSFD is going to transport and I am sad to see this happen after 30 years of your service!!! Hoping and praying for a silverlining that you all will be hired by CSFD. Huh after all these years this is what CSFD has always wanted..when so many cities are outsourcing to private transport like we already have today to save money! Talk to AMR and CSFD don't let them stonewall you..this is your life..don't be afraid to get anwsers..we are all adults here right? Prepare for the worst but exspect the best! Blessing to you all! Keep your chin up ..



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Posted by SILENT DOGOOD on 01/24/2013 at 2:47 PM

Where is has common sense gone?



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Posted by SILENT DOGOOD on 01/25/2013 at 1:06 AM

Where is common sense gone?



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Posted by SILENT DOGOOD on 01/25/2013 at 1:07 AM

Dear Mayor Bach, CSFD Chief Rich Brown, All of CSFD, and All of AMR Colorado Springs,

First I would like to apologize to all of the above...and so hope you will accept my humble apology! I allowed myself to get caught up into all this change because it potentially threatens the jobs many people that I care very much about! After reflection I found myself reacting and following potential mob mentality..not entirely my fault it is secondary to the lack of communication by all mentioned above!

When you do not communicate that causes wonder, worry,and panic leading to speculation. Mayor Bach, Chief Rich Brown, Management at AMR, I ask that you be considerate to all the employees at AMR and the firefighters.. have heart...sit down with all, be straight with them. Have the common decency to do so. Be respectful towards one another.

I believe no one is perfect, I believe when we are fearful we find a scapegoat. I will admit I listened to Chief Brown when he spoke at the ESA meeting..I felt his responses were rude as he answered questions it seemed " It is the City and we can and will do what we feel is best and I don't have to answer that" incredulous I thought..I was angry! The truth is whether I like it or not Rich Brown was right. Yes the city can do that..oh this pains me to the core to say so..but it is true! It pains me greatly to say maybe the city will transport and jobs will be taken away..it pains so much that so many may lose their job. What I realize the old saying " You can't fight city hall" well there is truth to that the point of all is if no one give you answer's keep asking..and if your job is taken...well that is tough one other than nothing can be done.

I did call Mayor Bach's office yesterday and was greeted by his very kind assistant could not have been more courteous and sincere and Denise I think is her name? She took down my information. I called regarding my huge overwhelming concern of close to 200 jobs at AMR being taken and to have it done in such a awful way similar to July 1992 when A-1 ambulance bought ST ambulance..people ought not to be treated in that way ever. To my surprise Rich Brown did call me, he was very personable, kind, professional, and what struck me the most was how excited he sounded for plans for our city not just with CSFD all of our city...I believe he was sincere! ( A cynic would say of course because he is getting the city to do ambulance transport) I really don't what is to become of any of this ...what I do know is he was excited and I strongly suggest if anyone has any fears like I did call him, call the mayor, call your management at AMR. If anyone does not have the decency to to talk to you then shame on them!!! I realized if CSFD does take over transport then my world will come crashing in as many others..most likely we would lose our house our home...no job no home. so I am not taking the lightly but yet I realized there is nothing I or you can do to dramatically change the outcome.

If AMR suddenly is laid off without warning then shame on all that did not have the decney to give warning!

There are things we can change in our life...I forgot to mention my two great friends Dolley Madison and Betsy Ross . As I listened to a well mannered Dolley Madison yesterday she reminded me of what firefighters, AMR paramedic, and EMT's can do...and ALWAYS do without exception towards your patients (whether they are homeless or have millons of dollars ) and when you all are working together be DECENT, Have DIGNITY, Be COURTEOUS. Please and Thank you really do go far!

Dolley Madison and Betsy Ross came from an Era where everyday manners really do count and they still do. Dolley Madison reminded me yesterday whether you are a paramedic for AMR or for CSFD and your medicine is good if you do not exercises manner and all of the above mentioned you are nothing.

Is is not a shame that that there is an ongoing power struggle here in our city running calls? Can't each give a bit? Can't each learn to be kind to one another? Maybe if you all stopped looking at each other as adversaries maybe you can learn something from one another? Maybe if AMR and CSFD shrunk their egos a bit you might find you work really well together.Maybe if CSFD could recognize just once the great skill of an AMR paramedic instead of making so sure to make everyone know you are in charge that would kind and polite. Similarly AMR paramedics just once if you recognize CSFD for a job well done. I think some of the most dreaded words to ever here whether you are on CSFD or AMR three words "GET THE COT" or "BRING YOUR WHEELS"

Wheter you would like to admit or not in general you all come from the same mold to do the job you do and to be good at what you do..you mirror one another. Maybe the city could save so much money and jobs specifiably AMR's jobs just hire mediator/ psychologist on how to get along and an etiquette coach for just plain old everyday manners!

I hope in months to follow there will be good news for all AMR's 200 employees and their families and for all of CSFD as well! I sure hope that CSFD Chief Rich Brown's very sincere excitement and true enthusiasm for our city..that he realizes the many years 30 plus worth of working with the AMR paramedic's and EMT's and hopefully has a vision for these citizens that make up our city too. Remember most of the 200 jobs at AMR they have families, families just starting out with a new baby, many with young children, many with teenage and college age children and they are so proud of their mom's and dad's. The impact would not just affect the paramedic or EMT..their kids..not matter how big or small (for levity).

I am greatly humbled by new insights and the temptation to have a mob mentality...what I learned is yes read all that I can but ask questions...folks at AMR don't be fearful for your job ..ask many questions and if you don't get an answer then find someone that will answer your question. Call Mayor Bach's office or Rich Browns..But remember as Dolley Madison and Betsy Ross would tell you be kind, please and thank you , upon asking questions.

Your Sincere Friend Of Our Community,


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Posted by SILENT DOGOOD on 01/25/2013 at 12:23 PM

How many know what Mayor Bach is doing regarding ambulance transport? How many know potentialy many local jobs will be lost? Shhh this has been very quiet..why?
Petition: for Mayor Bach to third ride for a shift with an AMR crew to see the other side.Mayor Bach you are only seeing the side of CSFD. You did ride along with CSFD. Please these men and women deserve a balanced decision..before you and CSFD alone decided their fate. Mayor Bach you went to AMR base and spoke to the crews ..you asked them to vote for you because you said government should not take over what small business is already doing. The crews put their faith in you and now look what you are doing. Will you third ride with them..will you go to their base now and ask them to continue to support you?


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Posted by SILENT DOGOOD on 01/26/2013 at 11:03 AM

Any intelligent fool can make things bigger and more complex... It takes a touch of genius - and a lot of courage to move in the opposite direction.
Albert Einstein

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Posted by SILENT DOGOOD on 01/26/2013 at 11:29 AM

Why is Mayor Bach and CSFD Rich Brown planning on taking jobs away from AMR? How can CSFD folks that work part-time at AMR look at the crews they run calls with knowing their boss may be taking away AMR's jobs..So many now on CSFD started out at AMR ...shame on you all for not taking a stand for these people with family's and that you have known for years! The disgrace and shame of it!!!

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Posted by SILENT DOGOOD on 01/29/2013 at 6:31 PM
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