The Las Vegas Fire Department is transporting more patients from Summerlin and wealthier neighborhoods on the west side and leaving more inner-city hospital transports to American Medical Response, according to a report by local research firm Applied Analysis.
“I’d suggest the data shows they are cherry-picking those calls,”said Scott White, general manager of the private ambulance company which paid for the study.
Applied Analysis said the fire department is showing a preference for “areas with higher incomes, less diversity, higher rates of insurance and ultimately, higher expected emergency medical services collection rates.”
The report also concluded that because of delays in contacting AMR by the Fire Department, some residents in wealthier areas are waiting longer to be transported. The average wait time before the department contacted AMR was nine minutes in March.
White believes the department is waiting longer to contact AMR in those areas because people there have better insurance and are more likely to pay.
The new hospital transport policy implemented by Fire Chief Willie McDonald on March 3 went from an automatic dual response of both the Fire Department and AMR units to a “we’ll call you when we need you” approach toward AMR.
Under dual response, the Fire Department responded to all emergency medical calls but only transported someone to the hospital about 30 percent of the time. AMR handled about 70 percent. McDonald has said he wants to increase his department’s share of hospital transports to 75 percent, but his immediate goal is 50 percent. So far, the department is transporting about 43 percent.
The study found in lower income areas, the Fire Department is reducing the number of hospital transport calls. Both the city and private ambulance companies charge to transport patients to hospitals.
The analysis looked at the entire city and and demographics in two ZIP codes. In 89134, which includes the Sun City Summerlin retirement community and is 81 percent white, where the average income is $77,387, the fire department took 63 percent of 182 transports, leaving AMR 37 percent.
In 89110, which is 63 percent Hispanic, the Fire Department took 17 percent of 255 hospital transport, leaving AMR 83 percent.
In 89134, the payment collection rate was 45 percent. In 89110, it was 21 percent.
Las Vegas Councilman Bob Coffin, who represents some of the inner city neighborhoods covered by the report, he said he hadn’t looked at it and wouldn’t comment until he sees a city analysis.
Contacted Monday afternoon, McDonald said he hadn’t seen the Applied Analysis report, which AMR gave to the city council on Thursday. He said he and White had a regular monthly meeting Friday but White didn’t mention the report or provide a copy.
“I have no reason to talk about anybody else,” McDonald said when asked to comment on AMR’s report.
He did provide a PowerPoint breakdown of payments by source — Medicare, Medicaid, private insurance or self-pay — that did not include data on household income, geography or demographics. The report from the department’s billing service showed that there is a jump in hospital transports, with the department averaged 71 transports per day in March, up from 47 a day in February.
Some 34 percent of Medicare patients account for 45 percent of the collections, the largest share. While average charges are in the $900 a transport range, the average payment is $310, although private insurance pays up to $610, the department’s billing report from Intermedix calculated.
AMR has discussed the chief’s new policy with every council member except Mayor Carolyn Goodman.
At one point, there was a discussion of dividing the city up into zones, and a tentative map had the city answering calls in Summerlin. But McDonald decided against that.
“The Summerlin plan they scrapped is what they’re now doing,” White said. “I believe they have implemented the plan they wanted to do all along. This plan does not put patient safety as the No. 1 priority.”
McDonald has said his decision was driven by patient safety since the department is a fire and rescue operation. The city has 22 ambulances and AMR has 69, with no more than 55 in service at any one time.
AMR pays the city $400,000 a year for an exclusive franchise agreement which expires in November 2015.
White said he feels his company has been “punished” for taking concerns to the city council.
On Jan. 21, McDonald sent White a text saying he was going to “recommend against any discussion regarding an exclusive relationship given recent actions by you, AMR Corporate leadership and your company representatives.”
The report, based on AMR’s data on 169 calls in March, said the average delay before AMR is called is 9 minutes after the initial 911 call.
During the period studied there were two cardiac arrest calls with an average of 17 minutes between the initial call and dispatch of AMR and 8 calls of an unconscious person with an average of 22 minutes before AMR was contacted.
In February only 18 calls were delayed, for an average of nearly 12 minutes.
“I would like to see the city council intervene,” White said. “I believe they will do something about it.”
In a May 8 full-page ad in the Review-Journal’s print edition AMR told city firefighters the chief’s decision was not in the city’s best interests but didn’t reflect on the work of the firefighters.
City fire chiefs since 1999 have advocated that their department handle hospital transports. Clark County has a system where private ambulances handle most transports. North Las Vegas switched from private to public, then switched back again.
The Las Vegas policy change was sparked by a 2012 report that said the city should either increase its revenues by handling more hospital transports or get out of the transport business to save tax dollars. The report was from International City/County Management Association’s Center for Public Safety Management, a nonprofit professional association of local government administrators. It didn’t recommend one plan over another, but McDonald decided to increase transports when he became chief last August.
Meanwhile, in the city of Los Angeles, another report has recommended that the city fire department ease out of the hospital transport business and launch a pilot program to see how that would work.
Contact Jane Ann Morrison at firstname.lastname@example.org or 702-383-0275.