The Las Vegas Fire Department since 1999 has been vying to provide more ambulance transports to hospitals, cutting into the business of private ambulance companies.
New Fire Chief Willie McDonald will make that happen starting today, to the dismay of executives at American Medical Response, known as AMR.
Las Vegas has a dual response system for medical emergencies. When someone calls 911 in the city, both the Fire Department and AMR are dispatched.
The Fire Department transports the patient about 30 percent of the time when a hospital trip is required. About 70 percent of the time, AMR transports the patient.
McDonald has a goal of flipping those numbers so that, by September 2015, his department handles 75 percent of the transports and AMR handles 25 percent.
He insisted he can reach the 50 percent level today without additional staff and resources.
“At some point, we may need to add some additional components to hit 75 percent,” he conceded.
McDonald and AMR General Manager Scott White both say patient safety is what drives their contrasting positions over speed, training and continuity.
But mostly it’s about money.
An ambulance ride can be billed at $1,000. Medicare pays about $230 a trip, and there are uninsured patients who can’t pay the bill and insurance companies that negotiate the cost.
In November 2012, a $155,000 independent report on the Fire Department made 23 recommendations. One was that the city should discontinue transports and save an estimated $14 million to $18 million in personnel and equipment. Or it should bump up its transports and see revenues increase between $12 million to $14 million. Either option would mean job losses for the Fire Department or the ambulance companies.
McDonald opted for increasing ambulance transports, following the path that other chiefs have advocated since 1999. He made it clear this was his plan soon after he started the job Aug. 12.
Numbers cruncher Jeremy Aguero, chief analyst for Applied Analysis, challenged the assumptions in the report by the International City/County Management Association’s Center for Public Safety Management, a nonprofit professional association of local government administrators.
Aguero, working for AMR, wrote in his analysis: “This seems to compare the potential top line revenue associated with taking on additional transports with the bottom line revenue associated with eliminating a service. How is this a valid comparison?”
The ICMA study was prompted by a 44 percent increase in the Fire Department’s budget from $77 million in 2004 to $111 million in 2013.
Areas in unincorporated Clark County and Henderson rely primarily on private ambulance services. Several years ago, North Las Vegas thought it could make money by increasing its Fire Department’s transports but didn’t have the resources to get the job done. So, transports are almost entirely back in the hands of private ambulances.
McDonald and White met for a couple of hours Friday.
“The chief told us that on Monday at 7:30 a.m, they are going to call us when they need us,” White said. “Could I have an ambulance in a parking lot and see an emergency and not get the call?”
McDonald countered it is the Fire Department’s role to provide fire and rescue services.
Other issues the two sides dispute include:
■ Will overly tired firefighters who work 24-hour shifts be less alert than private ambulance paramedics and emergency medical technicians who work 12-hour shifts?
The chief says no because supervisors look for signs of exhaustion and manage that problem. Told that White disagreed, McDonald noted White has never been a firefighter or supervised firefighters.
■ Will Fire Department workers be stuck waiting in emergency rooms until the patient becomes the hospital’s responsibility at the expense of responding to other calls?
With the “internal disaster” last week, when four hospital emergency rooms were closed because they had no room for patients, how much time will firefighters spend looking for an available ER?
McDonald said the plan is a moving target. If it doesn’t work or needs tweaking, he will make changes.
“I have an opportunity to evaluate the system and determine how it impacts the system,” he said.
But he is confident it would be an improvement.
Las Vegas City Councilman Bob Beers, a certified public accountant, said he will be watching the process carefully.
“I’m concerned in our zeal for efficiency we create inefficiencies,” Beers said.
Making many of White’s points, Beers said he has concerns about higher paid firefighters trained as paramedics waiting in emergency rooms instead of the lower-paid private ambulance paramedics and EMTs.
AMR officials estimated that, on a good day, the wait is 30 to 45 minutes before the patient is transferred to the hospital’s care; on a bad day, it is over an hour.
Beers also wonders whether the Fire Department’s bill collection service will be as successful as AMR’s collection service. “It’s one thing to bill; it’s another thing to collect.”
AMR’s collection rate averages 38 percent, White said.
Unknown, but of concern to taxpayers: Will this policy, when fully implemented, create more overtime for firefighters?
One proposal that McDonald has since withdrawn is that the city be divided into regions. Firefighters would respond to a swath of the western part of the city, including Sun City Summerlin, an area where people are more likely to have insurance. That would leave AMR with the majority of the less affluent neighborhoods. The fire chief said he has backed off that idea.
On Wednesday, McDonald will update the City Council on how many of the 23 recommendations in the ICMA report have been adopted or are in the process. He said the effort started before he came on board, and about 11 recommendations are implemented or partly implemented.
White will be there and expects a “sea of purple shirts” worn by union members who fear losing their jobs. AMR is represented by Service Employees International Union Local 1107.
“If there’s a reduction in work, that could impact more than 100 employees,” White warned.
Under the current franchise agreement with the city of Las Vegas, which ends in 2015, White said AMR pays the city $1 million a year for those dispatch calls. The city does not pay AMR.
The unanswered question is whether AMR can make a profit if its calls are cut and drop to 25 percent of the emergency ambulance calls.
AMR pays Las Vegas $396,512 per year under its franchise agreement.
The city has 22 ambulances; AMR has 70. “I wouldn’t be able to effectively manage without adding resources on a 24-hour basis,” White said.
McDonald, who meets every three weeks with the ambulance company executive, said, “The discussions haven’t been as collaborative as I’d hoped.”
Contact reporter Jane Ann Morrison at firstname.lastname@example.org or 702-383-0275.