MedStar, area cities are in dispute over subsidies, response times

[Guest guest]

http://www.star-telegram.com/news/story/1432146.html

MedStar, area cities are in dispute over subsidies, response times

By ANTHONY SPANGLER

aspangler@...

Fort Worth and 14 other cities that contract with ambulance provider MedStar are

reluctant to boost payments until MedStar can improve its response times,

especially to calls involving potentially life-threatening injuries.

MedStar says it needs the increased subsidies to afford increased staffing,

which will ultimately improve response times.

But city officials say they are frustrated by MedStar's history of failing to

meet the industry standard of responding to Priority 1 calls within nine minutes

90 percent of the time. Tensions have gotten so high that Haltom City and

Saginaw are considering dropping MedStar and using paramedic-trained

firefighters instead.

And instead of giving MedStar more money, the cities say they want MedStar to

dip into its $6.7 million cash reserves to pay for additional emergency medical

technicians and paramedics. City officials say they will consider paying more

only when MedStar meets expectations and obligations.

" We just want MedStar to prove to us that they can do what they say they can

do, " said Cain, Burleson assistant city manager.

To improve service, MedStar has already raised salaries to keep highly trained

personnel. MedStar is also deploying ambulances through a demand-based system

instead of stationing crews at specific locations, resulting in improved

response times, said Matt Zavadsky, MedStar's associate director of operations.

" We think we can get there soon because recruitment, retention and the way we

deploy our crews have all improved, " Zavadsky said. " We have a couple of

challenging geographic areas, like Saginaw, where we might not ever meet our

goals.  . . . But systemwide, we are doing much better. "

Continuing challenges

The Area Metropolitan Ambulance Authority, a quasigovernmental body that

operates MedStar, has struggled for years.

Established in 1986 as a public agency with a board that oversees a private

contractor, the authority has six members on its board — a medical director,

three members appointed by Fort Worth and two appointed by the remaining 14

member cities.

In 2005, the authority took over running the ambulances after it fired its

third-party contractor, Rural Metro, because it was not meeting response times.

But even under the board's control, MedStar has met the goal for Priority 1

calls during only two months in more than four years, according to MedStar data.

Ambulance dispatchers categorize calls as Priority 1 in cases such as a reported

heart attack or difficulty breathing or a wreck with major trauma, Zavadsky

said.

In 2007, MedStar was so understaffed that Fort Worth brought in firefighters to

help respond to calls.

And a 2008 consultant's report states that MedStar's method of measuring calls

over those years did " not accurately reflect actual performance. " MedStar

ignored calls when the system was overloaded or when crews could not reach calls

within target times.

" There is a reason that the standard was set by the Commission on Accreditation

for Ambulance Services, " said Jay Fitch, chief executive of Fitch & Associates,

a consulting firm hired by the MedStar board to examine operations and find out

why MedStar cannot meet its goals. " It's because it's been determined that

Priority 1 calls need advance life support transport within nine minutes. "

Last year, MedStar's board took steps to start turning things around.

It started an academy to train EMTs and paramedics. The program pays new hires

to train as EMTs and provides opportunities for existing EMTs to move up to

paramedic in exchange for a three-year commitment. MedStar also increased

starting salaries for EMTs from $25,619 to $30,129, and for paramedics from

$32,532 to $37,279.

Before the academy opened, MedStar's annual turnover rate was nearly 30 percent,

with most employees leaving because of low pay and morale. In 2008, turnover

declined to 25 percent, and it is about 9.8 percent this year. A 2007 national

survey reported a 15.2 percent turnover, according to the Journal of Emergency

Medical Services.

MedStar also expects to increase the number of ambulance crews from the 23 it

had about a year ago to as high as 36 by this summer, said Fort Worth Councilman

Danny Scarth, who sits on MedStar's board.

" We want to staff to achieve 95 percent response, even if crews call in sick, "

he said.

But MedStar increased staffing largely because of an extra $2 million from Fort

Worth last year. City officials said last week that they will cut funding next

year to the normal subsidy, about $1.04 million.

" We're not comfortable putting back in that $2 million this year, " said Tom

Higgins, assistant city manager. " We want to see them use their surplus reserves

to fund adequate staffing to hit their numbers. "

Starting to improve

The goals MedStar must hit, according to agreements with the 15 member cities,

depend on the severity of the emergency, with an emphasis on overall response

times and those for the Priority 1 calls.

Since 2005, MedStar has failed to meet those targets, and the number of late

calls has continued to climb.

But MedStar says that although it is not meeting the Priority 1 standard, the

average response time for Priority 1 calls has dropped from six minutes and 45

seconds in 2007, at the peak of its staffing problems, to five minutes and 54

seconds in 2009.

Times improved despite the tougher standards MedStar adopted in October to

measure its performance. MedStar excluded from calculations calls that came in

after the system became " overloaded " but now includes all calls.

The Fitch study suggested that before the change, MedStar did not accurately

measure its performance. MedStar officials say they overreported performance by

4 to 5 percent.

" We are almost to the 90 percent compliance right now, even including those

calls that would have been ignored under the old system, " Zavadsky said. " It

does mean we were doing much worse under the old measurement. "

New solutions

In the coming weeks, city leaders for municipalities that contract with MedStar

will ask their city councils to approve resolutions urging MedStar to use its

cash reserves rather than seek increased subsidies.

Burleson, Forest Hill, Fort Worth, Haslet, Lake Worth, Lakeside, Sansom Park and

Westover Hills pay subsidies. Blue Mound, Edgecliff Village, Haltom City, River

Oaks, Saginaw, Westworth Village and White Settlement do not pay subsidies.

Without increased subsidies, MedStar Executive Director Jack Eades said, patient

bills could rise as much as $350 per transport. Eades has proposed a flat rate

subsidy of $5.17 per capita, which would raise about $3.7 million. Under the

proposal, Burleson's contribution of $44,000 would increase to $170,000 next

year, for example.

The member cities countered with a recommendation of $1.04 per capita from all

cities. In Fort Worth, for instance, MedStar patients would pay, on average,

$1,117 for an ambulance ride compared with $1,480 for residents from a city that

does not pay a subsidy.

Last month, MedStar's board rejected the cities' recommendations while it waits

for Fort Worth to hire a consultant to study the best model for funding MedStar.

" The member cities agreed that we would all buy into the low rate, go to our

councils and recommend a $1.04 subsidy and ask MedStar to use cash reserves to

keep up its staffing level, " Cain said. " By the third year, if they can perform

where we expect them to, then we can consider going to a higher subsidy level. "

We think we can get there soon because recruitment, retention and the way we

deploy our crews have all improved.  . . . Systemwide, we are

doing much better. "

Matt Zavadsky,

MedStar's associate director of operations

ANTHONY SPANGLER,