Mo. ambulance firm asks for more time to respond

By Andrea Damewood
The Columbian

CLARK COUNTY, Mo. — Faced with declining Medicare payments and a bad economy, American Medical Response, the private company that provides ambulance service to much of Clark County, is asking for more time to arrive at medical emergencies.

The company is asking for a “stop the clock” agreement to give it two more minutes to get to a call, if another first responder (the Vancouver Fire Department or Clark County Fire & Rescue, for example) arrives on scene first.

But while the move would let a struggling AMR cut costs, several members of the Vancouver City Council said Monday night that they have serious concerns about the risk to patients.

In urban areas, AMR must be on scene within 7 minutes and 59 seconds 90 percent of the time, or faces fines under its contract. The “stop the clock” agreement would give it 9 minutes and 59 seconds to arrive.

Vancouver Fire Chief Joe Molina said that in many cases, his department, which strives for a five-minute arrival window, arrives on scene first. In those cases, his crews start care before passing the patient off to AMR for transportation to a hospital, so giving AMR two more minutes isn’t likely to affect care.

But Councilor Jeanne Harris said she sees it as letting the company off the hook for a contract it is failing to live up to, and worried that the change could mean patients who need immediate hospital care could be left waiting. She said that rather than cut services, AMR should be paid what it takes to make the level of service work.

“If we have to pay more, we pay more so that AMR can be staffed,” Harris said. “We don’t just turn and say, ‘OK, you can’t be there on time, so you don’t have to be there on time.’”

Molina acknowledged that there is a risk that a heart attack patient or car accident victim could be left on scene longer.

But Clark Regional Emergency Services Agency EMS Manager Doug Smith-Lee told the city council that the county’s medical program director has already signed off on the changes, and feels that the risk is manageable.

“It’s a very safe step in the direction to make better use of the resources we have,” Smith-Lee said.

For a decade, ambulance services for both private and government companies has been a losing proposition. AMR’s collection rate on its services was just 43 percent in 2010, down from about 60 percent 10 years before, Molina said.

Medicare now pays far less than it did, and the bad economy means more people are uninsured or unable to pay their bill. For that reason, it’s not practical for the city to provide the services itself — Vancouver would just be strapped with the low payouts, he said.

“Our system is unsustainable,” he told the city council.

Mayor Tim Leavitt said he understands the need for the change.

“What you’re telling us basically is we’re changing our expectations of responsiveness,” he said. “Not in a way that negatively affects victims. … It’s just, we’re holding AMR to unrealistic expectations.”

Councilor Bart Hansen also asked about whether each of the city’s 12 engines and trucks have a paramedic on staff at all times. Molina said that having a paramedic on each unit is a “top priority,” but

that occasionally, not enough paramedics are available to staff each emergency vehicle. Hansen said that risk might be a deal-breaker for him.

A major reworking of how ambulance services for most of Clark County are handled is under way, with a complete revamp set to launch in 2014, the fire chief said. The two-minute time extension provides a window for the members of EMS District 2 — which comprises most of the county, excluding Camas and Washougal, and communities served by North Country EMS — to find a new solution.

The move, if approved by all the agencies within the district, would save AMR up to $250,000 a year, half of which would be refunded back to the local governments.

Molina said he had hoped to bring the agreement to the city council for approval on Jan. 23, but that will be postponed so that another workshop can be held. The proposal will go before the Clark County Board of Commissioners for approval Tuesday.

Republished with permission from The Columbian