Oversight, costs vary elsewhere
By Michael O’Connor
Omaha World-Herald (Nebraska)
Copyright 2006 The Omaha World-Herald Company
A 911 call in Arlington, Texas, will send paramedics to your door, but the ambulance crew rushing in will work for a private company, not the city.
Arlington is among the six cities cited by City Council President Dan Welch as being similar in size to Omaha but that spend less on fire service.
Omaha’s city-run ambulance service is one of the issues that will be examined in an efficiency study of the Fire and Police Departments.
On Tuesday, the council overrode the mayor’s veto of spending $376,000 for the study.
Welch has emphasized that he hasn’t reached any conclusions about Omaha’s ambulance service and that the study would cover a variety of issues.
But he said if private ambulance service is as good as a city-run service and costs less, Omaha needs to consider making a change.
The cities identified by Welch are Colorado Springs, Colo.; Wichita, Kan.; Tulsa, Okla.; Arlington, Texas; Mesa, Ariz.; and Virginia Beach, Va.
The World-Herald contacted those cities to learn about their ambulance services.
Three of the cities — Arlington, Mesa and Colorado Springs — have entirely private ambulance service.
Tulsa has a partially private service. A public board independent from the city oversees the service, owns the ambulances and contracts with a private company for ambulance crews.
Wichita receives ambulance coverage through a countywide service operated by county government.
The most unusual arrangement is in Virginia Beach, which has a primarily volunteer ambulance service.
Privatizing ambulance service is often tempting for cities looking for ways to save money, said Robert Krause, a public safety consultant based in Ohio. He said private ambulance companies can save cities money and provide service that is comparable to the quality of city-run service.
But Krause said the cost savings are not always as significant as cities hope. The savings might be large in the initial years of the contract. But as operating costs rise, city subsidies increase, he said.
Cities that don’t provide strict oversight can face troubles with longer response times and other problems, he said.
Don Crowson, assistant fire chief for Arlington, agreed that having a contract with teeth is essential.
Arlington is different from Omaha in a number of ways. With a population of 363,000, Arlington is smaller than Omaha, which has a population of 414,521.
Arlington also is in a suburban area and has an average household income of $49,000 in 2005, according to the U.S. Census Bureau, compared with Omaha’s $40,500.
Arlington has had five homicides this year, compared with Omaha’s 26.
Crowson said Arlington’s contract holds the ambulance company accountable for response times, training of ambulance crews and other areas of service. The company must pay fines to the city if requirements for response times are not met, he said.
Lincoln experimented with privatized ambulance service, but in 2000 the City Council voted to turn the rescue service over to the Lincoln Fire and Rescue Department. Citizen complaints about response times under the private service were a factor in the decision, which was upheld by voters in a ballot issue.
Lincoln Fire and Rescue has met response time goals set by the city, said Mark Bowen, chief of staff to Lincoln’s mayor.
But the city is concerned about an operating deficit that has accumulated since the city took over the service in January 2001, said Don Herz, finance director for the City of Lincoln. The most recent figures show a cumulative deficit of $642,000, he said.
The figure represents the gap between fees paid by people who are transported by ambulance and the cost of operating the service, Herz said.
The funding gap developed because of a decline in Medicare reimbursements to the city, he said.
In Omaha, roughly half the estimated $8 million annual cost of operating the ambulance service is covered by fees paid by patients, said Fire Chief Robert Dahlquist. The other half is covered by city funds, he said.
Fees are $295, $395 or $445 depending on the level of medical treatment required, he said.
The city does not use a collection service.
Dahlquist said cities that switch to a private service are motivated by saving money, but they often end up subsidizing the service. Those cities can get stuck paying higher subsidies as operating costs rise, he said.
Another drawback, he said, is that cities with private ambulances lack adequate control over the quality of the service.
Tulsa, with its partially private ambulance system, recently began subsidizing the service’s cost.
The Emergency Medical Services Authority has run the Tulsa service since 1978. For more than a decade, Tulsa has used part of its local sales tax revenue to help pay for ambulance equipment.
But until this July, Tulsa did not subsidize the costs of running the service, said Tina Wells, spokeswoman for the authority.
The subsidy was needed because of a decline in Medicare reimbursements the authority had used to help cover operating costs, Wells said.
HOW SERVICES COMPARE
Omaha
Population: 414,521
Provider: The city’s ambulance service is run by the Omaha Fire Department.
Funding: Roughly half the estimated $8 million annual cost of operating the ambulance service is covered by patient fees. The other half is covered by city funds.
How long: The city’s first rescue squad went into service June 4, 1936.
Arlington, Texas
Population: 363,000
Provider: Arlington contracts with a private company for ambulance service.
Funding: Arlington does not subsidize the service, which is paid with patient fees.
How long: The city has had private service for at least 30 years.
Tulsa, Okla.
Population: 382,000
Provider: Emergency Medical Services Authority, a public entity, owns the ambulances and other equipment. The authority contracts with a private ambulance company, which provides the crews. The authority is independent from the City of Tulsa and provides ambulance service for Tulsa and its suburbs.
Funding: About 80 percent of the operating costs are covered by patient fees. The rest is covered by subsidies from Tulsa and suburbs receiving the service. Tulsa and the suburbs first began subsidizing the system in July because of a decline in Medicare reimbursements.
How long: Tulsa has had ambulance service through the authority board for nearly 30 years.
Wichita, Kan.
Population: 355,000
Provider: County government provides service to Wichita and other cities in Sedgwick County.
Funding: Patient fees cover 70 percent of the operating costs. Tax dollars from Wichita and other cities in the county cover the rest of the cost.
How long: The county has provided ambulance service for more than 30 years.
Virginia Beach, Va.
Population: 438,000
Provider: The city provides oversight for a primarily volunteer ambulance service. Trained volunteers staff the city’s 10 independent rescue squads.
Funding: There are no patient fees. Some operating costs are covered by fundraising by the volunteer squads, which buy ambulances and other equipment. The city pays for fuel, insurance and training for volunteers.
How long: The city has had a volunteer ambulance service for more than 60 years.
Mesa, Ariz.
Population: 443,000
Provider: Mesa contracts with a private company for ambulance service.
Funding: Costs are covered by patient fees. There is no city subsidy.
How long: The city has had private service for more than 25 years.
Colorado Springs, Colo.
Population: 370,000
Provider: County government contracts with a private company, which provides service to Colorado Springs and other communities in El Paso County.
Funding: Patient fees cover the cost. There is no city subsidy.
How long: The city has had private service for about 10 years.