By William Crum
The Oklahoman
OKLAHOMA CITY, Okla. — Federal allegations of an alleged kickback scheme engineered by the Emergency Medical Services Authority have prompted questions about whether Oklahoma City has alternatives for providing ambulance service.
The Emergency Medical Services Authority, or EMSA, trust oversees ambulance services in the Oklahoma City and Tulsa areas.
Federal attorneys allege EMSA received more than $20 million in illegal kickbacks from a Texas-based contractor that provided drivers, paramedics and emergency medical technicians.
As a beneficiary of the trust, Oklahoma City pays a subsidy to support EMSA operations.
Oklahoma City residents have the option of paying a monthly membership fee in a program called EMSAcare. Member households incur no out-of-pocket expenses for emergency medical transport services.
The council adopted the membership fee model almost 10 years ago to finance the city’s EMSA subsidy.
City council members generally see EMSA as the most cost-efficient alternative for ambulance services. Other models involve direct city oversight and/or having the Fire Department operate ambulances.
The Fire Department already sends trucks on thousands of emergency medical calls every year.
After dropping in response to reforms several years ago, that number once again is on the rise, according to a report to the city council on Feb. 14.
In 2016, City Manager Jim Couch described alternatives for providing ambulance service, in a memo circulated to the council.
In his introduction, Couch said the EMSA system is a “public utility model.”
His memo went on to say other models around the country break down into five categories: fire department-operated, private/for profit, government-based, hospital-based, and police-based. Variations exist within each model, he wrote.
Couch said the city council last reviewed options for ambulance service in 2011, when the Fire Department presented two alternatives, both giving direct control and oversight of ambulance operations to the city.
They were:
The Fire Department Model. Under this model, emergency and non-emergency ambulance transport would be overseen by the Fire Department. Oversight and administration is the fire chief’s responsibility. Ambulance transport personnel would be civilian employees of the city, and the city’s work force likely would grow.
The Private For-Profit Model. Under this model, the city would contract for emergency and non-emergency ambulance transport. The contractor would be responsible for labor, materials, supplies and management services necessary to meet response-time and performance standards. Contract oversight would by the fire chief’s responsibility.
For 2016, Couch summarized three additional models:
The Third Service Model: Under this model, a a stand-alone EMS department would be dedicated to emergency ambulance services, managed and staffed with civilian city employees. City leaders would directly oversee and control day-to-day operations. The EMS department chief would report to the assistant city manager who oversees police and fire.
The Fire-Private A Model. Under this model, a hybrid of the 2011 Fire Department model, the Fire Department would provide emergency ambulance response and transport. Emergency backup and non-emergency ambulance service would be contracted to a private provider. The Fire Chief would have overall responsibility for the system.
The Fire-Private B Model. Under this model, a hybrid of the Private For-Profit Model, a contractor would provide “basic life support” and retain exclusive ambulance transport rights in Oklahoma City. Fire Department paramedics would provide “advanced life support” and manage emergency scenes. Most fire companies already have advanced life support capabilities.
Couch said the Fire Department and city-managed models offered several advantages.
First, he wrote, ambulances could be positioned at outlying fire stations to help address the longer ambulance response times experienced in those areas.
Those “ready ambulances” also could be available in cases of extreme and unpredicted surges in call volume.
Staffed by on-duty firefighter paramedics, they could be placed in service in anticipation of pending disasters, such as tornadoes.
On- and/or off-duty firefighter paramedics in combination with private EMS staff also could react quickly to get additional ambulances in service, he said.
Couch noted that “ambulance availability can be insufficient to meet overload demands due to limited staffing.”
He was referring there to “level zero,” when EMSA reports to the Oklahoma City Fire Department that it has no ambulances available to respond to emergencies in the metro area.
According to Fire Department records, EMSA went to level zero more than 160 times in 2015. Performance improved in 2016.
When ambulance service goes to level zero, Oklahoma City sends fire rigs to all medical calls.
That defeats efforts to reduce costs and keep fire department paramedics free to respond to the highest-priority calls.
Copyright 2017 The Oklahoman