Texas city leaders push to add second ambulance provider
South Texas Emergency Care officials warned that allowing competition will cut into their non-emergency transports, which offset costs
Fernando Del Valle
Valley Morning Star, Harlingen, Texas
HARLINGEN, Texas — A move to allow outside ambulance companies to offer service here could cut into South Texas Emergency Care Foundation's services while leading the city to help fund emergency transports, a STEC official said Friday.
Last week, city commissioners met with STEC officials, who warned opening the doors to competition would cut into their non-emergency transport service that helps offset the high costs of offering emergency care.
During the meeting, Randy Whittington, the attorney representing STEC, told Commissioner Richard Uribe the company would share the cost of funding a "needs assessment" study aimed at offering better ambulance service in town.
"My thing is not to be short-handed," Uribe said during Tuesday's two-hour workshop. "What affects us is the times we're short-handed or not being able to service a call. What I don't want is the continual thing, 'We don't have someone available.'"
Now, STEC officials are considering boosting their non-emergency transport service, Leonard Callier, the nonprofit's deputy executive director, told commissioners.
"We're looking at adding more unit hours to be able to accommodate these non-emergency patients," he said. "It's our goal to get that patient to their destination in a safe, timely manner."
For months, Commissioner Frank Puente's pushed to allow other ambulance companies to offer lucrative non-emergency transport service in the city whose ordinance allows police to restrict competition from entering STEC's exclusive service area.
"I just want to know what is the problem with allowing other ambulatory services service Harlingen and not just STEC," Puente told STEC officials. "Respectfully, I'm not concerned about STEC's revenue. My obligation is to my constituency and that service to them. What is wrong with healthy competition?"
In response, Dr. Catherine Young warned the move could force the city to help fund emergency transport service.
"Your 911 service loses money — it always loses money. What your transport service does is it pays for that 911 service," she said. "When you start letting other people in, then you lose the revenue that's coming in, which means you're going to raise my taxes to cover that 911 service because you're going to have to supplement. Every place I've ever been, the citizens have had to supplement 911 service."
A move to open the doors to outside ambulance companies offering non-emergency transport could strip STEC of as much as half its revenue, Gavino Sotelo, a member of STEC's board of directors and a former long-time Harlingen city manager, told Puente.
"You take away that service from us, we're going to lose ... maybe half the revenue," he said. "That means we're going to have an affect on our operations as far as personnel and equipment."
Now, STEC's annual $4.5 million payroll funds the positions of 90 employees, including 64 paramedics and emergency medical technicians whose salaries range from $48,000 to $66,000, Callier said.
In 2011, STEC stopped charging the city an annual fee to offer ambulance service, billing its patients instead, Callier said.
Today, the nonprofit which offers ambulance service across most of Cameron County, stations eight to 11 ambulances in the Harlingen area, he said.
Meanwhile, agreements with other regional emergency services companies offer the city back-up service, Rene Perez, STEC's transport director, told commissioners.
"At any point in time, whenever we feel we need mutual aid, whether it's emergency or non-emergency, we can activate our mutual aid partners," he said.
During the workshop, commissioners said they wanted to cut residents' ambulance wait times.
"I've heard from other constituents here in the city of Harlingen — they're waiting hours and hours," Commissioner Rene Perez said, referring to some residents' complaints. "I understand emergencies always come first. I think that boils down to the quality of care the patients here in Harlingen are getting. I think you need help when it comes to transport services because it seems like there's a lot of dissatisfaction."
The coronavirus pandemic's led to longer ambulance wait times, STEC officials said.
"It's not because we don't have enough trucks," Perez, STEC's transport director, said, referring to his ambulances. "The call volume is definitely very manageable. It's because they're holding us up at the hospital. We have a greater number of patients out there. We have a big nursing shortage right now. We're sitting there waiting for a bed to open up."
Competition could help bring down rates, commissioners said.
About a month ago, a McAllen ambulance company offered to transport a nursing home resident to a Houston hospital for $2,700 while STEC was charging $4,500, Commissioner Perez said.
About four years ago, STEC boosted its rates to range from $795 for basic life support to $1,220 in the area where many residents are Medicare and Medicaid patients, Callier said, describing the company's rates as based on "one of the lowest fee schedules in the Valley."
"We try very hard to be competitive in the marketplace. As you know, in health care it is very trying to remain competitive and keep employees," he said. "Medicaid does not pay for the cost of the service. Fifty percent of our patients are Medicare or Medicaid patients. We don't ever bill anything below what Medicaid reimburses us. We know, in fact, we're going to get a third of the bill most of the time."
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