By David Garrick
The San Diego Union-Tribune
SAN DIEGO — Significant changes to how ambulances operate in San Diego have ended a response-time crisis that had sparked calls for the city to find a new ambulance company.
Response times have improved, staffing levels are up and new dispatch procedures have boosted efficiency since the city agreed in October 2017 to significantly change its contract with the company, American Medical Response.
The changes included a 24 percent increase in the cost patients pay for ambulance rides, softening of some response-time requirements and elimination of hefty fines the company had been paying for failure to meet certain goals.
The company also agreed to provide more personnel so the city could implement a new approach to 911 calls. The new approach prioritizes acute emergencies more heavily and aims to weed out non-emergency calls that waste scarce resources.
“We see more efficient use of our resources with no adverse patient outcomes,” Colin Stowell, chief of the San Diego’s Fire-Rescue Department, told the City Council’s public safety committee last week.
Stowell said city officials still plan to potentially replace American Medical Response by issuing a request for proposals this winter to operate the city’s emergency medical services.
But the city, which had been scheduled to issue that request for proposals this past June, delayed the process several months because last fall’s policy changes have been so successful.
“The urgency was there because of what was felt as a failure of our EMS system at the time,” Stowell told the committee on Oct. 24. “Response times were below standard and below compliance measures.”
But the changes, which were based on a comprehensive study of 340,000 incidents over three years, have made a big difference, he said.
“The urgency in the streets is no longer there,” Stowell said.
Shifting away from fines and requiring higher staffing levels appears to have been a winning combination, said Chris Olsen, fiscal and policy analyst for the city’s Independent Budget Analyst.
“The switch from the penalty-based system to this guaranteed-unit-hour system is really significant,” Olsen told the public safety committee. “The department has much more transparency into the number of paramedics actually working and serving the residents.”
In addition to helping reduce response times, that information will help the city strategically craft the request for proposals it issues this winter, Olsen said.
“They are doing a lot of creative things to use that data that they have access to,” he said.
Stowell agreed with Olsen that the fines had a negative impact under the old model.
“Sometimes it was easier and less expensive to pay fines versus them actually deploying the model we wanted to see,” he said.
Under the new model, response times are above the 90 percent compliance level for all three categories of incident: acute emergencies, urgent situations and non-emergencies.
Based on national standards, the city requires ambulances to arrive at acute emergencies within 12 minutes, urgent situations within 15 minutes and non-emergencies within 25 minutes.
From July 1 through Sept, 30, which is the first quarter of the city’s new budget year, ambulances met the goal for acute emergencies 93 percent of time, for urgent situations 95 percent of the time and for non-emergencies 97 percent of the time.
In addition to meeting the 90 percent goal citywide, American Medical Response must meet that goal in four specific zones: a border zone, a metro zone and two zones north of Interstate 8 – one inland and one coastal.
Before the policy changes last fall, the city had been divided into eight zones where the company was required to meet the 90 percent goal.
The goal of having eight zones was greater equity among communities. The bigger a zone, the more potential for the company to provide subpar service to some communities and still meet the response-time goals by posting stellar times elsewhere in a particular zone.
City officials didn’t provide data on how much the 24 percent rate hike had boosted revenue for American Medical Response, which bills patients directly and pays the city a $10.7 million annual flat fee.
The spike put San Diego’s ambulance fees near the top of communities in the southern half of the county, which the city defines as the area below state Route 56.
The spike hasn’t affected patients who have Medicare or Medi-Cal, which have maximums they will pay for an ambulance ride that were already below what the city charged before the spike.
It also hasn’t affected people who have private insurance where ambulance fees are already higher than their annual deductible.
Copyright 2018 The San Diego Union-Tribune