CLEARWATER – Pinellas County Commissioners continue to grapple with the financial solvency of a failing EMS system. Ultimately, it will take complete cooperation by 18 cities and fire districts.
Commissioners expressed frustration with the slow progress toward a solution during discussions Sept. 6. Commissioner Ken Welch said it was time the issue was put to bed.
“The public wants to know why we don’t fix it,” he said. “But, we can’t until it’s all on the table and we get it all in the open.”
Consensus between the county, local fire officials and municipalities is crucial and lacking.
Without consensus and support for a solution, it won’t be possible to get the Pinellas County Legislative Delegation to take the cause to Tallahassee to get an amendment to the Special Act that created the EMS Authority, commissioners say. And everyone has to agree on a funding formula to pay service providers.
A brief history lesson helps to understand the situation.
According to information in an EMS study prepared by Integral Performance Solutions, dual response was first used in Pinellas in 1973. Cities funded fire department paramedic programs using city or fire district taxes. Private ambulance transport was paid for by user fees often paid by insurance, Medicare or Medicaid.
Because there were so many fire stations across the county, the fire department was usually able to arrive on an emergency scene first – hence the name first response, the IPS study said.
In time, many municipalities started fire department first responder service with their own millage rates, physical medical director, medical protocols and types of equipment.
“There was little coordination between these programs,” IPS said in its report.
Some areas of the county did not have advance life support first responder services – in particular unincorporated areas. Cities used one or more private ambulance companies.
“Despite the well intentioned efforts of all the communities involved, these separate initiatives did not leverage the collective resources that were in place to develop a comprehensive system for emergency care and medical transportation,” IPS said.
In 1980, the county’s state legislation delegation pushed a special act through the legislature that created a countywide system of advance life support first responder services. The act made county commissioners the EMS Authority and authorized them to levy ad valorem taxes capped at 1.5 mills to pay for the system. Voters approved the act by referendum.
In 1986, a consultant was hired to do a study to look for ways to control costs that had risen 54 percent over four years. Commissioners adopted the recommended public utility model EMS system design, which included the use of a single ambulance service provider. Other improvements included a single medical director’s office in charge of medical direction to paramedics and standardized treatment protocols, medications and equipment.
The Authority purchased the trade name Sunstar Paramedics and has since held the license for paramedic services in the county. User fees paid for medical transport and ad valorem taxes funded first responders – much the same way as it works today.
Fire departments and fire districts are paid according to the number of responses and their call volume history. Service providers with low call volumes are paid the cost of one paramedic position, equipment and pertinent costs of a first responder fire engine. Higher call areas get the costs of two paramedic positions and two set of equipment. Highest call areas get a separate rescue vehicle and two paramedics.
The county retains a portion of ambulance fees to pay for administration, medical direction and another portion goes into a reserve fund to pay for costs associated with a disaster.
Since 1982, fire departments have submitted annual budgets of EMS costs. Each used its own method of calculating costs
“This inadvertently created incentives for fire department to allocate as much as possible to their EMS budgets,” the IPS report says.
Consequently, cost for first responder went up quickly. Funding disparities resulted that have grown larger over time. The county tried to change the funding method in 1987 to control costs and create a fairer payment system.
Fire departments who received more than their fair share in the past would get no more pay increases until it was justified under the new funding formula. In 1989, the city of St. Petersburg sued Pinellas County over the new funding formula.
St. Petersburg won and the county was forced to reimburse St. Petersburg for the difference between its payment under the old and new funding plan. To avoid additional lawsuits, the county agreed to pay all using a similar plan and the cost of EMS soared.
According to IPS’s report, from fiscal year 1990-1991 to fiscal year 2009-2010, first responder expenses went from $16.2 million to $40.7 million – a 251 percent increase.
Then property values bottomed out. Tax collections declined sharply. Staff worked to cut costs. Commissioners dipped into the reserve funds to balance the budget. A millage rate increase is probable for fiscal year 2011-2012.
LaSala said Sept. 6, the city of St. Petersburg was opposed to the new plan to create a more equitable and affordable funding formula. He said voluntary cooperation and cost cutting by cities was necessary as was building new levels of trust.
He said the EMS authority had the responsibility of levying taxes, but it did not control the program. The program is controlled by the special act, which can only be changed by approval by the state.
Officials say, it’s a dilemma with no clear solution.
