Pinellas County staff said Sept. 6 that a plan to improve emergency medical transport developed by two local firefighters had too many flaws to work.
The authors of the Pinellas County Medical Services Providers Cost Containment and Sustainability Model sent a memo to county commissioners on Sept. 23 rebutting staff’s analysis of their plan.
The memo from Capt. Jim Millican with Lealman Fire Rescue, Lt. Scott Sanford, firefighter and paramedic with Palm Harbor Rescue, and Pinellas EMS providers opens with a timeline on what occurred prior to county staff’s analysis.
“In the first half of 2011, two firefighters with 35 years of first responder experience in the Pinellas County Emergency Medical Services system developed a model for emergency and non-emergency fire transport. A small group of fire chiefs and city managers were asked to provide feedback on the plan,” the memo states.
County Administrator Bob LaSala contacted Millican and Sanford in mid-July and asked for a presentation, which according to the memo occurred on July 14 before LaSala, Maureen Freaney, assistant county administrator, and Craig Hare, county EMS division manager.
“At that meeting it was agreed that the providers would supply plan details in writing, the county would analyze the written plan and all parties would retain an open mind throughout the vetting process,” the memo says.
Firefighters delivered the written plan that advocates fire-based EMS transport to the county as promised on July 29. On Aug. 23, a second meeting took place, and county staff told firefighters it had found some “calculation errors and erroneous cost mistakes that were corrected immediately,” the memo said. County staff also offered “constructive criticism and suggestions” to make the plan “more practical and politically viable.”
“Many of the county’s specific suggestions were incorporated into the fire transport plan in an effort to agree on the facts, even if we could not come to terms on our philosophical differences,” the memo says.
On Sept. 6, LaSala presented staff’s findings to commissioners and “offered his concerns regarding fire transport in a memorandum. This document seeks to deal with some of the county’s positions,” the firefighters’ memo says.
Cost
The county says EMS transport by fire departments would require a tax subsidy where ambulance service via Sunstar pays for itself and generates revenue for the system.
The firefighters, aka providers, say, “there is substantial profit to be realized from transport and the taxpayers of Pinellas County should be capturing and utilizing those monies rather than sending them to a private, for-profit company in Texas.
Pinellas County currently maintains EMS contracts with 18 fire service agencies, and one ambulance provider, Paramedic Plus, operating under the trade name “Sunstar.”
The county says there is at least $12.5 million in expenses not accounted for in the firefighter’s plan. The last two pages of the memo contain information that refutes each of those costs line by line. View a PDF of the firefighter’s memo.
LaSala and Freaney questioned on Sept. 6 the willingness of cities and fire districts to assume added risks, costs and increased labor force required to take over transport duties.
“This is a reasonable concern but needs to be examined in the context of the bigger conversation at hand,” firefighters say.
The memo talks about the county’s efforts that began in April to garner support for solutions suggested in a study done by Integral Performance Solutions. Firefighters say the county has had little success with its proposed plan to overhaul EMS transport and had even encountered “outright opposition.”
On the other hand, in less than 30 days, the firefighters have received endorsements from the Pinellas Fire Chiefs Association, several fire districts, which are not named, and at least one city, as well as citizens groups.
The firefighters’ memo talks about the county’s concern that fire transport would “fragment” the existing system.
“The provider’s plan asserts that this is a step toward consolidation, eliminating a provider from outside our system and incorporating transport services into our existing city and district departments,” the memo says. “Further, this consolidation will allow for improved service delivery, economy of scale and cost containment.”
Another objection from county staff involves centralized management, oversight and administration. The providers say their plan agrees that these elements must be continued.
“The providers plan relies on the same management, supervision and administration as our current system; folding first response, fire suppression, emergency medical services and transport under the umbrella of one set of upper level management,” the memo to commissioners says. “In unique areas of administration (such as billing) both oversight and funding have been provided in the provider’s plan.”
Furthermore, providers say that the county’s worry over licenses is a “non-issue.”
Operations and accountability
Lastly, the providers address county concerns about supervision, costs and workload. According to the providers, the county contends that accountability to do a good job is part of the contract with Paramedics Plus “because of punitive payments that occur when service levels aren’t met.”
“The providers plan relies on the exemplary record of all 18 providers and decades of public trust to assure residents that accountability will not need to be enforced monetarily under a fire transport system, the providers say.
Failing system
County commissioners approved a 46 percent increase in the EMS millage rate Sept. 15. LaSala says the millage increase was necessary to preserve reserve funds, which have been used for the past three years to balance the EMS budget.
However, LaSala says increased taxes alone won’t sustain the system in the future. He advocates a new formula, as presented by the IPS study, of paying providers for services. The change must be agreed upon by all providers, as it requires a change in the special act that created the county’s EMS authority. Officials hold out little hope of approval of a change by the state without a unified approach. In addition, there is a danger of lawsuits from fire departments and districts if the county attempts to proceed with any change in the funding formula without agreement.
Meetings continue
The county scheduled a work session on emergency medical services on Tuesday, Oct. 25, 9 to 11:30 a.m. in the fifth floor assembly room of the courthouse, 315 Court St., Clearwater.
A meeting between the county and the city of St. Petersburg on the matter is scheduled on Monday, Oct. 31, 8:30 a.m. to 5 p.m., St. Petersburg Collaborative Lab, 13805 58th St. N., Largo.
