A recent assessment of ambulance systems in Fort Wayne and across Indiana was blunt.
“The idea that an ambulance only gets paid when the wheels move is crazy – absolutely crazy,” Indiana Emergency Medical Services Association President Nate Metz told The Journal Gazette's Devan Filchak. “Indiana is still sitting on an antiquated business model that no one else will touch.”
The model here is particularly outmoded.
Three Rivers Ambulance Authority is a public-private agency created in the early 1980s. It is governed by city and county officials as well as the chair of the EMS Foundation medical control board and operates as a public utility model. TRAA buys emergency medical services from Texas-based contractor PatientCare EMS Solutions, which owns the ambulances and handles operations such as hiring and vehicle maintenance.
EMS runs are paid with user fees that come from patients, insurance companies or Medicaid and Medicare.
Public utility models are rare, and the local service is the only one in place in Indiana.
A key argument for the models is that they don't directly cost taxpayers. But the local reality is the current operation is hamstrung by an inability to find or spend extra cash when EMTs are leaving for more lucrative jobs and response times are lagging.
PatientCare's contract requires medics to arrive to 90% of calls within 81/2 minutes, and that hasn't happened since last year. The company, which also runs ambulance operations in Florida, Mississippi, New York, South Dakota and Texas, has since been fined more than $575,000 for noncompliance in Fort Wayne.
Before TRAA, there was Fort Wayne EMS – an arm of city government with a budget, like other municipal departments, to fund its operations. That went away when the public utility model – a “competitive monopoly,” according to TRAA Executive Director Gary Booher – was adopted nearly 40 years ago.
Booher has acknowledged problems and has worked to help find solutions, including a system in which highly trained medics respond to life-threatening emergencies; less-advanced crews respond to less-serious problems.
There have been no recent reports of slower response times leading to catastrophes, but it would be wise to examine operational changes before that happens.
Fixes can be tailored to local needs, but options include “ex-public utility models” in which the ambulance authority remains but acts as its own contractor – giving it more flexibility over staffing. Some cities purchase ambulances, and that would lessen costs paid to a contractor.
Booher told Fort Wayne City Council members in July that TRAA might ask the city for financial or other help.
At least six EMS companies exist in Indianapolis. South Bend's system is fire-department-based, something pitched here in 2016.
Fort Wayne Fire Chief Eric Lahey said at the time that would ensure $900,000 in funding for emergency services would remain local, rather than sent to an out-of-state contractor.
Metz, the Indiana Emergency Medical Services Association president, said he envisions ambulance agencies seeking partnerships with nonprofits and grant funding to bolster bottom lines.
Whatever the solution, local officials should recognize nothing, especially emergency medical care, can remain static. The only constant is change, and it should be embraced – before an emergency.