The Waxahachie city council reviewed four bids at a workshop meeting on Monday submitted to provide ambulance service within the city.
The companies that submitted bids included Acadian, Allegiance, American Medical Response (AMR) and CareFlite, who is the city’s current provider. The city council will selected three finalists for interviews by May 27. City Manager Paul Stevens said the decision whether to use a private ambulance company or go to fire-based EMS would made within the next two weeks.
East Texas Medical Center (ETMC) EMS officials informed city officials on Jan. 27 they were pulling their service out of the county. CareFlite took over service on April 1 and is honoring the terms of the city's existing contract with ETMC EMS with no change in subsidy, what the city pays for the service. The contract is set to expire Jan. 2, 2016. The city council voted previously not to automatically renew the contract with CareFlite so city staff could explore other options.
Under the contract with ETMC, ambulances served Waxahachie, Red Oak, Ennis and the county, and all four entities shared the cost. When a request for proposals was drafted and sent out to EMS providers, the four government bodies joined together to solicit requests. When making a selection of their service provider, none of them are bound by the decision of any other. However, any that choose the same service provider can split the cost of service.
Waxahachie Fire Chief Ricky Boyd reported to the council that in CareFlite’s second month of operation, they had 304 emergency calls. Of those calls, 224 were transports and 205 of those were taken to Baylor Scott & White Medical Center in Waxahachie. There were also 10 helicopter transports. There were 181 total transfers and 55 of those were emergency transfers from Baylor Scott & White Medical Center to another hospital.
“They improved a little bit on their response time on priority one (critical) and (priority) two (emergency) calls and priority three (non-emergency) calls stayed about the same. Under the new contract, we are asking for all calls to be timed the same,” Boyd said. “Right now they get 8 minutes and 59 seconds for priority one calls. We are asking for eight minutes and 59 seconds on all calls. They get 12 minutes 59 seconds on twos and threes. So if you take all calls compared, they are right at a 89.53 percent compliance rate. So they have improved some on that.”
In the bid submitted to the city, Acadian is proposing to use six ambulances but did not specify where they would be allocated. Allegiance is proposing to have three ambulances in Waxahachie, two in Ennis, one in Red Oak and two reserve units with one stationed in Waxahachie and the other in Ennis. The bid from AMR is to have seven ambulances and one 12-hour ambulance. Boyd explained that a 12-hour ambulance is only staffed 12-hours instead of a full 24 hours and only during the peak call period.
“CareFlite is actually proposing 12 ambulances. They presently have one in Ferris. I think they have a three-year contract with them, which has been in effect for three months,” Boyd said. “They are proposing to have one transfer unit at Baylor Scott & White.”
All of the bids presented to the city were for a period of three years.
Also in the bids submitted to the city, Acadian listed its subsidy as $3.6 million but didn’t specify how it would be split. Allegiance submitted a bid of $0 for a subsidy. AMR submitted $1,379,575 per entity for a total of $5,518,300. The subsidy submitted by CareFlite is for Waxahachie to pay $540,373, the county to pay $456,522, Ennis to pay $285,714 and Red Oak to Pay $217,391. The total amount would be $1.5 million.
Acadian and AMR made optional bids in addition to the main one they submitted to the city.
Under the optional proposal, Acadian put in one optional proposal of four full-time ambulances and two 12-hour units, as well as reducing from two paramedics to one paramedic and one EMT. Acadian put in the prevision the first paramedic on scene stops the response time clock. They also stated that emergency units would be able to do patient transfers.
Boyd said two of the items that the department stipulated is that the ambulance showing up stops the clock on a response time and emergency units would not be able to do transfers. By allowing emergency units to do transfers, it takes away an available ambulance from emergency calls.
“They (Acadian) asked to go to 90 percent compliance in the cities. Right now, it is at 96 percent and 80 percent in the rural areas,” Boyd said. “Then with that, their subsidy bid is $500,000. Again, the assumption is for the four entities to share."
AMR’s optional bid was to reduce the response time compliance down to 90 percent. With that, its subsidy request goes down to $600,000 per entity. It also put in a second option that, with a 90 percent response time compliance and staffing the ambulance with one paramedic and one EMT, the subsidy would be reduced to $115,525 per entity.
Before coming to Waxahachie, Boyd served with the Irving Fire Department, which ran a fire department based EMS. Boyd told the council that staffing an ambulance with two paramedics is better than just one paramedic and one EMT.
Boyd said by staffing only one paramedic, only one person is completely in charge of all patient care. By having two, they provide backup to each other.
“Allegiance has not been in the emergency ambulance business for very long. One of the things that they put in the RFP is that they had to prove, I believe its five years of emergency service with at least three similar entities. They bought out Guardian a few years ago that is what they are kind of claiming as their history. So yes and no they do have history. But until we can talk to them, we don’t know if they brought any personnel over from Guardian that has experience in emergency runs. Before that, they were primarily a transfer ambulance company,” Boyd said. “If we go with a private bid and even if they promise seven ambulances, those ambulances are likely to go over to another county to make runs too. Providers can come back and ask for more money and pull out early. AMR did that in a Houston area emergency services district. The company that we buy our fire apparatus from, the owner of that company, is on an ESD board around Houston. AMR submitted a bid with a zero subsidy. The ESD bought the ambulances and all the equipment that went on the ambulances for them to go into business. Two or three months into it, they came back and asked for $12,000 a month. So I would be a little leery of the zero subsidy.”
Boyd added that with using a private company for the ambulance service in the city would not have any control over the medical personnel that they staff their ambulances with.
Boyd said if the city wants to go the route of providing EMS service through the fire department, they would have to let him know by the end of the month, so that he can order the three frontline ambulances and one for back-up.
“It takes seven months to build them. You have to give them the order. That way we could get them in December,” Boyd said. “We could buy the rest of the capital items in the next fiscal year; That is the defibrillators, monitors, the cots, the radios and all the other things.”
Boyd said by getting them in December, the city could get the licenses and have the ambulances certified by the state so they could be operational in January.
“In a couple of years from now when they build the high school and that end gets to developing, we are going to need another station,” Boyd said. “So if you push off EMS and we need EMS two or three years from now, the runs are going to continue to go up. We are going to need more fire apparatus and personnel just for the fire side of it not just for the EMS side.”
Council member David Hill said he felt having EMS based out of the Waxahachie Fire Department, the city could have a lower cost and the time to expand it with the community's growth.
Boyd estimates that about 24 new personnel would have to be hired by bringing EMS service in-house. He added there is a great need for quick response and transportation of patients. Boyd said it is estimated that 13,000 trauma patients die in Texas each year, 50 percent of which die in the first hour of emergency response.
“Besides taking it over in 2016, we could consider phasing it in. There are a few pros in that,” Boyd said. “We could hire the personnel over a longer period of time. Take a little bit longer to hire the personnel and get a little bit better personnel than trying to hire them all at once.”
Boyd told the council phasing in fire-based EMS could look at a one- to three-year implementation plan to take over when the CareFlite's contract with the city ends. They department could also dedicate more personnel per year for training as paramedics. The department currently sends about two firefighters to paramedic school year.
Some of the downsides of phasing in fire-based EMS are a change in the department's operations such as protocols, patients during the phase-in period could be continue to be underserved, there would be no income from ambulance billing, continued cost of the private EMS subsidy and, in a few years, the need to add a station or multiple stations.
To make fire-based EMS happen, other than obtaining ambulances and licenses, city ordinances for ambulance service and a contract for a medical director would have to be developed, current firefighters would need training as field training officers, more personnel would need to be hired, the fire department would have to seek credentials with insurance, Medicare and Medicaid and inform the public.
One of the options the council discussed to offset the cost of fire-based EMS was to charge a fee ranging from $5-$10 on the water bill. If the city would choose to bring EMS in-house, the billing process would be handled by an outside company.
“It just seems to me that we have made this huge commitment by having the new Baylor Hospital here, which has raised health care in Ellis County tremendously,” Council member Mary Lou Shipley said. “This just fits right in with it.”
The bids and RFP were only listed as discussion items, so the council took no action.