Changes to response-time requirements would reduce or eliminate hefty fines AMR has been paying the city
Today at 7:43 AM
By David Garrick
The San Diego Union-Tribune
SAN DIEGO — Ambulance rides would cost 24 percent more in San Diego and response time requirements would be softened under policy changes requested by the city’s ambulance operator.
American Medical Response says it’s losing $7 million per year because of a spike in call volume, San Diego’s challenging topography, lower reimbursement rates and response-time rules that aim to ensure equity among communities.
The rate increase — 9 percent immediately and 15 percent on Jan. 1— would push San Diego near the top of communities below state Route 56 for ambulance fees, according to a survey conducted by the city.
Changes to response-time requirements would also reduce or potentially eliminate hefty fines American Medical Response has been paying the city for repeated failure to meet those requirements.
The amended contract, which the City Council is scheduled to approve on Tuesday, would also allow the city to seek proposals from competing ambulance operators starting next summer.
San Diego hasn’t opened up its ambulance services to competition since it chose to forge a deal in 1997 with Rural/Metro, which American Medical Response bought in 2015.
City officials said the proposed changes are necessary to ensure that American Medical Response continues to provide service to San Diego while a new long-term ambulance deal is sought.
Tom Wagner, the company’s chief executive for the western region, said the policy changes would reduce but not eliminate his company’s financial losses in San Diego. He said the company has essentially no other choice.
“We understand this is a significant rate increase and we wouldn’t be here if we had not exhausted all of the possibilities,” Wagner said.
A consultant hired by the city says the policy changes are justified by significant new emergency response challenges in San Diego since the existing contract was signed in 2011.
The consultant, Citygate Associates, says the city’s response-time requirements are unrealistic based on a 22 percent spike in call volume over the last four years.
The number of emergencies requiring city response has increased from 111,506 in fiscal year 2014 to 136,559 incidents in fiscal year 2017, which ended June 30. The higher number translates to 374 incidents per day and 15 incidents per hour.
Citygate says additional challenges include dispatchers sending ambulances on more calls where they aren’t necessary, and longer delays dropping patients at hospitals making ambulances less available to respond to new emergencies.
On the higher fees, Citygate notes that many patients won’t experience the rate hike because they are covered by Medicare or Medical.
San Diego’s fees for ambulance responses including advanced life support services such as intubation or chest decompression would climb from $2,154 to $2,671.
Fees for less aggressive instances of advanced life support would climb from $1,933 to $2,396, and fees for basic life support, which might only include an assessment, would rise from $1,631 to $2,022.
The changes wouldn’t financially affect the city, which would continue to receive $10.7 million per year from American Medical Response for sending paramedics to many emergencies along with ambulances.
The rationale for those payments is the city not getting a cut of emergency response fees despite sending personnel to incidents.
The city would, however, have to back away from more rigorous response-time rules created in 2015 to ensure equity among communities.
San Diego had previously been divided into four geographic zones, allowing the contractor to provide subpar service to some communities and still meet the response-time goals by posting stellar times elsewhere in a particular zone.
To reduce the potential for that, the city shrunk the size of each zone in 2015 by doubling the number of zones to eight, which has required more robust coverage in many neighborhoods with weak response times.
The proposed policy changes would reduce the number of zones back to four. They will include a border zone, a metro zone and two zones north of Interstate 8 – one inland and one coastal.
Within those larger zones, American Medical Response would essentially be held to the same response-time requirements as now.
At least 90 percent of the time in a zone, they would have to arrive at life-threatening emergencies within 12 minutes, emergencies that aren’t life-threatening within 15 minutes and non-emergencies within 25 minutes.
The proposed changes would also adjust the penalty structure away from a series of small fines for minor response-time failures, to a structure levying larger fines for massive failures.
City officials said it’s notable that in exchange for the contract changes American Medical Response would allow the city to more quickly conduct a long-awaited request for proposals for a new contractor.
A city timeline predicts a “request for proposals” could be sent out next summer, after city officials craft a proposal and the state approves it.
That would possibly allow the city to have a new agreement in place by summer 2019, one year before the existing deal with American Medical Response is due to expire.
The city has previously been prevented from issuing a request for proposals by legal questions related to the county’s potential role in the process, but those questions are no longer a roadblock.
The city’s Independent Budget Analyst, Andrea Tevlin, said last week that the city would likely benefit from approving the proposed contract changes and then forging a new long-term contract that better meets the city’s evolving emergency response needs.
Tevlin, however, said the significant policy changes sought by American Medical Response could have “unintended consequences,” making it crucial for the city’s Fire Department to be vigilant and keep city leaders updated on changes in response times.
The City Council is scheduled to consider the proposed contract changes at a meeting scheduled to begin at 2 p.m. on Tuesday at City Hall, 202 C St.
Copyright The San Diego Union-Tribune