It seems that at times like these we should ask ourselves what constitute essential public services – and should we act to provide these services with tax money.

If Emergency Medical Services are a critical public function, and I think they ought to be, then why do we only pay for 30% of the cost for each emergency run with public funds – the remainder being paid by the recipient (or more correctly, their medical insurance company).

But since the cost split is stuck at 30/70, and the public turned down an increase in taxes to pay for a redistribution of services as the county population increased (and spread out), then what’s left but the ol’ free-market approach.

With over 100% of the cost of services being covered by these out-of-county contracts, the overage (known as “profit” in the business world) comes back to county residents as a way to further subsidize in-county emergency runs. Of course all the actual costs need to be figured into these out-of-county contracts (wages, benefits, supplies, operations, maintenance, and replacement) – including the wear and tear on trained staff and the likelihood that they may burn out on all that overtime.

If this way of avoiding tax increases is unpleasant to some, then offer an alternative suggestion. Perhaps there are those that feel that EMS should be fully privatized – I imagine the private ambulance companies would prefer this. We’ve done this with our drinking water – now owned by a French conglomerate (Suez is ranked as one of the worst corporate environmental offenders on the planet). We’ve also done this with many of our other public utilities – and I’m sure we’re all the better for it. I’m absolutely positive that the PUC will continue its excellent job in protecting our interests.

Of course, we could revert to the traditional way of providing public services – pay for them with public taxes. But maybe this is a little too traditional for most folks.

Seems to me the kids are fighting and the parents are not doing anything about it… Kinda like Boise City and ACHD, or various military braches tangling over who gets what weapon system…

Time for the commish to knock some heads together fire a few folks and tell the rest to do it right…oh yeh I forgot…the goverment never fires ANYBODY.

These little under-currents from turf battles result in waste and lower quality of sevices.

Here’s a thought. Why are we putting up with a bureaucratic “turf war” that is being fought with our money?

For at least the third time in the last thirty years, there is a proposal that the EMS be absorbed by the Fire Department: After the patient is stable, they are transported by private transport services.

We MUST get the county out of the “ambulance” business and get them back into the business of providing advanced life support for the community. The whole reason why we have not had ACEMS perform non-emergency transports is, “what do we do when there is a bona fide need for advanced life support and that unit is tied up hauling Aunt Tillie from St. AL’s to ST. Lukes?” That has been the historical justification for the EMS program. I really don’t see how the ACEMS could remotely justify transport.

And the justification of providing out of county services when the in-county services are being cut is absolutely ludicrous! I, for one, am getting real sick of being lied to by the bureaucracy! And while we are addressing this issue, could someone please explain why it costs $900-1200 dollars to transport a patient to the hospital?

actually Dave, I wasn’t referring to the television program EMERGENCY, but the paramedic industry as a whole…the show of course was inspired by the industry which had exploded just a few years earlier….I worked ER back in those days and the change was eye-popping.

I certainly don’t question the ability or the commitment of the paramedic here in Ada County.

At the same time, I go back to the days when we slept in sleeping bags on the floor of the Meridian Fire Dept. so there could be a 24 hour service via a “Quick Response” unit. Also, Idaho Mountain Rescue was doing a pretty good job with “high angle rescue” until the brand new Ada County EMS decided that there might be some “glory” in that activity. I am very aware of the costs that are incurred in transportation of patients and it is NOWHERE NEAR the $900-1200 figure that is being touted. I say this as qualifier to my statement to Voter1. This ain’t my first rodeo and about 80% of your post is baloney!

The EMS system has abused the taxpayers in this county for years and that “pony ride” is just about over! Oh, and with regards to the “pay us $60.00 because even though less than 1/10 of 1% of the population will need it, we sure wouldn’t want it to be you” extortion attempt by EMS, that still smacks of Mafia protection money!

All I can say is ,just wait till you need an ambulance and You’ll understand they are always a ” Godsend.” A few years ago my right foot was seriously damaged and the ada county ambulance got me to the VA Emergency ward.They are professional and do a good job and I would advise everyone , especially those with serious medical problems to pay that $ 60 and get the care it entitles you to. With my medicare A& B I would pay nothing for their services.There’s certain things that I cannot complain about -when your seriousy sick and can’t move and professional , thorough help gets you to the hospital, you will find no fault with them- believe me, but hope you don’t have to find out!
P>S>- byhte way- The surgeon at the V.A. did an excellent job repairing my foot- Now I set off metal detectors and have a good laugh!

I am happy for you Joe. And if you ever need an ambulance again, it will be there with all the professionalism there is, and (you reading along voter1?) the only difference will be that the paramedic whose there to help you will be wearing a FIREMAN’S UNIFORM!!! Gee, I get the impression that voter1 has a bit of a vested interest.

Dear reader,

As you read this you will probably put this down to “turf wars”. But ask yourself, when cyclops makes such rude comments, What would you do? Walk away?

I feel I must speak up.

First regarding SOT:
And as I recall, Ada County didnt start their SOT “for glory”, they were already the majority on the old state funded Idaho Back Country Mountain Rescue Team (BCMRT) in the 80’s. When that program went under, the STATE asked ACEMS to step up and continue the service. And up until reacently ACEMS SOT was the only rescue team that could send a PARAMEDIC with PARMAEDIC EQUIPMENT to help some one with PARAMEDIC level care. Next time your leg is broken, think about that when you get some morphine! We were reposnsible for trainign a huge portion of the treasure valley and Idaho..including some mebers of IMS&R and BFD. See what working “together” got us?

Second, regarding the membership program: This is not medical extortion, its a practice that has been used extensively in other parts of the country by air medical and ground ambulance services.
It is not always popular…but if the community wanted to fund us better, then they would have voted so. The community , and the Boise Fire department representatives too..wanted ACEMS to seek alternative funding. YEP…thats right…the current situation was encouraged by BFD, and other represenatives of the Ada County Fire Chiefs. My personal ffeeling is that thhey wanted us to get in further red ink, and die. remember these were the same people who promised to support us when we went to the bond overide and then came out against us. These are the same people who walked into the blue ribbon committee meeting in full clas A dress, and said they would be happy to fix ACEMS…just split it up between them. The very same people.

I have been told, when we (and yes, I am a paramedic) can get membership in Ada county up to about 10%, it will provide about 1 million annually to supplement our budget. Better training , more expansive education, public CPR..all have been talked about. But it takes several years to build up the membership. YEARS. And we are less than 3 months of a real program.

Third, ask yourself dear reader WHY the fire service wants EMS…job security, budget, and ego. I dont blame them for wanting to keep their job, but I do blame them for the underhanded, negative, and frankly mean, rude and hostile some of the “union jihadists” pursue EMS and bad mouth anyone who disagrees with them. Remember they are a UNION..one goal, protect their UNION members above all else. Think about the militant tactics other unions in other industries do…tons of comparisons there. In fact, isnt it Ironic that a UNION is accusing us of being some form of Mafia?

Seriosuly dear reader, do some research, see the scandals and failures that have and are currently plauging:

Washington D.C. Fire and EMS

Sacramento Fire and EMS

San Francisco Fire and EMS

New York fire department since they took over (hostile take over) EMS

Do your own research.

Just to clarify for Voter1. Boise fire does not send High Angle Rescue outside of Boise unless requested by another agency. If requested, the agency making said request will pay all costs of salaries for backfilling fire dept. personnel. Off duty firefighters will be called in to man the station if an out of area response is needed. The apparatus was not burden to the citizens of Boise.

The cost of the equipment was almost entirely paid by federal grants. Homeland Security has been very generous with Boise Fire. We smartly use federal grants whenever possible. As a bonus, the rescue rig will eventually count as a “truck company” for ISO purposes which will lead to a better ISO rating for the city and in turn lead to lower insurance bills for the tax payer.

The Haz Mat Team is a similar story. Federal grants paid for the equipment and outside agencies bear the cost of responses outside of Boise. Eventually the spiller will be billed for Haz Mat calls. There are 7 regional teams in Idaho – all manned by firefighters. We do not leave the city and leave a “hole” in fire response for the citizens of Boise. We backfill for the Haz Mat Techs. because we have plan in place and we know it will not cost Boise taxpayers anything more than normal operations.

Can Ada County claim that their service was not in any way diminshed when they sold themselves to the forest service?

Just to clarify for Voter1. Boise fire does not send High Angle Rescue outside of Boise unless requested by another agency. If requested, the agency making said request will pay all costs of salaries for backfilling fire dept. personnel. Off duty firefighters will be called in to man the station if an out of area response is needed. The apparatus was not burden to the citizens of Boise.

The cost of the equipment was almost entirely paid by federal grants. Homeland Security has been very generous with Boise Fire. We smartly use federal grants whenever possible. As a bonus, the rescue rig will eventually count as a “truck company” for ISO purposes which will lead to a better ISO rating for the city and in turn lead to lower insurance bills for the tax payer.

The Haz Mat Team is a similar story. Federal grants paid for the equipment and outside agencies bear the cost of responses outside of Boise. Eventually the spiller will be billed for Haz Mat calls. There are 7 regional teams in Idaho – all manned by firefighters. We do not leave the city and leave a “hole” in fire response for the citizens of Boise. We backfill for the Haz Mat Techs. because we have plan in place and we know it will not cost Boise taxpayers anything more than normal operations.

Can Ada County claim that their service was not in any way diminshed when they sold themselves to the forest service?

So what are you telling me is that its OK for the fire department to contract and provide services that are needed to the State and Federal Government but it’s not OK for EMS to provide serviced to the Federal Forest Service when contracted to do so. The answer is a No – 911 services where not affected at all by the forest contract. The personnel came from an off-duty pool of interested paramedics. The vehicle is a backup vehicle that is not used for emergency responses. No one was “sold” in this situation. No more than the fire department accepting grants or reimbursement from the State for HazMat Responses inside and outside the city and county.

Yes, why does it cost so much for ambulance service?

The Paramedics web site indicates a budget of about $ 9 million. Number of calls answered about 18,000. That works out to a little over $ 500 per call. But EMS charges $ 900 per call, almost double the cost.

I can understand some “mark up” but almost 100%? No wonder “…the budget was successful due in part to good business sense.”

Perhaps it’s time for EMS to begin better educating the public with regard to salaries, service levels, and the need for more funding. Posting the budget detail on their web site would be a good start.

The Ada County budget, which we mere mortals are not allowed to question, seems to indicate a $ 2 million reserve fund in the Paramedics part of the budget. Why can’t a part of that money be used to provide 24 hour, 7 day a week service to Eagle?

Voter1, any comments?

JQP

Voter1

First, a sincere thanks to you and your co-workers for being there in our times of need.

Second, we share a common concern that “… ALL emergency services watch billing/expenditures …” It is my expectation that ALL tax supported organizations, (federal, state, and local) provide service delivery in the most efficient manner possible and that all managers of public funds be “proper stewards of taxpayer dollars.”

Third, thanks for the information about uncollected accounts. Factoring that in gets us to about $ 700. Good progress. The “extra” $ 200 at this point works out to $ 3.6 million a year. More than enough to fund a reserve account.

Folks I know who follow other tax district budgets tell me at least one maintains a 5% reserve in its budget for “contingencies.” That’s on top of the extra thousand(s) here, extra thousand(s) there tucked away in the line items.

I’m not suggesting that EMS is tucking a lot of extra money away in their budget. I’m just curious about the $ 2 million, how it got there, and what it might be used for. I’m not buying into the equipment, buildings, etc. thing for the reserve account. I’m pretty sure that’s cash in the bank – literally – not a balance sheet entry. If it’s for capital expenditures and/or depreciation thats one thing. If it’s for “contingencies” the amount is very high in relation to the overall budget.

Seems we’re still waiting on a non-binding legal opinion about whether a reserve fund is required or allowed but I’m tending toward allowed.

My point is this. EMS management could make a stronger case for the service and the need for additional funding if a breakdown of the $ 900 fee (I realize it may vary by call) was provided to the public. Maybe that has been done and I’m out of the loop. That type of information should be part of the basic budget process. If EMS management can’t easily provide that information to the public, I’d be really skeptical of their budget process. Having the entire EMS budget on the EMS web site would be really nice. After all, the budget is a public document.

I admit to being somewhat skeptical about EMS management because of the “overtime” problem that received a lot of press a number of years ago. Overtime, to a point, can be efficient and a good management tool. But there’s also a point where it’s cheaper to hire more workers than pay overtime. And using overtime to artificially boost take home pay doesn’t sit well with me. Market wages should be paid commensurate with both the skills required for the job and the responsibilities of the job. Overtime gets paid when necessary, not to artificially boost wages.

Lastly, I’d like to hear your comments, and maybe the County Commissioner candidates (Sharon – you reading this?), about why Ada County pays entry level Paramedics about $ 13 per hour to start while paying a LPN for the Sheriff’s Department over $ 16 per hour to start. I got the LPN information today (10/11/06) from the Ada County jobs web site. The Paramedic pay rate comes from the Paramedic web site. It appears pay priorities are a bit screwed up at Ada County.

By the way, I’m a lot more skeptical of the management of some other public agencies.

EDITOR NOTE–The 5% contingency is pretty good and indeed is ALLOWED. There is a trend in some local government to “save up” to get around bond elections which allow the public to vote on long term debt.

JQP,
I’m happy that I could answer some of you questions. Honestly, the best person(s) for you to contact are the BOCC or the EMS Director. I think it’s always good to hear things “from the horses mouth” so to speak.
In reference to the average $700 / call analysis you listed: In the simplest terms you are correct. But things are more complex than that. For example, if you factor in all the refusals, treat/release, and other calls where paramedics respond and give patients advise, etc, then that $700 / call will most likely increase. However, it still takes the same resources to respond to the calls where there is no reimbursement as it does to the calls where the County collects payment. If you look at the Boise Fire budget of $32 million (all tax dollars) and take an annual call volume of 15,000 that means they charge the tax payers $2133 / incident. Furthermore, if you compute that 70% of what BFD does is EMS responses that would leave you with 4500 fire/rescue/etc calls or a cost of $7111 / fire incident. It still takes the fire department the same resources to respond to “granny with a broken hip” as it does car fire, etc. Whether or not the fire department needs to respond to all medical calls is another question – but I do appreciate their service as a paramedic and a taxpayer. County EMS would love a reimbursement of $2311 / incident…then all ambulance rides would be “free” right?
I will investigate further about the reserve budget. I have reasons for saying what I said before about most of the reserve budget being assests – but that was information thats about 3 years old. Things may have changed and I don’t want to mislead you. City/County budgets are public documents. I’m sure a simple call to the Director of EMS or the County and you could find out what stack of forms you have to fill out to retrieve budget info.
There’s alot to be said about the paramedic wages in the County and in healthcare. LPN, RN, Paramedic comparison is an apples to oranges way to look at things…but I do appreciate you looking. Everyone knows when they become a paramedic that they will not start out at premium wages. We work 48hr weeks…thats 40 hours of straight time and 8 hours FLSA adjustment (aka factored in overtime). So a starting paramedic makes about $35,100 annual on the 48 hr week. Not a great salary but certainly a good entry level paramedic position. The Boise Fire Dept starting is about $39,000 annually but the work a 52 hour work week and because of tax laws do not get OT until they go over 52 hrs/week. Thats only a hourly salary of 14.42. No one is getting rich in public safety. There are good benefits from working for the govt and the pay does balance with longevity.
I say screw the Statesman and their reporting techniques…I haven’t seen many thoroughly investigated and non-biased articles come out of that rag.
I have more to say but this is already a long response.
Thank you again, Voter1

Ah, the old “fire vs. ems war”. This war has been fought in lots of cities with varying results. Ada County EMS is an outstanding service with an excellent national reputation. It seems a shame that they are not getting the funding they need to continue to provide quality service. Fire departments historically go after EMS when fire responses go down and they are trying to justify their big budgets.

The fire service has “saftied” themselves out of work, thanks to smoke detectors, building codes, etc. Most firefighters join the fire service to ride the big red truck, not work on the “box”. Most large fire based systems require the new employees to work on the ambulance for the first year of two, and the majority see it as punishment or “doing their time” until they can get on a fire truck, where they will run a lot fewer calls a day. Are you sure you want someone who wants to be somewhere else taking care of you or yours?

As far as the bill, I would be willing to bet that everyone who ACP responds to is going to pay their bill. Between the people who can’t pay and the others who don’t, the fine folks with insurance end up paying more. Have you priced 2 Tylenol at the emergency room? EMS is a bargain.

Don’t worry voter one when your house is on fire and you or your family/property are in need of rescue/suppression and high quality advanced life support we will be there 😉

you call 9-1-1. fire fighters show up. Ada County Paramedics show up. the firemen stand there and smile as people tell them how they are their heros while the actual paramedics take care of the patient. even though the firemen are USUALLY good people, they are many times uneccessary when it comes to 75% of the calls. I would personally feel better with more high-quality firemedics or at least higher paid ada county paramedics and a more efficient system in the fire dept. THE PARAMEDICS ARE IMPORTANT (VERY PROFFESSIONAL AND PROVIDE VERY HIGH QUALITY CARE) AND DESERVE RESPECT!