Well, Cyclops, we dont always agree, but here we do. This is not the end of this issue unfortunately.

And I also think the council is on the right track…but man, I see this change as unnecessary and rife for potential abuse…

I find it interesting that the Chief Doan finds it nessesary to have the ability to “enter into contracts”. Does this mean that he doesnt have to get council approval (or even inform them) until after the fact? If at all?

Seems to me that this change was simply the ability to enter into contracts for routine medical supplies, maintenance, etc. … Well he already has that now, why does he need more authority?

Does this give him the ability to hide away from council oversight things like gurney purchases? Ambulance leases? Contracts to purchase Ambulances? (sound familiar anyone???) Contracts with private ambulances? All because he now has the “ability to enter into contracts”?

This is one question I really hope would be asked.

I really want to believe the best, and perhaps there is a hard between-the-lines understanding between the council and Chief Doan what he can and cannot do with his “authority to enter contracts”, but I have to say that past performance predicts future practice.

I applaud the Guardian for keeping on this issue, and invite all in Boise, Garden City, and even Ada County to keep a close eye on this.

That, more than anything, is what will keep the FD in line with the needs of the taxpayers, and not the union.

Seems we need an Ombudsman even more than ever.

Nemo, always about the unions, empires and absolute control. Why don’t you think it is about getting the people of Boise the best patient care (scene control, medical command), with the fastest response times (joint deployment model), and the cheapest service (ACEMS has the highest fee schedule, Why)?

Also I have read your complaints about fire medics before and I was just wondering if you actually read the study in USA today that you keep referring to. I did read it and what I got out of it was that too many medics is bad. Too many, as in 8 medics on scene. Between ACEMS and MFD or BFD is there ever 8 medics on scene? I also got out of the article that that the optimum number of medics is 2 or 3. Does ACEMS run with 3 or at least 2 medics 100% of the time? The fire medic seems to compliment the standard one medic and one EMT ambulance very well.

And Just tell everyone who you are.

Does anyone know why the folks out in Kuna are paying for an ambulance tax when ACEMS does not have a unit out there, nor do they respond out there?

James Lyn

Kuna: Your post is not accurate. ACEMS does indeed respond out to Kuna. They always have and always will. The current arrangement is at the request of the Kuna city council, and in essence we respond out there to all requests when the KFD is either busy, or want assistance for any number of reasons. In fact we used to have a unit out there. The current arrangement is what is worked out with the Kuna City Council and ACP at Kuna’s request.

Too many medics on scene: The majority of the units are double medics, though this fluxuates a bit with hiring, internships, etc. And while we are looking at the same studies referenced in the USA today articles, and since, it seems the maximum number of medics is 2 or so. There is minimal documented benefit of 2 vs. 1, but when you get into the three or more the clinical impact rapidly declines.

What you arnt mentioning is what the real reason more medics on scene is bad: th more medics you have in a given system, the less experiance there is for the medics to gain, and THAT impacts clinical competency as well….That is clinical exposure. That is what the upcomming joint staffing proposal (which was ACP’s idea by the way) will address in a small measure.

It makes far more difference if the medics are experienced (and Im not talking years of service), and constantly exposed to critical calls rather than simply showing up for 5 minutes and going away.

I have also discussed this extensively. if you really want to bore the BG readers with this topic again, so be it.

Finally, I believe that it was shown that ACP has a lower fee schedule compared to other similar sized services, far lower than services like AMR and Rural Metro. At least thats what I recall from watching the video of the meeting BG put on a few months ago. We are lower than Portland, Spokane and others in the NW I believe (though it is difficult to compare apples to apples here) The population mix of medicare/ medicaid and private reimbursement, rural vs urban vs super-rural milage…collection percentages vs. write offs….all make real comparisons difficult, even in services that lay next to each other.

But if you really ant a comparison…. do you really want to compare tax rates of EMS vs. ANY FD in the area?

Now, I feel we have gotten a bit off topic….

Just as the BG tries to bring light to many tax related topics, I am just trying to shed light in my little corner of the ocean.
Otherwise, the only light will be that of a big (red)angler fish

http://s3.amazonaws.com/readers/scienceray/2008/07/27/236807_35.jpg

Namaste my friend….

Nemo

Kuna: I don’t care who realized that there was a useless supervisor rig responding to calls for 5 minutes than going home. The point is that ACEMS is taxing the folks in Kuna and not providing a service. True if the KFD is busy on another call ACEMS would respond just like if Eagle FD was busy on a fire and Star FD had to respond to a call in their district. Does this mean that all Eagle residents should be paying Star fire tax. No. this is a mutual aid agreements and the ambulance tax money from Kuna should be given to the ambulance that actually responds to calls in Kuna. But ACEMS isn’t concerned with doing what is right they are just trying to protect their empire. That sounds familiar, like comments made earlier. Good for the city council out there for noticing a waste of tax money and putting an end to it. Now we just need ACEMS to forward any ambulance tax monies to the ambulance that deserves it.

Does any one know who a person could talk to about this? Kuna city council? Ada commissioners? Statesman? Channel 7?

Too many medics: no one is arguing why 8 medics is bad just that the study says 8 is too many, 1 to 3 is a good number.

Seems like the “majority” of ACP units that have double medics are complimented very well by the majority of fire units that just have EMT’s. The few non double medics are complimented by the fire medic units. The only question… Are the fire medics placed around the city to fit where ACP places its single medic units. Are the single medic ACEMS units placed around the county where the fire medics are? Is there a link someone can show me where there is a plan of all agencies working together? No? Sounds like everyone is doing their own thing and placing resources where ever they want. Seems like working together wouldn’t be a bad thing here in some kind of… what would you call it… joint deployment model.

ACEMS does have the highest fee schedule in the state. I’m sure that the information provided by ACEMS (not an independent source) is going to make ACEMS look good. What idiot would make themselves look bad when no one is actually going to check the stats. I had to call 911 a couple years ago and was shocked to see that my ambulance bill was about $950 and my hospital bill was about $1000. At the hospital I got an xray, blood drawn, nurse, a respiratory person, a doctor, and very expensive inhaler (don’t get the hospital one, take a RX to a pharmacy its much cheaper). The folks on the ambulance did give me an IV but still $50 difference? Either the hospital is undercharging (fat chance) or the ambulance is over charging.

And why can’t ACEMS join the Blue cross network to help lower the cost for the people of Ada county. I know that they force you to write off part of your charges but still help us out. Probably won’t happen though, what are the people going to do call 922 instead of 911 because ACP is out of network.

Moral of the story being I don’t know if ACP should have to do what the chief says, or the FD should have to do what ACP says. But it looks like Doan is trying to work together in some way to make things better and ACP is not. Why?

FactsFirst, Quite right on the user fees. This is a two part equation but fire chooses to look at only one half in order to create a deception. The whole equation is higher taxes and lower fees or lower fees and higher taxes. Which would fire prefer ACEMS use? Additionally, if a person does not want to risk the user fees, they can buy a membership @ 60.00 per year and not pay any user fee at all. I would also be very interested to see Nemo’s comparison between the tax burden placed on Boise citizens by Fire vs EMS.

Alan, you hit several points I wanted to make, and probably briefer than I would have as well, for which I am sure the BG is very grateful 🙂

One point on user fee in Idaho, that is hardly a fare comparison, as there is no service in Idaho (except perhaps Canyon County) that runs a similar service. Most services are either BLS or ILS (not ALS), many are supported by rural fire districts or city fire departments (or sometimes both, Like Kuna) with a higher tax levy(s), and the majority use a high percentage of volunteer labor. Not knocking the volunteers at all mind you. With out them, many of these communities would have NO EMS.

Additionally, most of these communities in Idaho are considered RURAL or super rural for re-reimbursement purposes. In short, medicare pays them more to do the same transport that they would pay ACP, especially in miles.

Not that I am disagreeing with this, without this many rural communities EMS service would not survive…but you must appreciate that it is not an apples to apples comparison.

Thats why comparing ACP to Spokane, Portland, and other cities is more accurate and also more truthful.

As for the burden placed on the taxpayers, simply look at your property tax (Its that time of year) for EMS . Then look at your property tax for your own fire districts, or if it isn’t itemized, request a itemized list from your city you live in.

When we start talking about fees, I understand there is Medicaid / Medicare set reimbursement schedule. In addition, I know all insurance companies have some type of payment reimbursement schedule with both venues amounting to only partial compensation against the overall fee charged by ACEMS. You throw in the amount of indigent care that ACEMS has to endure with….which I am assuming with little or no payment recovery, I certainly understand having to increase fees to compensate for this ongoing burdensome situation. Having said that…..Its really irritating to me as a responsible bill paying and tax paying citizen, I get stuck with a BLS transport to the hospital bill for 975.00 and 14.75 a mile(for 2 miles) Total cost of $1004.50 Because they can’t collect in some areas, I get stuck compensating for that deficiency? Might I add that a friend of mine in a similar situation, however not financially set as I am, unfortunately had his bill turned over to collections. ACEMS tacked on a 275.00 collection fee before turning it over to collections. Are you kidding me?? Those seem like Payday loan rates, don’t they?? As always…just a thought!

Just a Thought….You make me laught…but I mean because the Payday Loan comment was actually really funny!! LOL. I see your point. I understand your irritation with having to compensate fees and prices for people who cannot or will not pay their bills. I also understand Jim’s point with regard to the appearance of The Boise Fire Department trying to work together with no help from the other side. I have to admit, I am not as educated as I should be on some of the language people post here…BLS? I also am uneducated with regard to staffing levels which Jim mentioned and seemed to have a very good grasp on. I am in the process of trying to educate myself.

That being said…I believe I have a pretty good understanding of fees/costs/services with regard to health care. Over the past several months, I have been following this debate and doing my own investigation. For the amount of fees charged plus the amount of the Ada County EMS tax levi plus the level of services available (numbers of medications/medical interventions/staffing levels) provided by Ada County compared to other areas of the same/similar size (square miles covered and population)….the emergency paramedic services system here is great. The City Fire Department just could not do it for less. It may be a wash for the first year, after that iot would be far more expensive to the tax payer…either with increase in Fire Tax, fees for service from the fire department (they would have to send bills) or a combo of both (for me, numbers just don’t lie). City and County fire departments have much higher tax rates AND send bills out to people when they get into the business of amblances (usually about a year after starting). I did sit through a city council meeting some time ago. There, Mr Doan gave a presentation with regard to Amulance fees, service prices, etc. I can tell you that entire presentation came from a person who maybe did not understand the information he collected, did not get all of the required information to make an informed decision, or was attempting to misdirect the council (I have tio admit it made me some what sick to see a Fire Department Official do that. I don’t believe Mr Doan is a good representation of the Boise City Fire Department. The fire personnel who work at the fire station near my home are wonderful!!) Again, I am saying this with regard to user fees, insurance payouts, taxed funds, etc.

To Just a Thought and Jim…Thank you for your opinions and information. Both of you have given me much more subject matter I need to educate myself on!

PS. Just a Thought…in my own “investigation”…lol….I know that Ada County has “compationate billing”….place people on a payment schedule, etc. Did that not work with your friend? Just wondering

FactsFirst…Captain, damn I keep doing that, Chief Doan, jumped from Station Captain to Chief with management skills of keeping track of station cleaning supplies so don’t expect him to be able to quate numbers and facts concerning any type of ALS Transport Service. Doan’s limited financial management skills are equal to his tactical fire skills…limited. As a Captain most of his Fire Ground Command responsibility was relieved upon the arrival of a battalion chief who assumed command of the fire incident.

But Doan’s inner “Command Staff” has some very impressive fire/ems managers, EMS Deputy Chief Randy Howell should be able to help Doan along concerning EMS matters. I do find it somewhat interesting the two highest Chief positions in BFD came right from Captain positions, but their are a few Chiefs with in the staff with earned and proven experience. Maybe with the next Mayor, Boise will get a new Fire Chief?.

Lisa… Ambulance drive, damn now you got me doing that, Chief Hagen jumped straight from ambulance driver to chief without being a CEO of a fortune 500 company. All he was responsible for was checking the batteries in the flashlight so we shouldn’t expect him to be able to work with others to try to make improvements to the system, just maintain. Hagen’s limited interpersonal communication and problem solving skills can be equated to his c-spine skills that… terrible. As an EMT most of the patient assessment responsibilities were relieved upon the immediate arrival of the paramedic that came in the same vehicle.

I do find it interesting that the pot is calling the kettle black and maybe when we get new commissioners Ada county will get a new ambulance chief.

After reading some old posts, how many times are you going to dip in that well?

Nemo, This is true about me being misinformed regarding Chief Hagen’s resume. I have better things to do with my time than to Study him.

I would like to say thank you for agreeing with me. Since the only thing in my last few posts that you feel is wrong and needs correcting is Hagen’s resume, you must agree with me about the fire medics complementing the ACP units is a good thing for the citizens. You also must not have a rebuttal for the idea that Chief Doan is trying to work together to make the system better and Chief Hagen is turning his back on him. And that ACP is stealing money from the ambulance that actually serves the folks in Kuna, and ACP shouldn’t be taxing the Kuna Rural Fire district. Stealing probably isn’t the best word to use there but ACP should be forwarding any tax monies from that area to Kuna Fire.

Thanks for your support

Jim

First, BG: job well done on staying on top of the issues as they develop. There definetly needs to be a check and balance system that presently does not exist within the City of Boise and you are providing at least some public watchdog oversight.

Second, The continued partisan pickering is ridiculous. If you are so one sided ACP or BFD on this issue that you can’t look at the Big picture without ruffling your union sticker or tarnishing a white shirt then you live a very limited life – but ignorance is bliss isn’t it.

That being said, I do believe that Dennis / BFD’s goals are to obtain a position of power over EMS transport. I also believe that the hiring practices of medics in the fire department (with some exceptions) is not condusive to good overall medical care. There is no real precepting program in place to validate skills or experience (if it exists), but the simple fact of the matter is most people don’t care and it’s a losing battle to argue it. But that doesn’t make it right either.

Third: ACP as a dept treated BFD like second class citizens for years and are now starting to reap the benefits of that (not really). As a result there is a joint deployment / staffing model being proposed that would essentially pay BFD / MFD for providing 3.5 positions on an ACP ambulance. Is it the right thing for ACP to do…. pay fire dept personnel to work on a transport vehicle? Won’t that create OT in the Fire Dept? Likewise won’t that eliminate jobs for the paramedics at ACP? Why is that fair or the right thing to do for either service or the taxpayers at large? The answer is, it’s not. If medicine was important to the fire depts. and training their staff was a core value of the organization, they would have found an avenue to do this much earlier in the game than now. … But they haven’t. Likewise, it smacks of ACP trying to buy the Fire dept off and that’s a bit of a joke in itself. This won’t delay the goal, which is to gain 1)Control 2)More revenue to fund a fire mission that seems well funded and staffed for it’s present mission.

Typically I don’t put much stock in beating around the bush and try to be direct, honest and fair. My comments may not be well received, but for the most part, they aren’t personal either. I can back them to most logical people if they are willing to listen. If anyone out there is truly interested in seeing public safety (EMS / FIRE) move forward in a stewardly way, they would promote the notion and development of a county wide public safety division. The reasoning for this is it takes out the partisan City Fire / County views of what patch you wear and who it is that you work for. Fire / EMS ??? Get over it. Let medical folks do medicine and they won’t try and put out the fire/fires that come along and vice/versa. The missions are different as should be the primary focus of each specialty.