But how will it play in Peoria?

[Duffman]

From the Peoria Journal Star.


PEORIA - Representatives of Peoria's sole ambulance service want the city to sign an agreement giving them exclusive rights to continue treating and transporting patients for the next 10 years.

"Every time you turn around the fire department is proposing to start up ambulance service," said Andrew Rand, Advanced Medical Transport executive director. "We want to create some stability . . . who needs to be in fear of municipal takeover? It's a distraction to our principle goal of tending to patients."

Rand made those comments and others during a Thursday meeting with the Journal Star's editorial board and on Friday. His independent not-for-profit organization backed by Peoria's three hospitals has provided ambulance service to 22 Peoria-area communities for more than 10 years.

For several years, city officials have discussed the option of allowing the Fire Department to expand its role to include transporting patients to the hospital and providing advanced life support, the highest level of paramedic care.

That would mean upgrading the current highest level of fire department service from basic life support - which happens to be the lowest level as well - in addition to creating a new substantial revenue stream for the city by billing patients.

But Dr. George Hevesy, director of Emergency Medical Services and chairman of the emergency medicine department at OSF Saint Francis Medical Center, says it's not that simple.

If Peoria firefighters took up that role, he claims it would threaten to fragment the current EMS system and potentially jeopardize patient care.

"Does that mean two ambulances will be racing to be first at the scene?" Hevesy asked, adding that firefighters also might then be distracted from their primary role.

Moreover, Rand said the change "could produce catastrophic events" by destroying the core of AMT's business which Peoria now provides, and in turn would affect the service they provide outside the city, eventually putting the business at mortal risk.

Fire Chief Roy Modglin said on Friday he couldn't yet comment on the proposal.

Proponents of letting the Fire Department transport the patients argue that the department is usually first on the scene of an emergency situation.

Additionally, a number of already-employed firefighters have the training necessary to employ the expanded role.

Still, Rand asked why city officials would want to risk millions of dollars by tampering with what he called an already-excellent service that doesn't cost taxpayers a dime.

Another part of the proposal, which will be up for discussion during the next City Council meeting Tuesday night, is for AMT to pay the city a fee of $60,000 every year for using the city's dispatch system.

Currently, AMT receives the service for free.

The proposal would also have AMT provide free training to Peoria firefighters to help upgrade their status to intermediate life support, meaning firefighters would be able to administer some drugs and start intravenous fluids, which they presently cannot do.

[FFSTA2]

Everyone should watch how this subject progresses. as being a part of both sides of the AMT and PFD, with many friends in both jobs, there are several items to be adressed before this situation gets better. 1. The whining from both upper management , union officials and fire chiefs needs to be adressed and taken care of. There can be no more of this he said she said crap. Everything shold be brought out into the open and discussed.
2. Employees need to be taken care of during this issue, this fued is causing unneeded stress and presenting a tension between the PFD and AMT. Both can do there job professionally, and it could be done together, however the employees of both have been directed by others to "write them up" when someone does something wrong. Also the union has no problem voicing that they would like to do ambulance service. They need to remember that these are peoples jobs and lives that they would be altering. Talk of layoffs sure made City firefighters nervous, just remember your job is just as important as AMTs job.
3.The City of Peoria is in a dire time with virtually no money, there is no way the City cold possibly dream of running ambulance service and make money, it doesnt happen, and there is no way that the City could come up with the money to get these ambulances.
So with that said and knowing that no one is in jeopardy maybe we should drop the subject and get along, because the number one job is pt. care and protection of life and property. How can that be done with this crying of services.

[smurfe]

there is no way the City cold possibly dream of running ambulance service and make money, it doesn't happen,

I have to disagree with this statement. I work for a Municipal EMS service in a city of comparable size. Our service "makes a profit". In fact every dollar that is collected from taxes is returned to the general fund as we are a self supporting service. We do not have bare bones equipment or skimp any at all on labor costs. We just do our jobs very efficient. Our FD is trying to absorb our department into theirs as they want out revenue. We have been resisting this for a few years now as we don't want to mess up a good thing.

Smurfe:D

[RoryEl]

The pendulum has swung back in the Fire departments direction as a general rule. I'd be surprised if the Fire dept didn't eventually take over the EMS service. A ten-year contract, hopefully the city management will see this for what it is and reject it outright. A transition from one provider to another is always fraught with uncertainties and missteps, but patient care is the highest priority. When we took over the EMS service from the local hospitals we temporarily hired many of the workers with job offers extended after 1 year. Most didn't want to fight fire and left for other opportunities. I'm still friends with several who left, and to a man, they wish they had taken the FD offer. This is a political issue about public policy. I wonder how politically active AMT has been recently? When you subtract the actual cost of all city support (dispatch, stations, etc.) and compare private with public supported EMS the comparison is tilted in FD based favor in an overwhelming majority of cases for numerous reasons. Primarily, response time, manpower utilization, infrastructure, span of control, and fiduciary responsiveness (duty is to public vs. share holders /financially vested interest), etc.

[Toering]

It sounds like AMT is doing a good job. For the little that I know of the story I see no reason why PFD needs in on the party. If it's not broke, WHY FIX IT??????? I would love to follow up on this story, would some one please remind me to check up on this one.

[FFSTA2]

in regards to smurfe s post, i must point out that every dollar collected from taxes, isnt this a form of double billing, how can the fire dept work at a house fire for 3-4 hours using all there man time, equipment, and so forth and not send a bill, yet when they run an ambulance call spending no more than 1 hour with a pt, yet they send then a 300 to 400 dollar ambulance bill. sounds like the fire dept is using the wrong practice here, also you didnt include your funding from Medicare/Medicaid, im sure you will look and without taxes this ambulance service would be losing money.

[FFMEDIC51]

OSF St. Francis and the Management at Advanced Medical Transport of Central Illinois (AMT) will lead people to believe that the Emergency Medical Services (EMS) System in Peoria is one of the best and progressive systems in the nation. The Peoria EMS system is flawed and has been for years. They feel there is no reason that the Fire Department should enter into providing ALS care because it would compromise over all patient care and fracture the great system we now have in place. WOW!!!!! What a load that is. Working in the Peoria area for 15 years as a Paramedic, I worked in the system when the transition was made from Mobile Medics to AMT in 1990. Paramedics who worked in the system, including the Fire Departments (paid and volunteer) were optimistic about the new ambulance service. Some of the reasons that the Peoria hospitals restructured Mobile Medics were because there were only two advanced life support (ALS) ambulances and three basic life support (BLS) ambulances covering the City of Peoria. Peoria County was served by a very small BLS private ambulance service. The advantage to the hospital based Paramedics were the experience that they carried, low turnover, good moral, and patient care was excellent. The problem was not the quality but the quantity of ALS ambulances.

The hospitals then decided to create a third service (non-for-profit) owned by the hospitals and managed using a board of directors. Each hospital would have a representative on the board and the rest would consist of powerful private sector business leaders. AMT was created. One thing that was funny was that the Project Medical Director (PMD) (who was over every EMS provider in the Peoria EMS system) was on AMT’s payroll as their Corporate Medical Director. He has since been promoted to the Director of Emergency Medicine at OSF St. Francis (our system resource hospital) and still holds the title of Cooperate Medical Director with AMT. Isn’t this conflict of interest? I found in the early stages of AMT that management at AMT wasn’t interested in working with other departments within the Peoria EMS system. They were mainly interested in monopolizing every aspect of EMS. They’re only competition was small private services and the Fire Departments. AMT purchased all the smaller ambulance companies, but the Fire Departments would be a thorn in their side causing a threat to always be there. They are currently trying to keep all the fire departments at the basic level and getting in the way of advancing their care.

Three years ago AMT paid out over 3 million dollars to our state and federal governments, because of a settlement, over a charge against them of Medicare/ Medicaid fraud. Talk about screwing the public. Hardly anything was said about this and it was kept quite. The hospitals and private sector did a good job keeping the lid on that whole mess by taking care of the fine. They are currently on probation. Another misconception is the fact that AMT received a perfect score on a national accreditation, which was advertised a great deal in the media. The truth is that they had to pay approximately $20,000 to receive that accreditation and the Medicare / Medicaid fraud was never brought to the surface to the accreditation company.
.
Another problem with AMT is that the workforce doesn’t retain experienced paramedics. The average medic works about one year, gets experience and leaves for other services or fire department jobs. This inexperience causes the EMS system and ultimately the patient to suffer. The PMD doesn’t even trust his medics on the street, making the Peoria area system behind in the times as far as advancement. I found it interesting how fast the system catered to AMT and when the local fire departments wanted to upgrade their services from BLS to ILS (intermediate life support) or paramedic level. The fire department ran into many obstacles because of AMT. It was said that the Fire Department was trying to put AMT out of business. AMT threatened a huge negative smear campaign against Fire Based EMS and Firefighters. They say the fire service wants to justify their existence. The truth is Peoria Firefighters or any Firefighters don’t have to justify their existence or their jobs. The Peoria Fire Department has been providing service to the citizens of Peoria for over 125 years and will be here long after AMT is a memory. There is no reason why the Fire Department shouldn’t be able to provide advanced life support (ALS). They have been trying for the last 12 years. They have Paramedics on staff now and they are in the process of training more.


The latest act against the Fire Department was the 10-year contract. AMT wanted exclusive transport rights in the City of Peoria good for 10yrs paying only $60,000 a year to the city in exchange for the 911 dispatching and the fire department supplying help to them when it is needed. Also the contract stated that the Peoria Fire Department could in no way upgrade to Paramedic level within the contract (Why not?). There would be no accountability for their poor response times, number of ambulances available for 911 calls, and no penalties if the service were to deteriorate further. The contract didn’t mention that any other private company could come into the city and operate at the paramedic level, but SPECIFICALLY excluded the fire department from doing so. Talk about paranoid. This contract was brought to the Peoria city council with representatives from all three hospital administrations, AMT’s board of directors, Project Medical Director, and Emergency Medical Director. The vote was close but it failed. I am sure that this is not a closed issue. This contract will be modified slightly and brought back to the council.

I really find it a shame… AMT does have the potential to be one of the best EMS providers in the system; the management of that company could work with the fire department, treat their employees better with higher pay and incentives for retention. AMT management made a choice early on to compete with the providers and not work with them. I wish that it was a different situation but unless there is a big change in management and changes throughout the resource hospital, I feel it’s going to get much worse before it gets better. There is no reason the Firefighters should roll over on this issue and keep quite while the system suffers. They have tried on numerous occasions to work with AMT management and OSF St. Francis to improve this situation and ultimately improve overall Pt. care. The Firefighters priority is the Pt. and the community they serve and I’m sure most street Paramedics priorities are the same. I have no doubt the Fire Department will be providing ALS services in some capacity soon. It’s a win win for the city and the citizens. Some forget why we are here in the first place. “It will play in Peoria” It’s just a matter of time…

[swrr88]

Well, I have this all before. I now work for a fire department that has a suppression and an EMS section. There is some dual role ALS providers but the majority are single role. We have a pretty good relationship with the suppression side though there are always issues just like any family...we're like brothers growing up in the same household. EMS has been a part of the department for 20+ years.

A few years back I was employed by a private 3rd party provider doing EMS for Lincoln, NE. The agency had been there for decades under a local company and then a national one. The local fire department was running ALS first response but wanted more. They wanted to take over the transport side, too.

There was a terrible fight between the two sides...in the city council meetings, the hospitals, the city's EMS control board, and on the streets. The fight got worse as the contract issue came to a head with the city. ALS providers were required to document ALS care and interventions. There was a limit to the number of providers who could be allowed to practice to the medic level. So, the Fire guys were racing to get skills in before the medic unit arrived. EMS guys were racing to get to the scene to get the skills first. Then there were the write ups. Everyone wanted to make sure to prove the other side was wrong. So, it seemed like every call ended with one side or the other writing the other guy up. One side accused the other of delaying informing of the other agency about calls to improve times for themselves and hurt the other. It was crazy.

Then there were the promises. The private side said they could do it with a profit with no help from the city. However, we really didn't have enough trucks on the road because of the money. The Fire side said the could put more trucks on the road and make a profit for the city. Everyone said they would provide better pt care.

Despite the strong ties between the private agency and the city the Fire Union and the department was able to take away the contract from them with the help of a mayor who they strongly supported in the last election. The Fire department hired some of the staff but many were out of a job or relocating (like me). The fire side took over with rented ambulances because their units weren't ready. It cost a few pennies to do that until the trucks came in. Since then they have had problems with billing, less than predicted results on money and times, and recently had to admit to wrongly billing for non-covered care to medicare (because they provide the bulk of transfer service, too).

They did put out more providers and trucks on the road. Are they better than the previous service? No. They are probably equal to the skill of the former provider. Do they make a profit for the city? That's a question to be answered in the future. Let's see where they are in 5 years.

My whole point for rambling on like this...its the same fight. Fire services that didn't get into EMS in the beginning are scrambling to get into it now. Why? They aren't putting out that many fires anymore...at least not enough to justify the current and future growth of the department without EMS. They need EMS to grow. Even the IAFF will tell you that. Plus, payroll...if you want a salary increase you need to show what you give to the city. Going to a city council meeting with stats that show you provide ems,fire, and prevention will get you a bigger piece of the pie than without it.

They won't give up. They will continue to take this fight to the city council until they win. Both sides are probably going to make promises that they can't keep. There is no long term profit in public ems...no matter how good you are. You may keep your head above water but your not going to be the cash cow that people try to say they are. System abuse, medicare and medicaid under payment, training/equipment costs are all going to affect the money you can make. Private services can cut costs a lot easier...is it right? I don't know but they can. Besides cities aren't supposed to make money and any department trying to use the profit side to take over EMS is not being truly honest. Patient care is the only reason that EMS should be taken over. However, saying you can do it better and actually doing it are two different things. Again any department who can make blanket statement they can do it faster,better,safer without any previous experience is also not being truly honest. They may do it as well as the other guy but I doubt they can do it better at least not any time soon.

[FFMEDIC51]

I agree with a lot of what you said in your post. I wish privates and fire administrators would work together for the best interest of the community. Unfortunately in most situations that does not happen.

[swrr88]

http://cgi.tennessean.com/cgi-bin/print/pr.pl

Ambulance bills cost taxpayers up to $37M


Here is some more on "profits" in public ems

[FFSTA2]

Well, good points by FFMEDIC51, never thought about George being on their payroll,and putting the 2 together. I am 100% sure that the problem of Fire Admin. and AMTs Admin. not getting along is on the AMT side. need any more info Im me. thanks

[F18Wub]

FFMEDIC 51

Is the corporate MD for AMT the new medical director or the old one? I have heard the the previous PMD over there could be a little challenging to work for. I heard about the little multimillion oops they had. Isn't it funny how that stuff is so easily forgotten.

[FFMEDIC51]

AMT¡¦s corporate medical director is the old PMD who is now the Director of Emergency Medicine at OSF SFMC. There are a lot of things in the Peoria system that is messed up. Of course the public is usually kept in the dark. The Medicare issue was covered up well by the hospitals and AMT. They pretty much covered the fine. It would be nice to have a level playing field between Fire, AMT, and the EMS system but that is unlikely to happen. For years the Fire Departments have been treated as second class citizens and has had to fight to get there EMS status upgraded. As long as the hospitals and the system caters to AMT it probably won¡¦t get any better. I feel it¡¦s a blatant conflict of interest. It¡¦s a real shame¡KI try to be optimistic, but seeing over the years how the system works it will never be the progressive system it is capable of being. Most of the firefighters don¡¦t have problems with the medics on the streets. We all have a job to do and bills to pay. I¡¦ve worked on both sides private based and municipal based EMS. I have found that when they work together that type of model is hard to beat. They both have good and bad points. In my opinion as long as the management of AMT tells there employees that BIG RED is the enemy and they should work against them and the hospitals cater and cover there butts, the system and ultimately the patients will suffer. ƒº Stay Safe¡K

[mfdff2]

I know exactly what you are talkng about. I worked for GHAS in Galesburg for a few years before I went to the fire department and they are the same way look out for the big red enemy. I was a medic when I got hired at the fire department but some of the guys at work went through the class and had to do there internship with GHAS and were treated like a red headed step child. We now have four medics and the next three guys on our list are medics, so hopefully we can move on and give our citizens the treatment that they deserve.








these are my views not the views of the city

[MIKEYLIKESIT]

Coming from a fire department that has provided ALS service for THIRTY years I feel I am somewhat qualified to comment. The whole reason we went ALS is because the private sector wasnt dependable. I can count on two hands and feet the number of private ambulance services that have come and gone in the Southern Suburbs of Chicago. AMR came in like gangbusters and lasted a whole 3 years or so. We ARE still providing the same level of service we were doing in 1973. we KNOW our community. We DONT have a turnover rate anything like the private ambulance sector does. There is one service that does many 2nd party ALS care and transports in our area. They have some good medics and they do provide 911 service to some of the poorest areas in the U.S.."The big boys" who came in and found out there wasnt a big profit margin FLED this area as fast as they bought up the "Mom and Pop" companies. They also work with the area fire departments whether or not they serve that community. I do believe however they are a rarity. And if you talk to their medics, many are looking to get hired by a municipal provider/fire department.

[btroutm]

I would have to completely agree with MIKEYLIKESIT. I work for a private myself, and I strongly believe that 911 EMS response should be handled by the fire deptartment. I have great pride in my company; we have good medics, good equipment, and good service, but I would not call them in an emergency. Privates are great for hospital to hospital and other transports, but they just don't work well for 911. Why? Because they are a business, not a municipality. Like any business, their largest concern is making money. Even if they're able to work shifts out of a local station with accectable, consistent response times, decisions are still made based on profits, not patient care. This is just my opinion and it may not apply everywhere, but it certainly does here.

[BVFD1983]

Another problem with AMT is that the workforce doesn’t retain experienced paramedics. The average medic works about one year, gets experience and leaves for other services or fire department jobs. This inexperience causes the EMS system and ultimately the patient to suffer.

AMT transports on our EMS calls. I know what you are saying, it always seems like I am meeting a new medic on a call. I guess that could be from the sheer number of medics they have though. I will say that they do have some excellent paramedics. Not all are bad.