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Wednesday, March 23,2011

EMS in the red

The city of Lansing loses $1 million a year in its emergency medical service operations. But the question isn’t so much how the city will fix it, but if.

by Andy Balaskovitz

The city of Lansing is losing $1 million a year on its emergency medical services, or EMS, the city’s finance director said Tuesday.


That represents 5 percent or more of the estimated deficit of up to $20 million that the city faces in the coming fiscal year, which begins in July.


Privatizing all or part of the service — as the city of Jackson has done — could put the city on a break-even basis, but Finance Director Jerry Ambrose said that’s not being considered.


“We provide a higher level of service” than private companies, Ambrose said.


Asked in what way, he and Fire Chief Tom Cochran said city paramedics are trained as firefighters as well. Cochran said “if any one of our medic units are busy, any of them (firefighters) can be contacted.”


While the city brings in $3.2 million annually on costs related to emergency response and taking people to the hospital, the Fire Department spends $4.2 million to keep personnel on staff 24 hours a day all week, equipment, supplies, fuel and vehicle maintenance, Ambrose said.


“It provides a high level of service and is valued by residents,” Ambrose said. “I don’t think it was ever set up to be a money-maker or even to break even. It’s one of the many things we do that are not money-makers. They were never intended to be. It’s part of the heart and soul of what the city does.”


The city maintains five ambulances, with two more on reserve. The fifth ambulance was brought out of reserve in July because of the increased number of EMS calls the Fire Department received. Ambrose said ambulances costs between $150,000 and $200,000 each.


Cochran said the city is able to cover “most all of our medic calls with our own units.” He added that there are no pro posals to cut EMS that he has seen.


Last year, the Fire Department fielded 16,659 calls. Of those, 14,398 — more than 86 percent — were EMS-related. And while the number of fire-related calls in 2010 was about the same as in 2006 (around 2,200), the number of EMSrelated calls has only increased. The city received 2,246 more EMS calls last year than it did in 2006.


The city also sends out fire engines in certain circumstances, along with an ambulance. These instances include cardiac arrest, birth and shock. While the city’s five ambulances are docked at four fire stations, fire engines are at all eight stations.


Cochran said “a lot of that is getting people there as quick as possible.”


Before 1997, Lansing residents’ property taxes covered the costs of ambulance service. Since then, the city has charged customers a fee, which runs about $800 for advanced life support service, Cochran said.


There are a few ways the city can remedy the $1 million gap, if it chooses. It can sell ambulances it has on reserve or it can scale back its level of service and contract “overflow” EMS calls out to a private company or other municipalities.


But contracting EMS service out to a private company — and taking away from city employees — isn’t a popular idea with the city.


Ambrose said the two local private companies — Mercy Ambulance and Lansing Mason Area Ambulance Service — are not used more often because “we believe we are able to provide the level of service they (Lansing residents) want,” Ambrose said.


Does that mean the Lansing Fire Department provides better ambulance service than private companies?


“That’s our belief,” Ambrose said. 


Ambrose added that the city is considering outsourcing its golf and cemetery operations to private companies.


“In some places, that makes sense (to privatize). Ambulance is not one of those areas,” he said.


But are Lansing Fire Department paramedics better than paramedics who work for a private company?


Dennis Palmer, president of Mercy, said no, but added that he’s not in the business of picking that fight.


“Our family has never gone into ‘Our medics are better.’ To me, it’s not worth the breath of air,” he said, adding that Mercy is “basically a training ground” and a “staffing reservoir” for paramedics who go on to work at the Fire Department. “And we’re very proud of that.”


And the fact that the city is losing money is more evidence that private companies should be considered to balance the city’s checkbook, Palmer said.


In 2008, the Bernero administration signed a “mutual aide agreement” with Mercy, which basically was a formal way of the city saying we have your number if we need it. Palmer said Mercy has been called “three or four times.” Cochran said it was “a few” times but did not know when or in what instance.


“I just know we don’t get called on with any regularity,” Palmer said.


Palmer said after 1997 when the city started charging fees for each call placed, the “whole relationship changed.” Then, the city became a competitor for services, he said.


Mercy, with about 60 employees, has 10 ambulances situated around Lansing and mostly services southern Clinton County. And while the city charges $800 for advanced services (basic life support is “less than that,” Cochran said but couldn’t say how much), Palmer said Mercy’s prices range between $400 and $600.


Randy Talifarro, East Lansing’s fire chief, was the EMS coordinator in Flint until three months before the city switched over to an entirely privatebased service in 2001. He said that transition didn’t go smoothly because some companies didn’t want to service indigents and uninsured people. He also said the transition was too quick.


But, he said the effort was a costcutting one and that there are successful examples of public/private EMS partnerships. He said any tension that exists between public and private ambulance services is “complex.”


“I think it’s a more complex problem than people think. The solutions are just as complex,” he said. “I think there are examples where good opportunities for public/private partnerships work and examples where it has failed miserably.”

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