The city of Tower’s ambulance service should move cautiously and focus on mission as it implements a paid on-call service in an effort to improve response time and generate more revenue.
There’s little question that some paid on-call staffing may make sense for the service. Call volume has been increasing and that’s put more demand on a limited number of volunteers. But based on our interviews with ambulance directors from other area services, all have taken a gradual and cautious approach to adding paid staffing.
In Tower’s case, the city council approved the plan after a 15-minute presentation by the city’s ambulance director that failed to account for tens of thousands of dollars in costs associated with the plan. It made assumptions that are unrealistic regarding potential new revenue from inter-hospital transfers and assumed (we believe, incorrectly) that the new hires the city plans to work for 60-hour shifts would not be subject to overtime rules. Most other ambulance directors have established staffing systems that avoid overtime to minimize this added cost.
Other services took pains to structure their paid on-call systems to benefit their volunteers. Yet the system proposed by Tower fails to do that. Indeed, none of the system’s volunteers applied for the 60-hour-long shifts when the positions were first advertised last May. No one with a family or a regular job could possibly work such a shift into their schedule. In Cook, volunteers are allowed to select any convenient time or length of shift that works for them and is consistent with the service’s staffing needs. Hoyt Lakes, after working with a consultant, went with four-hour shifts, which make it far easier for volunteers with a family or a regular job to fit in a shift or two on evenings or weekends— providing a nice supplement to their incomes. These volunteers are the lifeblood of any small ambulance service, and they should absolutely be considered in designing any paid on-call system.
At the same time, too many questions remain about how the city’s ambulance service can pay for its plan, which will cost at least $165,000 a year, including base pay, payroll taxes and other fringe benefits, and the cost to rent quarters for the workers. If the workers qualify for overtime, as is likely, that would push the cost to at least $190,000 a year.
While the city’s ambulance director contends that the city can generate that much additional revenue by accepting more transfers, the service only nets about $1,000 per run. And it already accepts 30 percent of the transfer requests it receives. Even if it took 100 percent of the remaining requests, it would have only generated about $160,000 in additional revenue this year. Yet no one we spoke with believes the service could responsibly accept anywhere near 100 percent of transfer requests. Ely’s ambulance only accepts about 40 percent of transfer requests it receives even with paid on-call staffing 24/7. Indeed, none of the departments we spoke to is willing to accept a transfer unless they know they have a back-up team ready to fill in. Bob Norlen, state EMS coordinator for northeastern Minnesota noted that a service’s first priority is to respond to emergency calls.
As he noted, there would be a lot of explaining to do if an ambulance and it responders were unavailable for an emergency because they were providing what is essentially glorified taxi service.
And that gets to mission, which is to respond to medical emergencies. Ambulance officials complain that increasing call volume is putting too much demand on its volunteers. Yet transfers comprised more than 20 percent of Tower ambulance runs that actually involved a transport in 2017. If the service is looking to relieve its volunteers, officials should consider reducing the number of transfers they accept and using its volunteers’ time for the purposes for which they are trained. At an average of six hours per transfer, the service demanded 864 hours of volunteer time just for transfers last year. Under the latest plan proposed by the ambulance director, the service would expend more than 2,700 staff hours on transfers.
Finally, rather than a focus on increasing transfers to generate revenue, the ambulance service should be exploring how it can up its game by transitioning over time to an advanced life support service, through the use of more paramedics. ALS services receive a higher level of reimbursement for emergency calls and provide a higher level of patient care.
But before doing anything, the city needs to fully understand the implications to mission, costs, and sources of revenue. This is too important to leave to back-of-the-napkin figuring. The city should rethink the current plan and design one that meets the needs of both residents and the service’s own volunteers.