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Pinellas County faces maze in quest to reduce EMS costs

Trying to figure out the best way to fix Pinellas County' emergency medical services system is a bit like trying to find a way out of a maze while scores of people shout contradictory suggestions.

What makes it even harder is that none of the folks offering suggestions are disinterested. They all have a stake in the outcome.

Elected and non-elected officials say they want to save tax money. But they also want to be re-elected or keep their jobs. Some are also caught in the eternal power struggle between cities and counties.

Firefighters, paramedics, emergency medical technicians and fire chiefs want to save lives but they, too, want to save their jobs and make good salaries.

And the folks who contract with the county to provide ambulance service want to retain the agreements and make a profit.

On Tuesday, the local head of Paramedics Plus, the company that runs the Sunstar ambulance system, and his attorney came to meet with the Times' editorial board to explain why the system is fine as it is.

Under Pinellas' current system, an emergency medical call to 911 means two vehicles are sent. The first belongs to one of Pinellas' 19 fire departments. The county collects property taxes and doles it out to the departments to provide the service. The overall cost: About $40 million.

The second vehicle is a Sunstar ambulance, owned by Paramedics Plus. The county bills the person who is transported to the hospital an average of about $500 and gives $240 of that to Paramedics Plus. The county keeps the rest. The amount that goes to Paramedics Plus: About $30 million from these fees.

The dual delivery system has come under fire from taxpayers who do not understand why it is necessary to have four or more paramedics or EMTs on every medical call.

Firefighters, fire chiefs and the city of St. Petersburg all have presented alternative plans that are variations on a theme: Let the fire departments take over the job of Paramedics Plus by transporting patients. They all say that will save money and time.

Not so, said Mark Postma, who oversees the Sunstar operation on behalf of Paramedics Plus.

"We haven't seen a profit here yet," Postma said.

Part of that is because of the startup costs. When Paramedics Plus took over five years ago, it bought 54 new ambulances. It has since added 10 more ambulances and a critical-care vehicle for a fleet of 65 vehicles. All need to be replaced at an estimated cost of $5 million. But Paramedics Plus is holding off until it finds out if the county will renew the contract, using the first of two three-year extensions.

Postma said the amount that various groups, including Medicare and private insurers, will pay for transport is going down. That eventually will affect how much the system brings in.

If the fire departments took over the ambulance service, they would have to find the money to pay for new ambulances, Postma said. If Paramedics Plus leaves, it takes its ambulances with it.

The fire departments would also face higher labor costs than Paramedics Plus. All 19 of Pinellas' fire departments pay more than Paramedics Plus — in some cases, substantially more. Labor costs are 80 percent of the price tag for the service, Postma said.

Additionally, the fire departments would still need to send two vehicles to most calls because it takes more than two paramedics to handle certain medical crises, such as heart attacks. Any savings based on the idea of eliminating dual response and sending one vehicle to all medical emergencies is a flawed analysis, he said.

Anne Lindberg can be reached at (727) 893-8450 or alindberg@sptimes.com.

Pinellas County faces maze in quest to reduce EMS costs 06/16/09 [Last modified: Tuesday, June 16, 2009 6:04pm]

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