Pinellas County's emergency medical services system is a gold-plated operation designed in an earlier era when property tax revenue was rising and cost was no concern. Now the system is no longer financially viable, and County Administrator Bob LaSala has proposed reasonable reforms aimed at maintaining response times while cutting expenses. St. Petersburg and some other cities complain the changes would be too expensive for their fire departments, but these would be modest adjustments that should be bolder.
Under the system established more than 30 years ago, fire departments are first called to car accidents and other medical emergencies. The firefighters/paramedics get there quickly and provide immediate medical help, then the private Sunstar ambulance company takes over with its paramedics and transports patients to the hospital. Cities and fire districts are reimbursed for their firefighters/paramedics from a countywide property tax. The ambulance company is paid through private insurance, Medicare or Medicaid that covers the patient.
The primary problem now is a countywide property tax no longer covers the cost of reimbursing the fire districts and the cities for the firefighters/paramedics, and the system faces a $16 million shortfall next year. Declining property values, property tax reforms and rising health care costs have created a situation that is not sustainable. The deficit has been covered by reserves for several years, but that money will be gone by 2013 and the system will be broke without significant changes. Add to that the funding inequities between fire departments and the overreliance on the countywide EMS tax to subsidize fire service, and the system needs an overhaul to make it fairer and more cost efficient.
Pinellas is pursuing two reasonable changes recommended by a consultant. The first proposes a greater emphasis on prioritizing emergency calls. A call for a broken ankle, for example, should not require the same urgency and manpower as a call for a heart attack. Those sorts of commonsense judgments already are being phased in.
The second change is far more controversial and involves changing the way fire departments are reimbursed. In broad strokes, the county would pay for the costs of more EMS units but reduce the number of paramedics it pays to staff each unit. That could save the county more than $15 million a year, but it would force cities and fire districts to reduce the number of firefighters or come up with the money to pay for them. For example, the change could cost Clearwater and Largo more than $1 million each. St. Petersburg would lose more than $8 million. While these cost shifts would be tough to swallow in some city halls, they would inject more fairness into the system and begin to recognize that the county EMS system cannot keep subsidizing fire departments at the current level. Yet St. Petersburg Mayor Bill Foster and the City Council are following their typical parochial approach, talking about attorney general opinions and lawsuits.
LaSala, who recommends raising the property tax rate for EMS service for 2011-12 to help cover the shortfall, plans to spend months selling these changes and hopes they will be in place for 2012-13. While they will generate controversy, they are modest compared to the broader conversations that should take place about further reducing costs, streamlining emergency medical services and consolidating fire departments.