1. Opinion

Editorial: Baby steps to EMS efficiency

Published Jan. 31, 2014

After years of studies and political fights over the future of Pinellas County's Emergency Medical Services, the bottom line remains the same. The system provides quality service but costs too much — and there is not the political will to make dramatic changes to EMS and fire departments to truly reform a complicated system. So county Administrator Bob LaSala's new pitch to county commissioners this week is a modest attempt to more fairly distribute costs and establish future limits on the county's expenses.

Pinellas' countywide EMS system is a hybrid Cadillac. City fire departments and fire districts respond first to car accidents and other emergency calls, and a private ambulance company transports patients to hospitals. The ambitious goal is to respond to at least 90 percent of the calls within 7 ½ minutes, and the actual response time is often faster. But there are no cost controls on what the county pays cities and fire districts, and some cities are essentially subsidizing their fire departments with EMS money. The county's escalating expenses in recent years have been covered by increases in the countywide property tax for EMS and by raiding reserves. That is not a sustainable system, but some county commissioners, city officials and fire chiefs have derailed more aggressive efforts to cut costs and increase efficiencies.

LaSala's latest proposal reflects the political realities and should be less painful to St. Petersburg and other cities. First, the county would make small adjustments to EMS payments to cities and fire districts over three years to make them more equitable and better reflect the true costs of the system. Three areas would divide an additional $765,000: Tarpon Springs, Palm Harbor and the Redington beach communities. Ten would remain flat, but five would see a total cut of $2.3 million: St. Petersburg, Clearwater, Largo, Pinellas Park and Lealman. St. Petersburg's cut would be $1 million of that total, but it would be spread over three years and should be manageable.

Aside from those adjustments, the county would freeze EMS payments for the next three years, which could force more efficiencies. For the next seven years after that, increases would be tied to a medical consumer price index or some other standard formula. The county estimates the payment freeze followed by the cap on increases would save more than $16 million over a decade, a modest amount for an EMS system that sends more than $40 million a year now to city fire departments and fire districts.

This is a far cry from more than two years ago, when LaSala hoped to save more than $15 million a year by changing the way fire departments are reimbursed and reducing the number of paramedics it pays to staff each unit. St. Petersburg stood to lose more than $8 million and threatened a lawsuit. That plan went up in flames, and more consultant studies and political grandstanding have yet to generate any savings in a system where the status quo can't survive in the long term.

LaSala hopes to rekindle the conversation with county commissioners Tuesday with this scaled-down alternative. The commissioners should listen closely and embrace this direction. Other critical aspects of state and local government have had to become more efficient, and EMS should be just as accountable. The harder conversations about restructuring the hybrid EMS system and downsizing fire departments will have to wait for the political will to build. If county commissioners can't take even this tiny step, they risk creating a bigger financial mess that will be harder to fix.