TO: Mayor and City Council
THROUGH: Keith Stahley, City Manager
FROM: Mike Niblock, Fire Chief
SUBJECT:
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Salem Fire Department Proposal for the Reintegration of Ambulance Services: Implementing the Ambulance Operator Model under Fire Department Oversight.
Ward(s): All Wards
Councilor(s): All Councilors
Neighborhood(s): All Neighborhoods
Result Area(s): Safe and Healthy Community
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SUMMARY:
summary
An EMS Valuation & Optimization Study for the Salem Fire Department conducted by AP Triton provides the comprehensive analysis to establish actionable benchmarks and propose tailored recommendations for sustainable ambulance transport within the City of Salem. The study recommends Option #2, the Ambulance Operator Model, which capitalizes on the specialized skills of single-role paramedics and EMT Basics to enhance efficiency and effectiveness in EMS operations, while projecting sustainable net revenue over expenses. This model is projected to facilitate further investments into the Emergency Medical Service (EMS) infrastructure, ultimately serving the best interests of Salem's citizens and the City's fiscal health. The implementation and operation of the recommended model will require close oversight and coordination by the fire department to ensure the successful deployment and delivery of emergency medical services.
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ISSUE:
Shall the City Council authorize the City Manager to allow Salem Fire Department to proceed with the approval of Option #2 (Ambulance Operator Model), designating the Fire Department as the exclusive provider of Ambulance Service starting July 1, 2025, thereby discontinuing the practice of subcontracting with an external contractor for ambulance services within the community?
RECOMMENDATION:
recommendation
Authorize the City Manager to allow Salem Fire Department to proceed with the approval of Option #2 (Ambulance Operator Model), designating the Fire Department as the exclusive provider of Ambulance Service starting July 1, 2025, thereby discontinuing the practice of subcontracting with an external contractor for ambulance services within the community.
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FACTS AND FINDINGS:
AP Triton was contracted to perform an extensive Emergency Medical Services Valuation and Optimization Study for the Salem Fire Department to set practical benchmarks with clear outcomes. The objective was to offer specific recommendations to ensure the sustainability of ambulance transport in Salem. This analysis gave the city critical insights regarding the financial implications, potential weaknesses, and risks associated with its EMS and ambulance services.
Following established best practices and standards, including the NFPA 1710 guideline for fire suppression and emergency medical services, AP Triton's study drew on the expertise of its specialists, focusing on the well-being of Salem's community, the fire department, and its staff. AP Triton recommends the Ambulance Operator Model (Option #2) as a strategic choice for Salem, emphasizing the utilization of specialized paramedics and EMT Basics to boost EMS efficiency and financial sustainability. This option is expected to create a stable net positive revenue, allowing for reinvestment in EMS resources.
The research further suggests increased involvement in the Ground Emergency Medical Transport (GEMT) Program, which provides improved reimbursement rates for Medicaid services. This would benefit the Salem Fire Department and the EMS Enterprise Fund. It is recommended that GEMT funding be expanded to solidify the financial foundation of this program for the benefit of Salem's community and the EMS Enterprise funding framework.
Additionally, a reevaluation of transport fees is suggested to improve revenue. The current private ambulance provider's suggestion for a 25% fee increase to boost recruitment and meet contractual obligations is supported by financial analyses, indicating that such adjustments could solidify the economic foundation for reintegrating EMS services within Salem and ensuring its long-term financial health.
By adopting Option #2 and effectively leveraging GEMT funds and adjusted transport fees, the initiative is poised for financial and operational success, aligning with the best interests of Salem's citizens and the EMS Enterprise Fund's stability.
BACKGROUND:
For the past two decades, the City of Salem has relied on a contracted private ambulance service to provide ambulance transport services to the community. This decision to outsource ambulance services came after the Salem Fire Department had been the sole ambulance transport provider before July 2005. The shift away from the Fire Department's direct involvement in ambulance transport was primarily driven by financial considerations, precisely the challenges posed by low Medicaid and Medicare reimbursement rates at that time.
Fast forward 20 years, the current private ambulance service provider faces difficulties maintaining the required deployment levels stipulated in the contract. This has caused the Fire Department to expend $3.3 million overtime dollars to subsidize the EMS System to ensure appropriate service delivery to the public, dating back to November 2021. This operational strain has prompted a reevaluation of the existing service delivery model. The proposed solution involves a strategic realignment towards reinstating the Salem Fire Department as the primary provider of ambulance transport services. This transition is supported by various factors, including the recent implementation of increased fees, the availability of Ground Emergency Medical Transports (GEMT) Funds exclusive to public entities like the Salem Fire Department, and the adoption of single-role medics andEMT basics within the department's structure.
Moreover, it is essential to note that the third-party contracted study incorporated input and data from the Salem Fire Department and Falck Ambulance, ensuring a comprehensive and collaborative approach to identifying the most effective and sustainable ambulance service delivery model for the City of Salem. By leveraging the insights and expertise of all stakeholders involved, the City is poised to implement a transport system that addresses current challenges and aligns with the evolving healthcare landscape and community needs.
MIKE NIBLOCK
FIRE CHIEF
Attachments:
1. SALEM FIRE - EMS VALUATION STUDY