Ambulance companies to fill gap left by largest provider
By Reggie Ellis
Visalia – Tulare County may be losing its largest ambulance provider, but local emergency medical officials say residents won’t see the difference.
On May 19, American Medical Response (AMR), part of the nation’s largest ambulance service, announced that it would be shutting down its Tulare County operations by Aug. 31, 2016. AMR, which began operating in Tulare County in 1981, stated in a Feb. 24 letter that it was considering closing its local operations unless it could negotiate wage concessions with its union and obtain a consensus from the other ambulance providers on a rate increase. In her May 19 letter addressed to the Central California Emergency Medical Services Agency (CCEMSA), which oversees ambulance service in Tulare, Kings, Madera and Fresno Counties, AMR’s Regional Director Cindy Woolston said the company was unable to do either.
CCEMSA Director Dan Lynch said AMR responded to almost a quarter of Tulare County’s annual call volume. Of Tulare County’s 46,000 emergency calls for service in 2015, AMR responded to just under one-third of those calls. AMR also handled 34% of the transports for patients released from local hospitals to other facilities or to their home.
“This was a business decision and other ambulance providers here don’t have the overhead costs that AMR had,” Lynch said. “Local companies are more able to live within their means in Tulare County.”
While that seems like a huge void to fill, there are still seven other ambulance providers covering calls in the County – including Dinuba Fire and Ambulance, LifeStar Ambulance in Tulare, Imperial Ambulance in Porterville, Exeter District Ambulance, California Hot Springs Ambulance, Camp Nelson Ambulance and American Ambulance of Visalia. Lynch said AMR is the only ambulance company with offices in two cities (Visalia and Porterville) but other companies will only have to absorb about 30 calls per day Visalia and 7 calls per day in Porterville. “American will close the gap in Visalia and Imperial will easily fill the gap in Porterville. The other providers have been meeting on this since February,” Lynch said.
Lynch said American Ambulance is also gearing up to take on AMR’s call volume in Lemon Cove and Lindsay. Both areas were originally gaps in the system that were filled through a posting rotation between three providers – AMR, Imperial and Lifestar in Lindsay and Three Rivers Ambulance, Exeter District Ambulance and AMR in Lemon Cove. Lynch said Imperial has agreed to take on the additional rotation in Lindsay and American will take on more shifts in Lemon Cove as the all-volunteer Three Rivers Ambulance stepped out of the EMSA contract in 2010 because they could not meet the requirements for paramedics to staff every ambulance.
In his annual report to the Tulare County Board of Supervisors on May 24, Lynch described the multi-provider system in Tulare County as the strongest in Tulare, Kings, Fresno and Madera Counties. Since 2009, nine ambulance companies have worked together to dispatch the closest ambulance to calls throughout the county. That year providers started meeting as the Ambulance Providers Association of Tulare County and worked out a system to dispatch the nearest ambulance regardless of previously established territories. The providers also created a single dispatch called the Tulare Consolidated Ambulance Dispatch in order to track where every provider’s ambulances are to reduce response time. In 2015, County ambulance providers exceeded the 95% compliance threshold of responding to life-threatening calls within 10 minutes 98% of the time.
Supervisor Allen Ishida said he was thankful that the supervisors allowed the companies to work out their differences despite a recommendation from the Health and Human Services Agency to move to a single provider system.
“This board had the wisdom to keep the system of providers that we have now,” Ishida said. “If we had decided to go with only one provider and then that provider decided to leave we would be in a world of trouble.”
AMR’s Visalia office met its compliance standards for response times in every month, but the Porterville office fell short of the 95% in both January (93.7%) and November (94%). The only other ambulance company to fall short in response time for emergency calls was Exeter District Ambulance with 94.1% in January. But the two providers filling the gaps in those areas (American and Imperial) exceeded the standard in every month last year.
Lynch said the biggest financial obstacle for ambulance providers like AMR in Tulare County is the number of residents without health insurance. About half of Tulare County’s population is enrolled in Medi-Cal, according to the California Department of Health Care Services and the reimbursement rate for ambulance providers has dropped steadily since the 1990s. In fact, Lynch said providers are only reimbursed for about $106 on each transport, lower than the rate in 1999, and about $500 less than what it costs to provide the service. Even those enrolled in Covered California, the subsidized public option for low income residents who don’t qualify for Medi-Cal, can’t meet the high deductibles of up to $5,000 per year. This is compounded by the lack of non-emergency medical transports, such as wheel chair vans, operating in the area.
“Insurance companies have started refusing non-emergency transports to the ER, and when the insurance doesn’t pay typically no one pays the bill,” Lynch said. “But the providers continue to provide the service and aren’t allowed to refuse medical transport to anyone.”
Supervisor Phil Cox asked what AMR is doing with the 71 employees it employed out of two offices in Tulare County. Cindy Woolston, regional director for AMR, said the ambulance company is building a list of employees who want to transfer out of the area and help with the process of finding employment with other providers for those that want to remain in the area.
Paul Main, president of American Ambulance in Visalia, said his company is committed to hiring more people and putting more than $2 million into ordering new or replacing aging ambulances in its fleet. “We are working with AMR and national recruiters to hire additional paramedics and EMTs.”