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Cha-ching! City sees green in EMS role

Emergency services would bring in cash; ambulance firms balk


Photo Credit: TRIBUNE FILE PHOTO - Portland officials say the city is taking a fresh look at possibly allowing the fire bureau to charge to transport people to local hospitals, much like private ambulance services.When an ambulance responding to a local 911 call drives someone to a hospital emergency room, the company sends a bill for up to $900.

But when Portland firefighters respond to the same call, even if they arrive first and perform vital lifesaving duties, the city charges nothing.

Now the city of Portland is exploring whether it can earn money by charging for its emergency medical services.

There’s a pipeline of new money flowing into the local health care system due to the Affordable Care Act and the increase in insured patients, says Alan Ferschweiler, president of the Portland Firefighters Association. “Everybody knows there’s money that’s going to be coming in, and everybody wants some of that.”

In this case, the Portland City Council approved a little-discussed budget note when it adopted the 2014-15 city budget in June. The two-sentence note directs the city to “reconsider the city’s role and potential reimbursement in regards to emergency medical response, including medical response services operating under a city supervising physician.”

It appears there are differing political agendas and motivations driving the simple budget note. As Ferschweiler observes, sometimes the smaller the budget note, the bigger the deal and the bigger the controversy.

Some ambulance paramedics and others fear the city could try to supplant American Medical Response by taking over its emergency transport duties — thus collecting those $900 payments.

In 1993, Multnomah County commissioners voted to have the city fire bureau do just that, supported by a young Portland city commissioner overseeing the fire bureau: Charlie Hales.

But the plan blew up when ambulance paramedics forced a 1994 ballot referendum, and voters rejected the fire bureau takeover — causing bad blood between firefighters and paramedics who work closely together on the scene of medical emergencies.

“There is interest in this building in taking a fresh look” at that transport role for firefighters, says city Commissioner Dan Saltzman, who oversees the fire bureau. But it’s not coming from him.

“Clearly, I think, the mayor’s office is interested in this issue, and I think the fire bureau,” Saltzman says.

Josh Alpert, Mayor Charlie Hales’ policy director, says the mayor has no “predetermined conclusions” on whether the fire bureau should again seek to handle emergency transport duties. “I think he is open to the entire spectrum of what’s possible,” Alpert says.

The idea grew out of city staff work on the budget, Alpert says, when it was an “eye opener” to see the significant role played by the fire bureau in emergency medical responses.

Randy Lauer, general manager of American Medical Response in Oregon, says the genesis of the budget note was the city’s desire to retain 26 firefighters whose positions were eliminated in the 2013-14 budget — but retained when the city landed a $2.3 million-a-year federal grant that expires next year. “I believe the message to the fire chief was to find $2.5 million to fund those positions from somewhere or you’re going to lose those positions,” Lauer says.

The spokesman for Fire Chief Erin Janssens didn’t respond to interview requests.

City commissioners, by adding the reference to a city medical officer for emergency medical services, also may be trying to put pressure on Multnomah County and its medical officer, Dr. Jon Jui. Jui sets the medical protocols that guide staffing of ambulances and dispatching of fire and ambulance crews on 911 calls. Saltzman says Jui is too cautious and winds up requiring too many personnel be deployed to medical calls, driving up costs.

“He’s, in my opinion, been the main obstacle to the deployment of more effective solutions,” Saltzman told the Portland Tribune editorial board during his spring re-election campaign.

Officials at Multnomah County Emergency Medical Services declined comment for this story.

Ferschweiler, who handles paramedic duties on fire bureau calls, says Jui is cautious, but that has resulted in a higher “save rate” for people suffering cardiac arrests in the county. “He is having people walk out of the hospital that never should have been 15 years ago, and that is due to him.”

Ferschweiler likes the idea of having an independent county medical officer, who can function much like a “special counsel,” rather than having someone subject to control by the fire chief or politicians on the City Council.

Ferschweiler and Lauer also say Jui has been more accommodating in recent months, including supporting Saltzman’s initiative to deploy more two-person crews in SUVs on lower-level 911 medical calls instead of four-person fire engine crews.

City Commissioner Steve Novick, who oversees the Bureau of Emergency Communications — which runs the 911 dispatch center — says he’d like to see if there are some ways the fire bureau can be reimbursed by the medical system for the work it does. However, Novick sees no need to take over the ambulance transport system.

Novick and others want to change what some call “perverse incentives,” whereby firefighters get no reimbursement and ambulances are only paid if they take someone to costly hospital emergency rooms.

The city is working on a pilot project with Health Share of Oregon, the new Coordinated Care Organization for the tricounty area’s Oregon Health Plan recipients. People who call 911 for lower-level health issues are being transported to clinics instead of emergency rooms, with transport by a cab instead of an ambulance. A $50 cab ride instead of a $900 ambulance journey “seems like a no-brainer,” Alpert says.

Fire Chief Janssens now is preparing a report to review various money-raising ideas for the bureau. Saltzman says he’ll meet in coming weeks with county leaders and others, in preparation for a City Council work session on the issues by year-end.

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