20 Tough Questions For the Fire Chief: Are You Prepared To Answer Them? Question 15

This question is a continuation of last month’s discussion about fire-based EMS. While it is widely considered a best practice by efficiency consultants to benchmark and compare your organization to others, this question implies, ironically, that such a...


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EMS transportation creates a demand on resources that should be considered prior to entry. Depending on community demographics, the size of the community and the location of hospitals, the resource commitment to provide transportation services can be significant. While it may not be broadly known throughout society, issues with how healthcare is managed nationally have an impact on EMS systems. For many citizens, their first (and only) means of medical care is through the hospital emergency room. Often, the perceived means of access to the healthcare system (for medical issues as non-emergency as poison ivy or constipation) is through EMS transportation to a hospital. This has led to a tremendous load on the EMS system and a fair amount of system abuse.

Only a small fraction of EMS transports are truly emergencies. A vast majority of patients transported did not need to be taken to the hospital emergently by ambulance. In fact, most didn’t need care or treatment in a hospital at all. But the absence of alternative means of transportation and alternative forms of healthcare have created a system ripe for heavy use (and abuse). EMS providers know the system is broken, but the issue is much larger than EMS. In fact, EMS in many respects is a victim of failings of the broader healthcare system.

Nonetheless, until the system gets fixed, EMS will be saddled with the responsibility of responding to every call for service and providing transportation services to hospital emergency departments for patients who really did not need the service.

Paying the bill

The challenge is compounded when customers do not have a means to pay their bills for EMS transport services. For those who cannot pay, government then assumes the financial cost of providing the service. If those without a means to pay become system abusers, the drain on city resources can become significant.

One exercise worthwhile is to determine the fixed costs to provide EMS services. These would include facilities, vehicles, equipment, personnel, training, utilities, insurance and opportunity cost (the cost of lost productivity for other things the staff might have done had they not been on an EMS call). These are the costs that would not change based on the call volume. Next, calculate the variable costs. These are the costs that would change based on the call volume. Examples would include supplies, fuel, maintenance and billing-services fees (if the fee is based on a percentage of billings). Based on fixed and variable costs, calculate the average cost per call for service based on an estimate of the number of calls. Keep in mind the cost of a transport will be greater than the cost of a non-transport, so estimate the percentage of EMS calls that would result in transports.

 

Richard Gasaway presents “Fireground Command Decision Making and Situational Awareness” at Firehouse Expo 2013, July 23-27 in Baltimore, MD.