At a special Oklahoma City Council meeting July 12, Fire Chief Keith Bryant presented the city’s “window of opportunity” to opt out of the Emergency Medical Services Authority trust and either hand over ambulance services to the fire department or have the city or fire department manage emergency medical services and contract with a private company to operate the ambulances.
But leaving the trust probably won’t be as easy as a simple City Council vote.
The current “window of opportunity” is provided in the trust contract, and the city’s fire department was asked by the city to formulate a working group to examine the matter.
A decision must be made by the council by Oct. 31, and if the city opts out, it would take effect Nov. 1, 2013.
EMSA is a trust established in Tulsa in 1977, and in 1990, Oklahoma City was added to the trust and two divisions — eastern and western — were created. Besides Oklahoma City, the western division includes Edmond, Yukon, Mustang, Bethany, The Village, Nichols Hills, Warr Acres, Piedmont, Arcadia, Lake Aluma and Valley Brook. The eastern division includes Tulsa, Bixby, Jenks and Sand Springs.
While Oklahoma City initially didn’t subsidize EMSA’s ambulance service, the economics of providing the service caught up with the western division and caused the trust to experience a deficit, according to the fire department report. A loan was used to keep the district sol vent, but revenue did not improve, and the city began providing annual support from its general fund to close the revenue-expense gap, the report states.
In fiscal year 2010, the city implemented the medical services program, which allowed city utility customers to take part in EMSA’s TotalCare program in exchange for a $3.65 charge on the customer’s monthly utility bill, the report stated. The fee is expected to generate about $7 million this fiscal year and allow the city to stop using money from the general fund to support EMSA.
EMSA’s western district is expected to have a $9.6 million shortfall this year, partially shored up with revenue from Oklahoma City TotalCare payers, the report states. However, that shortfall is expected to increase to $10 million in the next five years, requiring more money from those participating in the TotalCare program, according to the report.
“I’m not sure our system is broken, but we owe it to our citizens, I think, to take a look at whether we’re providing the best and most cost-effective way we can provide the service,” City Manager Jim Couch said at the meeting.
Fire Chief Keith Bryant, who delivered the report to the council, said there are several inefficiencies in the current system, such as dispatching a fire unit to most EMSA calls.
Even if the council chooses to maintain the EMSA service, combining the dual-dispatch system of EMSA and the fire department would save an estimated $1 million, Bryant said.
“If the council decides to stay within that current model, there are still means to be considered that we believe could result in savings to the system,” Bryant said. “We believe consolidating that function (would) reduce fire response to such calls by 20 percent.”
Couch said reducing such inefficiencies is one of the primary concerns of the council.
“That’s probably one of our least efficient things we need to address, regardless of which option moves forward,” he said.
EMSA president and CEO Stephen Williamson said EMSA was already exploring ways to reduce such redundancies, and the reason it is done that way is Oklahoma City asked that the two functions be separate.
Williamson also warned having the government take control would reduce efficiency and accountability.
“Where we might see some efficiencies in having the same group doing both functions, (the service) would lose accountability and efficiency of using the private sector, because they make their efficiencies and quick response times by having their best people down here,” Williamson said.
According to the report, switching to an ambulance service run by the fire department, which is the practice of most of the nation’s largest 200 cities, could give the city the maximum control and management of the system, increase efficiency and use of resources, consistent coverage using fixed geographic locations, improve employee retention, and reduce duplication in administration, training and equipment management.
Some of the disadvantages include personnel management issues with an increased number of employees, uncertainty of a major system change, risk of reduced revenue by contracting out for billing and collections, and the availability of civilian medical employees, the report states.
Couch said issues remain unknown, such as how the suburban districts that rely on EMSA would react, whether the revenue stream to fund the EMS system could be maintained, and Tulsa’s plans.
“I think there are three or four things that are really unknown at this time,” Couch said. “No one’s gone through pulling out of EMSA before.”
However, even if the city chooses to go out on its own, it may have a difficult time convincing everyone involved to do the same, which is a perquisite to dissolving the trust. OKC and Tulsa, which is also considering the matter, each have four trustees on the EMSA governing board, and two other trustees also come from both the eastern and western districts, respectively. Dissolving the trust must be first approved by each city’s governing body before being unanimously approved by the trustees, said OKC municipal counselor Kenneth Jordan.
If the proposal passes those hurdles, it must be approved by the governor before the trust is dissolved.
If the dissolution is unsuccessful and a city simply opts out, the trust still retains all of the assets serving the area, which could lead to litigation, Jordan said.