Voluntary Ambulance Operation Fee

[ny10570 745]

FYI Voluntary does not equal volunteer. Voluntary refers to hospitals operating ambulances staffed by paid EMTs and Medics in the 911 system.

From the Wall Street Journal.

By MICHAEL HOWARD SAUL

New York City will begin charging private hospitals as much as $1 million a year for hospital ambulances dispatched by the city's 911 system, a controversial initiative that some medical professionals fear will prompt hospitals to stop providing the service.

Mayor Michael Bloomberg approved the new fee as part of his administration's effort to combat a multibillion-dollar budget deficit in the fiscal year beginning July 1. The Fire Department, which runs the city's emergency medical services, began alerting hospitals to the policy change earlier this month.

The Fire Department has agreements with 25 private hospitals to provide voluntary ambulance services in the five boroughs. These hospitals account for roughly 37% of the ambulance tours in the city.

Full article

[Goose 188]

Ironic, seeing how badly the FDNY needs the privates...after all, without them there would be massive holes in the system...

[ny10570 745]

Where would there be massive holes? You mean like in the uninsured area covered by North General that no one from St Lukes/Roosevelt or Continuum tried to pick up? FDNY stepped in after Vinnys, North General, Mary Immaculate, St Johns, Cabrini, Vinnys Midtown, and OLM closed. Its just the insured communities around lower manhattan, queens, and downtown Brooklyn that the voluntaries fight for. Voluntaries didn't get their units by filling the gaps. They were given to them by a mayor and fire commissioner that had no interest in providing municipal EMS.

[PEMO3 523]

The sad part is the use of privates by the city in the 911 system is a double edged sword. Back when EMS was under HHC it was the only part of the agency that actual operated in the black due to its positive revenue stream. It was brought into FDNY not for management reasons but to bolster call volume at a time when fire call volume was deceasing but that is a different thread. The voluntary units as they are called were and still are, are know to "homing pigeon" well insured patients to their home facilities and "dump" medicare and indigent patients in the HHC system. If the city wanted they could easily increase the number of tours and there by remove the voluntary units from the 911 system, become self sufficient and gain control of the system instead of having multi-service system but that would be a political hot potato that no politician it his/her right mind would touch. Right now you have FDNY EMS units, FDNY EMS Supervisors, Voluntary units, Voluntary supervisors and a city system paid for by the city that runs it. Chief John Perugia is on the money when he say that the voluntary units should kick in for the benefits of the system. In effect it would be a "pay to play" system. I find nothing wrong with that. Lets face it the average FDNY EMS unit does 6 to 8 calls per shift and more than pays for itself.

[nycemt728 49]

This is penny wise and pound foolish. Ok so the city gets $$ from the voluntaries in order from them to play. But if as the article states, if many hospitals can't afford to play, they pull out. They pull out and what happens? FDNY has to either pick up the slack or face the music when response times go up. If they choose to pick up the slack, the money for those extra tours has to come from somewhere. The city is still crying broke, so how does this make sense?? This is simply another way for FDNY (both admin and union) to force the voluntaries out of the system; only this time they found Bloomberg as an ally. Anyone who doubts that should search for the letter that the FDNY union posted after North Gen closed telling its members to pick up the extra tours to show the other "non professionals" that they were not needed in the system.

What slack did FDNY pick up after OLM closed? OLM aka Monte still provides the same units it always has. Yes the ALS unit got taken away by FDNY, yet magically months later they were assigned another BLS in its place.

What costs does the city absorb? Perhaps one or two extra dispatchers and a few radios?.Certainly cheaper than a full out bus and crew. The docs would be on call anyway so no savings there. Correct me if I'm wrong but the city pays nothing to the voluntaries; it doesn't pay their bosses or crews. The bosses have no operational control, FDNY does.

I've said it once, I'll say it again, FDNY is not the be all to end all for EMS in NYC. I don't care who saves my loved one in an emergency so long as they do their job and do it right.

[abaduck 123]

I don't get this at all.

"The 911 system cost-sharing initiative would allow the city to recoup the costs associated with 911 system dispatch and telemetry that are currently borne by the city..." Excuse me, isn't 911 an essential service which the city HAS to provide? The notion of trying to 'recoup' those costs strikes me as... peculiar.

So what's next? Change 911 from toll-free to premium rate? That would raise money.

They're charging ambulances for using the system? Shouldn't they be *paying* for ambulances if the city needs them? If most of the tours are run by FDNY, most of the fee will be paid by FDNY, in other words the taxpayers?

As I said at the beginning, I don't get this at all!

[nycemt728 49]

Exactly abaduck, much of the costs that the city aims to recoup is already inherent to the system. You are also right in the sense that this will only work if none of voluntaries pull out of the system. Then the city will have pure profit. But in this current economy w/ hospitals in NYC closing left and right, I really don't see that happening. Emergecny medicine at hospitals is a losing business as it is...this cost can only make that worse.

I don't get this at all.

"The 911 system cost-sharing initiative would allow the city to recoup the costs associated with 911 system dispatch and telemetry that are currently borne by the city..." Excuse me, isn't 911 an essential service which the city HAS to provide? The notion of trying to 'recoup' those costs strikes me as... peculiar.

So what's next? Change 911 from toll-free to premium rate? That would raise money.

They're charging ambulances for using the system? Shouldn't they be *paying* for ambulances if the city needs them? If most of the tours are run by FDNY, most of the fee will be paid by FDNY, in other words the taxpayers?

As I said at the beginning, I don't get this at all!

Edited December 9, 2010 by nycemt728

[PEMO3 523]

What everybody is missing is simple economics. It is in the city's best interest to have FDNY run all of the EMS tours. On average a FDNY EMT costs the city with benefits approx $55 per hr. A BLS call bills on average $550 and ALS calls start at $800 on up. With the city doing 1 million plus EMS call per year recovering the 30 to 40% of the calls that go to the voluntary units amounts to big revenue. Even if they had to staff the extra tours it would still be a cost effective proposition. Problem is the voluntary units could not guarantee the "insured patient" revenue stream their home base usually gets as the city units would be more prone to transport to the closest facility based on the "10 minute rule". As far as OLM maintaining their ambulances after the Montefiore take over one only needs to look at the political weight on the Montefiore Board of Directors to answer that question. As far as the dispatchers already being there and the telemetry staff already on duty, you are correct but there is a separate issue that the article is pointing out. Why should the voluntary units reap all the benefits and be able to bill for the calls with out sharing the wealth if the city provides the support for their operation. Lets face it, everywhere else you have to support the dispatching organization, whether it be an answering service or 60 Control why not in NYC.