The City Council candidates are often asked at forums what ideas we have for generating more revenue for the city. Gary Sandberg has suggested that the City should provide its own ambulance service, severing its contract with Advanced Medical Transport (AMT). The way he sees it, we already have a professional fire department that is first on the scene and capable of providing basic life support (BLS); it would not take much to have these guys trained to provide advanced life support (ALS) as well.
Mayor Jim Ardis apparently heard about this and took up his pen to write an editorial in the Journal Star. He says:
During the current campaign for City Council, some candidates have suggested that the city consider starting its own ambulance service. As a 14-year veteran on the council, I have studied this question time and again and the answer is always the same. A city-operated ambulance provider will require a taxpayer subsidy from our general fund and lose millions of dollars each year.
AMT doesn’t receive a taxpayer subsidy. In fact, AMT pays the city a dispatch fee that generates $100,000 per year. We have a good medical emergency response system. It is not broken and meets the highest national standards defined to date. Private studies have provided the same conclusion.
Start-up costs to begin transport would be nearly $3.5 million for equipment and training. AMT writes off more than $2 million per year as uncollectable, bad debt. The company also discounts $5 million for Medicare and Medicaid. The city could not afford to lose a penny of revenue and still wouldn’t run this operation in the black. Simply put, transport is not a core service for our citizens.
…Our ambulance service agreement with our professional fire department is an idea that works. Adding to our already strained payroll is an idea that does not make sense.
I’m not going to dismiss Ardis’s criticism out of hand. But this explanation leaves a lot to be desired. Given the numbers put forth in this editorial, one has to wonder how AMT didn’t go bankrupt years ago. Why is AMT able to operate in the black, but the City of Peoria couldn’t? Since AMT is a not-for-profit organization, I took a look at its Form 990.
According to the 2009 Form 990 (the latest available), AMT’s total revenue was $11,696,795. That revenue went up every year from 2005 ($9,224,551) to 2009. Total expenses were $10,776,223, including the executive director’s salary of $256,549, the assistant executive director’s salary of $113,612, and the controller’s salary of $110,651. Considering they’re a non-profit company, and thus their services are priced accordingly, I’d say they’re doing pretty well, and have been for a number of years.
Again, I’m not saying that Ardis is necessarily wrong — I’m just saying his article doesn’t explain why AMT is able to make almost a million dollars a year and pay handsome salaries to its top brass, but somehow the City would lose money hand over fist if it provided the same service. I’m also unclear why we would have to “[add] to our already strained payroll.” Why couldn’t the existing personnel who are already BLS-trained also be ALS-trained? There would be training and equipment costs to be sure, but why couldn’t those costs be covered by the revenue the City would receive the same way AMT’s training and equipment costs are covered by the revenue they receive?
We need Paul Harvey to give us the rest of the story.
The PFD has ALS people and engine now. Peoria fire had a ambulance not long ago. AMT makes some money on non-emergency trasports, the city ambulance would not do that like East Peoria FD. But it still needs a serious look see. Heck the city wanted to buy the Water Co and spent lots of money in the prosess. This look see would not be nearly as expensive.
I had the same thoughts as I read the article. How could a private company make a profit but the city can’t? Something doesn’t add up. I’d like to see the city buy it out just so we wouldn’t have to see Andrew Rand’s smug, arrogant face all over town.
you need to check further into some of the numbers. Much like many other health care facilities, AMT writes off a significant amount of services for those who cannot pay. They also contribute “profits” to help heartland clinic (which benefits low income residents)and other organizations, even neighborhood projects. If the city ran the almbulance service, the salaries of the ambulance drivers would jump significantly and then there is the pension and benefit packages. Remember the city and the state government are already making huge contributions (or should be) to retirment funds. The city would not making contributions along the lines that AMT does, as you know, any “extra” money must be spent on the latest fad project, or some type of “funding” for re-election purposes. AMT also is paying fees to the city of Peoria, If you remember, they were used to shore up the city’s deficit budget a few years ago. What has the city done with that “extra” money. Given the projected deficit which will undoubtedly result in more layoffs and higher taxes, who would run the service after that? Who collects the payments from those who cannot pay for medical services? The city won’t be writing it off and you will see further red ink coming from your taxes to fund the shortcomings. Do some thorough homework on this before re-opening that can of worms.
AMT doesn’t make “some” money on non emergency transports, it makes “almost all” of its money there.
You see, there is no money in emergency transports to the hospital. Ask anyone at East Peoria Fire Department what the ambulance service costs the city, by the time you factor in cost of the ambulances and firefighters to staff them and the fact that you will never collect all the money you bill out, you lose money on an emergency-only ambulance service.
Contrast that to what AMT does. They don’t just come to pick you up when you call 911. In fact, they make most of their money from scheduled transfers, taking patients from a nursing home to a doctors office or hospital for tests. The 911 runs just add to this workload. If the City of Peoria took over emergency transport, AMT would still exist and make money on the scheduled work. AMT also is more profitable because they have a monopoly (they are owned by the 3 Peoria hospitals which means those hospitals and all their entities will always choose to use AMT even if another private service came to town) and because they don’t pay their workers very well. Their turnover rate is very high, in fact AMT higher ups call the company a “stepping stone” for people looking to get to another position.
A fire-based ambulance, like East Peoria has, doesn’t operate like a private company does. I think there are advantages and disadvantages to both, so no way is right or wrong, but Mayor Ardis is correct in his statement that starting an ambulance service would cost the taxpayers of Peoria big bucks and would never ever be a profitable venture.
Also, an EMT-Basic course is about 1 semester of training and you are ready to go. To get to the EMT-Paramedic level you need another year of classroom work plus about 700 hours of internship time in various settings. So, it would take quite a bit of training to get enough firefighters trained to offer ALS ambluance service. Since Peoria already has free (to the city) ALS service it would be hard to justify these costs and other startup costs. Additionally, the IDPH would never allow the city to take over emergency transports if they couldn’t offer the same level of care as AMT does.
Tony’s right. they have gotten rid of the EMT-I rating so all firefighters would have to jump up to EMT-P or at least, the ones on the bus. I don’t think the state is going to allow the city to take over transport as we would need to maintain the ALS rating on all shifts. That would require at least two paramedics or EMT-Ps on each shift just sitting and waiting for a medical call. Given that most of the fire calls are medical and given that having the PFD taking over for AMT, you would need about 20 people trained for each shift.
That said, AMT could just fold into the fire department but then, all that free service will cost the taxpayers money. I don’t see why mostly conservative people in this town want to put a private venture out of business. I know this is about jobs. I know this is about the fire department trying to keep its numbers up. But I don’t know if this is the best way. That said, some of the AMT people are about as unprofessional as you can get. So who knows.
I actually agree w the mayor. This is a bad idea. Until government is serious about running buisness like a bsuiness ideas like this won’t work.
My suggestion is to see how Rockford Fire does it and compare their numbers since they are a close comparable. They just added 2 ambulances to the current fleet of 5. Acouple of items are not completely true in the above comments also. And Paul is correct , AMT does contribute money and “in-kind” to the city but that jsut began apx two years ago….and it still isnt enough to cover what the city delivers to AMT. AMT could never meet the response standards and many times dont come close, w/o the FD, and that includes the volunteer FDs in the area also. Dont get hurt on a Sunday morning or you are in deep shit, I dont care what the powers-to-be-say. But do not be naive…AMT makes a huge amount of money wherever it comes from.
There are different ways to run ambulance services and can be tailor made to invidual communties…the way it is currently run may not be the most feasible, but closed mindedness thinking Mayors may never let us find out.
All city run services: Let’s see…… Dial 911 and then..”Press 1 if you need an ambulance Press 2 if you need a fire truck Press 3 if you need police Press 4 if you are a hostage Press 5 if you are holding hostages Press 6 if you want to order a pizza.
No, I think I’d let Rand run the ambulances…for now. If they lose money on hauls then it’s because of the great youth we have here in Peoria that shoot each other and can’t afford the ride even though they can buy the gun and it’s bullets
@Emtronics…I don’t think they buy the guns…
If AMT didn’t make any money on 911 calls, why did they fight so hard to keep doing them?
I’m not being naive, I know for a fact that the bulk of AMTs profit comes from transfers, not emergency calls. They fight hard to keep the 911 work because it is more money coming in and more work for the people that would already be working doing the transfers. I have been told they have up to 10 ambulances on the streets of Peoria.
The other thing is, the PFD can’t just train guys to be Paramedics and buy some ambulances. They would have to hire people just to staff the ambulances. Startup costs would be training, ambulances, supplies, and at least 30 new firefighters to staff the ambulances.
My guess is that if AMT uses 10 ambulances for 911 and scheduled work for their whole response area from the Peoria base, the PFD could probably get by with having 5 ambulances. Which would also make sense if Rockford has 7, Peoria is smaller.
I have lived in Chicago, Rockford and some much smaller cities, as small as 700. They have all had fire dept ambulance services. How do all these other cities make money at it and Peoria can’t. Peoria Heights has their own ambulances. Are they losing money?
When I moved to Peoria 4 years ago, I was shocked to hear there was no city ambulance service and city run water department. I can’t drink our water in Peoria and I’ve had to go to the hospital in AMT, and was not impressed by the service I received.
Yes, Peoria Heights is losing money. So are all the other towns if they have full time staff. Most small town fire based ambulances are volunteer, such as West Peoria or Tremont.
The insistence that Peoria NOT run it’s own ambulance company is political. The owner of AMT is Andrew Rand, who is a member of the Peoria County Board. The hospitals are investors in the ambulance company. That this is allowed to continue is ONE of the reasons change needs to happen at the Peoria City Council.
Paul Harvey died in 2009.
And now you know… the rest of the story.
“How do all these other cities make money at it and Peoria can’t. ”
Because we’re Peoria?
Billy, Peoria has never run its own ambulance company. AMT is what happened when all the little ambulance companies that used to exist and funeral homes stopped transporting and the only thing left was the old Mobile Medics which were based out of the hospitals. The hospitals got together and decided to offer transport for all levels of care, not just sending out Paramedics like they did before.
The arrangement to have a private company transport is VERY common in the EMS world.
Its also common to see a private company go out of business, just like what happened in Bloomington-Normal. Even privates have a hard time making money sometimes. Then, the local government has to step up and provide the service because the free market can’t.
I am no “fan” of AMT, but its existance is proof that some essential services can and should be provided by a private company, and not just absorbed by the government. The City is broke. What would be the justification for losing money on an ambulance service just because you can?
Billy, of all people you should believe that too.
Tony:
What you said could also apply to any other services the city provides.
Not ANY. Things that require legal jurisdiction like roads, police, and fire can’t be provided by a private entity.
Some things COULD be left to private enterprise, though.
Trash pickup is.
Most major road projects are contracted out.
Oh, yeah, and hotels and battery making.