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EMS: healthy service, weak funds



HUDSON—Columbia County’s Emergency Medical Services (EMS), which oversees ambulances operating in the county, faces new challenges. Last year, the county hired the consulting firm Fitch and Associates for advice on how to sustain its EMS through the next 10 years and last month Fitch presented its findings to the County Board of Supervisors and rescue squads. Fitch’s most important findings, according to county EMS Coordinator PJ Keeler are the needs to establish “proper controls” for taxpayer funds, to merge or coordinate participating EMS agencies and to standardize benchmarks.

In response to these findings, the EMS Advisory Board plans to meet in September and decide what actions to take.

“Systems should be designed from the patient’s perspective,” Mr. Keeler said on July 31.

In 2010 Columbia County revamped its EMS and became the first region in the state to set up a system of contracting with existing agencies to cover under-served areas, Mr. Keeler said. Under this program Columbia County “conscripts” ambulance services from local EMS agencies on an “as-needed basis,” providing both mutual aid and resource posting, the Fitch report noted.

There are currently five such agencies: Chatham Rescue Squad, Community Rescue Squad, Greenport Rescue Squad, Northern Dutchess Paramedics (NDP), and Valatie Rescue Squad. Together these five agencies cover the whole county, Mr. Keeler confirmed.

Community Rescue Squad serves Ancram, Copake and Hillsdale. NDP, headquartered in Rhinebeck in Dutchess County, also serves Clermont, Gallatin, Germantown and Livingston. The county pays those agencies for their services.

Initially the 2010 revamp met its goals. Response times to medical emergencies fell by 40%, Mr. Keeler said. More areas got timely service. The local agencies’ finances stabilized, the Fitch report said.

‘Systems should be designed from the patient’s perspective.’

EMS Coordinator PJ Keeler

But by last year, the situation had changed. Challenges included increased call volume, staffing shortages, off-load times at hospital parking lots, reimbursement expectations, inter-facility transports, and specialization of hospitals—which makes inter-facility transports more necessary. In addition, the Fitch report noted, each agency has its own overhead costs. They compete with each other for staff and share some staff, while a sharp increase in the cost of living in Columbia County makes it “difficult” for EMS personnel to live here.

Furthermore, the Albany Med Health System, Columbia Memorial Health’s parent company, has recently contracted with a private for-profit ambulance company, Ambulanz, to transport patients between facilities. Though this would reduce workload pressure on the county’s local ambulance agencies, it would also reduce their revenue, and that would increase the amount of taxpayer money local EMS services will need, Mr. Keeler said.

The county’s 911 Dispatch “is currently providing excellent communications services,” with proper controls in place for performance and quality assurance, “though it needs updating,” the Fitch report says.

Fitch says the contract system’s current model seems not to “provide optimum value for” its cost, primarily because of “limited controls in place regarding the county funds.” As solutions, the report recommends “more controls regarding the county funds,” and possibly merging agencies.

The Fitch report asks: “How or can the county alter response expectations to limit potential taxpayer subsidy? Ultimately the county and municipalities must determine what they can afford to ensure an equitable response and baseline level of service.”

Mr. Keeler gave reduced response times as an example of the system’s success up to now. He said that in addition to “value for resources invested,” benchmarks should include clinical outcomes.

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