Tenn. County Commissioners Leaning Toward Creating County-Operated Ambulance Service

Aug. 24--The Shelby County Fire Department could operate ambulances by early January, replacing American Medical Response after the company's requested contract modifications that could more than double the annual cost to the county.

On Wednesday, the commission's law enforcement, fire, corrections and courts committee discussed the AMR situation with county administration and Fire Chief Alvin Benson, giving every indication they'd support a fire-based ambulance service over changing AMR's contract or finding another ambulance vendor.

There are "some things government just does," Commissioner Reginald Milton said.

The net cost would be about $4 million a year, paid by the residents of unincorporated Shelby County, who would see an 8 percent increase in fire fees, or about $3.20 a month for the average homeowner, said Tom Needham, public works director.

Residents in Arlington, Lakeland and Millington also contract with the county for fire services. But those cities have different formulas for paying the county for the service.

Officials in those cities also back a county-run ambulance service, Needham said.

"We have a schedule in place right now that we will have ambulance service on the street by the first of January," Needham said.

And although there are leanings toward the in-house service, they also will investigate the feasibility of another outside vendor.

"It's just due diligence," said Harvey Kennedy, county chief administrator officer. "We're guessing that we know how it will turn out from a cost basis, all things considered. But I think due diligence says you look at all your options before you select one."

In 2013, AMR entered into a $1.7 million five-year contract with the county to provide ambulance services for the unincorporated areas and the three municipalities.

But in July the company advised Benson it was not making money under the arrangement and proposed increasing the contract by $2.8 million annually, by $2.2 million annually with the county staffing two of its ambulances or terminating the contract with 120 days' notice, which either AMR or the county is allowed to do.

The big negatives with a private provider are that it's expensive, the questionable value-to-cost benefit, the unpredictable subsidy increases and it's market- and profit-driven, Benson said.

The big benefit to a fire-based system is that a multi-trained firefighter responding to a wreck can extinguish the fire and stabilize the patient, said Benson, who, as the former director of the Memphis Fire Department, came from such a system.

"It is a proven model," he said.

Commission Chairman Terry Roland said he predicted this scenario when AMR's $1.7 million bid came in so much lower than the $2.9 million bid from Rural/Metro, which served the county for 15 years.

"I'm going to tell the people sitting right over there from AMR, shame on you. And if we can get rid of you, I'm going to support that," Roland said.

Officials with AMR attended the committee meeting and offered to answer any questions. The commissioners had none.

AMR had collections of about 33 percent, but that figure has dropped to 31 percent, said Rich Bartus, operations and finance officer for the South Region.

Because of changes in health care coverage brought on by the Affordable Care Act and high-deductible insurance plans, not enough ambulance users were paying their bills and AMR couldn't make the numbers work, Bartus said.

"Revenues continue to decline and our costs continue to rise. That's been our challenge for the last three years," he said.

Bartus confirmed they'll work with the county during the transition.

"At no point do we intend on abandoning the county," Bartus said. "We're going to work on a transition plan with the chief that makes sense, but at no point will the citizens not be covered by ambulance service."

Commissioners were also disturbed by the knowledge that AMR had raised concerns as early as March, but they were never told about the problems.

"Why were we not given any kind of notice that there was a problem?" said Commissioner Heidi Shafer.

Kennedy apologized, but said his training is to not "dump" a big problem without some recommendation for a solution.

Copyright 2016 - The Commercial Appeal, Memphis, Tenn.