Impact - Emergency Medical Services
The University of Massachusetts Medical Center (now UMass Memorial Health Care) began providing EMS services, that is emergency medical response and ambulance transport, to the City of Worcester in 1991. This occurred when Worcester City Hospital, which had previously provided EMS, closed. UMass Medical Center contracted with the City to operate ALS-level (Advanced Life Support) ambulances in the City on a 24-hour-a-day basis. For that purpose the Hospital purchased and maintained the ambulances and all associated equipment (including radios,) and hired and trained all personnel. EMS has been provided at no cost to the City and there has been no indirect cost to Worcester taxpayers. Hospital-based EMS means it is an integrated part of the Hospital's emergency department, overseen by a full-time medical director providing quality assurance and clinical oversight. The full range of UMass training and other resources have been available to the ambulance service paramedics. By all accounts, the paramedics have been delivering a high quality of medical care, while the arrangement saves Worcester's taxpayers the expense of operating a municipally-run ambulance service.
Yet beginning in 1995, two years before the first contract between the City and UMMC was to expire, the Worcester Fire Department began to express interest in taking over EMS. The Fire Department, which has been the City's "first responder" to 911 calls for emergency service since 1974, argued that it should replace the existing arrangement for two reasons: First, the Department could provide a higher quality of EMS; and second, it could add revenue to the City by providing ambulance transports for which patients would pay the Fire Department. The Fire Department's interest in providing EMS is part of a nationwide trend resulting from the substantial decrease in structure fires and the resulting quest by fire departments to provide another service so as to justify maintaining their staffing levels.
At the end of 1996, the Research Bureau issued a report evaluating the service provided by UMMC and the claims of the Fire Department to be able to provide a better quality, revenue-generating service. We found that contrary to the Fire Department's claims, EMS had adequate coverage of the City for the calls received, and was not experiencing an excessive number of coverage shortfalls. Response times were well within the guidelines established by the Accreditation Commission of the American Ambulance Association. Since the Fire Department never issued a proposal for operating EMS, it was not possible to evaluate the likelihood of EMS becoming a revenue-generating service for the City. However, by identifying the factors that were likely to affect that revenue, the Research Bureau concluded that its revenue-producing potential from ambulance service was highly questionable. Those factors based on the experience of UMass and other EMS providers included the following:
- Limitations that urban EMS providers face in collecting ambulance fees from populations they serve.
- Costs of providing EMS such as personnel and training costs; overtime, and injured-on-duty costs; capital equipment, medical supply and operating costs; vehicle insurance, malpractice and liability insurance; licensing, dues and billing costs - all of which are borne by UMass.
- The need to address the dissimilar character of, and functions involved in, emergency medical care and fire suppression, including the Fire Department's lack of background and experience in EMS; difficulty integrating EMS into current Fire Department operations and ensuring future availability of adequate resources from the City for EMS operations; and the willingness and capacity of department rank and file to assume this new role.
The Research Bureau findings were in evidence during negotiations when the contract between the City and the Hospital was renewed in 1997 and again in 2002. Since the Fire Department continues to press its interest in assuming EMS, the Research Bureau has continued to monitor the performance of the service through its reports benchmarking public safety. In 2004, the EMS response time was five minutes fifty-six seconds, its lowest during the last 5-year period. UMass Memorial has consistently demonstrated response times that are better (lower) than the industry standard of 90% of paramedic responses arriving on a scene within eight minutes.