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Original post made
on Oct 24, 2012
Seems the Weekly people deleted my first postingso let's see if this one survives their censorship
The Palo Alto Fire Department's expenditures have been pushing 30M, of late. The $1.3M in savings cited in this article amounts up to just over 4%. If both the Police and Fire Department budgets are consideredthe savings is barely 2%. Given the claim that this is a major "reorganization"where's the savings? This money could easily be gobbled up in the next big pay raise for this Department.
The PA Finance people make it difficult to determine the total costs of running any department in their published budget. So, the capital costs of the "reorganized" department needs to be considered, before we fully can appreciate any real impact of this change. The article doesn't seem to ask: "what will be the cost of ambulance services to the residents in the future?"
We desperately need an analysis of:
1) Outsourcing ambulance services to the private sector
2) Merging the Fire Department with nearby cities.
While the narrative of this change sounds good, it's not clear that the savings will end up being very large.
Why can't firemen be firemen, and paramedics be paramedics? An employee with both sets of skills is bound to be much more expensive, salary-wise, for the city.
We simply do not need as many fire stations as we have here in PA. CDF needs firefighters far more than we do, especially in the dry months of the year.
I agree with Wayne, who obviously does the math, that we should contract out for paramedics and EMTs, and pool resources with nearby cities for firefighters. Then we would have a noticeable savings that would make a dent in the city's deficit.
It really is not very hard to do the analysis. The PA ambulance service pays for itself and subidizes part of the regular Fire budget. Contracting out the abulance service would reduce ambulance revenue and endup costing the City.
Also the saving cited in the story were for ONE QUARTER not a year - at least read the stories.
I too agree with Wayne. By outsourcing and merging, the city would no long have to pay into these huge pension and medical costs. Also, savings on the high salaries and overtime costs too. According to reports, in less than 10 years, most cities will be paying more into the pensions than salaries each year.
Are you kidding me?? honestly? There are going to need more ambulances to transport the administration of PA, City Council and this paper!!!
To whom is it new news or a new idea that EMS is a huge portion of what FD's do??? Nobody I know who has a pulse would tell you this is a new concept.
The City of Palo Alto for over 20 years was staffing an ambulance with overtime at the direction of the City Council and City Manager.
The firefighters (I encourage the newspaper to fact check for themselves) has been begging the City to hire more paramedics and quit staffing ambulance with overtime and instead staff it properly!!
PA was one o the last cities in the Bay Area to make being an EMT a basic entry requirement!! most depts required that over 20 years ago!!
The City is saving money on overtime because Station 7 was shut down and the City hired over 20 firefighters and paramedics last year!! the Study had nothing to do with it!!
The firefighters themselves and their union has been asking the city for many years to improve EMS services, now the City does one thing the Union was asking for for decades and the City and City Council want to take all the credit for the "new direction"!!
Again, how about this paper do some old school reporting and look into who and when actualy brought up the "new direction" of improving EMS service!!
Also did anyone look at the fact that the PAFD has been providing paramedic sevices since mid 1970's?? If the neeed was such then and the amount of calls has only increased by te thousands since then, than why is it a mystery to anyone that the one ambulance staffed in 1970's would not be enough to handle call numbers?
Again, The City Manager and City Council staffed a part time 12 hour ambulance with OVERTIME 365 days a year for 12 hours a day!! It was not the firefighters or Unions call, now the City actualy hires postions to staff it properly and they pat themselves on back over the common sense move.
News flash Palo Alto, EMS is not a new direction for FD and it has been a standard service delivered for about 40 years.
Good luck with that. The city wants to hire firefighters with more skills, but respect them less and pay them less. Anyone thinking of taking that job needs to know that any time money gets tight the city will try to take it out of the department budget.
I don't understand comments like this one: "Contracting out the ambulance service would reduce ambulance revenue and end up costing the City."
If that were true, then why does every other city or agency in Santa Clara county - including San Jose and County Fire - contract out for ambulance service? If running a service was indeed a money-maker, would not all of these other cities do it too?
Many of the other depts in the valley would like to offer transport service BUT, they are not allowed to by law. The PAFD is allowed to because they were doing it prior to the private ambulance companies lobbying to pass bills preventing FD's who were not already providing transport from starting that service.
The privates want the profit and they did not want FD's providing transport. Check it out news service if you want to.
I forgot to post, regarding ambulance transport details.
Commonly known as 201 Rights, or EMS Act 1797.201
Deals with who and who cant provide transport services.
The private sector needs to make a profit, but is balanced by the fact that there is competition. In theory, outsourcing doesn't make sense if the city operates efficiently.
However, with no competition and rampant union influence, the city is currently so inefficient (we pay close to double in total comp. vs. what would be required to pay to staff any given govt. position given the above market pensions, union-driven work rules, job security, relative lack of accountability, etc.)
Definitely much more savings can be had outsourcing. We're still on the hook (or our children will be) for 100K+ pensions when these firefighters retire in their 50s. The sooner the better.
"If that were true, then why does every other city or agency in Santa Clara county - including San Jose and County Fire - contract out for ambulance service? If running a service was indeed a money-maker, would not all of these other cities do it too?"
Most counties have ambulance service contracts covering the entire county - the City of Palo Alto is the lone exception in Santa Clara. The ambulance companies make a lot of money in cities but lose money in the coverage of outlying areas and Santa Clara has many outlying areas. The payment for service (mostly insurance) in cities subsidize the service provided to outlying areas. So city dwellers subsidize rural dwellers. That is not the case in PA - PA is not subsidizing service to the rest of the county and instead use the "profit" to help subsidize the remaining Fire program. PA makes a lot of money providing the ambualance service and by the way they have had to rely on private ambulance companies to fill the gap between what they can provide and what the real needs are. PA is now adding more ambulances because they can make more money by doing so - they are adding business that they could not cover before.
The other cities in the county are locked into the County ambulance contract so they can not do what PA is doing.
It's nice that this ambulance service is making money, but the city still has to pay into the pension fund and provide medical and salary for these employees. The city would no longer have to do this if this service was done by a private company. I'm sure the savings of outsourcing would be a lot greater than what this service is bringing in.
You miss the point - if PA goes to private company they will have to use the County provider and the county provider will take the revenue and lose the subsidy currently going to Fire. Ask the City for details. Come on if the City was not making money (even after accounting for Pension costs) on the deal then do you really think they would be expanding the program? You based your comment on an uninformed opinon so go to the City and educate yourself!
A private ambulance company needs to cover direct costs, lots of overhead and profit for the shareholders. They also need to cover all of shortfall caused by having to cover all of the rural areas of the county. On top of that the county takes a cut. PA may have higher direct costs but they do not have the other burdens and the bottom line is the PA and it's residents are better off having a dedicated service. Los Altos Hills relies on the County service - less reliable response times and a lower level of service - not something I look forward to in the event of a medical emergency.
> less reliable response times and a lower level of service
> not something I look forward to in the event of a
> medical emergency.
Comments like this abound on these blogs when public safety is discussed. Without an unbiased report from an outside audit agency, there simply is no evidence that claims like this one are actually true. These sorts of claims are an insult to our collective intelligence, as well as the local governments of each of Santa Clara County cities that contract with the private sector for ambulance services. Keep in mind that people who are experiencing health care emergencies are "on the clock"so if ambulance services become "unreliable", then the mortality rates associated with these services would become noticed, and the local governments would be forced to make changes. These changes would have attracted public notice.
It's a real shame that we don't have a Palo Alto Auditor that would take on the task of obtaining the data from other cities, to provide hard data about these aspects of 'in house" vs "out house" services providers.
You could call the PA Finance dept - it is pretty simple to get reliable information.
As for my comment "and a lower level of service"
The County private company provides one Paramedic and one EMT per ambulance versus two Paramedics on a PA ambulance - so yes there is a different level of service. Call the SC ambulance provider and ask them. You do not need an auditor - just the will to learn.
The studies by ICMA and Tri Data were completed as well as an Emergency Medical Services study. If you did a little bit of research you would have found out that the PA ambulances not only provide an excellent service, but they clear over $2 mil per year AFTER operating costs. This money goes to the the City's General Fund, and not the Fire Dept. The study also showed that by adding another ambulance would "capture" the emergency medical calls that were missed and handled by the private count ambulance, who in turn, are getting paid and that moey is NOT going to the City. Why would you want to cut a sevrice that pays for itself and then some??
There are advantages to keeping ambulance services within PAFD beyond the bottom line. In my time in PA I have been a bystander to several major medical incidents/accidents, and I have never met a more motivated and effective department than PAFD.
Having worked with private sector ambulance companies that couldn't keep their rigs stocked properly, with large turnover and burnt out employees in bad shape, I really appreciate knowing that I would be getting the best possible care from PAFD.
I am always surprised to hear people say we don't need fire stations - there will always be fires, car accidents, entrapments and hazmat spills. A few weeks back I was in a major Californian city where I walked up on an assault victim who was semi-concious and bleeding. It took 25 minutes for the local fire department to show up - it felt like an eternity. In my experience PAFD's response time has always been extremely fast; the official numbers state the average response time is around 5 minutes. It is reassuring to me that PAFD has the resources to provide prompt and effective medical care.
For anyone claiming that private sector ambulance services are not "reliable", I would ask that you provide the following information, based on yearly activity:
Name of ERU provider?
Average time of ERU arrival at incident site?
Number of people dead on arrival of ERU?
Number of people who expired during transport to hospital under care of ERU?
Number of people who expired within first 10 minutes in ER after transport by ERU?
Average transit time by ERU to local hospital?
Average charge per incident by ERU?
Average time spent stabilizing patients before transport by ERU?
Average number of ERU assigned to incident?
from the following local cities
Without having this sort of data at our disposal for review, there is simply no way to say that the Emergency Response for a given city, or ERU-provider, is "unreliable". It's hard to believe that the billing systems, and/or the Emergency Dispatch systems, of each of the ERUs servicing these cities don't have the data necessary to provide a meaningful view of the ERUs performance
> You could call the PA Finance dept - it is pretty
> simple to get reliable information.
Really, have you ever called the Palo Alto Finance Department and asked for data on the Fire Department's total yearly expenditures? Some times that Department responds, and sometimes it doesn't. (I've been waiting for two years for data on the Palo Alto Airport which was promised. So farnothing.)
This area of "total costs" are not always straightforward. For instance, Palo Alto doesn't seem to include the long-term costs of providing site/land and inter-departmental cross-charges in its yearly published budgets. There are so many ways to "hide/bury" costs in any accounting system. The City of Palo Alto is no different. In the past, pension costs were nominal, now they are not. Post-retirement health care should be included in the Fire Department's yearly total-cost accounting. Disability payments are often funded not from the General Fund, but some sort of insurance that more-often-than-not does not show up as a direct expense against a departmentwhile the employee on disability was injured performing duties associated with emergency response.
We are long past the time that the City began reporting true-costs to the residents, and the Council. We would probably find that the actual costs for providing any department's services are anywhere from 15%-25% higher than are reported under the current scheme.
> Better levels of service
The previous posting asking for hard data on EMS responses should have made a clear point that simple, anecdotal, observations hardly qualify as the basis for making policy decisions on minimum service levels for public safety responses. It's just not clear that having more people respond to an incident really increases the "quality of service" to the person needing attendance--while it is clear that the costs go up for these "high levels of service".
For instance, I was in a store not too long ago when an elderly lady fell down. The store employees called 9-11. There were so many EMSers on the scene that I took notes
12:05: Elderly lady seems to have fallen down and sprained her knee. Four emergency vehicles have arrivedthree from the PA.FD, and a private sector ambulance. There are six PA.FD EMS people, and someone in civilian clothes attending to the woman, who is not otherwise in distress, other than her knee. At least one Fire Captain on the scene.
One of the PA.PD vehicles broke down outside store. Took a while before a tow truck appeared.
It's not clear why so many units needed to be assigned to this particular incident. As it turned out, the store where this happened was within two minutes of a fire station, so if more than one initial unit were to have been required, it would not have taken long for additional unit(s) to arrive.
The point here is that a smaller response of only one unit would likely have been all that was necessary to determine the lady's physical state, and immediate medical needs. This "higher level of service" was wasteful, and suggests a review of the need for such a high level of personnel assignments for non-life threatening "emergencies".
How about we cut firefighter compensation in half, about to where market level is, and hire both a firefighter and a paramedic? I think everyone will be better off (except overpaid public employees).
I get a little annoyed at people like you who twist my comments to fit your purpose, whatever that purpose may be.
I did not say the county service was unreliable - I did say "less reliable response times" and that is absolutely true. I had a neighbor who called for an ambulance and after it arrived the driver said they had to drive from Los Gatos. Obviously that does not happen all of the time but it does happen because there are a limited number of trucks. I suppose something like that could happen in PA also but at least they have dedicated trucks so it is less likely.
You seem to have very poor reading comprehension so stop complaining and get your own information. It is no wonder why PA Finance does not call you back!
When you call 9-1-1, it's supposed to be for a life threatening emergency. That is what is taught to first graders.
So when someone calls 9-1-1 and the conversation is "I have a lady whose on the ground", the immediate alarm bells is "woman unconscious!" Or otherwise in serious trouble. You sure as heck want the cavalry on a call like that. And in fact the dispatchers in Palo Alto act very quickly to send help.
If it turns out that the people calling might have overreacted a little- so it WASN'T a 9-1-1 LIFE THREATENING emergency - then hey, no big deal. So they called out the big guns when it was not necessary. But what if it really was someone who was having a heart attack or possibly even their heart stopped? (Which, remember, is why someone is SUPPOSED to call 9-1-1.) Seconds and minutes literally count and you don't want to mess around with interrogating the 9-1-1 caller to see if it's REALLY an emergency before sending out an emergency response. I sure as heck know that if my loved one was dying, I would not want a crew of two people trying to arrive and then call for backup. If it happened in a hospital, a heart attack patient would be swarmed by a crowd of medical providers - certainly not just two.
To blame the fire department that there were "too many people" on scene when someone decided to call 9-1-1 - you know, the EMERGENCY phone number - is ridiculous.
A 911 call for a medical emergency in PA and most cities on the peninsula will result in the closest FD unit (3 people total usualy) and an ambulance (2 people). Total of 5 usualy.
911 callers report emergencies, ie someone fell down or "I just saw bicycle hit by car. The dispatcher has no way of knowing what exactly is happening or how seriously the person is injured. And they can't take the voice on the other end of the phone as to what is happening as fact. Often times 2 ambulance people are not enough to handle emergency. Often they are enough. 5 people can handle more serious emergencies and if two people only responded and the person needed ALS level care, CPR, trauma, etc who would drive ambulance to hospital? one person in back of ambulance would have a hard time doing CPR by by themself. In the scenario you described you witnessed you said a vehicle broke down, that would explain one of the units being sent to fill in for broken down one. Private ambulance may have been driving by area and was flagged down by bystander possibly? so they stopped. Cold have been after or prior to 911 call being made. Private ambulance Co's do not have radio to speak with PA dispatchers. Private ambulance Co's are often driving through PA to or from desinations in PA or Stanford Hospital clinics. The third PAFD unit may have been BLS ambulance (EMTs only), If call is not very serious and meets County protocol for BLS unit transporting PAFD medics will access patient first and then transfer care to BLS unit to transport. That free's up paramedic ambulance for more serious calls if needed. Often times there are multiple medical emergencies occuring at same time in PA. Elderly people often fall and sustain wrist, arm, leg, ankle injuries that are ofen minor in nature, but the reason they fell was because there was a serious underlying medical emergency that contributed to them falling. IE cardiac, diabetic emergency, stroke, TIA, hypotension, etc. If 911 caller stated ankle sprain only and dispatcher sent one BLS ambulance with 2 EMT's only and it was in fact a serious medical emergency there would be a longer delay in getting proper and enough people there once the EMT unit discovered it was above there scope of practice and training. If there were people sent who were not needed in fact they will often assist with care and or lifting to prevent possible injuries from lifting people, BUT they are available to respond to another call from that scene. The bottom line is that 911 reporting party callers do not know for sure what the exact injury is and the dispatcher can not take layman diagnosis as gospel. A ALS level call will take more than two people and even 5 people is not enough sometimes. Anyone who has ever been in a ER knows how many trained people one patient can require.
> I did say "less reliable response times"
And your point is? Response time is one factor in determining service levels, but how does a response time variance of 1-2 minutes reflect in the quality of service rendered the people needing medical care? Ultimately, costs to provide emergency response needs to be added to this equation. While no one wants to wait an hour for an ambulance, tossing around vague terms like "less reliable response times" is not helpful to this discussion. Can you provide any hard evidence of private sector response times, such as: average response time with variance? (ieART-6 minutes with variances of 2 minutes)? And keep in mind that Palo Alto is very small, geographically. It's very hard not to travel from Point.A to Point.B in a short period of timeparticularly if you have a siren blaring to part the sea of traffic.
The need for hard data to better model emergency response is obvious. Sadly, this data is generally not available. I did get a data set from the PA FD once, but the data was incomplete in many places, so it wasn't as useful as it could have been.
For people who have stopped breathing, they need emergency response within four minutes--or they will die. There are very few emergency response teams in the world that can guarantee that they can appear on the scene of an incident and provide life saving care. For all other non-life threatening injuries, does it rally matter if an ambulance arrival time is 6 minutes, 8 minutes or 10 minutes?
> whatever your agenda is ..
My "agenda" is simply to put all of the cost data on the table (which the City rarely does) with the goal of making intelligent decisions involving public funds.
I got to wondering about the cost of ambulance service here in Palo Alto. I located the 2012-2013 BLS/ALS prices on the City's web-site. The cost of a BLS incident response will be about $500 for 2013 and about $1800 for ALS response. The ALS price increase was about 12.5% and the BLS increase about 7.8%. Using these price increases, I did a quick projection of ERU prices in the coming years:
I was not able to find a cost for private sector ambulance response quickly, so I don't have a cost comparison to offer. However, if the City were to continue these very expensive yearly price increases, the cost of ambulance service will very quickly jump into the stratosphere.
Emergency response should be a service provided residents and businesses as a necessary function of governmentnot a profit center that overcharges because of a lack of competition.
Ambulance costs have been going up yearly across the nation because of decreased support from local governments, less medicare reimbursements, and a rising number of uninsured patients. This is not just an issue in Palo Alto.
I believe you were able to find the numbers of PAFD easily because they are a public agency. As I am sure you would agree, this transparency is a good thing and one of the advantages of a city-run department.
The numbers for private agencies are more difficult to access and not generally available on the internet. Since you seem concerned about over-billing, consider these cases: last year in Ohio Rural/Metro had to pay $2.4 million dollar in fines for incorrect medicare billing. Again last year, Rural/Metro in San Diegeo was accused by a whistle-blower that the company might have overcharged the city by up to $18 million over several years. This year Rural/Metro in Alabama had to pay $5.4 million dollars in fines for incorrect medicare billing. This year, AMR in Manchester NH had to pay $4 million in fines for medicare over-billing.
These are are profit-driven private companies worried about their bottom line - they have to because their margins are so low. I am not sure a "lowest bidder" provider would necessarily be in the best interests of the taxpayer.
This whole thing is a scam.
The fire department is adding positions. We are adding EMS directors etc. The only real loss in positions came because SLAC pulled out and of course some of those positions had to go. No other positions have been lost and we have added some.
The entire discussion of a merger is also a joke. The 6 positions being eluded to from police and fire are all police positions that are now helping run the fire department likely at a staffing expense to the police department.
One big shell game with no savings as any reduction in budget if there ends up being one also has an offsetting revenue reduction from SLAC pulling out.
> this transparency is a good
> thing and one of the advantages of a city-run department.
I had to work at finding this information. It seems to me that that in the past the FD produced a CMR that had provided the public with a detailed cost breakdown of ambulance services. I could not find such a CMR this year. Unfortunately, as everyone knows, the City's web-site is a mess--particularly were content and searching is involved, so maybe these documents exists, but just aren't on the web-site.
I was able to locate costs for private sector ambulance companies in Santa Clara County 2-3 years ago. Presumably, as costs go up, these companies have decided to be less transparent, where there costs are concerned.
> concerned about overbilling .. consider the following
Thanks for identifying those situations. Not familiar with them, but will spend a little time researching. The fact that other agencies have been accused of over-billing suggests that there is some authority over these agencies, that was able to review, and subsequently fine, those guilty of "over-billing". So, what agency exists that has the power to investigate, and fine, the City of Palo Alto for any possible "over-billing"? While the Santa Clara County Grand Jury does have the power to investigate, it has no judicial power. The Santa Clara County District Attorney does have judicial power, but doesn't seem to use it very often. Getting the Grand Jury interested in reviewing possible over-billing here in Palo Alto is problematic. And getting the DA to do something is even more so.
It would just be better to let the market place moderate prices, rather than live under a government-controlled situation where there is no auditing, or openess in the price-setting process.
what the???????? "It would just be better to let the market place moderate prices, rather than live under a government-controlled situation where there is no auditing, or openess in the price-setting process."
Crazy talk in face of the privates running roughshod over the process as DOCUMENTED "consider these cases: last year in Ohio Rural/Metro had to pay $2.4 million dollar in fines for incorrect medicare billing. Again last year, Rural/Metro in San Diegeo was accused by a whistle-blower that the company might have overcharged the city by up to $18 million over several years. This year Rural/Metro in Alabama had to pay $5.4 million dollars in fines for incorrect medicare billing. This year, AMR in Manchester NH had to pay $4 million in fines for medicare over-billing."
Just crazy, crazy talk and crazyness.
Look at the Florida governor and his fraud: "In 1997, Rick Scott was implicated in the biggest Medicare fraud case in US history, stepping down as CEO of Columbia/HCA after the hospital giant was fined $1.7 billion and found guilty of swindling the government. As Florida's new governor, Scott is now trying to kill off an anti-fraud database that would track the fraudulent distribution of addictive prescription drugs in Florida, over the protestations of law enforcement officials, Republican state lawmakers, and federal drug policy officials."
Omigawd! How bad do you have to be to be fined fined $1.7 billion?!?!?!?!?!?!?
> Crazy talk in face of the privates running roughshod
> over the process as DOCUMENTED
The fraud in Medicare is undeniable. However, the failure is with government, for having designed systems that can be so easily manipulated--and for not monitoriing/auditing the vendors who have drained billions out of the system.
The "fraudsters" do get caught, from time-to-time, but the real villians are the government bureaucrates (up through our Congressional Representatives) who have built this house of cards that most assuredly is coming down around our ears.
Having the government become nothing more than a "money spiggot" has serverly perturbed every market it gets into--from housing to medical care.
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