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Medstar: Cities need to pay more for ambulance service

FORT WORTH -- Cities that use Medstar ambulances will have to pay more if they want to eliminate the slow response time and staff turnover that have plagued the agency for the past year, according to a report today from the agency’s executive director and a consultant.

"I don’t know what our subsidy needs to be, I can tell you it needs to be more than it is now," Medstar Executive Director Jack Eades said during a presentation to the Fort Worth City Council on Tuesday.

Medstar has been under pressure since last fall because it failed to meet its standard of responding to the most urgent calls in less than 9 minutes, 90 percent of the time. At one point, Fort Worth firemen were riding with ambulances to help improve response times.

Fitch and Associates, which specializes in emergency medical systems, has been studying the Medstar operation for several months. In addition to more funding, the system needs to work on its management structure to address morale and turnover among its paramedics and emergency medical technicians, consultant David Williams said.

The turnover rate is about 30 percent annually, more than twice the rate in similar systems around the state, although Medstar recently granted big raises to its ambulance crews.

Medstar, which serves 14 cities, is funded by a mix of user fees and city funding. Currently, seven of the 14 cities pay no subsidy to the system. The others pay between $1 and $4.50 per capita annually, with Fort Worth paying $1.90.

Williams recommended that all the cities pay at least what Fort Worth does, and probably more. In the smaller, semi-rural cities in the region, it costs more to provide ambulance services because of the low call volumes and longer distances.

Fort Worth's subsidy hasn’t changed in about a decade, even though the cost of ambulance service has nearly tripled. As a result, people with private health insurance are paying more of the cost of the system. Eades said about 20 percent of the patients -- those with the ability to pay -- are paying 50 percent of the cost.

Eades said he expects to have a new funding agreement in place with the cities by 2009.

“Right now, if the subsidy remains the same, my only alternative is to raise the bill,” he said.