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Where Is the Financial Evidence?

Like every good crime, there needs to be evidence to demonstrate what happened. This holds true for mobile integrated health (MIH) or community paramedicine (CP) programs. Before you change over your entire department to a different model, do you have the evidence you need to be successful?

In April's EMS column, Check Your Bus Ticket First, I cautioned against getting on the wrong bus. While I was not overwhelmed with support for my position, neither was I overwhelmed with disagreement.

My position as the chair of the EMS Section is to look globally at EMS within the fire service. I recognize that every department does things differently and so there’s a 50-50 chance you won’t appreciate my thoughts on this, or on any other subject.

For clarification, I am not saying you can’t deliver good service with a new model. The purpose of this article is to discuss the financial aspects of these programs. I do suggest any fire-EMS departments considering a significant change like MIH or CP first do their homework and find the evidence to help guide their decisions.

Can it work? Yes. Does it generate enough revenue to cover your costs? Maybe; maybe not.

Don’t be fooled if you haven’t looked at all the costs. Here are some expense areas I think you need to evaluate and include in your overall cost/revenue budget:

  • Cost of a Needs Assessment – Have you evaluated the community completely to determine if your fire department is needed to provide a different level of service like community paramedics or mobile integrated health programs? Have you met with and talked over your ideas with key organizations within the community, like the local hospitals, skilled nursing, assisted-living and independent-living communities, home-health agencies, public-health agencies, rehab facilities, non-emergency transport services, wheel-chair van services and senior centers, to name a few.
  • Transport Revenue Budget – What will the impact be on your transport revenue budget if you suddenly decrease the number of patients transported? Does your alternative service (MIH or CP) make up for that decrease?
    Please note, I am in favor of alternative destination or treat-and-release programs for everyone, but you have to consider that this level of service will likely be paid much less than they are for a transport (when, or if, that funding mechanism is approved), so that decrease in revenue must be factored in how it will impact your department’s ability to be response ready.
  • Training Costs – What is the cost of additional training for your EMS personnel as a community paramedic or MIH paramedic? Is there a cost for the developing that training? Is there a cost for ongoing continuing education for that training?
  • Billing Costs – Since you’re adding a new service, is there an additional cost for billing? Will you need a new billing service?
  • Start-up Costs – What are the start-up costs for equipment and supplies for a new service? What is the ongoing cost of an MIH or CP program for equipment and supplies?
  • Vehicle Costs – Is there an initial cost for an alternative vehicle or vehicles to run this new service? What’s the ongoing cost for fuel and maintenance for these vehicles?
  • Insurance – Will a change in your level of service, one not recognized within the current scope of practice, be covered by your current liability insurance carrier, or will you have to increase your coverage?
  • Early Operations – Is there funding available to fund the operations for at least 90 to 120 days up front until the service billing and receipts catch up with the new level of service?
  • Cost of Readiness – An important area that is often not included in a cost evaluation is the cost of readiness. Have you taken the time to determine the expense of having the equipment and personnel being in place and ready to respond?

Most fire agencies are often funded with some form of a tax or municipal budget. The services provided are often not reimbursed. Subsidizing a program like MIH or CP from a tax program or a grant doesn’t necessarily mean it will be successful in the long run.

I’m open to hear from departments that have developed a successful model of alternative care. I would love to see the details of a successful program that included all their costs to show they’re covering expenses, making money or perhaps losing money.

Chief David S. Becker (Ret.), EFO, is the chair of the EMS Section. He’s been a member of the IAFC since 1991.

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