Fine-tuning the contract

Five months after the new contract between American Medical Response and most Spokane County fire districts took effect things seem to be going well. AMR has been tweaking where it stages ambulances to lower response times, which have been dropping steadily for the most part.

The only hiccup has been rural areas with few ambulance responses, said Spokane Valley Fire Department Deputy Chief Larry Rider, who is administering the contract. AMR is required to meet response times 90 percent of the time. In urban areas AMR must respond in less than 10 minutes for a “code” response with lights and sirens. The times are longer for “no code” responses and locations in rural areas.

As an example, in July there were two calls in the rural area of Zone 6, which is north of the Spokane and Spokane Valley city limits. AMR was late for one of those calls, giving it a 50 percent compliance rate. In that same area in September there were five calls and AMR was late to one, resulting in an 80 percent compliance rate.

“This contract could be in breach because of a small area,” Rider said. “That doesn’t even make sense.”

A contract amendment is in the works that would allow AMR’s run information to be evaluated every quarter instead of monthly so the information is more statistically significant. The response time compliance requirement would drop to 80 percent in rural areas but AMR would still have to meet a 90 percent compliance rate in terms of the total number of calls in the county.

“We’re not going to abandon the very rural people in favor of the urban people,” Rider said. “They can have a small failure in a low volume area from time to time. It gives them a little flexibility. We don’t want them to fail, but we will hold them accountable.”

Spokane Valley Fire commissioners have already approved the change in contract language and other departments and districts are following suit.

The low call volume areas always present a challenge, said AMR general manager Rocco Roncarati. “We’re pushing ambulances further out into those areas,” Roncarati said. “We’ve made some significant improvements.”

A look at the numbers shows the improvement. The urban areas in Zone 3, which is south of the Spokane Valley city limits, had a 46 percent compliance rate for “code” responses in July. That number went up to 56 percent in August and 74 percent in September.

Rider will still receive information every month from AMR, including an e-mail that lists every call AMR was late on and why. AMR can ask for exceptions so the late calls don’t count against them. If the ambulance arrives more than 10 minutes past the required response time, the patient is not billed.

There were 84 exception requests in November. “The month prior there were significantly fewer of these,” Rider said. “These are all going to be because of snow.”

There were only four requests for exemptions in September and five in October, Roncarati said. “Obviously November created its own challenges.”

Rider decides whether to accept or reject each exception request. “I have the ability to waive that and call that a positive call,” he said. He takes a harder look at calls where AMR was more than 10 minutes late, because if he accepts the exemption request the patient will be billed. “That exemption is much harder to grant,” he said.

An ambulance was nine seconds past the response time limit on a call on Nov. 3 after it was delayed for more than four minutes by a train. Just because an exception request seems like a slam dunk doesn’t mean it will avoid scrutiny, Rider said. “There’s not a given here anywhere,” he said. “Each one will be looked at by its merits. I’m a tough nut.”

Roncarati said AMR is limited in its ability to ask for exemptions. It can’t ask for them for delays caused for traffic and road construction because the assumption is that construction projects would be known and response plans would be adjusted accordingly, Roncarati said.

Overall Roncarati said he thinks the established response times are realistic. “We’re meeting most of those response time requirements now,” he said.

Rider agrees with Roncarati’s assessment. “Their unit hours are going up,” Rider said. “Their responses are getting better. They’re being a good partner.”

While Rider said AMR is being very forthcoming in providing him records every month, he still checks up on them. Every month he selects 50 calls at random and checks whether the response times and other information match what he was given. He also checks billing records and sends postcards to 50 randomly selected AMR customers to ask if there were any billing issues.

“I’ve had two phone calls and both times there was nothing wrong with what had taken place,” Rider said.

Rider said he takes his role as a watchdog seriously and is pleased that people are seeing better service and flat-rate billing. “I work for the citizens,” he said. “Overall it’s a pretty positive experience for the citizens. We’re much better off than a year ago.”