After years of discussion, a group of almost all Spokane County fire departments and fire districts, led by Spokane Valley Fire, have finally agreed to an ambulance contract with American Medical Response.
The only groups not included in the contract are the city of Spokane, which has its own contract with AMR, and Fire Districts 2 and 12, which have their own ambulance service. Part of Fire District 4 in north Spokane County also is not included in the contract area because it is served by Deer Park Ambulance.
The new contract sets out response time guidelines based on where people live and sets a fixed cost for ambulance transport.
The discussion dates back to 2006 when the Spokane Valley Fire Department began negotiating a contract with AMR. The department was within a couple of weeks of signing an agreement when Chief Mike Thompson was approached by representatives of other fire districts who said they wanted to join the contract. AMR has always provided service to the area, but there were no performance measures or cost controls in place, Thompson said.
Spokane Valley Fire, the cities of Airway Heights, Medical Lake and Cheney joined with Spokane County Fire Districts 3, 4, 5, 8, 9, 10, 11 and 13 to form the Spokane County Ambulance Service Cooperative. All signed an interlocal agreement to have an Ambulance Service Board of fire department representatives negotiate a contract. Because several cities were involved the board had to solicit bids for the contract and only AMR submitted a proposal, Thompson said.
Spokane County Fire District 8 Chief Bill Walkup was involved in the negotiations. He said everyone seems happy with the end product even though it may not be exactly what they wanted. “Everybody’s interest is not always going to be the same,” he said. “I think everybody understands it’s a product of collaboration and consensus.”
The city of Spokane was involved in the contract discussion until recently when things got bogged down. “Contract administration was an issue,” said Thompson. The city of Spokane wanted to administer the contract for $342,000 a year plus an anticipated $120,000 in “liquidated damages” charged to AMR for not meeting performance requirements in the contract. “Those prices were going to be passed on to the consumer and that’s not what we wanted to do.”
Spokane Valley Fire Commissioners said that they could administer the contract for $50,000 a year and didn’t want the higher cost passed on to consumers. On March 15 the commissioners voted to negotiate the contract without including the city of Spokane. The following week the Spokane City Council voted to withdraw from negotiations because they wanted more than one seat on the board.
After that things moved quickly, Thompson said. “Once we had that definite direction, we were able to put that on the fast track,” he said.
Thompson said the department’s technical staff is writing a program to pull needed information from dispatch records automatically to determine if an ambulance arrives late. “It’s all time stamped in dispatch,” he said. That will allow a much less labor intensive process for finding contract violations than what the city of Spokane proposed, he said. “We don’t know about every call out there. We just want the ones that didn’t meet performance standards.”
The new contract, which is still being voted on by all the fire districts, is set to take effect on July 1. It sets a flat rate of $941 per transport plus $17.57 per mile. Under the previous rules AMR charged different prices for basic life support and advanced life support. Other charges for things like oxygen and medication were tacked on, often bringing the charge for an advanced life support transport to well over $1,000, Thompson said.
In urban areas AMR must respond in under 10 minutes for a “code” response with lights and siren or 20 minutes for a “no code” response at least 90 percent of the time. The response times are longer for suburban, rural and remote rural areas in the county. If AMR is more than 10 minutes beyond any response time limit, the patient cannot be billed. There also are reduced charges available for people who meet certain income guidelines and in some cases there will be no charge at all.
Those last two stipulations are fairly unique, Walkup said. Everyone agreed that they would rather focus on what was in the best interest of residents rather than just piling on more fines for AMR to pay if they don’t meet response time requirements. “At the end I think everyone at the table realized it was all about services to the citizens,” he said.
Violation of the agreement can lead to fines, but those fines will be waived for the first three months of the contract. “I think they’re going to have to make some adjustments,” Thompson said. “They are saying they can live up to the terms and conditions.”
The contract is through Oct. 31, 2013 and can be renewed for three years based on good performance. “I think it is going to improve services,” Thompson said. “It’ll definitely keep them on their toes.”
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