News

Calif. County, AMR Agree to 5-Year Contract

12/10/2014

Dec. 10--STOCKTON -- The network of ambulances whisking people to hospitals in San Joaquin County will stay the same into 2021 through a Tuesday vote by county officials.

At its regular meeting, the county Board of Supervisors approved an exclusive arrangement for American Medical Response -- West, or AMR, to provide ambulance services to most of San Joaquin County starting in May 2016. It is the third five-year agreement with the company since the county created exclusive zones for ambulanceservices in 2006. It was a controversial move, and it spawned lengthy and expensive litigation between Stockton and the county over dispatching services. Tuesday's approval of the new agreement without discussion was placid in comparison.

The lack of controversy validates the changes, county Emergency Medical Services Administrator Dan Burch said. "The system we had planned for in 2006 is working. We're continuing to improve the system, rather than replacing it."

Rates charged for ambulance trips will rise by more than 10 percent under the terms of the agreement, but those fees are paid by patients or their insurers. AMR is responsible for billing and collecting the fees. AMR will pay San Joaquin County $675,000 for the five-year contract. The cost includes the county monitoring AMR's performance in the first year, a fee that will rise in subsequent years. The agreement covers most of San Joaquin County, including the cities of Stockton, Lodi and Tracy. Other ambulances have exclusive agreements for parts of the county, including the cities of Manteca, Lathrop, Escalon and Ripon.

Only AMR submitted a proposal for the new agreement, though two national ambulance companies told the county they opted out because of the county's requirement proposals include providing dispatch services. It's a requirement that makes the service provider accountable for the whole response, from the moment a dispatcher talks to a 9-1-1 caller reporting an emergency, Burch said. "There's no passing the buck."

AMR has separate agreements to provide fire dispatch to 14 fire districts in the county, but the ambulance agreement with the county includes requirements for fire dispatch, too.

The performance standards for ambulances require AMR to meet agreed-upon response times 90 percent of the time or face fines. And AMR typically meets that target system-wide, according to the county. But that is not always the case for each zone.

AMR exceeded the 90-percent target every month from June 2013 through June 2014, according to the most-recent compliance report available from the county. But it has not always met the target for each zone within the ambulance company's area of operation. For example, the county figures show AMR met the target more than 92 percent of the time in May, overall, but missed the target in the zone including north Stockton, hitting the response-time measure a little more than 89 percent of the time.

Missing the target in that one zone constitutes a $5,000 fine under the current agreement. The fine would be the same under the new agreement, because the company met the target more than 89 percent of the time. But the new agreement allows increasingly steeper fines for each percentage point below 90 percent. The fine in a month when compliance falls below 70 percent would by $250,000.

The goal of the graduated fine structure is compliance, not to collect more money, and it could mean more ambulances in service, Burch said. The fines for missing percentile targets would be on top of any fines for missing other standards in place for individual calls.

Something else new in the agreement would bring "critical care transport" between hospitals. These ambulances would have a registered nurse on board to care for a patient being transported to a different hospital for specialty care. It would be similar to transport currently provided by air ambulances, but it would be available in fog or other weather conditions that could ground a helicopter.

Board Chairman Bob Elliott said he was pleased with the new agreement. "We certainly want to do the best we can for all our residents."

Contact reporter Zachary K. Johnson at (209) 546-8258 or zjohnson@recordnet.com. Follow him at recordnet.com/johnsonblog and on Twitter @zacharykjohnson.