Ga. city sets minimum EMS standards after dispute with ambulance company

Gold Cross EMS ambulances should have a paramedic on board, track available units and perform quality control reviews, Augusta committee says


Susan McCord
The Augusta Chronicle, Ga.

AUGUSTA, Ga. — An Augusta Commission subcommittee adopted minimum standards Monday for the city's EMS provider but said the city is hamstrung by its lack of call data.

Recommendations from Deputy Fire Chief Shaw Williams, who was serving as interim chief until last week, included the minimum level of ambulances kept in service that includes Augusta's three, which were taken out of service last year.

We are dependent on trusting the provider's information and word when it comes to the number of mounting delays and subpar service,
We are dependent on trusting the provider's information and word when it comes to the number of mounting delays and subpar service," Augusta Deputy Fire Chief Shaw Williams said (Photo/Gold Cross EMS)

The subcommittee approved a minimum skill level on board the ambulances of advanced medical technician, with a paramedic preferred; developing a system to track the number and location of available units, and to perform periodic quality control reviews.

Developing the standards has been a challenge without call data from provider Gold Cross, Williams said.

"The lack of data is the most hindering factor in our ability to formulate a reasonable future expectation for our current EMS provider," Williams said in a statement to the subcommittee. "We are dependent on trusting the provider's information and word when it comes to the number of mounting delays and subpar service."

Gold Cross has not been allowed to attend the subcommittee meetings and Vice President Steven Vincent said he was not yet aware of its decisions Monday but disagreed with Williams' assessment of its service.

Last week, Mayor Pro Tem Bobby Williams said a local judge had contacted him about a long wait for an ambulance, and Commissioner Dennis Williams has cited other delays.

The commission and Gold Cross have jousted over EMS service since the Martinez provider bid for and obtained a regional committee's designation as the sole EMS provider for Augusta- Richmond County, giving it exclusive access to all EMS calls. It has been provider for more than 15 years.

The city has repeatedly attempted to withhold Gold Cross' city "subsidy" said to cover the cost of unreimbursed care while Gold Cross recently requested to raise the base cost of an EMS response to $1,750. The increase would make up for the 70% of calls Vincent has said Gold Cross is paid $400 or less per call due to Medicaid or Medicare restrictions or people not having insurance.

Last year, the city's ambulances responded to 7,292 EMS calls resulting in 4,342 transports, Williams said. Seventy-one percent were covered by Medicaid, Medicare or private insurance, but only received payment for 2,733 transports, he said. Those likely included city employees, who are not billed, while Augusta doesn't send unpaid EMS bills to collections, he said.

New Fire Chief Antonio Burden said historical data would reveal more precisely how many ambulances Augusta needs to have in service at different times of day.

"That historical data provides you information to make those assessments," he said. The lack of data leaves the city "hamstrung," 911 Director Daniel Dunlap said.

Commissioner Ben Hasan, the subcommittee's chairman, said the city's provider should keep eight ambulances in service, bringing the total during peak hours of 8 a.m. to 8 p.m. to 11 ambulances.

The subcommittee's six commissioners present Monday voted in favor. Commissioner Sammie Sias, who participated by phone, voted no.

The subcommittee gave a lot of discussion to how to track the service. Commissioner Dennis Williams said the city needs a process for receiving data from the provider such as the number of EMS responses completed, the nature of the call, its outcome and the amount Gold Cross is able to collect from patients.

Sias said the city needs a paramedic or registered nurse to serve as contract administrator, while Commissioner John Clarke said the staffer needed a background in customer service and investigative reports.

The commissioners all voted yes to requiring a periodic review, implementing a quality control component, monitoring customer service and response times, including when EMS is at "service level zero," meaning there are no available ambulances.

The city would have ready access to call data if it didn't have to route EMS calls to Gold Cross dispatchers, which can add a minute or more to response times, Dunlap said. But eliminating the call transfers would require more staff, new software and agreement by the provider, he said.

"I don't see them giving up that," Hasan said.

Dunlap said the state is unlikely to take action regarding Augusta's EMS zone based on response times alone but would need other performance-based measures such as health outcomes to do so.

The requirements head to the full commission Aug. 3.

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