By many benchmarks Chicago’s Emergency Management Services (EMS) significantly lacks what is needed for a major city like Chicago. The unit’s capacity needs substantial increases and it is missing significant opportunities to boost income. This can be accomplished by creating a Bureau of EMS under a separate command structure within the Chicago Fire Department (CFD) so as to ensure that EMS objectives are equally prioritized with that of firefighting. Under a Vallas administration the CFD EMS would see their personnel, equipment and revenue numbers significantly increased. The number of ambulances would be greatly expanded as would provision of reimbursable services and related income. EMS training would be improved and support services such as post-traumatic stress counseling established. CFD would enter into agreements to provide income generating services and improve collections. Transforming EMS would include establishing a comprehensive Community Home Health Program to serve the indigent and the socially isolated. Many of these services are Medicaid, Medicare and private insurance reimbursable.
EXPANDING CHICAGO’S EMERGENCY MANAGEMENT SERVICES
The failures of the Emanuel Administration
Historically EMS have been the poor stepchild of the CFD. Understaffed, under resourced, Chicago citizens have suffered from the limited services offered and the City administration has lost opportunities at greater income generation. Conditions for EMS have worsened under the current mayor as the EMS has not only been largely ignored but in some cases punished for the outspokenness of its personnel. Consider the following:
There continues to be a severe shortage of ambulances despite a signed agreement by the Mayors Office with union negotiators stipulating the addition of more ambulance teams.
The City failed to add additional ambulances and paramedics despite lengthy response times that place the public at risk. Rahm Emanuel placed citizens at risk for payback to paramedics. All because a small group of CFD paramedics backed Jesus Garcia in the last mayoral race.
Shortage of ambulances is having a negative effect on fire suppression and rescue as fire engines are continually being sent to EMS call because there is no Ambulance available. This is not cost effective. Sending fire engines to EMS calls should be used as a back up system only not a replacement. While the number of fires may be down they are devastating and using fire engines in EMS runs due to ambulance shortage only impedes the main mission of Fire Suppression and Rescue.
The closing of many mental health clinics has left many people without proper care and has increased the burden and the risks for EMS staff and other City public safety personnel who are not sufficiently trained to deal with people with serious mental health issues. CFD EMS responds to an average of 25,000 psychiatric emergencies per year, yet have not received the same training CPD has started receiving.
Failure to collect revenue generated by CFD ambulances. CFD has recovered only 37% of its billable revenue during Rahm Emanuel’s term as mayor.
Failure of the CFD to Implement a Community Home Health Program despite empirical evidence that it significantly increases the quality of life for patients while also reducing use of the 911 system and emergency rooms. Such a program can be an income generator.
Foregoing other income generating opportunities because CFD does not have the means to compete with private EMS providers to provide service to City supporters private events such as concerts, festivals, and sporting events.
A stagnant EMS system due to the fact that EMS decisions are made by firefighters rather than paramedics. This has led to a system that has failed to keep up with the advances in EMS technology that have proven to have a positive patient outcome.
Identify CFD “single duty” paramedics who were not allowed to be cross trained as firefighters due to an arbitrary age limit of 38 for such training and lift the age limit.
Last but perhaps most important has been the City’s failure to provide counseling and support to paramedics who suffer stress on the job and often experience “post traumatic stress” from the tragic situations cases they encounter.
The Vallas Proposals
As the father of a combat Medic for 5th Marines who served in Afghanistan and an uncle to a Fire Department paramedic, Paul Vallas has deep respect for those who serve the public in that capacity. His commitment to CDF EMS will be unwavering. Specifically. Vallas will:
Create the Chicago Fire Department Bureau of Emergency Medical Services within the Chicago Fire Department under a separate command. (Similar to the New York City Fire Department model.)
EMS decisions should be made by paramedics. EMS budget should be determined by EMS as well as the Mayor’s Office.
Add ambulances promised in the Letter of Agreement signed in 2014 between the City and Firefighters Union.
Increase the ambulance fleet substantially in keeping with the demand for service. The demand for EMS service has risen while the number of ambulances has not.
Minimize the costly practice of using fire engines on EMS calls except when there is no available ambulance.
Increasing the ambulance fleet and the number of paramedics will allow CFD to begin to cover special events in Chicago.
Immediately lift the age limit of 38 on EMS cross training while recruiting future firefighter candidates who are already EMS qualified while offering all Firefighter EMT paramedic training based on their work schedule so as to facilitate the training. Along with this is the caveat that FFPMs would only be used on ambulances due to emergencies, never to balance EMS manpower. This would also allow FFPMs to be available for Special Event Overtime work opportunities.
Increasing the EMS fleet will provide the opportunity and the assets to establish a Community Health Center Program to contract out with hospitals and community health centers to provide Medicaid and Medicare reimbursement eligible health services, to the indigent and isolated. These individuals will often show up in the Emergency Rooms without such “preventive services”. (Los Angeles Fire Department model)
The establishment of a comprehensive and ongoing training program to help paramedics and other public safety personnel deal with patients who have serious and sometimes dangerous mental health issues.
Develop a drug and opioid intervention program to expand the City’s ability to provide critically needed emergency services.
Establish an EMS “feeder program” by partnering and supporting select Chicago neighborhood high schools and colleges willing to offer EMS prep and certification programs.
Last but not least I will prioritize the creation of a program to provide comprehensive counseling and support services to help EMS and other City “First Responders” who are suffering from PTS as a result of their job experiences.
CFD EMS billing can be significantly improved while EMS can be monetized, generating sufficient resources to cover the costs of the expanded and needed services. Here are some examples.
1.) Increase the ambulance collection rate for “private insurance” providers to increase income with minimal cost to citizens.
2.) Public-private partnerships with area hospitals for a community paramedic service program to provide services that will reduce unnecessary readmissions. Hospitals would pay for such services.
3.) Hire a billing and collection service that actually works claim denials. This will increase revenue substantially through an audit process to insure claims are correctly coded for maximum reimbursement.
4.) Immediately contract with a company to obtain cost recovery for motor vehicle accidents. The car insurance companies are responsible for clean up and mitigation of a scene.
5.) Connect EMS revenue with the fire department budget by creating a Fire Department Enterprise Fund for income generated from CFD, especially EMS fees and services. The income would be dedicated to the CFD. The current system places the revenue into the general fund which limits accountability.
6.) Establish specialist position for a qualified individual to review and make recommendations to the billing company that will maximize revenue.
7.) All special events within the City of Chicago should use CFD EMS when available instead of a private EMS service provider, which will be billed directly to the promoter or venue as a standby charge.