The ambulance war is on.
After 10 years with Rural/Metro Medical Services as the city’s exclusive ambulance contractor – and some complaints of slow response time – Buffalo is on the verge of entering a new ambulance contract for at least the next five years.
A lot is at stake.
Hundreds of thousands of dollars in revenue annually to the city.
Likely millions of dollars in revenue annually to the ambulance company – even an entry way to more business in New York State in one case.
And for residents, it could be life or death: How fast will an ambulance be there when you need it?
The Brown administration wants to stick with Rural/Metro. The company made the city the best offer, and has agreed to a new contract which, the administration says, puts more ambulances and personnel on city streets and, for the first time, includes response time minimums with penalties.
But one of Rural/Metro’s competitors is crying foul.
“We are hoping to have all the proposals viewed and in the open, and have a transparent process,” said Thomas McEntee, the chief executive officer of American Medical Response, a Colordo-based company working in 41 states around the country, but not, at this point, in New York State. “Generally, when we submit these responses, they are scored and analyzed by a group of experts. When we proposed to Buffalo, everything went silent,” McEntee said. “We never had a follow-up discussion with anyone in the city.”
McEntee also said that while he hasn’t seen the full contract the Brown administration hopes to enter into with Rural/Metro, what he has seen doesn’t provide adequate accountability to the city.
“It doesn’t appear this contract has a lot more teeth than the old one,” McEntee said. “It’s not a performance-based contract. We would enter into a much more performance-based contract with a higher level of accountability.”
The Brown administration calls AMR’s complaints sour grapes, saying that AMR’s proposal was reviewed by a panel, which determined the Rural/Metro bid was superior.
“There was a bid process. They didn’t win,” Mayor Byron W. Brown has said of AMR. “They offered less than the group that won the bid process. If this was so important, they should have put a better bid on the table that offered more for the residents of this community.”
The dispute is now in the lap of the Common Council, which earlier this week formally received the contract proposal the administration wants to enter into with Rural/Metro.
The contract was referred to the Council’s Finance Committee for review. It is expected to be discussed at a committee meeting Tuesday. The contract requires Common Council approval.
“We sent it to the Finance Committee to discuss. We might even invite the other companies,” said Lovejoy District Councilman Richard A. Fontana, who chairs the committee. “We will make sure the contract will meet the needs of the city for years to come.”
Council members grilled Rural/Metro leaders last week in response to a recent case in which a 90-year-old woman waited 48 minutes for an ambulance following an accident on Hertel Avenue. Rural/Metro officials said the call came at a particularly busy time, and that fire department crews already at the scene reported to them that the woman was stabilized and had only minor injuries.
But the call was not an isolated case. In 2012, a Buffalo News investigation found that nearly every day, there had been a point when an ambulance was not available to respond to a call in Buffalo.
Rural/Metro disputed that, saying the company, which works in Buffalo and surrounding areas, calls in its ambulances from nearby communities, and also works with other providers, when additional ambulances are needed in the city.
Rural/Metro does, however, acknowledge instances, such as occurred on Hertel Avenue, when an unexpected spike in calls resulted in longer-than-normal waits while more serious calls were being answered. It’s called triage, said Jay Smith, the company’s regional division manager.
“Those are typically triage non-emergency calls that got held,” Smith said. “Those are typically the ones we get criticized for. You are holding that call because you’re responding to a life-threatening emergency.
“Surges in volume do happen,” Smith added. “It is inherent in all EMS systems. Our competitors are not immune to those surges.”
Critics also note that Rural/Metro entered Chapter 11 bankruptcy in August 2013. It came out it in December 2013, Smith said.
“We were proud to have maintained a high level of service to all of our contracted customers during that time,” he said.
Brown recently said his administration had concerns with some Rural/Metro’s performance issues in the past, but that the new contract addresses these issues.
“This will be a 20 percent increase in staffing with a continued commitment to local hiring of city residents, implementation of a community paramedic program, implementation of a rapid access program,” he said.
The five-year contract, with options for two one-year renewals, includes these provisions:
• A minimum of 20 ambulances in the city during peak hours, and 10 in non-peak hours. That’s up from 14 and seven, respectively, in the city’s prior agreement with the ambulance company.
• Response time minimums set in the contract, requiring ambulances to arrive in less than nine minutes – at least 90 percent of the time – on the most serious life-threatening emergency calls, those requiring advanced life support; and arriving within 15 minutes on the least serious calls.
• Rural/Metro creating alternative transport and service options for non-emergency calls that require medical or mental health service but which do not warrant an ambulance transport.
• Rural/Metro paying the city annual franchise fees, starting with $450,000 in 2015 and gradually increasing to $477,614 in 2019. That represents a 28.5 percent increase from the current contract, with some of the funds used to create an oversight panel to monitor contract compliance.
• The contract also states that failure to meet contract standards could result in penalties, including a $1,500 fine for not meeting response time compliance for one month, a $10,000 fine for failing to meet response time compliance in four consecutive quarters, and a $25,000 penalty if the situation not corrected.
Smith said Rural/Metro looks forward to working under the new contract. He said his company has 67 vehicles in its Buffalo fleet – more than three times the required minimum, and also access to its larger fleet working in the greater Buffalo area. It’s the first time, Smith noted, that the contract has stated minimum response times with penalties.
McEntee said his company, AMR, would have 30 vehicles in Buffalo, with 25 available for the busiest times. Included in the fleet, he said, would be eight community-based ambulances. He said the most serious calls would be answered in under nine minutes, and others in under 12 or 15 minutes.
The AMR executive said his reading of the city’s proposed contract with Rural/Metro, compared to others he’s familiar with nationally, is that it doesn’t go far enough.
“To miss four quarters and be fined $10,000. That is miniscule,” he said. “That is zero teeth. Every late response should be penalized.”
The specific amount of the franchise fees were not part of the original bid, according to Smith and McEntee. Instead, the city negotiated the fees with the ambulance provider – in this case Rural/Metro – after selecting the company for the new contract.
“For a city the size of Buffalo, for that amount of franchise fee, it’s not the least and not the most. It depends on the services that go along with that fee,” McEntee said.
AMR, McEntee noted, does not currently have a certificate of need from New York that would allow the company to work in the state. A limited number of certificates are issued, he said. If AMR got the Buffalo contract, he said, the city could obtain a municipal certificate of need that his company could then work under.
Once working in Buffalo, McEntee said, his company would hope to get its own certificate of need from the state, which would allow the company to expand in other parts of the state.
“We are looking to grow and expand out business,” he said.