In the case of partner cities Apple Valley, Lakeville and Farmington, the three agreed to drop their ambulance service in 2008 to contract with Allina Health and to improve service, said Steve Mielke, Lakeville city administrator.
“We were concerned about quality of care,” Mielke said. “For smaller agencies, it can be difficult just to maintain the latest and most up-to-date capabilities and training. … We’re very pleased. They’ve brought a level of expertise we didn’t have.”
Hiring Allina eased the burden on city employees who were responsible for running the ambulance service. The city consortium still holds the ambulance license, which Mielke said allows it to change providers if service isn’t good enough.
In 2008, the cities estimated that hiring Allina collectively would save them $61,000 each year.
Firefighters as paramedics
In cities where ambulance service is part of fire department duties, the cost of emergency services is embedded in the overall fire department budget.
As fire prevention has improved and fire calls have declined for many departments, the primary job of firefighters is now responding to medical calls.
“Some people would say we are an ambulance service that provides fire service,” said Darrell Todd, Edina’s interim fire chief. “I see us as an all-hazard service.”
While the number of medical calls in Edina has grown by 35 percent since 2000, the collection rate on ambulance bills has dropped from 84 percent in 2002 to 42 percent in 2012. Burnsville’s collection rate dropped from 67 percent in 2003 to 49 percent in 2012. Most of the gap in payment is due to changes in Medicare reimbursement.
The cities have coped by raising charges for ambulance runs. So far, that and the increasing number of emergency trips have combined to raise revenue from ambulance operations: Edina’s ambulance revenue increased from $1.3 million in 2002 to more than $1.8 million in 2012, while Burnsville collected $1.1 million in 2003 and $1.9 million in 2012. Both cities put that money in their general funds, as does St. Paul.
Edina’s Todd said it’s the service, not the money, that matters.
“While it’s great that we can offset our costs, this is the level of service that the City Council has decided it wants to provide,” Todd said. “The city’s function isn’t necessarily to make money. We’re here to provide services to people and business owners.”
St. Paul has 12 ambulances that run out of 15 fire stations, Burnsville four ambulances at two stations and Edina three ambulances at two stations.
In Edina, most police are trained as emergency medical technicians, and they carry oxygen and external defibrillators in their cars. Because they are already out in the community, they often are the first responders to a medical call.
John Wallin, Edina’s finance director, said he thinks it would be hard for an outside provider to improve on the service the city already offers.
“They probably would not keep two ambulance sites in Edina, so response times would be different,” Wallin said. “And minutes can make a difference.”
Navigating health changes