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Officials considering tweaking county, city EMS agreement

Thursday, September 6, 2012 by Michael Kanin

The City of Austin and Travis County appear to be headed toward a significant change in the inter-local agreement that governs how the parties manage the Austin-Travis County Emergency Medical Service.


“Both sides have agreed that we want to do something totally different,” said Danny Hobby, the Travis County executive in charge of Emergency Services.


The news came a day after City of Austin Public Safety Commissioner Mike Levy pressed EMS officials about field vacancies and low morale at a meeting of the city’s Public Safety Commission. All summed, this illustrates the increasing pressure on the 36-year-old inter-local agreement between the local governments.


Hobby told In Fact Daily that changes being discussed deal mostly with the formula by which operations and finances are allotted between the city and the county.


“Under the current agreement, we basically have a problem when it comes to adding on, either on their side or our side,” Hobby said. According to Hobby, both the city and county run into problems whenever either party tries to expand service in its jurisdiction.


In essence the county and city are trying to look at how they can approach delivery of services differently. “We are trying to look at a county model, not just a city model in the county,” Hobby said.


Among other options, the county is exploring whether it could use the federal 1115 Medicaid waiver program – the same program that could bring in a chunk of federal funds for Travis County Central Health’s efforts associated with a potential new UT Medical School – to finance changes in EMS operations. If successful, a successful 1115 application could bring $1.46 in federal money for every $1 spent by the county.


Whatever the resulting system, Hobby said the finances and operations would be the “best they can be” for the patients and “fair on both sides” for the taxpayers of Austin and Travis County.


Hobby added that the city and county are not yet to the point where they have discussed specifics about how the new system would work.


At the city commission on Tuesday evening, Levy spent roughly 20 minutes digging into what he maintains is a conflict between vacancy numbers reported to commissioners and those reported to the city’s partners in the EMS enterprise in Travis County, as well as issues associated with the vacancies.


Austin-Travis County EMS Chief of Staff James Shamard and the assistant director of finance for the service John Ralston did their best to address Levy’s concerns.


Levy maintained that he and his colleagues were told on Aug. 6 that there were about 30 field vacancies  – those associated with practicing EMS staff. He argued that the true number of open field EMS positions is closer to 60, and that a chart requested by Travis County reveals that figure.


Ralston insisted that the chart presented by Levy was not something that he was familiar with. However, he allowed that the figures might have been part of a discussion with Travis County. In the end, Shamard threw out a different figure: 49 field vacancies, 12 of which would be filled at the opening of the Mueller EMS station scheduled for July.


But as the meeting drew to a close, Levy announced his intention to continue his questioning in October. “I hate to do it, but I need to add back to the agenda again, EMS staffing,” Levy said. “For instance, we know we have an attrition rate of 14-20 paramedics a year, and we know that the attrition rate on these new cadets every year in each class is between 50 and 75 percent.”


For his part, Hobby was not necessarily focused on the number of empty positions. “I’m concerned about the vacancies, but I’m more concerned about how do we fill these vacancies,” he told In Fact Daily.


Hobby has asked Austin-Travis County EMS Chief Ernie Rodriguez to come up with a timetable that would illustrate how the city plans to fill those vacancies. Hobby said that Rodriguez is working on the document. All told, the city-county EMS employs more 300 workers.


Whatever the vacancy figure, Levy drew a line between the staff shortage, low morale, overtime and a potential drop in care that might result from it all. “Even if it’s voluntary, and a paramedic may want the extra dollars, it isn’t necessarily in the interest of patient care,” he said.


“Regardless of how you look at the number of vacancies, there are a significant number given the total number of field paramedics,” Levy later continued as part of a direct address to Shamard. “Low morale plus fatigue impacts patient care in just about all cases, wouldn’t you say, James?”


Though Shamard admitted that could be the case, he was reluctant to concur with Levy’s read of the situation.

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