By Julia Cardi
The Detroit News
TROY, Mich. — Oakland County’s largest city is considering bringing emergency medical services entirely in-house, ending its longstanding practice of contracting out the service to private providers.
Troy officials say offering their own EMS could cost between $4 million and $5 million to start, but operating costs would eventually decrease and in-house services could help the city decrease response times. The city of roughly 84,000 now has a contract with Universal Macomb Ambulance Services through the end of 2025, which costs nearly $815,000 each year.
At a special meeting to discuss Troy’s options for EMS services last month, Deputy City Manager Bob Bruner said private EMS providers have faced challenges: Reimbursements for providers from private insurance and government-sponsored health care such as Medicare are generally fixed, leading to staffing shortages because EMT jobs don’t pay a lot, according to Bruner. He added the COVID-19 pandemic also created a hiccup in recruitment.
Should the city want to extend or renew its contract with its current provider, Universal, past the end of this year Bruner said that would require agreement on the fees paid by the city.
“We’re looking for some direction on how to proceed now” rather than wait until the last minute later this year to decide, he said.
Fire Chief Peter Hullinger said bringing EMS services in-house would decrease response times. Under the current model, medical calls go through Troy’s 911 dispatch before they are relayed to Universal and a responder assigned.
“That alone can add a minute and a half to three minutes just to the initial 911, before the ambulance is dispatched to the call,” he said.
The city first contracted with Alliance Mobile Health in 2003, according to a memo from City Manager Frank Nastasi. City Council approved the current contract in 2022, and lasts until the end of 2025, though Alliance has since been acquired by Universal Macomb Ambulance Services. Universal didn’t respond to a request for comment.
Hullinger said the city estimates transitioning to a public EMS service would cost Troy between $5.2 million and $5.7 million during the first year, and between $2.2 million and $2.5 million the second year.
However, he clarified the estimate for the first year represents operating expenses, and doesn’t include capital costs such as purchasing EMS vehicles. The city’s estimate for the first year differed from the estimate in the study prepared by Fitch and Associates, which pegged the cost for the first year between $4 million and $4.3 million.
He noted a transition to a fully public EMS service could take up to two years, and the city would need to continuing to contract with a private provider in the meantime.
Troy is one of the last in the immediate surrounding area that does not have city-run EMS services, according to a feasibility study prepared for the city by Fitch and Associates. Clawson , immediately to the south of Troy, is the only other town that uses private rather than fire department-based EMS services.
Councilmember Theresa Brooks said she’s not opposed to considering Troy running its own EMS services, noting she understands response times can mean the difference between life and death for patients, but pointed out it would mean the city shoulders the responsibility of dealing with reimbursements from insurance. She noted the city needs keep in mind a federal congressional proposal to cut $880 billion in funds covering Medicare and Medicaid.
“I just wonder about these numbers with some things that are going on at the federal level, and if we’re really fully taking into account all of these things,” Brooks said.
She added insurance companies tend to follow the government’s lead on trends in reimbursement rates, so if they drop, payments from private insurance tend to also.
The city has also put on the table a possible provision, in which the city would provide medical first responder services in-house and contract out ambulance transport services. Hullinger said the city-run medical services would cost the city an estimated $3.5 million annually, and the cost for private ambulance services would increase but is unknown. But Hullinger noted that under such a model, Troy would not get any revenue because it comes from ambulance transport.
Councilmember Ellen Hodorek said she needs more information about the available options before she can decide what she thinks the city should do.
“I feel like I’m looking at this car. I like it; I want to see if it’s a good color; if it’ll serve me for 10 years,” Hodorek said during last month’s meeting. “I’m there with you to think this through, but I need more, because it is such a significant policy change, and a legacy change for us.”
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