Why Knox County may stick with its ambulance provider despite complaints about long wait times
The Knox County committee in charge of selecting an ambulance provider has decided to stick with its current provider, American Medical Response, despite wait times that have stretched to more than an hour for some patients and prompted Knoxville police and fire personnel to raise a public alarm about the problem.
The decision was announced Oct. 26. The recommendation must go through the Knox County Commission for approval before the current contract expires in January.
The county provided a copy of AMR's proposal after news broke of the committee's decision. As expected, the contract will require new subsidies to shorten wait times for patients in need of emergency care. AMR provided two options varying in cost from $2-$2.8 million annually, with a 3% annual increase built in.
The process for rebidding the county’s emergency services contract coincided with skyrocketing delays for service, including for some reasons that are out of control AMR, including understaffed emergency medical service systems and hospitals. Emergency rooms are overwhelmed by people using them as primary care, forcing ambulances to wait with patients because AMR policy does not allow them to leave patients until a hospital has taken over care. At the same time, hospitals are struggling to attract and retain health care workers.
These problems aren’t unique to East Tennessee, or to AMR. They're happening across the country as ambulance providers become the first option for residents who lack health insurance or a ride.
A third party hired by Knox County to review the situation, Fitch & Associates, said the current expiring contract is "financially nonviable." A Fitch representative told commissioners Oct. 16 the county will likely have to subsidize any contract by paying $1.9-$3 million each year.
"We all know that there have been some significant issues with healthcare and ambulance services – not only here but across the country," Knox County Mayor Glenn Jacobs said in a statement. "We put the current contract out to bid early because we realized, with 12 amendments already, it was becoming a hindrance to EMS services in the county. Though this new contract and its significant updates won’t immediately fix all the problems, we feel like it will be a big step forward.
"We still have high wait times at understaffed hospitals, but the new contract should help alleviate some of the associated issues, and, as always, we remain committed to working with all our partners to continually improve emergency access in our community," he continued.
How the committee selected the company
The committee in charge of reviewing the proposals was made up of five members, which included Colin Ickes, director of Knoxville-Knox County Emergency Management Agency; Jay Garrison, procurement coordinator from the county; Jennifer Ranson, an emergency medicine physician; Kevin Parton, senior director of the Knox County Health Department; and Steven Hamby, emergency response coordinator for the health department and chairman of the Tennessee Emergency Medical Services Board.
The committee scored each company on four segments: administration, operations, quality management and cost. The total possible score was 5,000. This is how they finished:
AMR: 4,761
Priority: 4,124
Falck: 4,060
AmeriPro: 3,655
"Knox County ran a fair and focused process and we are thrilled to win the competitive process and be able to continue our long standing service to the citizens here," Brett Jovanovich, AMR's regional vice president of the southeast region, said in a statement.
"The new and much different contract will help address many of the problems plaguing the EMS industry nationwide and we salute the county for taking a different approach."
What’s next?
The ambulance contract has historically been a contentious vote for the commission and there’s no guarantee AMR has the six votes required to approve the contract at November’s meeting.
"We’re only half way through this process and nothing is guaranteed. I anticipate having a robust workshop where we examine the process to date and have an opportunity to question the health department, executive branch leadership team and AMR. There are a lot of unanswered questions and past promises made that need to be discussed in a public process," Commissioner Larsen Jay wrote in a statement to Knox News.
He said AMR officials must convince commissioners they will improve their service here before the county accepts, rejects or demands changes to the proposed contract.
Commissioners’ hands are tied when it comes to suggestions or tweaks to the contract. Their only role in the process is to vote the committee's suggestion up or down. If they decide to reject it, the contract will require a rebid and the process starts over, which would take months.
To complicate matters, AMR’s current contract is set to sunset at the end of January. Even if AMR retains the contract, the current one would presumably have to be extended. If AMR's bid is not approved, it will take time to get a new ambulance service up and running.
Such confusion has precedent. In a heated ambulance contract debate in 2002, two Knox County Commission committees voted against awarding the contract to AMR, which won the rebidding process over Rural Metro, according to Knox News archives. Rural Metro had the contract the previous 17 years.
Weeks later, County Executive Tommy Schumpert removed a final vote on the contract minutes before the commission could take it up after Rural Metro filed a complaint with the county about how the procurement process was handled.
Schumpert originally supported AMR but later changed his tune, supporting Rural Metro instead. Months later, the commission approved a contract with Rural Metro. In the interim Rural Metro's original contract had to be extended so the county could continue receiving ambulance services.
AMR bought out Rural Metro in a 2015 deal worth over $500 million.
Correction: This story has been updated to clarify it is AMR policy, not state law, that requires medics to stay with patients until a hospital has taken over care.
Tyler Whetstone is an investigative reporter focused on accountability journalism. Connect with Tyler by emailing him at tyler.whetstone@knoxnews.com. Follow him on Twitter @tyler_whetstone.
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This article originally appeared on Knoxville News Sentinel: Knox County recommends commission stick with AMR for ambulance service
