MedStar and the city of Fort Worth are looking for new ways to make the long-running EMS service financially viable — but until they find a solution, the city might have to fill in funding gaps.
MedStar chief executive officer Ken Simpson confirmed in a board meeting that the EMS authority asked the Fort Worth City Council for $1.5 million per quarter in the next fiscal year to help keep MedStar afloat while a third-party vendor gathers recommendations for future financing options.
“I want to emphasize that it would be transitional funding through the study period, which means that we would need to make sure that we’re in a sustainable position on the other side of that study,” Simpson told board members June 28.
City council members told the Report that they’re likely to approve the request — but it won’t come without scrutiny.
“The safety of our residents is of the utmost importance,” District 3 council member Michael Crain said. “There will be a study to look at the long-term viability of the current model, but right now we need to make sure that when someone calls 911, there is ambulatory service available.”
District 10 council member Alan Blaylock said MedStar will need a concrete plan moving forward to become self-sustaining. Both Crain and Blaylock said all options are on the table — including looking into fire-based EMS services. Under a fire-based EMS system, firefighter-paramedics are the primary responders to emergency medical calls.
“The reality is the writing’s on the wall for a little while, based on their budget,” Blaylock said. “I don’t think it’s any surprise that help was needed.”
MedStar serves 15 municipalities across 436 square miles in Tarrant County. The EMS authority was first created by the city of Fort Worth in 1986, after lackluster performance by private EMS companies in the area. Municipalities agreed to an interlocal cooperative agreement in 1988 that allowed MedStar to provide EMS services across their boundaries.
The authority has struggled to fund itself independently over the last few years. Increasing call volumes, paired with rising costs and smaller reimbursements, have resulted in the EMS system falling in the red from month to month.
A Citygate fire and EMS staffing study commissioned by the city last year found that MedStar funds all of its services through a fee structure. That reliance on fees puts MedStar in a more precarious position, the study’s authors wrote, because Medicare and Medicaid don’t pay the full cost of an ambulance transport. MedStar’s bills are far above their actual collection rates.
“We want to make sure that we’re in a sustainable position moving forward that is the least dependent on city dollars as possible, which the city seems to share that thought,” Simpson said at the meeting.
District 6 council member Jared Williams said the council can’t make a decision on temporary funding without thinking about the bigger picture. He’s asked city staff to research what other options, like fire-based EMS, would cost the city, and how much staffing they would require.
Some Fort Worth firefighters have previously criticized MedStar, most recently over how MedStar changed its method of prioritizing calls in an effort to improve EMS response times. The fire union expressed concerns that the effort would result in negative patient outcomes.
“We don’t outsource our police services, we don’t outsource our fire services,” Williams said. “Should we be outsourcing our EMS services?”
Fort Worth City Council expects the other municipalities who rely on MedStar to also give financial assistance. Those municipalities want to see what Fort Worth will do before committing funds, said District 8 council member Chris Nettles. Once the council makes a decision, he said, the other municipalities need to be prepared to chip in as well.
“How do I tell my taxpayers that we’re gonna fix MedStar’s issues, but no other municipalities’ taxpayers are going to fix them?” Nettles asked. “I don’t think Fort Worth is going to take a liking to using tax dollars to help other areas out, if they’re not using their tax dollars to help.”
The proposal won’t come before the full council until at least August, as there are no City Council meetings in July. It will run up against a tight budget deadline; the next financial year’s budget must be approved by September.
“All cards are on the table, because at the end of the day, lives depend on EMS being functional, financially sustainable, and most importantly, patient centered,” Williams said.
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