Though an election to annex Pflugerville and its extraterritorial jurisdiction into Travis County Emergency Services District No. 17 is slated for Nov. 2, city officials are moving forward with negotiations with a private ambulance service provider.

During an Oct. 12 meeting, City Council approved a motion to begin negotiations with Acadian Ambulance Services of Texas LLC.

City documents state a probable contract contains a base term of two years with an option of up to three subsequent years and would begin Jan. 1, 2022.

Founded in 1971 in Louisiana, Acadian operates primarily in Louisiana and Texas, including Bastrop, Live Oak and Bexar counties.

A document from Acadian states, should officials contract with the company, it could launch four dedicated units, one of which would be equipped and staffed at the critical care transport level.

The document states the company would use street corner posting in areas of highest need and could increase resources to meet demand.

The actions from council form the latest volley in a dispute between the city of Pflugerville and Travis County ESD Nos. 2 and 17.

The crux of the dispute centers on ESD 2 officials citing a need for an annual subsidy from the city of Pflugerville of about $2.8 million to continue providing the area with EMS and advanced life services.

Moving forward with Acadian

Deputy City Manager Trey Fletcher said Acadian distinguished itself in the selection process through compassionate billing protocols and its preponderance of experience in Texas as well as Pflugerville's previous experience working with the company through various city events.

Troy Mayer, associate VP for Acadian, addressed council Oct. 12 and said his company, while large, is also 80% employee owned.

"So, it is contingent upon employees that they provide exceptional service," Mayer said. "Our team basically goes through a vigorous amount of training."

Among myriad other benefits and services, Acadian has a full-time medical director, it requires continuing education for staff, it focuses on accountability, and it employs highly trained technicians to work on ambulance transports, Mayer said.

In a document to the city of Pflugerville, Acadian provided its rates that range from $868 to $2,763 per transport, depending on the type of vehicle used as well as the level of care provided. The company also charges $26.49 per mile. Its EMT rates range from $35.85-$83 per hour.

Compassionate billing, Mayer explained, pertains to those who are unable to pay Acadian bills. Should they meet certain criteria, they will not have to pay or they will pay less than full billing.

Council Member Cesar Ruiz said he has looked into Acadian and has not found one emergency services department in the state of Texas that has had a positive word to say about Acadian's compassionate billing program.

"My biggest deal isn't the average citizen; it's the people who are economically disadvantaged," Ruiz said.

Council Member Omar Pena asked about Acadian's services in Bastrop County, where billing and response issues have been reported.

Mayer said in response that some of the allegations Pena referenced were overblown. He said Bastrop County has since renewed services with Acadian, and Acadian has also made improvements based on previous reported issues.

"If any EMS service is going to tell you they will run 100% with no problems, that is deceiving," Mayer said. "Our goal is to meet compliance, if not exceed it."

Council approved the motion 5-1 to authorize City Manager Sereniah Breland to negotiate a temporary contract with Acadian. Ruiz was the sole no vote.

The approval for an RFP also comes two weeks after Pflugerville officials set in motion an ordinance establishing a franchise requirement to provide emergency medical services within city limits. That ordinance passed unanimously on a second reading Oct. 12, with Council Member Rudy Metayer absent from council.

In response to the franchise requirement, officials from ESD 2 sent a letter dated Oct. 11 to Pflugerville City Council expressing the district's concerns.

Among the concerns, ESD 2 Board President Michael Bessner said for-profit ambulances have high EMS billing rates along with aggressive billing collection practices.

In the letter, Bessner also quoted a Sept. 18 letter from ESD 2 to Pflugerville City Council that states for-profit EMS will identify the minimum level of service needed to be profitable and accept significant lapses in response times.

He cited as evidence for-profit services in Bastrop, which in some cases had ambulance response times of 47 minutes to 55 minutes.

Public sentiment

During public comment at the Oct. 12 meeting, most attendees who spoke were staunchly against commissioning a private ambulance service.

Accountability over profit stood firm as the unified message from the majority of those who addressed council.

Ronald Cunningham, a resident of Pflugerville's ETJ, said he doesn't like that council took away his choice to vote for the creation of the ESD 17 overlay district. He stressed his staunch opposition to hiring a private ambulance provider.

"I'm concerned about predatory billing practices of for-profit ambulance services," Cunningham said.

Those who spoke in favor of seeking alternate ambulance services or finding a better compromise with ESD Nos. 2 and 17 cited incorrect accounting of funds and a need to seek an equitable solution for all involved.

Pflugerville officials have based much of their decision-making in recent months on a report they commissioned with AP Triton, a consulting firm specializing in service delivery methodology and practices for fire and emergency care services.

On June 21, Rich Buchanan from Triton AP said the study found ESD No. 2 does not need an annual payout of $2.793 million that it has requested from the city. He also laid out five options for Pflugerville during the June 21 workshop, one of which involved contracting with a private ambulance service.

ESD 2 officials responded in early July by saying the AP Triton report was not entirely accurate.

In addition, the city of Pflugerville has endorsed suits against ESD 17 with regard to annexation into the district. So far, those efforts have been unsuccessful, and it remains unclear what impact contracting with a private ambulance provider will have should voters approve the ballot measure in November.

The city of Pflugerville this summer commissioned AP Triton to conduct an EMS system valuation study. Council discussed the results Oct. 12, which put forth several recommendations.

Among them, the report suggested the city initiate discussions with private ambulance providers to determine if it is possible to provide services at no cost to the city.

The second AP Triton report

During the Oct. 12 meeting, Buchanan presented the city-commissioned system valuation report to council, stating the prime objective was to "determine first responder and ambulance costs and revenue projections as a data driven model to extend across the entire district."

Buchanan said the study determined the EMS system could improve without adding a tax burden to the city.

With regard to billing and revenue collection, the report stated ESD 2 charged about $5.8 million and collected about $2.2 million in FY 2020.

"Just adjusting [ESD 2's] billing process could net them about $3 million," Buchanan said. "We estimate that with a few more changes they could be at $3.6 million, which would be more than enough to pay for this system."

Ultimately, the cost to run the EMS system is $2.7 million, Buchanan said.

The report concluded by 2030 the area's service demand for EMS transport will increase to 4,689 calls for service from 4,056 calls in 2020. The bulk of the calls for EMS service occur on the west side of Pflugerville, which is one place Buchanan suggested two ambulances could be parked while waiting for calls.

"Most of the call volume for the ETJ, and by that I mean 90% of the call volume in the ETJ, is in the northwest corner of the district," he said, adding that is another area to place an ambulance waiting for calls.

Buchanan said the data show a four-ambulance system would handle 99.99% of all calls for service.

Response times were a key component of a successful EMS system within the report, and Buchanan said providers should be at the scene of an emergency within eight minutes.

Buchanan said data from his company show Pflugerville citizens will take in a significant increase in taxation through the ESD 17 annexation with no increase in services, and the city could provide EMS/ambulance transport at no cost to the taxpayer with a better response standard than is being provided by ESD 2.

Buchanan stipulated he does not believe private ambulance service is a sustainable solution long term, but could be viable until issues are figured out with ESD 2.