Fort Worth changes EMS delivery model

MedStar operates as a public utility under the direction of the Metropolitan Area Emergency Medical Services Authority, which was created by the city of Fort Worth in 1986, according to the MedStar website.

On Sept. 19, Fort Worth City Council approved a $2.6 billion budget, including $4.2 million in funding for MedStar to address a budget deficit. To help assess a more financially sustainable model for the future, City Council contracted with Fitch & Associates, a consulting firm that evaluates emergency medical services, on Oct. 31 to compare Fort Worth to 20 other communities nationwide.

The firm examined the following data points as part of its evaluation: governance issues, organizational structure, operations, response times, billing, revenue and expenditures.

While the Fitch report showed MedStar is under-resourced—the entity operates with one of the smaller budgets of the entities in the study and does not receive public funding—it also highlighted that MedStar did not meet Fitch & Associates’ desired response time objective of 8 minutes. City of Fort Worth documents state delays in MedStar’s response are typically caused by the dispatch process, in which calls navigate through three communications centers.

Valerie Colapret, communications manager with the city of Fort Worth, said response times should improve by 5 1/2 minutes with the EMS shift.

“[MedStar has] been fighting an uphill battle,” Flores said at the May meeting. “They ran out of financial runway, but they did not run out of dedication. We’re here to change the system to a sustainable model. The fire department stands ready, and is collaborating with our MedStar partners and member cities to make this happen.”

According to MedStar documents, revenue typically comes from five sources: Medicare, Medicaid, insurance, health care facilities and billing patients directly. Increasing costs and decreasing revenues have created a shortfall in MedStar’s operating budget, according to city documents.

According to MedStar documents, the deficit was caused by:

• Insurance companies paying less
• A rise in uninsured people or uncollectible expenses
• Rising labor and fuel costs
• Lingering pandemic impacts

Simpson said there are around 600 open city positions without having EMS. Therefore, the 550 MedStar employees could transition to the city’s fire department.

“There’s a sense of excitement in what we can build,” said TL Drake, a paramedic field training officer with MedStar.

The new EMS system will:

• Report to Fort Worth City Council and the city manager
• Be funded by Fort Worth taxpayers
• Allow MedStar employees to become fire department employees

MedStar provides emergency medical services, including ambulance care, to Fort Worth and 13 area cities. Colapret said response times should improve by as much as 5 1/2 minutes because emergency calls won’t be routed through MedStar any longer.

“The reduction in call and data transfers through a single communication center is going to be the primary source of reduction in the caller's experience with the system,” Colapret said.

A map of MedStar’s service area can be found here.

What’s next

The transition to a fire department-based model will take up to 18 months and cost $10 million, officials said.

Colapret said the city will be taking part in the fiscal year 2024-25 budget process for MedStar to determine efficiencies and overlaps that exist within the fire department, other city departments and the MedStar annual budget.

She added that revenue recovered from EMS billing will likely go to the general fund to offset the cost of providing the service.

“It is no longer sustainable to run a major EMS system without public funding,” Dr. Jeffrey L. Jarvis, MedStar’s chief medical officer, said.