Kevin Mohatt was dead for 10 minutes.

With his car right in the middle of the intersection of Higley and Warner roads Feb. 14, the 59-year-old Gilbert resident had suffered a massive heart attack. But nearby motorists, police and Gilbert paramedics revived the frequent hockey player and fifth-degree black belt. He is back on his feet today.

“I wasn’t supposed to make it,” he said. “I’m in a very rare club.”

The town is hoping Mohatt’s experience is one they can replicate for more Gilbert residents over time. Getting faster response times throughout the town was a main argument the town made for taking ambulance service in town out of the private sector and under control of Gilbert Fire & Rescue Department in 2021.

Now, nine months into the town running the service, early data indicates the town is doing just that: providing faster service and doing it at a lower cost than was previously being achieved.

The Gilbert Fire Department reported it is responding in fewer than nine minutes on 95.2% of all ambulance calls, well above the 90% threshold required by its Certificate of Necessity—the plan approved by the Arizona Department of Health Services that allows an entity to provide service in a geographic area.

Furthermore, the department’s base billing rate is $84 less per transport than in neighboring cities with the service or with American Medical Response, which previously serviced Gilbert and still does for most municipalities in Maricopa County.

Still, the change from a privately-provided service to a public one was a contentious issue in some quarters when the change was made, and critics remain skeptical of the benefits despite the early results.

“It’s still pretty early, but honestly, there were no surprises,” said Vice Mayor Aimee Yentes, who voted against the service. “I think the information we’re going to get is going to validate what point [the town] wants to be made.”

Improved response times

Fire and Rescue Department Chief Jim Jobusch admits the data is limited at this point as the town is early in the life of the service, which expanded to townwide coverage July 26.

However, Jobusch expressed satisfaction with those early results.

“What we are seeing is that the response times are outstanding,” he said.

Jobusch noted that the town’s goal was to respond in fewer than nine minutes 90% of the time and in fewer than 15 minutes 95% of the time. But not only is the town hitting under the nine-minute mark 95% of the time, it has yet to have a call response in excess of 15 minutes.

“So that’s fantastic as well,” he said.

Gilbert’s data showed AMR previously hit the 90% requirement of its CON. Gilbert officials expressed unhappiness that the northeast corner and southern portion of town were under a 90% rate.

Gilbert substantially raised the mark in the northeast from 78% to 100%, though the south remains a virtual wash at 86% on only 14 calls through Feb. 1. Assistant Fire Chief Bob Badgett said that was too few calls to really gauge there.

“We're seeing that pretty consistently across the town,” Jobusch said.

Even if an area begins to lag, Jobusch said the town is in position to adjust.

“That's kind of the beauty of us running this service internally,” he said. “We can adjust to those issues pretty quickly.”

Financial measures

The town projected over eight years—the typical life of an ambulance—the service would earn $35.3 million in revenues against $30.05 million expenses, plus another $2.49 million in startup costs.

That would leave $2.76 million in net revenue, which could then be reinvested in replacements, according to the town’s financial plan.

To fund the startup costs, the town borrowed $3 million from its general fund with plans to replenish it over nine fiscal years.

Jobusch said the early financial results have been good.

“The revenue is where we projected it to be, and actually a little bit better,” he said. “I think over time, we'll be able to pay back that debt that we had to the general fund, the money we borrowed to start this service. And then we can manage the ongoing operations cost as well.”

Gilbert Budget Director Kelly Pfost confirmed the revenues as healthy enough thus far to set the town on a path to repaying the internal loan and to build a healthy repair-and-replace fund.

Pfost said the town anticipated revenues to start slowly because of the lag from service to billing to receiving the amount owed. Nonetheless, the town’s accounts show Gilbert turning a positive cash flow by September and since then, with the exception of January because of some one-time expenses, Pfost said.

The most recent month on record, March, showed the town in the black by nearly $192,000.

To date, the town is in the red by about $8,000, about $253,000 less than what it was through August, despite the heavy one-time January expenses.

If there has been a challenge, Jobusch said it has been staffing the service.

“In this industry, it can be pretty transient as far as the employees because a lot of them would like to be firefighters,” he said. “So they come to work on an ambulance and get some experience and then they go off and be a firefighter somewhere else. We expected that.”

Jobusch said they still are able to replace people rapidly. However, Pfost said personnel costs are an area to watch.

“We know that there is pressure everywhere on making wages stay competitive,” she said. “And so we need to make sure that revenues and expenditures stay balanced over time.”

Innovation in the space

While town staff feels the operation is running smoothly, Yentes said she still has concerns about the service and feels there was a never fair discussion on the data when comparing AMR’s service levels.

“Response times is one dimension of service, and there's been studies done by public fire associations that actually make the point that response times aren't necessarily a corollary of patient outcomes,” she said. “It's one metric. It's not an irrelevant one. I appreciate it, but it's certainly not the whole story.”

But Yentes said her greatest frustration is abandoning a market-based approach.

“I truly believe will slam the door shut on any innovation that happens in this space,” she said. “And the tradeoff will be for better health outcomes for patients.”

Yentes pointed to models used in other states that are not just traditional ground transportation, but a blend of approaches.

“You also have that incentive and you have that pressure that comes with competition,” she said. “It's not a mystery how these and why these dynamics play out that way.”

Jobusch, who is retiring in July, remains confident in his department’s level of service.

“We're doing exactly what we said we would do,” he said. “And I have no reason to believe that won't continue and in fact improve as time goes on. I think [residents] can be confident that this was the right move for the town of Gilbert, and our citizens are reaping the benefit of it. I can assure you that.”