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Matt Zavadsky, MHA

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Hi Matt,
 
I hope that all is well with you and that you've survived the hurricanes etc. intact. 
 
I liked your article, and I like where you chose to publish it. emsnetwork.org is a great resource.
 
For debate purposes, I'd like to raise a couple of issues - maybe you can address them in follow-up articles.
 
1. Identifying ourselves as "health care" to the exclusion of "public safety" puts us at a competitive disadvantage. Communities are willing to support public safety with community dollars, but they are not willing to pay for health care. Reference who is "in" and who is "out" when it comes to homeland security dollarsetc., ad nauseum.
 
2. In the systems I've been associated with, the costs of "being there" for the public are someplace between 50 and 80% of system costs. "Being there" confers a benefit on the community in terms of assuring quality of life. Yes, some of our time we provide service to individuals, but so do the cops and firefighters - when they rescue a hostage, foil a crime in progress, or extricate someone from a car. 
 
3. Public safety services ostensibly serve everyone, regardless of need or ability to pay. Health care services, on the other hand, do not. If they did, we wouldn't need volunteer free clinics, etc., and our ambulance services would be paid a fair buck for transporting Medicaid beneficiaries and indegent uninsured. Health care agencies, on the other hand, close up or cut back when they're not sufficiently profitable. And the federal healthcare bureaucracy (DHHS through CMS and the Medicare program) have sent the opposite message - they're working hard to shift the costs of a decent EMS system back to the local taxpayers (e.g., in the direction of public safety). That was a stated goal of some officials before the Fee Schedule process, and from that perspective it was quite successful. Hospital and private EMS services around the community are doing everything they can to get their hands back in to the public pocket, or throwing the keys back to the responsible political jurisdiction (witness Leon and Marion counties in FL, and everybody else appearing on emsnetwork.org.
 
4. Unfortunately it's reality that the health care system treats its employees (except physicians and CEOs) poorly. Why they think it's appropriate for employees in physical jobs (like nurses and paramedics) to have to work to age 65, and then provide them with a meager or with no pension, is beyond me. The public has seen fit to do better through its high-risk public safety pension programs, and our workforce has recognized this by letting their shoes do the walking.
 
I guess in the end I don't want us to be "pure" anything. We can't be really successful if we become purely "public safety" and we can't survive if we become purely "health care." Somehow we need to continue to be in both camps and draw from the best that each has to offer. And that doesn't even get to the discussion of public funded services provided by the public sector versus publicly funded services provided through the private sector. There's lots of literature on that discussion from the refuse disposal industry, but precious little from ours. Of course, it's much easier to measure quality in the trash business than in EMS, but.....
 
Hey! Take care and stay in touch.
Skip

Skip Kirkwood, MS, JD, EMT-P
Executive Director / Chief
Area Ambulance
701 10th Street SE
Cedar Rapids, IA 52403

About the columnist: Matt is the Director of Tri-State Ambulance, a not-for-profit subsidiary of the Gundersen Lutheran Healthcare System located in La Crosse, Wisconsin. Tri-State serves as the sole 9-1-1 advanced life support provider for the 2,200 square mile greater Coulee Region local in Western Wisconsin and Eastern Minnesota. 

He holds a Masters Degree in Health Service Administration and has 25 years experience in EMS including volunteer, fire department, public and private sector EMS agencies. He is a former paramedic and has managed private sector ambulance services from 10,000 to more than 100,000 annual call volume in locations including Fairfield, Connecticut; Augusta, Georgia and Orlando, Florida. He has also served as a regulator in Lincoln, Nebraska and Volusia County (Daytona Beach), Florida. 

Matt is a frequent speaker at national conferences and has done consulting in numerous EMS issues, specializing in high performance EMS system operations, public/media relations, public policy, employee recruitment and retention, data analysis, costing strategies and EMS research.

He has served as the American Ambulance Association as Chair of the Industry Image Committee and membership on the Professional Standards, Strategic Development and Management Training Institute Committees.

Matt is an Adjunct Faculty for the UCF's College of Health and Public Affairs teaching courses in Healthcare Economics and Policy, Ethics, Managed Care and US Healthcare Systems.

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