Unhappy with ambulance response times, San Diego plans to take over staffing and billing control from Falck

Fire Chief Colin Stowell says fundamental changes are necessary to cut response times and that he plans to shift the city to an alliance model used in Contra Costa County.

Feb. 18, 2023 10:23 AM PT

San Diego plans to fundamentally change ambulance service in the city by taking authority over billing and staffing away from private ambulance provider Falck, according to Fire Chief Colin Stowell.

The move comes after many months of Falck falling short of the staffing and response-time promises it made to the city when it took over ambulance service in November 2021.

The city’s new plan, which Stowell said he’s negotiating with Falck officials, would give San Diego the power to increase ambulance coverage by hiring multiple companies.

San Diego isn’t shifting to in-house ambulance service similar to San Francisco and Los Angeles, where city workers operate the ambulances. Instead, San Diego will follow what is known as the alliance model created seven years ago in Contra Costa County.

Falck and other private providers will still own and staff ambulances operating in San Diego, but the city will take control over how those ambulances are deployed. It also will bill ambulance patients and collect payments from them.

Whereas under the current model Falck pays San Diego $9 million a year for the right to charge patients, the city will now pay Falck and other providers fees to operate the ambulances and will have the right to charge patients itself.

Though the model shifts financial risk from Falck to the city, proponents of the alliance model say state law gives public agencies better reimbursement rates from Medicare and MediCal patients than private ambulance providers get.

Stowell said revenue generated under the new model would be reinvested into the city emergency medical system to improve service.

Critics of the alliance model say it eliminates competitive bidding for ambulance services, allowing city fire officials to handpick the providers they will use.

Falck is expected to be the city’s primary ambulance provider under the new model, but city officials said they expect to have more than one.

“We would subcontract with multiple ambulance providers to ensure we provide the necessary hours for the community,” Assistant Fire Chief Dave Gerboth told the City Council’s Public Safety Committee on Feb. 15.

Falck spokesman Jeff Lucia said the company is enthusiastic about the new model.

“It will help further stabilize the emergency medical system,” he said. “We think it’s an excellent example of public-private collaboration.”

When Falck took over ambulance service for the city, it promised 1,008 hours per day of coverage, but during most months it has been providing roughly 930 to 960 hours per day. That’s more than the 840 hours per day provided by the city’s last provider, American Medical Response, before it was replaced by Falck.

Gerboth said taking control of staffing will allow the city to adjust the number of hours of service based on seasonal increases in emergencies and other fluctuations.

Stowell estimated it would take three to four months to implement the alliance model after he concludes negotiations with Falck.

In the interim, he said, Falck would be required to bring on a second ambulance provider as a subcontractor until the city is ready to take over.

Both the alliance model and Falck‘s use of a subcontractor are to be part of an amendment to Falck’s contract with the city. The city has leverage to renegotiate that contract because Falck has fallen short of its obligations under it.

Stowell said he expects to present the proposed amendment to the Public Safety Committee in March and hopes to take it to the full City Council soon afterward.

“We’re working as fast as we can on some of the language in this amendment,” he told the committee. “There’s a lot of data to review, a lot of financials on the expenditures and the revenues and how best this alliance model is going to play out.”

Councilwoman Marni von Wilpert, chair of the Public Safety Committee, praised Stowell’s new plan.

“I’m happy we have a concrete strategy to move forward and change what’s happening,” she told the chief. “We would not have changed ambulance providers, we would not have done this whole request for proposals, if we were OK with the status quo, which is what we’re getting under this contract.”

Falck also may soon see an improvement in its struggles to recruit and retain paramedics and emergency medical technicians to staff the 65 ambulances it operates in San Diego.

The company has reached a tentative three-year agreement with the labor union representing its workers that includes 9 percent raises in the first year and 4 percent raises in each of the next two years.

Tony Sorci, leader of the union, said the new deal has been a long time coming for his workers. The roughly 400 union members are expected to vote on the agreement by the end of this month. The current starting annual salary for Falck paramedics in San Diego is $57,206.

Sorci said the alliance model likely would boost morale because there would be more ambulances and staff on the road, reducing the need for forced overtime shifts. ◆