MedStar/EMS

When someone calls 911, there must be, and will be, high-quality patient care sent to help, at all times. In the past year, the issue at hand has been about sustainable funding and continuing to deliver a high-quality Emergency Medical Services (EMS) system to the City of Fort Worth and surrounding areas.

In May 2024, the Fort Worth City Council approved the EMS Ad Hoc Committees recommendations, which include establishing an EMS system within the Fort Worth Fire Department. This will ensure that the EMS system for residents and visitors is financially sustainable, responsive, timely and focused on high-quality patient care. Current recommendations include: 

  • Focus on three categories: interfacility transports, EMS system changes and governance.
  • Interfacility transports are to be removed from the 911 call system and privatized.
  • Primary governance will move to the City under the Fort Worth City Council.
  • Advisory boards will be created to better represent member cities, first responders, and the medical/clinical aspects of patient care.
  • Service-level agreements will be created to memorialize EMS structure/relationship with participating member cities.
  • Create a single-role civilian position within the Fire Department.
  • Maintain independent medical direction keeping the Office of the Medical Director independent from the Fire Department.

Fitch & Associates, the consultant hired by the Fort Worth City Council to evaluate the current EMS model and provide a comprehensive study, will manage the transition of the EMS system from MedStar to the Fort Worth Fire Department and implement the process in partnership with the City of Fort Worth, the Fort Worth Fire Department and MedStar. There is an anticipated 12- to 18-month timeline, which includes a communications plan for stakeholders and end users of the EMS system. 

The Fort Worth City Council, by separate resolution, will create two advisory boards in support of the EMS system, including an EMS Advisory Board and Medical Control Board. They will also enter an agreement with the other member cities and transition the EMS system to the Fort Worth Fire Department. The City of Fort Worth will continue to meet with member cities to align on next steps.

Background

In 2023, the City recognized the rising costs of EMS delivery and the stagnant revenues affecting the MedStar EMS delivery model.

  • The City began an examination into solutions to ensure the long-term viability, stability, efficiency, and success of the EMS system that serves Fort Worth and other member cities.
  • An Ad Hoc Council Committee on Emergency Medical Response was established to provide support and guidance to have a financially sustainable, responsive, timely, and high-quality, patient-centric EMS system. The committee conducted regularly scheduled public meetings where Fitch presented findings and recommendations to City staff and other key stakeholders in the medical community.

    Fitch reviewed all aspects of the EMS process, including operational performance, personnel and staffing models, fiscal performance and governance.

  •  In April 2024, Fitch provided the City and the Ad Hoc Committee with its final report concerning the EMS Comprehensive Study, including recommendations concerning the system’s governance and operation.

The Study 

  • The interim report from Fitch was a comprehensive study of the current EMS system and compared it to 20 other communities nationwide, looking at governance issues, organizational structure, operations, response times, billing and revenue, and all costs and expenditures.
  • The current EMS system did not deploy sufficient resources and had less personnel available to meet the desired response time objectives in 2023. The system calls significantly exceeded established standards for best practice.
  • If the system were resourced to control for calls, then response time performance could potentially be improved by as much as 5.5 minutes (from the current 13.5 minutes to just an 8-minute travel time for all emergency 911 responses).
  • The City of Fort Worth actively engaged with member cities and other stakeholders regarding EMS system governance. 

MedStar Background

  • MedStar operates as a public utility model, under the direction of the Metropolitan Area Emergency Medical Services Authority, to provide emergency medical services, including ambulance care, to Fort Worth and 14 surrounding cities.
  • MedStar funds the majority of its services from fees collected for those services from health insurance and government programs, such as Medicare and Medicaid.
  • Between 25 and 30 percent of EMS calls resulted in no form of payment (lack of insurance or decreased state or federal reimbursement). Combined with supply chain issues and soaring personnel costs on the capacity of the healthcare industry, MedStar was spending more than it was taking in to maintain the current level of services.
  • Many other EMS systems are facing similar challenges.
  • Because of funding from health insurance and government programs, the City of Fort Worth, along with other MedStar member cities, has not supported MedStar financially since 2009.
  • As the Authority’s largest customer, Fort Worth accounted for 90 percent of its call volume and was represented by five of nine seats on the Authority’s board of directors.

 

Frequently Asked Questions