Sabra Shay waited nine hours at UCHealth Grandview Hospital on narcotics to ease her pain before the hospital called an ambulance to take her for emergency gallbladder surgery.

Her daughter had driven her to the hospital initially, but by the time the ambulance was scheduled, she didn’t have any other option.

Ambulnz by DocGo, a private company, sent a driver and two other emergency medical services professionals, one a trainee, to get her.

“I did not feel confident in their abilities … There was no sense of sympathy. I may as well have been a box of widgets that they were moving from Point A to Point B. I was a job that needed to get done,” Shay said.

She was billed $900 after insurance for the service.

The high costs of ambulance care can give patients pause about whether to call 911 in an emergency, said Adam Fox with the Colorado Consumer Health Initiative. The nonprofit assists residents with high ambulance bills and advocates for state legislative change.

“It essentially forces people to gamble with their finances or their health,” he said.

The Colorado Springs Fire Department has proposed a plan it says would work better than relying on private contractors.

They want to end their contract with American Medical Response and run ambulances themselves, much the way a majority of suburban cities in the Denver metro area do.

The Fire Department says putting would-be profits into services would save more lives, lower ambulances bills, and improve patient experiences and pay employees better.

After nine years, the department expects to have $42 million in the bank after the switch.

But American Medical Response has argued the Fire Department is over-projecting revenue and says it won’t provide enough ambulances to get to emergencies as fast as AMR can.

The City Council begins weighing on Monday whether to go with the Colorado Springs Fire Department plan or renew the contract with American Medical Response. The contract is set to expire in a year.

But how do the proposals stack up on benefits for residents?

Gazette reporters have compiled a comparison of the two plans using criteria such as the impact on staffing, level of care and costs.

Staffing

Colorado Springs Fire Chief Randy Royal and department Fire Chief of Operations Jayme McConnellogue said under their plan, civilian emergency medical technicians and paramedics will work fewer hours and less overtime, leading to less burnout.

In a written statement this week, AMR said it has boosted staffing amid a nationwide workforce shortage but provided slim specifics about staff shifts or expectations.

Across the state, the industry has been plagued by a workforce shortage driven by the pandemic and generational changes as older workers retire and fewer young people come in, said a member of the state’s EMS System Sustainability Task Force, Sean Caffrey. He is also CEO and commissioner for the Crested Butte Fire Protection District.

To be competitive, agencies need to offer attractive pay, benefits and hours.

Paramedic Andrea Fox (no relation to Adam Fox) said while she worked for AMR in Pueblo for more than four years, ending in 2015, the company constantly ran short on staff, relying on the employees’ sense of duty to their colleagues and community, as well as a constant flow of new hires fresh from school to fill positions.

“It’s cheaper to run short-staffed than to pay all the individuals you need to keep the service up and running,” she said.

While overtime was not mandatory, it was expected, she said, recalling numerous times when she would work a 12-hour shift, go home to sleep for four hours, and return to work for part of a day shift. Her record was 20 hours straight.

It was a work ethic driven by a strong brotherhood and sisterhood of looking out for each other and the community.

“We have a very strong sense of duty, we have a strong sense of responsibility,” Fox said.

But, she said, they were often sleep-deprived, which “puts the community at a huge risk of us falling asleep.”

Rather than having a station to rest or work out, like many firefighters, AMR employees work from their ambulances, making each day at work one long car ride.

Under the Colorado Springs’ model, EMTs and paramedics will work eight-, 10- or 13-hour shifts and can move from one shift type schedule to another for more flexibility, Royal said. Fire Department documents assume 128 ambulance staff in 2025, the enterprise’s first year.

The department hopes to have enough part-time and fill-in employees, as well as those who volunteer to take overtime, to cut down on over-hours the EMTs and paramedics work.

Their plan also ensures EMTs and paramedics won’t spend their whole shift answering 911 calls, Royal and McConnellogue said. Part of the shift would be dedicated to emergency response and the other to completing required paperwork.

“… We understand that if they’re too tired to perform, then that adds a level of danger, or that lends itself to poor patient outcomes,” McConnellogue said.

EMTs and paramedics would work their shifts from their ambulances, but they will have access to the 24-going-on-25 fire stations across the city, the department headquarters and Fire Department complex to eat their meals and use their facilities, McConnellogue said.

AMR did not specify how many paramedics and EMTs are deployed at any given time in Colorado Springs, or how long their shifts are.

The company’s current staffing plan requires 53 paramedics and 87 EMTs, according its statement. Its team includes 94 paramedics, 53 of whom are full-time AMR employees; and 118 EMTs, 82 of whom work full-time.

“AMR continues to make significant investments in the recruitment of first responders through scholarships, paid training, and bonuses,” the company said.

AMR did not address Fox’s claims but spoke to “the outstanding work (its) first responders accomplish each day, as exemplified by (the company’s) 30-year history in Pueblo.”

In Colorado Springs, AMR “has become an integral part of the community, promoting the safety and well-being of residents and visitors of Colorado Springs,” it said.

Falcon Fire Protection District Chief Trent Harwig said in his district, most of the paramedics formerly worked for AMR, where they responded to between 12 and 14 calls a day during a 12-hour shift.

“It’s just demanding, it’s exhausting,” he said, referring to their former roles with AMR.

The Falcon district ended a contract with AMR to improve response times. It owns and staffs three ambulances. The district’s staff respond to far fewer calls and receive more generous compensation, making it appealing, he said.

If Colorado Springs does move to a fire-run EMS service, Royal said the city will continue or add onto mutual aid agreements it has with other fire agencies across the county. Colorado Springs would send ambulances to aid in disasters like mass casualties or fires, and vice versa, he said.

Level of care

Royal said the Fire Department’s model will allow them to enhance their creative programs, like the department’s Community Medicine Response Units (CMED) program, where EMTs in medically outfitted SUVs respond to non-life-threatening calls like a sprained ankle. The CMED units render aid, then determine the best course of action.

He expects crews responding to less emergent calls could respond to 30%-40% of calls, freeing up ambulances for emergencies and improving response times. The city sees about 80,000 calls a year.

The chiefs said Colorado Springs will also deploy more ambulances than AMR, though the private ambulance company said the opposite is true.

The Fire Department will purchase 25 ambulances, 18 of which will respond to emergency calls at peak deployment.

AMR’s peak deployment has exceeded 22 ambulances in Colorado Springs over the last eight weeks, adjusted for demand based on the time of day, the day of the week and the season. That figure includes the number of rigs used for non-emergency transports, but it is a fraction of the whole, AMR said.

“We respond on average to fewer than five non-emergency transports per day, so it’s accurate to say that at peak we schedule our deployment to meet the city’s emergency medical needs,” the company said.

The city’s ambulances will not take patients between health care facilities — AMR will continue that service, said Jamie Fabos, chief of staff for Mayor Yemi Mobolade, who supports the Fire Department’s plan, in an email to The Gazette editorial board.

AMR counters that time spent transporting patients, or instances where ambulances may be out of service because of delays in offloading patients in hospital emergency departments, can add up.

“It is much more challenging for a care and transport agency — be it a private or a public one — to be in position, ready to respond, when they spend an hour or more on a call and transport. That said, (Colorado Springs Fire Department) is proposing a system that deploys fewer ambulances than AMR currently deploys. Clearly, Colorado Springs is at risk for slower response times in that type of system,” the company said.

Paychecks and benefits

Colorado Springs would pay EMTs and paramedics better than AMR, but not as much as firefighters who are trained to respond to medical emergencies, fires, hazardous materials calls and rescues, Royal said.

However, new employees could move up in the Fire Department and become firefighters, as well.

In 2025, new EMTs would start within a range of $23.12 an hour to $27.57 an hour, and paramedics between $29.94 an hour to $35.64 an hour depending on experience, Fire Department figures show.

Job postings as of Friday on the Global Medical Response career webpage, AMR’s parent company, showed a basic paramedic and an EMT wheelchair driver in Colorado Springs start at $25 per hour and $17 per hour, respectively. AMR declined to provide pay data.

Fabos said a valuation by the Public Employees’ Retirement Association of Colorado, which provides retirement and other benefits to current and former public employees in the state, found the proposed city ambulance enterprise’s impact on Colorado Springs’ net pension liability was less than 0.1%.

The city has included in its salary and benefits projections the association’s expenses paid by the enterprise during an employee’s tenure, she said.

Bills for services

The Colorado Springs Fire Department expects to charge 40%-47% less for ambulance services than AMR, according to a city presentation shared with The Gazette. The costs are billed to insurance providers and patients would likely only see a portion of the cost.

Colorado Springs plans to charge $2,050 for Advanced Life Services (ALS) transports and $1,750 for Basic Life Services (BLS) transports in the enterprise’s first year. Basic Life Support includes the basic provision of medical supplies and services while Advanced Life Support provides more invasive procedures and the administration of various medications.

In comparison, AMR’s 2024 transportation fee for ALS is $2,827 per transport, and for BLS it is $2,569 per transport, the presentation showed.

In its statement, AMR said the Colorado Springs Fire Department regulates and approves the private company’s ALS and BLS transport charges.

AMR doesn’t get tax revenue to offset its rates, but the city says it wouldn’t use taxes either. The city, too, would receive federal Medicaid payments to offset its costs that AMR doesn’t qualify for.

AMR has also argued Colorado Springs will struggle to receive its projected revenue per transport of $755, predicting the city will receive much less in payments through Medicare, Medicaid and private insurance.

The Fire Department contends its projections are conservative.

Estimating what residents could pay for ambulance services is tough because it depends on their insurance coverage, City Auditor Jacqueline Rowland said in a Friday memo to the City Council and Mayor Mobolade, shared with The Gazette. Estimating what Medicare and Medicaid can reimburse is easier, she said.

For this reason, her office adjusted the mix of reimbursement the Fire Department can expect from insurance, Medicare and Medicaid so it is more conservative, the memo said.

“Based on review of data and input from industry experts we believe the payor mix is based on reasonable estimates. However, because of the complexity of the revenue calculation and dependency on estimates, forecast variances would be expected,” Rowland wrote.

Residents typically come to the Colorado Consumer Health Initiative for help with bills between $700 to $2,500 for their ambulance care, but a few can run as high as $10,000, Adam Fox said. The high-end bills tend to come from more rural services.

“There is not a whole lot of control on what ground ambulances charge, especially if they are publicly funded,” Fox said.

A 2019 state law prohibits a private ambulance company from billing a patient directly for services not covered by their insurance company if the insurance company is state regulated. So, if an insurance company agreed to pay $700 of a $2,000 bill, the rest could not be sent on to the patient.

Public ambulance services are not subject to the same rule, Fox said. Insurance companies regulated by the federal government, which cover many residents, don’t have to abide by the rule either, he said.

The nonprofit has been advocating for protections at the state level, but it would take a federal change practices at federally regulated insurance companies, Fox said.

McConnellogue said the city Fire Department has “no intention” to bill patients the remaining ambulance balance beyond insurance reimbursement.

Positive experiences elsewhere

A break-up with AMR would be the latest evolution in ambulance services for the community. In 2013, the city pulled out of a partnership with El Paso County to provide ambulance services via a private contract.

The fire chief at the time said the agreement didn’t represent the city’s best interests and was full of bureaucratic hurdles. But EMS System Sustainability Task Force’s Caffrey recalled it as a “national rock star” with quality oversight, care and training.

The model worked because of the high number of calls in the community that can fund either public or private ambulances services, Caffrey said.

“They are not in any economic peril regardless of the choice,” he said of Colorado Springs.

Public services are necessary in rural areas where the number of calls can’t generate enough revenue to reach a profit. But they are also common in cities.

South Metro Fire Rescue, for example, operates 30 fire stations and serves over 300 square miles in Arapahoe, Douglas and Jefferson counties, dispatching its own publicly funded ambulances along with its fire trucks.

Manitou Springs, the Falcon Fire Protection District and South Metro Fire Rescue all ended contracts with private ambulance providers to bring services in-house.

South Metro made the transition 25 years ago, and now operates solely under the EMS direction of its own fire department.

In the early 2000s, according to South Metro Fire Rescue EMS Division Chief Jens Pietrzyk, individual cities had their own fire departments and there were still volunteer fire departments at work.

Over the last two decades, Pietrzyk added, “every city grew to the point where every city has a full-time paid fire department and tax revenue coming in.”

Pietrzyk said he joined Littleton’s fire department right after the department switched to internal EMS dispatches. Littleton is now under the jurisdiction of South Metro Fire Rescue.

“Our system works fine for us,” he said. “We utilize the same resources for firefighting activities as well as for medical activities. We can use folks from the engine to go to the medical unit and vice versa. So, that’s good for us.”

As for Shay’s experience, the private company Ambulnz responded to say that it follows rigorous standards for clinical excellence and patient satisfaction. 

The Gazette’s Noah Festenstein contributed to this report.