The Colorado Springs City Council appeared split on Monday about bringing ambulance services in-house, following five hours of presentation from the Fire Department and city staff on the plan to create a new emergency medical services enterprise.

Some councilmembers characterized the potential move away from the city’s current ambulance services provider, American Medical Response, as an opportunity to improve public safety and for the Fire Department to “control the entire pie” of emergency response. Others questioned whether the proposed enterprise would be and would remain financially viable, and if the Fire Department could meet targeted response times.

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The city’s current five-year contract with AMR expires next April.

“I think the council is struggling with making sure we’re doing the right thing for the city,” Councilman Dave Donelson said in an interview following the discussion.

Donelson said he has not decided if he supports the proposal from the Colorado Springs Fire Department to take over ambulance response or if he believes it should remain in the hands of third-party, private providers.

Fire Department representatives and city staff reiterated arguments for a fire-run EMS system in the community: It will save more lives, lower ambulance bills, offer better pay and benefits to its employees, and improve and expand the department’s creative programs like tiered response.

“As technology grows … there’s going to be new and better ways to do this. If we don’t allow you to have control of the entire pie (emergency response), that’s really going to restrict our ability to be innovative going forward,” Councilman David Leinweber addressed Fire Department officials during the discussion.

Fire Department projections show the city will save $42 million at the end of nine years if Colorado Springs brings its ambulance services in-house, while charging people less for ambulance rides. 

Financial projections are based partially on how much money the department estimates it will receive in payments through Medicare, Medicaid and private insurance for every ambulance transport.

The amount Colorado Springs believes it can receive is about $755 per transport, city projections have shown. AMR receives somewhere between $530 to $550 per transport, Chris Williams, the regional director for Global Medical Response, AMR’s parent company, said Monday.

Because certain aspects of the financial projections are based on variables — like the mix of reimbursement the Fire Department can expect from insurance, Medicare and Medicaid — the city cannot determine exactly what its revenues will be until the enterprise starts operating, some councilmembers said.

“We’ve got a financial model based on what we hope will come to fruition,” Risley said.

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Deputy Chief of Staff Ryan Trujillo repeated statements that the estimates are conservative. A review from the City Auditor’s Office, released Saturday, further adjusted the mix of reimbursement the Fire Department can expect so it is even more conservative, he said.

Councilman Mike O’Malley raised concerns that if a large insurance provider no longer provided insurance to a broad swath of residents it could negatively impact the city’s financial projections and its expected ambulance transport revenue. 

For example, failure to strike a deal between CommonSpirit Health and Anthem Blue Cross and Blue Shield of Colorado meant that, as of May 7, some 7,800 El Paso County residents with Anthem are no longer in-network with CommonSpirit’s hospitals, clinics and doctors’ practices.

“If you haven’t put that into your model, it’s a miscalculation,” O’Malley said.

Fire Department representatives and city staff said that risk would also be true for AMR.

Because the Colorado Springs model would be an enterprise, the city legally cannot subsidize it with funds from the General Fund that supports some basic city services, like fire protection. 

“So if it struggles and it’s not working, we would have to ask this company we just terminated to come back” and provide ambulance services, Donelson said.

He wondered if the city ambulance enterprise could meet targeted response times of 8 minutes for emergent calls in urban areas. Fire Department officials have said their fire trucks meet these response time thresholds currently; an ambulance service also could, they have said.

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AMR consultant Daniel Cole said response times for fire trucks and ambulances can’t be equally compared.

“The Fire Department is not going to transport people to the hospital in the fire trucks that are responding quickly now,” Cole said. “You could double the Fire Department budget next year and of course it would be responding even faster. … But that wouldn’t impact ambulance response times one bit.”

The number of ambulances on the street determines ambulance response times, Cole said.

Colorado Springs’ plan calls for 18 ambulances at peak deployment, while AMR deploys 22 ambulances at peak. AMR’s number includes ambulances used for non-emergency transports, such as moving patients between medical facilities; Colorado Springs’ number doesn’t.

But AMR deploys fewer than five ambulances a day for non-emergency transports, so that number is a fraction of the whole, Cole said.

Councilwoman Nancy Henjum said the Fire Department’s EMS model is “an opportunity” for the city to improve public safety.

“I think the case has been made that it is time to bring EMS services into our fire department,” she said.