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Ambulance firm may get three-year extension on monopoly in Multnomah County

County also may adopt pilot so not all 911 callers must go to hospital emergency rooms


With the health care delivery system in flux, Multnomah County may simply renew its existing ambulance contract with American Medical Response rather than put it out to competitive bidding.

The Multnomah County Board of Commissioners is slated Thursday to consider extending American Medical Response’s contract for up to three years. That would retain AMR’s exclusive right to respond to 911 calls within the county, possibly up until Aug. 30, 2018. That contract, which essentially grants AMR a monopoly for emergency transports within the local 911 dispatch system, otherwise would expire August 30, 2015.

The Multnomah County Health Department, which oversees the county’s emergency medical services system, recommended the extension of the contract, saying it would give time to see how health reforms will fit into ambulance service provision. Preparing a new bidding process would have cost the county more than $300,000, county officials estimate. And they feared if the contract was put out to bid next year, the contract terms might soon be outdated by changes in, for example, how ambulance fees are paid.

The health care system is evolving quickly with the ongoing launch of the U.S. Affordable Care Act, often dubbed “Obamacare,” which expands health insurance to many of the uninsured. In addition, Oregon is deploying new Coordinated Care Organizations, which are focusing more on preventive health care than the old "fee-for-service" model, among other changes.

Those changes could upend the way we pay for emergency ambulance services, which are now charged to the patient or the patient's private insurer, Medicaid or Medicare.

Ambulance rates are all over the map, depending on who’s paying. Often ambulance companies are left with nobody to pay in the case of uninsured people. Another problem with the current system is that some uninsured people are using the ambulance system and hospital emergency rooms as a way to get routine health care services for free.

In a separate but related move, Multnomah County health officials hope to launch new ambulance service pilot programs, including one also before commissioners this week. That would allow some patients contacting 911 with non-emergency or “lower acuity” health issues to be taken by taxi, private vehicles or medical transport to medical clinics, urgent care centers or their regular doctors.

Right now, 911 callers are routinely picked up by ambulances and dropped off only at hospital emergency rooms, even when the callers are experiencing no detectable medical emergency. Analysts say that is a case of overkill that wastes significant funds at hospitals and ambulance companies.

County commissioners will be briefed on the two proposals Tuesday morning, and then vote on the changes Thursday morning.

Commissioners meet at 10 a.m. Tuesday and 9:30 a.m. Thursday at the Multnomah Building, 501 S.E. Hawthorne Blvd.

County health officials declined to discuss the new proposals before explaining them in person to county commissioners Tuesday.

For more information, see: multnomah.granicus.com/ViewPublisher.php?view_id=3.