The only reason we get away with giving such large doses of epinephrine to these patients is that they are already dead.

- Rogue Medic

NY City Decides to Cut Back on Ambulances

Mayor Michael Bloomberg appears to be trying to convince people that he really does not understand business.

New York City will begin charging private hospitals as much as $1 million a year for hospital ambulances dispatched by the city’s 911 system, a controversial initiative that some medical professionals fear will prompt hospitals to stop providing the service.[1]

The Fire Department has agreements with 25 private hospitals to provide voluntary ambulance services in the five boroughs. These hospitals account for roughly 37% of the ambulance tours in the city.

Beginning in January 2012, the administration plans to charge these hospitals fees based on the number of scheduled ambulance tours they operate in the 911 system. The annual fees are expected to range from about $73,000 to $1 million per hospital.[1]

The trick is in charging enough to make some money lose less money, while not encouraging the hospitals to decide that EMS is not a profitable business to be in.

“The 911 system cost-sharing initiative would allow the city to recoup the costs associated with 911 system dispatch and telemetry that are currently borne by the city, namely, the costs associated with the staffing and operation of the Emergency Medical Dispatch Center and Online Medical Control (Telemetry) center,” John Peruggia, FDNY’s chief of EMS command, wrote to one of the hospitals.[1]

I have a suggestion for cost savings on their Online Medical Control (Telemetry) center. Scrap it. Make doctors available for consultation on an as needed basis, rather than all of the Mother-May-I? that requires this system. Of course, that means that medical directors should be paid more to provide aggressive oversight for EMS. Online Medical Control is not oversight.

Frank Gribbon, a spokesman for the Fire Department, said the hospitals benefit from bringing in patients. The city views the fee as “cost sharing.”

“The goal here is not to drive anybody out,” he said. “The goal is to share the burden and the cost.”[1]

How many of the hospitals will just decide that they do not want to share this cost?

The city has 967 eight-hour ambulance tours scheduled every 24 hours. Of those the Fire Department handles 614 of the tours and the private hospitals’ ambulances handle 353 of them. If the private hospitals were to drop out of the system, the city would be forced to pick up the slack or sign agreements with other institutions to meet the demand.[1]

If FDNY were to hire to cover all of those tours, that would be almost 400 new employees. Let’s assume a cost to NYC of $100,000.00 per employee per year.

How much is that going to save cost NYC?

Last month, the mayor unveiled $585 million of new budget cuts in the current fiscal year and $1 billion for the following fiscal year. Charging the hospitals these fees will save $8.7 million annually.[1]

If my math is close, that would be about $40 million annually and the hospitals would not even be paying this fee. Rather than saving $8.7 million, they would be adding $40 million – we should also include the cost of new ambulances and supervisory personnel.

Maybe NYFD won’t hire to cover the openings, but will just work the current ambulances and employees harder. Then there is the option of saving money by paying overtime to staff the ambulances. This may work in the short term for both employees and the agency, but after a while extra pay is not worth it. The burn out leads to bad patient care and increased turn-over. Wimps – just work a measly 40% harder each week.

Look at Philadelphia. In order to protect their nonsensical residency rule, they are several hundred medics short. Their responses sometimes require them to travel across the entire city. But they can brag that all of their paychecks go to people who live in the city. With a patch, a pulse, and a Philly address, who cares about quality?

I would be cynical, if I were to suggest that politics is dramatically more important than quality of care in Philadelphia, so I won’t suggest that.

Take a look at the way NYFD pays EMS. Clearly, FDNY takes EMS seriously.

Basic EMT – $31,931 to start.

A major factor driving up the city’s poverty rate was the cost of housing, which has remained relatively high despite the real estate collapse. To account for the cost of shelter, city officials raised the poverty threshold for a family of four by nearly 25 percent, from an annual income of $24,353 in 2005 to $30,419 in 2008. The federal threshold in 2008 for a family of four was $21,834.[2]

After a 5 years of this, how many people are going to decide that they are sick of being run into the ground. Time to abandon EMS for the fire side? Probably not that easy, but there won’t be much pay to give up to move to some other EMS agency that pays better and is in a location with a lower cost of living, such as Chappaqua.



*Base salary does not reflect overtime, shift differential, meal money and benefits. Salary and vacation provisions are subject to change pursuant to collective bargaining settlements.

After 5 years as an EMT for FDNY – $45,834.[3]

After 5 years as a firefighter for FDNY – $76,488.[4]

What a wonderful way to let EMS know that they are valued. Working on an ambulance handling several times as many calls as those working on a fire truck, but for poverty level pay that is laughable compared with those fire fighters.

Maybe Mayor Bloomberg’s plan is to keep EMS too busy to realize what is going on. Don’t tell.

Followed by NY City Decides to Cut Back on Ambulances – Comment from John and later followed by Excellent Coverage of Mayor Bloomberg’s Attempt to Blackmail Voluntary Hospitals.

Footnotes:

[1] City to Charge for Ambulances
Private Hospitals Will Get a Bill as Mayor Adds Fees to Narrow Budget Gap
By Michael Howard Saul
December 9, 2010
Wall Street Journal
Article

[2] Calculating Poverty in New York: More by City Standard, and Less by Federal One
By Sam Roberts
Published: March 2, 2010
NY Times
Article

[3] Benefits and Salary for EMS Members
FDNY web page

[4] Benefits and Salary
FDNY web page

.

Comments

  1. The city is hoping hospitals drop out of the system. The hospital units (commonly referred to as voluntary units) generally serve more affluent and therefor better insured segments of the communities in which they’re located. Hospitals really make their money on critical care admissions. Every ER is a money vacuum that exists only to draw more and sicker patients into the facility. In the current system where these most critical patients are simply taken to the closest appropriate hospital and patient steering is a big no no, what benefit is there to running a hospital based system unless it is generating some kind of cash income. So either the ambulances make money or these units are steering patients to their home hospital. The truth is if FDNY could take control over all 911 ambulance tours they actual decrease the operating cost to taxpayers through increases in insurance payments.

    As for the income disparity between EMS and Fire, thats an issue going back to the severe mismanagement of the system under HHC. Correcting the disparity takes time since no mayor is simply going to hand a 20k/ year pay bump to 3,000 employees and get re-elected. That being said the gap isn’t as bad as it appears. Firefighters base salary is based on an addition 220 hours per year, their fringe benefits include all of their differentials and contractual overtime. The listed EMS salary is truly our base salary, the absolute minimum we can make. A 5th year medic working an extra 220 hours makes over 70k a year. One serious roadblock to salary increases is the prevailing wage of EMTs and Medics in NYC. After including healthcare and pension benefits we become the best paid EMS system and the second largest provider, Transcare, becomes the worst. We can’t argue for more money when someone is doing the same job for less.

    One last point, no EMT or Paramedic is fleeing NYC for Chappaqua. I’m from Chappaqua’s slightly less affluent neighbor Pleasantville and our 40k+ per capita is still a whole lot more than NYC’s 22k.

    • Then again people might just opt not to call 9-1-1 if they think that the FDNY ambulances are going to try to steer them to a city run hospital.

      If you think that voluntary ambulances are steering patients to their hospitals, then you should report that to CMS and you’ll like become pretty wealthy. I’m not current on the rules about steering, but at one time the feds pretty much required hospital based ambulances to bring patients to their affiliated hospitals as the feds were worried that they would steer indigent patients AWAY from them in order to reduce ED costs. Which is counterintuitive to me, but what do I know, I’ve only spent my adult life in the EMS industry.

      My other question would be who has more down time during their shift? Are the FFs able to get enough rest that they can work their other jobs? Maybe it’s different in NYC, but around these parts just about all the FFs I know have outside jobs that make them more money than their FD jobs. I don’t know of many in EMS that have lucrative outside employment, but I’m sure that there are some.

      • An excellent point, patients who understand that the city hospitals are in fact city hospitals might feel that way. However most who understand that connection also know their right to request a hospital. I was too blunt accusing them of steering patients to their home hospital. When given the choice they’ll take patients to the hospital they’re most comfortable with. Everyone does the same thing, we go to the place where we know the other crews, the nurses, the docs, the delis, etc. At the previous assignments it was a city hospital we usually went to as our station was right there. Now its mostly to the Private hospital because I and the majority of my fellow units have a very low opinion of the hospital closer to our station.

        Please, the real perks with being a firefighter blow away EMS, PD too for that matter. Down time, beds, a house, unlimited control over their schedule, an incredibly supportive workforce and command structure, community support, etc etc

    • Lenny,

      The city is hoping hospitals drop out of the system.

      That is not the impression that Mayor Bloomberg is giving.

      “If they don’t want to have the patients in their hospitals, they won’t get ‘em,” said Bloomberg, referring to the possibility of hospitals no longer participating in the city’s 911 system.
      Mayor Michael Bloomberg, Metropolis 12/09/10 City Vows To Fill Potential Ambulance Void

      FDNY And Bloomberg Replace Ambulances Providing 911 Service With Extortion Services

      The truth is if FDNY could take control over all 911 ambulance tours they actual decrease the operating cost to taxpayers through increases in insurance payments.

      Is the EMS part of FDNY’s currently profitable?

      If it isn’t, is there any reason to believe that more of the same would eliminate operating losses?

      As for the income disparity between EMS and Fire, thats an issue going back to the severe mismanagement of the system under HHC. Correcting the disparity takes time since no mayor is simply going to hand a 20k/ year pay bump to 3,000 employees and get re-elected.

      Takes time?

      Wasn’t it 1996 when FDNY and Mayor Giuliani eliminated NYCEMS and made it the lowest paid part of FDNY?

      How much time does it take?

      How little are EMS employees valued, compared with the much less busy, but much better paid firefighters?

      That being said the gap isn’t as bad as it appears. Firefighters base salary is based on an addition 220 hours per year, their fringe benefits include all of their differentials and contractual overtime.

      As Too Old To Work, Too Young To Retire points out, it is traditional for firefighters to have a second job, while EMS is so busy that this is much more difficult.

      I am not complaining that firefighters are overpaid.

      I am complaining that EMS is underpaid, especially when compared with their fellow FDNY employees.

      A 5th year medic working an extra 220 hours makes over 70k a year.

      The newly hired basic EMTs must feel great about that.

      One serious roadblock to salary increases is the prevailing wage of EMTs and Medics in NYC. After including healthcare and pension benefits we become the best paid EMS system and the second largest provider, Transcare, becomes the worst. We can’t argue for more money when someone is doing the same job for less.

      Interesting.

      Many unions do exactly that. Somebody has to make more money than everyone else.

      Is Transcare providing 911 ambulances for the hospitals?

      What are the hospitals paying their EMTs?

      One last point, no EMT or Paramedic is fleeing NYC for Chappaqua. I’m from Chappaqua’s slightly less affluent neighbor Pleasantville and our 40k+ per capita is still a whole lot more than NYC’s 22k.

      That was sarcasm. Even with benefits, a regular paycheck that puts one at the poverty line, is not something that is easy to live on.

      Do you cash in your benefits to cover expenses?

  2. The plan formulated clearly does not consider the negative impact on prehospital emergency medicine (yep, medicine) on the people of this city. EMS is being de-volved into an operational rescue service geared towards rapid turnover of patients, instead of what it should be, a medicially focused response to illness and or injury. If the city wants to save real money, give all the ALS to hospitals, including medical control. This will provide us with a medically driven system and save the City big time.

    • Why, when half the hospitals handed over their EMS operations to Transcare? Where is their continued commitment quality prehospital emergency medicine?

      • Lenny,

        Why, when half the hospitals handed over their EMS operations to Transcare? Where is their continued commitment quality prehospital emergency medicine?

        That suggests that Transcare does not provide medical oversight that is as good as FDNY.

        Is that the case?

        Is Transcare providing worse care than other EMS in NYC?

        I do not know what Transcare is like in NY. I left 15 years ago and had never heard of them when I left, so I don’t know.

        Connie’s suggestion really appeals to me. I think things might be different –

        If the hospitals were only providing ALS.

        And.

        If the REMAC were made up of doctors comfortable that there was aggressive medical oversight from the hospitals.

        Maybe that is not practical, but I would like to see someone consider it.

        It might be significantly easier to get people to bring attention to quality of ALS issues, if the publicity affected just the hospitals.

        • A little info on TransCare in NYC 911. TransCare does nothing directly with FDNY. All their 911 is done as a sub contracted ambulance provider for several hospitals in NYC. As for the level of care they, as well as any voluntary provider, gives is probably under more scrutiny tham FDNY EMS. All NYC EMS operates under the same protocols and OMA oversight. The voluntaries are further scrutinized by the hospital EMS medical directors and JCHAO standards, TransCare included. TC also has their own QA/QI proceses and an additional medical director to make sure the highest level of cared allowed within the restrictions of the protocols. I know this because I used to be a part of the team ensuring quality. I would even argue that TC and the other voluntaries provide a better level of care than FDNY in that they carry glucometers and CPAP (which FDNY determined to be too expensive, again all about the money) and have carried these items for quite some time.
          About me, I have no reason to support TC, in fact I despise them for what they did to me. However, when it comes to the care they provide their patients (EMS is about the patients, right?) I will stand behind what they provide. A patch that says FDNY on the left shoulder still says NYC Medic or EMT on the right one, just like every other 911 provider in this system.

      • Where do you get your stats – oh, probably the same place FDNY does…HaHa. Several hospitals which did not have their own ambulances contracted with private agencies so they could place an ambulance into the 911 System. That hardly suggests half of our city’s hospitals cast off control of their ambulances to another agency. Most of the hospitals operating right now have had ambulances (and hospital based EMS education) for decades before FDNY ingested NYC EMS. Hospitals are community based operations and interact with their communities daily. They have a vested interest to, and are committed to the continuity of the prehospital care they provide.

    • In the NYC system, you still need medical control for the BLS. They call all the time for transport decisions, online medical controls for refusals, and med consults.

      The hospitals have the ability to become telemetry for their own units, some of the older ones in the system still are, but most choose not to.

      Why, you ask? Money.

      Why pay for a REMAC certified doctor to be available on a taped phone line with radio back up 24/7 when the city provides it for FREE?

      • John,

        In the NYC system, you still need medical control for the BLS.

        FDNY could certainly handle that for BLS if FDNY handled all of the BLS. Probably at much lower cost than for the medical control that NYC currently pays for.

        They call all the time for transport decisions, online medical controls for refusals, and med consults.

        In other places, there are also transport decisions, online medical controls for refusals, and med consults, but BLS does not require much in the way of medical oversight. This is not really an issue.

        The hospitals have the ability to become telemetry for their own units, some of the older ones in the system still are, but most choose not to.

        It would seem that the proposal from Connie is to have all of the ALS taken over by the hospitals. The medical control contact system does not need to be by radio, but Johnny and Roy fans love it. There are many things done more efficiently, when the traditional NYC way of doing things is not seen as mandatory. New Yorkers are actually known for being innovative.

        Why, you ask? Money.

        You keep using that word. I do not think it means what you think it means.

        There are many motives for everything in life. If you are going to claim that the motive is always and only money, but only when you do not agree with the decisions, you need to provide some evidence.

        Why pay for a REMAC certified doctor to be available on a taped phone line with radio back up 24/7 when the city provides it for FREE?

        Why mess around with the antiquated REMAC system, when you do not have the ability to provide real oversight to the medics?

        Why use this failed attempt at medical oversight?

        Requiring on line medical command orders only encourages medical directors to approve incompetent medics to work as medics.

        We should not encourage this. There is no reason why medics can’t make a phone call to consult with a doctor, when the medics feel it is appropriate.

        Oversight by radio transmission is a fraud and endangers patients.

        Why would a hospital want to participate in that kind of malpractice?

        This is just a waste of money that satisfies the Dark Ages medical directors.

        Sometimes, even when something is free, it costs too much.

      • Many hospitals – especially the large teaching hospitals – do have on line medical control facilities in their emergency departments. They are staffed by REMAC credentialled physicians. Many of these docs also work part-time/per diem in FDNY’s telemtry.

        The reason we need so much medical control for BLS is because they are not allowed to make any kind of clinical judgement anymore. You can’t blame FDNY for this… entirely. We live in a ligitious society where everyone has learned to sue, so a paper (voice) trail must be maintained to cover EMS butts. FDNY does do many studies which require BLS and ALS to constantly call in with info.

    • Connie,

      The plan formulated clearly does not consider the negative impact on prehospital emergency medicine (yep, medicine) on the people of this city.

      It is all about how people view EMS.

      Many see EMS as part of public safety. If public safety is the goal, then why mess around with medicine, other than what comes in autoinjectors?

      If I am having a heart attack, which is one of the main things that EMS trains for, then a public safety approach, even with an autoinjector, is not what I need.

      I need someone who can recognize the signs of a heart attack. this is something that is not done well by a lot of EMS organizations.

      I need someone who can initiate proper treatment and take me to a hospital capable of catheterization. This is medicine.

      I do not need someone who can misread a 12 lead and use that to justify taking me to the closest hospital, or convincing me to not go to the hospital, under the impression that epigastric discomfort should be presumed to be indigestion. This is public safety.

      EMS is being de-volved into an operational rescue service geared towards rapid turnover of patients, instead of what it should be, a medicially focused response to illness and or injury.

      This is what the IAFF (International Association of Fire Fighters) wants. This is a powerful, but out of touch, union that is probably not even doing what its members want. How many firefighters want to work on an ambulance?

      If the city wants to save real money, give all the ALS to hospitals, including medical control. This will provide us with a medically driven system and save the City big time.

      That is an excellent idea.

      There would be a lot of things to work out, but I have worked in ALS response systems and they are a great way to keep the number of medics low, which results in more skilled medics. Other than the IAFF, is there anybody who doesn’t want highly skilled medics?

  3. As much as we all would like to speak about medical care and respose time it all comes down to the mighty dollar, sad but true. EMS is a busy were a basic pick up and drop off will run you 500 to a arrest could be up to 2000 dollars and they charge for everything. Fireman and Cops get paid good money because there is no one else they could bring into NYC that could do there job unlike EMS. Maybe FDNY EMS will get paid more now that there not at expendable. Nows ur time to shine Local 2507.

  4. Take this out of EMS for a second.

    If this were livery cabs, and the only way to get a cab was to call a central, municipally administrated phone number, would it be too much to expect private cab owners who are given runs by the dispatchers to pay into the cost of running the system?

    Back to EMS now.

    The city gives the non FD-ambulances the GPS, the radios, and the telemetry support needed by law to run an ambulance in the NYC 911 system, and gets no re numeration. If any of that equipment breaks, the city fixes it, usually before its own stuff. FD dispatches the calls, and then gets no money for the call, the ER visit or the possible admit, which gets billed by the hospital based ambulances, or the privately contracted ambulances. It not too much to ask you to pay for the part of the system you use?

    While I appreciate Rogue Medic’s take on the situation, my perspective on the situation is quite different than RM’s claim that the department is looking to eliminate ambulances. Quite the contrary, if the non-municipal ambulances drop out of the system, the city is mandated to cover the tours.

    This isn’t about ambulances, this is about money. The same way the suppression side has been looked at to charge for responses to car accidents and other non-suppression life safety operations.

    The city and the FD, and the non-municipal ambulance providers play this “sky is falling game” with their employees all the time when it comes to bargaining, and compensation. Why is the muni-EMS pay so disparate with other uniformed unions?? Because the city says “if you don’t do what we want, we let the privates into 911″. The privates close EMS departments, and hospitals the moment the bottom line is in the red.

    The city hasn’t laid off an EMT in the 17 years I’ve been here, can the Voluntaries say the same? I’m not saying that the Big Red One is all hearts and flowers, but if we, the people who work on the streets, were in one bargaining group, we would eliminate management’s ability to play games, and push for the ability to provide quality patient care in the City, and simultaneously earn a living wage.

    • A few points in response to this post:

      The city DOES NOT pay for the radios, GPS, or Turn Out gear that they require Voluntary (hospital-based) ambulances to have in order to operate in the 911 system. That expense is borne solely by the hospital at cost. An ambulance mounted GPS-capable MDT runs between 10-12k, portable radios 3k, turnout-PPE gear 1k/person. Its all done by one or two private contractors, one being All-Tech on Avenue U in Brooklyn NY (the FDNY actually sends some of their own vehicles there as well for radio installations) All this is paid for by the hospitals as per the latest FDNY contracts. Regarding Medical Control and FDNY, it’s actually run under NY-Presbyterian’s license because as per the state Medical Control has to be hospital based, and when the FDNY took over from HHC, that’s the arrangement that was made. So without voluntary hospitals cooperation FDNY would be in a hard place running 911 just based on that fact. Furthermore, in all most other municipalities, dispatch is handled by the government out of tax-payer money regardless of whether or not the ambulances are public or private. In NJ, ALL ALS are hospital based and none pay any “cost sharing” to their respective local governments. It’s public safety we’re talking about, one of the most fundamental and important government services provided. To think that they would charge anyone willing to provide EMS in the city a fee is absurd, and those who entertain this or somehow justify this by comparing EMS to a taxi service need to step back and think a little, or otherwise have their heads examined. And by the way, FDNY can’t staff their current ambulances because of attrition and low-pay, so good luck finding 400 more EMT/medics to work in an over-abused and grossly underpaid service.

  5. Oh, and by the way, with the abundance of hospitals in the city, and the patient’s right to go where they want, its pretty tough to prove ambulance steering in NYC.

    Comptroller Hevesi, in 2001 wrote a report regarding ambulance steering, and there was nothing done.

    Here is the link.

    http://www.comptroller.nyc.gov/bureaus/opm/911%20ambulance%20report/Chapter%201.pdf

    Its not like most of the country where there may be miles between hospitals. In NYC, there are LITERALLY some places where two hospitals on the same block: Jacobi and Einstein in the Bronx, or Bellevue and NYU in Manhattan, or Kings County and Downstate in Brooklyn. In each example, campuses are on either side of the same street.

    In response to these issues, the city even brokered a deal with Medicaid, where the definition of “closest hospital” was changed. In NYC, the “nearest facility” is any facility that is within 10 minutes travel from the scene of the call to the closest facility. Our Ten Minute Rule was designed to allow ambulances to transport patients pretty much where ever the patients want to go, as long as the patient was stable. In the past, Medicaid would only pay if the patient was brought to the closest facility, and most commercial companies followed suit.

    Its all about the money. Always.

    • John,

      In NYC, there are LITERALLY some places where two hospitals on the same block: Jacobi and Einstein in the Bronx, or Bellevue and NYU in Manhattan, or Kings County and Downstate in Brooklyn. In each example, campuses are on either side of the same street.

      What about Montefiore and North Central Bronx?

      Aren’t all of these hospitals part of the same hospital systems, since they share doctors?

      Its all about the money. Always.

      The rules seem to have been changed to allow the patients some flexibility in destination.

      Having to go to the closest hospital was not in the best interest of patients. It only encouraged patients to call private companies, neighbors, or taxis for transport. That may have made the Medicare people happy, because it was easier for them to deny payment.

      Other than the government using this rule to deny coverage to patients, how is that about money?

      Comptroller Hevesi, in 2001 wrote a report regarding ambulance steering, and there was nothing done.

      I could write that its all about writing reports and forming committees, but that would by cynical and very biased.

  6. Health care in this country is driven by the pursuit of “MONEY”. Thats it!! Once you understand this very simple concept than you will be in a better position to understand the more difficuilt parts of this system. If you still beleive that hospitals want to provide the best of care irregardless of expences incurred than you are foolish. But like every business out there a business operation can not sucessed without a good product. Good hospitals that provide good care and have compassion will get the patient. More patients, hense more money. So when Mayor Bloomberg says:

    “If they don’t want to have the patients in their hospitals, they won’t get ‘em,” ;

    he has no clue what he is talking about. He does not understand how EMS in NYC works. The little old lady up the block that has been going to Maimonides Medical Center for the last twenty years will still request to go there whether transported by a FDNY ambulance or a Hospital based ambulance. The mayor’s comments are ill-informed. The hospital will still get the patient and still get to bill the patient as normally would, because she is comfortable there! The mayors comment can also be misconstrued to imply that FDNY ambulances will start stearing patients to city hospitals… which because of his ill-informed knowledge of NYC EMS is ILLEGAL!!.

    Now to this “cost-sharing” nonsense… What can I say… I’ll just be frank about the matter but its a dick swingging match right now. The FDNY Fire Commissioner Salvatore J. Cassano was told to cut cut cut the fat out of his budget by the Mayor. Mr. Cassano than passed the buck to his subordinates one of which is Chief of EMS John Peruggia. Mr Peruggia who has worked with the hospital based ambulances services for quite some time and only resigned because the FDNY told him that his position as Chief Of EMS would be a conflict of interest. Because his resignation was not followed with a moment of silence at the hospital he worked for he threw a tantraum and since than has hated the hospital based ambulance services. So when I heard about Mr. Peruggia’s “cost-sharing” initiative, I was not surprised. I would just like to know one thing. If the FDNY’s dispatch and medical telemetry is currently payed by tax dollars and if this nonsense of a bill is passed… where does the money go?? It should go back to the tax payers right? WRONG………… For years since FDNY has taken over HHC EMS income generated by FDNY era EMS has went to buy lavishly BIG RED FIRE TRUCKS!! No new technologies for EMS yet. So they threw a Walmart brought fridge into the trucks and now where state of the art medicine. WHAT EVER!! FDNY is as I stated way above…………… EXACTLY LIKE HOSPITALS!!! IN THE PURSUIT OF MONEY!! Welcome to the 21 st century!!!!!!!!!!!!

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  2. [...] Medic looks in depth at the FDNY decision to charge hospital based 911 ambulance providers an exorbitant fee for dispatch and on…. While this may seem like a normal practice to some New Yorkers, others generally refer to it as [...]

  3. [...] Rogue Medic has already done some research into the cost differential associated with the FDNY work … which may be a real eye opener for some. I want to focus on something slightly different, that of [...]

  4. [...] Rogue Medic Blog-  http://roguemedic.com/2010/12/ny-city-decides-to-cut-back-on-ambulances/ [...]

  5. [...] on NYC Hospitals Looking At Big Bills To Run 911 EMS. This was also a topic that Rogue Medic looked at deeply, that I view as extortion, and it looks to be a dominating story going into 2011 as the hospital [...]

  6. [...] You can read the rest of NYCMedic07‘s comment, which provides more details about the actual costs, here. [...]

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