County government, EMS employees and MetroAtlanta divided over ambulance services deal

Controversy over EMS privatization rages on in Bartow

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Pete Quinones, president and CEO of Marietta-based MetroAtlanta Ambulance Service, has definitely seen the angry comments on Facebook.

"When you look at social media, you see all kinds of stuff," he said. "We had people thinking we were going to respond from Marietta and from other parts of our operation and that we're going to pull all the units out of Bartow — but that's not the case."

Perhaps the biggest piece of gossip, he noted, is the hearsay that Bartow taxpayers will be on the hook for his company's operating expenses.

In reality, Quinones said his company isn't receiving "one dime" from Bartow County or its taxpayers under the contract MetroAtlanta inked earlier this month with Commissioner Steve Taylor to provide countywide 911 response ambulance services — with one exception.

"The only thing we will be being paid for will be when we transport an employee of the county," he said. "That will be a 90 percent Medicare rate. That's the only time there will be any dollars exchanged, and that's a good contractual rate for the county — the same we offer Cobb, the same we offer Paulding."

Considering the local ambulance service, according to data from Bartow County Administrator Peter Olson, has lost approximately $13.5 million over the last decade, Quinones argues that privatizing emergency services is going to produce significant savings for county taxpayers.

"We're saving the taxpayers probably $7 million from what I've heard," he said. "And that's a huge thing, over five years to save a community $7 million."

Not that he expects the expanded operations in Bartow to be a "cash cow" for his company, however.

"We have a little bit in common with the grocery business. We work off less than 5 percent profit margins, and that's what we're going to be doing here," Quinones said. "Our mission is to break even and to have a little bit of profit ... you have to be financially stable in order to keep the mode going forward to improve."

THE TRANSITIONAL PHASE

Olson, at a county commissioner meeting Wednesday, described the logistics of how MetroAtlanta is expected to operate in Bartow County.

"They're initially going to operate out of the same stations that are there now, with six 24-hour trucks and they're actually going to have more 12-hour trucks than we have now," he said. "With time, the fire department would like them out of their stations. They need the room, so they typically rent properties to operate their 24-hour trucks out of, so they may evaluate and have better locations that will provide better response times."

As to when the full transition from Bartow EMS to MetroAtlanta is expected to take place, Quinones said that depends on how fast some "critical equipment" can be brought online and employees can be trained.

"I'm optimistic that 60-90 days, it'll be turnkey," he said. "It will be a seamless transition."

He said that all full-time and part-time Bartow EMS employees — if they want them — have jobs waiting for them at MetroAtlanta. He anticipates about 80 percent of current Bartow EMS personnel will join his company.

"We'll move people around from our operation," he said. "We have a lot of folks who live in Bartow. They work for us already in Cobb or Paulding, and we've had a lot of folks who have expressed interest if and when an opening does occur, they want to work here."

Quinones said part-time paramedics will see their pay increase by about $5 an hour, while EMTs will see hourly increases of about $2.50. The rates for employees working in Bartow, he said, will be the same as those for his employees working out of Cobb or Paulding.

"When it's all said and done, I think we're looking at about an 8 percent increase across the board," he said. "That does not include management, which will probably be a little bit higher."

The transition will entail a change in "culture," he added.

"They're going to receive benefits in a different style and they're going to have profit-sharing, which they don't have now," he said. "We're going to do a lot of measuring and monitoring, trying to improve different aspects."

As for former Bartow EMS employees losing benefits in the transition from the public to private sector, Quinones said he didn't know all the specifics.

"That's something that the administrators within Bartow have worked with them," he said. "We don't want them to have any kind of gap in anything. I can't speak for what they receive within Bartow, but they're going to receive very high quality compensation, insurance and benefits that we offer at MetroAtlanta."

Carryover employees, he said, would be eligible for health insurance benefits from "day one." As for customers, Quinones said MetroAtlanta is currently in-network with BlueCross BlueShield and also works with Kaiser Permanente and UnitedHealthcare.

The company is also in talks to expand their insurance coverage to Cigna customers as well.

"I'm very happy to tell you that there seems to be a change at the legislature because of the balanced billing that was brought up last year," he said. "There seems to be a concession with a lot of these insurance companies to bring their rates up, and I'm very happy to see that."

PROFITS AND MOTIVES

Many locals, however, are not happy with MetroAtlanta taking the reins of Bartow's ambulance services. Count Cartersville resident Lori Sutton, whose spouse Landon has worked for both MetroAtlanta and Bartow EMS, among the most vocal critics of the county's decision to privatize its emergency medical services.

"While no one is losing a pension from my understanding, they're just going to be frozen," she said. "There are employees who are two years away from full retirement benefits who will forever be two years away from full retirement benefits."

Furthermore, she said the increase in wages means very little when it also entails a substantial insurance rate hike for employees.

"It'll be higher pay, but what comes along with that is a much higher cost of health insurance," she said. "It's going to be for [my husband], probably ... about $400 more a month for our family's health insurance versus what he's had through Bartow EMS."

Sutton argues that Bartow EMS underperformed financially because it wasn't sufficiently funded. She also said the local ambulance service wasn't compensated for several programs and services they provided for other agencies and departments, essentially, for free.

"So could there have been a way to charge for some of those services?" she asked. "Could there have been a way for some cost-sharing across departments that would have helped EMS rather than EMS carry the full burden of a budget cost that doesn't just affect EMS?"

Ultimately, she said her fundamental concern about MetroAtlanta is that — in her eyes — they are first and foremost a business and not a public service.

"[Bartow EMS] was the 2016 Georgia EMS Service of the Year. This is not a service that has been racked with complaints or with issues that have not provided a good service to our community," she said. "To bring in a business that's purely here to make money, providing the same service or at least the service that they will bring here, I would only assume that means they'll be charging higher rates for what they do."

In terms of billing, Quinones said his company's rates are about $100 more expensive than current Bartow EMS rates. Still, he said MetroAtlanta's rates "fall below the average cost" of competing emergency services providers in the region.

"The national companies, the ones that are owned by private equity firms, we have a few hospital-owned ambulance services — those generally tend to be higher in their charges, all the way up to $2,000 in some markets," he said. "It's a very fair rate compared to the rest of the metro Atlanta area."

Regarding uninsured customers, Quinones said his company doesn't place liens on clients. 

"We treat those who can pay and those who can't pay the same," he said. "We had over $14 million in uncompensated care last year, so that's nothing new for us."

A MAN IN THE MIDDLE

If anyone can speak to the operational differences between MetroAtlanta and Bartow EMS, it's 41-year-old Landon Sutton. The Cartersville resident once worked for MetroAtlanta for four and a half years and he's spent the last four and half years of his career working for Bartow EMS.

He recounted a meeting EMS employees had with Taylor, Olson and Quinones shortly after the privatization deal was inked. Rather than the county telling them about the announcement, Sutton said his coworkers learned about the news through Facebook posts.

"Metro has promised to keep things the way they are for about a year," Sutton recalled. "What that's going to do for that year is it's going to allow them to gather data so that after that year, they're not going to be using the stations anymore, they're going to relocate these trucks to where they see fit."

That troubles Sutton, who worries that residents in less populated parts of Bartow like Pine Log, Rydal and Euharlee will have longer delays because they're not posting the same call volume as neighborhoods closer to Cartersville.

Nor does he think MetroAtlanta has enough personnel to effectively service three counties.

"Metro's always short-staffed. Their turnover rate is high, it's constant," he said. "They're always going to be short-staffed, which will lead to further delays and call volumes, especially if they're pulling trucks to assist with Cobb County or another county that they service from the Bartow area."

While he believes that MetroAtlanta is "very good at running a business," Sutton said he has concerns about transparency — particularly when it comes to response times.

"Bartow EMS is a government service. They have to report all their stuff," he said. "I was told when I worked there that Metro, being a private service, doesn't have the same reporting responsibilities."

When it comes to the financial performance of Bartow EMS, Sutton said the numbers being presented by both the county and MetroAtlanta are skewed.

"There was a changeover that had to happen that put a lot of the Medicaid and Medicare finances on hold for 120 days. And they had to do that twice," he said. "Since the first of the year, Bartow EMS hasn't been able to collect anything, or very little, just because of the changes that had to be made."

While Sutton doesn't have many complaints about the county's deferred compensation plans in the public-to-private transition, he said many Bartow EMS employees aren't too pleased with the change in insurance costs.

"I know right offhand that the first responders that will be going over to Metro will be paying two to three times more a month in insurance with Metro as compared to what they were with the county," he said.

Sutton said he expects about 40 percent to 60 percent of Bartow EMS employees to make the jump to MetroAtlanta — many of them, he said, due to economic necessity.

"Pete Quinones said it would be 90-120 days before the transfer. Well, everybody knows things don't work that fast in the business world," he said. "It's not giving employees a fair shot on being able to find another source of income, so they're almost forcing them to go with them, to an extent, because of the timeframe all this happens in."

Still, he said many of his coworkers, despite their opposition to privatization, will join MetroAtlanta's ranks.

"Some are going because they don't have time to find anything else right now and some are going for a pay increase and some are going just to keep the same personnel in their county — they're wanting to serve their county, so they're willing to stay, even if it is with Metro."

At this point, Sutton said he's undecided as to whether he will accept a position with MetroAtlanta.

"It comes down to loyalty to my brothers and sisters that I work with to help them transfer over, if they see fit, or to go find somewhere else," he said. "It's an ethical dilemma and it's a loyalty dilemma. Which one do you go with?"

Sutton said his biggest fear is that MetroAtlanta will sell off the county's remaining Bartow EMS assets — its ambulances, its emergency response equipment, etc. — thus leaving county residents without a "leg to stand on" in case the local government cancels the contract or MetroAtlanta breaks the agreement.

"We either bend and pay this service that's going to end up costing the county money or we try to get another private service in here that's going to do the same thing," he said. "The thoughts of ever having another Bartow EMS is gone."

THE BOTTOM LINE?

Cartersville Medical Center is just one of 29 hospitals MetroAtlanta works with throughout the state. The MetroAtlanta coverage zone spans as far south as Piedmont Henry Hospital, as far west as WellStar Paulding Hospital and as far east as Eastside Medical Center in Snellville.

With 911 response operations in Cobb, Paulding and Bartow, MetroAtlanta now covers a geographic area of about 850,000 people.

At Wednesday's public meeting, Olson said MetroAtlanta would like to absorb as many ex-Bartow EMS employees as possible because "they don't have employees to fill those positions." 

Quinones didn't shy away from concerns about that lack of personnel.

"Make no mistake, there is a shortage and not just in EMS, in all public safety throughout the country," he said "So we're doing everything we can to mediate that by having our own academy and recruiting ... we've been very successful on that so far."

Under the five-year contract, Olson said the county has an annual option to suspend the agreement and pursue other providers. 

"We will control the service, we're not turning it over to them, we're contracting with them," he said. "There are a number of other companies that would be happy to take this service."

For Lori Sutton, questions linger about MetroAtlanta's ability to effectively serve Bartow residents.

"I'm not so sure we're going to get full disclosure on how these response times are calculated," she said. "There are concerns that after the first year when MetroAtlanta reevaluates call volume that ambulances will not be as close to rural areas as what we have currently with our stations."

Olson, however, said MetroAtlanta is contracted to provide response times that are, on average, four minutes faster than current Bartow EMS response times. 

Meeting that requirement, Quinones said, shouldn't be a problem.

"We have a track record of adhering to those kinds of high performance-type numbers and we're going to continue doing that," he said. "We wouldn't have been able to maintain a contract for almost 18 years [in Cobb] and have received accolades like 'service of the year,' both from the state multiple times and from the region multiple times, if we weren't doing an excellent job."

To boost response times, Quinones said MetroAtlanta will increase the number of ambulances in its fleet, expand its unit hours and the amount of time an ambulance is staffed within Bartow. He said MetroAtlanta is also working on a computer aided dispatch (CAD) hybrid that will allow them to communicate with local agencies, such as the sheriff's office, much faster. 

Still, Lori Sutton remains skeptical.

"I feel like we have a phenomenal service in our existing county EMS," she said. "There seems to be an overwhelming response of support for our local EMS, and I know it has been said that it will save taxpayers money, in the end we're going to be paying the same amount in taxes but we're going to be getting less service."

EMS privatization, Quinones said, has been successfully implemented throughout the country — and he said he sees no reason why that model wouldn't also work in Bartow.

"What we bring is accountability. We bring a contract, we have everything spelled out. We have response times, we have minimal units, we have how we're going to staff, what we're going to do ... everything that's in the contract holds us accountable for performance," he said.

"I don't know any government agency that has one of those."