Monday, September 28, 2009

Your MAST posting of the week...

Q&A How will the MAST takeover by Kansas City change service?

 In the next few months, Kansas City plans to meld MAST emergency services into the city’s Fire Department. Fire Chief Smokey Dyer says the cost of that service should not increase as a result and the quality of care will be maintained.  Wright

The Kansas City Council’s recent vote to merge the MAST ambulance service into the city’s Fire Department left many questions.

Fire Chief Smokey Dyer said the new system can maintain quality, eliminate redundancy and cost no more than the old system. “I don’t see how we could increase the cost,” he said.

But skeptics said the council’s Sept. 17 vote was hasty and left too much uncertainty.

The Star talked with the city’s budget officer, other officials, Dyer and consultants who will design a new citywide emergency services plan.

Key questions and answers:

When will MAST become part of city government?

The transition should start in the next few months. A consulting firm, Emergency Services Consulting International, is being paid as much as $116,000 to recommend a new system. The consultants should begin next month and finish in about four months. This is no end of annoying that we have to pay someone to tell us how to reconstruct a perfectly good system...

Will this really save taxpayers money?

The city expects to save money on insurance, marketing, outside legal fees and administrative duplication. But critics warn savings could vanish if the ambulance employees cost considerably more in employee pensions, health care, overtime, workers’ comp and liability claims. Potential savings won’t be clear until consultants do a financial analysis. So we are going ahead and making this radical change without a full analysis of the possible savings. Does this make sense to you? Is the savings worth the risk of compromising patient care. We don't know; we haven't done the analysis yet. I say again, does this make sense?!

What about additional pension costs?

The initial estimate is $17 million, which might be spread over many years. But some people worry MAST employees will be folded into the more costly firefighter pension system. Louie Wright, president of Local 42 of the International Association of Fire Fighters, says folding MAST workers into the firefighter pension system would be cost prohibitive, and he does not believe it would be legally permissible. How they are incorporated into the city employee pension system and at what cost are likely to be issues. This is no small issue. John Sharpe himself said MAST employees will not be vested year for year in the city pension plan. So they lose out money for (questionable) pension security. And local 42 is not the only local involved; the union that covers people like Parks Department employees might have something to say about how MAST people are folded into the pension plan.

Will my MAST membership be honored?

Those memberships — $59 to $99 a year, depending on whether the household has insurance coverage — will be honored. But how the memberships will work will not be known until the new system is designed, Dyer said. He’s certain the city can continue the non-emergency service, “but it may not be in the fashion we’re doing it now.” We hope so. Many rely on these memberships to contain the cost of ambulance services.

Will MAST continue to serve other cities?

Dyer said he’s already visited with those cities to let them know that the service will continue. Instead of having a contract with MAST, they will contract with the city. “I’ve let them know we have no intention of terminating their service,” Dyer said. The municipalities and Platte County have indicated that they were and are not in favor of this change; I think they fear service will not be as good.

Will every MAST employee be absorbed into the city?

Dyer notes that he told the council “substantially the entire work force” would be taken into the city. But jobs not involved with patient care would be reviewed. For example, a custodian might not be taken because the city contracts those duties. As for administrators, “substantially” all will be needed, at least for this transition period. After the one year period, it's a total crapshoot for MAST employees.

Some people remember when the firefighters went on strike nearly three decades ago. Would the city be without ambulances if another strike occurred?

Highly unlikely. It currently is illegal for firefighters to strike. But it may not be illegal for MAST employees to strike. Bringing them into the Fire Department would make it illegal for ambulance workers to strike, Dyer said.Wright of Local 42 said the strikes of 1975 and 1980 occurred in a much different era, when many public employees across the country were striking. He said the union’s relationship with city management has improved dramatically since then. We hope so. I had never heard of firefighters going on strike until I came to Kansas City. Dennis Smith wrote a novel about this possibility in New York City. Thank God it never came to pass. It has always been illegal for FFs to go on strike in New York.

Should Dyer oversee emergency medical care given that he questioned a change in how to treat heart-attack victims?

In 2006, the city’s emergency medical director, Alex Garza, ordered a dramatic change in the way emergency responders treat cardiac patients. Dyer said he asked Garza for more time to react to the new order, but Garza declined. Dyer acknowledges that Kansas City, as a result of the change, has one of the nation’s best cardiac save rates. The incident shows the medical director will be in charge of medical decisions, Dyer said. “He’s the czar. And I’ve proven it.” Smokey Dyer is a good man, caught in the middle. A good man can always admit when he is wrong.

Will the Fire Department seek more funding from the city’s health levy, which currently subsidizes MAST?

Dyer doesn’t relish competing with the city’s indigent health providers, such as Truman Medical Center, in seeking more funds from the health levy.

Budget Officer Troy Schulte says MAST gets about 40 percent of its budget from the city: $11 million from the health levy and $1.5 million from the public safety sales tax. In the short term, he does not anticipate more health levy money going to MAST. But if MAST sees a drop in its other revenues (from customers and insurance), then it could require additional city funding. Not only has MAST been performing in an outstanding way in the field, it has been doing a good job collecting payments from insurance, Medicare, Medicaid and patients. MAST must continue to get the monies from billing for services rendered as effectively as now. There will be no savings if the income from these sources drops off due to incompetence in the billing office. Also, MAST needs to be ready for changes in health care reimbursements due to changes on the federal level. There will be changes; will the new structure be the best to deal with them?

How long will Dyer be around to oversee this new system?

At 61, Dyer says he has no plans to retire. The Fire Department has no mandatory retirement age. Good health to Smokey for a long time. The trust in him is the reason the takeover passed City Council. And even then, he's not primarily a EMS guy. There will be culture shock in the firehouses. And there are already indications that a change in philosophy about response time is in the air.

What if people still oppose the consolidation?

Kansas City voters may have a say next year.

Opponents are gathering petition signatures to try to put a measure on the April 2010 ballot that would keep MAST as a separate, nonprofit agency and preclude the city from operating it.

Petitioners say they have about half the 4,200 signatures needed to qualify for the ballot. This change was made in haste, with limited public participation and comment, and without sufficient information. If you think that this change of MAST's governance is a bad idea, or you would just like a chance to slow the process down, the petition drive is going hot and heavy. People will be out and about gathering signatures at retail locations and other spots throughout the city. If you would like to contact Citizens to Save MAST, email Put in the subject line, "I want to save MAST!" You can also contact this blogger through the trusty comment portal, and we'll get right on it.

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