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Staff recommend two-year extension of ambulance contract as Spokane grapples with paramedic shortages and low reimbursement
Summary
Fire and EMS leaders recommended a two-year extension to the city's ambulance contract to preserve continuity as staffing shortages, rising labor costs and constrained reimbursement complicate transport operations. AMR officials outlined payer-mix challenges and offered to explore alternate funding paths.
Spokane Fire Chief Obert and city staff recommended the City of Spokane extend its ambulance-transport contract for two years rather than pursue an immediate new procurement, citing staffing shortages for paramedics and economic pressure on private providers.
Chief Obert told the Public Safety and Community Health Committee that a two-year extension would ensure continuity of service while staff, council and the vendor study system-level reforms. He cited national staffing and economic challenges and said the city’s current partner has been compliant on response-time performance.
Nut graf: The recommendation is driven by two linked problems: provider staffing shortages that threaten response capacity, and limited reimbursement that restricts providers’ ability to absorb rising labor costs. Council members pressed for details on rate impacts and alternatives the city might pursue.
Paul Priest, associate vice president for American Medical Response (AMR), told the committee the Spokane market has an 81% Medicare/Medicaid payer mix and only about 4.8% commercial insurance. “We can’t solve yesterday’s problems with the same solutions that we once did,” he said, urging work on system redesign and alternative funding sources. Priest suggested exploring programs such as the Ground Emergency Medical Transport (GEMT) reimbursement mechanism to increase the share of market revenue that would respond to rate changes.
City and fire staff reviewed operational data that underlies EMS decisions. Fire leadership reported March dispatch statistics on overdoses: dispatchers sent responders to 164 overdose calls in March; crews reported 127 incidents that officers classified as overdoses, transported 78 patients, administered Naloxone (Narcan) on 123 occasions, and found five patients dead on arrival.
Chief Obert described the city’s nurse-navigation and CARES social-work programs as tools to reduce low-acuity ambulance transports and help route people to alternate care. He said an existing tiered response model — sending the appropriate level of medical resource to each call — has helped preserve ambulance availability.
Council members asked whether an extension would include the current rates and how the city would handle a longer procurement timeline. City and AMR representatives said rate adjustments are likely but have limited pass-through effect because Medicare and Medicaid form the large majority of the payer mix. The city will provide rate details to the committee following the meeting.
Ending: The committee received the briefing and asked staff to return with contract rate information and options for system-level funding strategies; no formal vote on the extension was recorded during the meeting.
