Troy Council debates three paths for emergency medical services as current contract nears expiration

Troy City officials on March 10 reviewed options for the city’s emergency medical services as the current contract with its private ambulance provider expires Dec. 31, 2025, and staff warned the 90‑day notice window for renewal approaches.

City Manager Frank Nastasi opened the discussion, saying, "Our current EMS contract expires at the end of this year," and asked staff to present possible pathways. Deputy City Manager Bob Bruner told council the city had paid directly for ambulance services only since Jan. 1, 2024, after an earlier amendment of the Alliance contract following a company consolidation, and added, "we're coming to you now to talk about options because the renewal or extension of the contract depends upon mutual agreement of the fee."

The presentation — led by Bruner with Fire Chief Pete Hollinger and city finance staff — summarized three primary options: (1) continue subsidizing a private ambulance provider (the current model), (2) a co‑provision model where the city staffs medical first responders while contracting transport to a private company, or (3) convert EMS into a full municipal service operated by the city.

Staff gave preliminary cost and service estimates for each approach. Option 1 is the least disruptive but offers no revenue to the city and is already challenged by private providers’ staffing limits and constrained reimbursement rates. Option 2 would make the city responsible for roughly $3.5 million in operating costs to staff three 24/7 paramedic first‑responder units while still contracting transports, with all transport revenue retained by the private contractor. Option 3 — a fully municipal, advanced life support (ALS) EMS — was modeled on the Fitch & Associates feasibility study: Fitch recommended five units daytime and four at night, with a first‑year operating cost Fitch estimated up to about $4.3 million and staff estimating $5.2–$5.7 million; second‑year net operating costs were modeled at roughly $2.2–$2.5 million as billing revenue ramps up. Bruner and Hollinger noted capital costs for vehicles and facilities were not included in those operating estimates and would be additional.

Hollinger said the city could expect 18–24 months to build an in‑house EMS operation, and that capital items such as ambulances typically have a 5–7 year service life. He also pointed to a recently passed state legislative change (described in the meeting as a House bill for additional Medicaid transport funding) that, if applicable, would be available only to municipal EMS providers and could boost revenue for an in‑house model; staff described that potential revenue gain as material but cautioned it was not fully quantified for Troy.

Council members pressed for more precise numbers and short‑term plans to improve service now. Several members said they were inclined to explore option 3 because it would give the city more control over dispatch and response times, but stressed they need detailed capital and ramp‑up cost breakdowns and contingency planning for an economic downturn or federal reimbursement cuts that would reduce billing revenue. Fire Chief Hollinger said bringing dispatch in‑house would cut delays tied to call transfers and could measurably reduce response times.

Public commenter Vince Morrighis, a consultant who reviewed the Fitch study, offered his firm’s assistance, saying, "We are here, we are available for consultation, we're available to help, provide whatever information or statistics that you might want to help you guys make a good intelligent decision." Council members also asked staff to reengage the current contractor — identified in the meeting as Universal (the successor to Alliance) — to seek renegotiation and to explore competitive bids if renegotiation does not yield acceptable performance and cost outcomes.

No formal vote was taken. City Manager Nastasi said staff will: refine the cost estimates (including capital and start‑up overlap costs), reopen discussions with Universal about contract terms and service performance, and analyze what a competitive procurement or a municipal stand‑up would require; he indicated staff would return to the council with more detailed numbers and recommended next steps, targeting further action this spring with a decision point before summer budget work.

The council emphasized two parallel priorities: (1) improve service and accountability under the existing contract in the near term and (2) obtain detailed financial and operational data to decide whether to rebid the contract or build an in‑house EMS service that shifts long‑term control and revenue to the city.