Legislative auditors cite long waits, equipment and training problems in interfacility ambulance transfers; recommend local control and clearer rate-setting

Brian Dean, the legislative deputy auditor general, told the committee June 18 that a recent audit of Utah’s ground ambulance system focused on interfacility transfers and how the state sets statewide rates. "We specifically focused on how inter facility transfers . . . are licensed and how Utah sets statewide rates," Dean said.

The auditors reported numerous complaints from hospitals, including long waits for ambulances to arrive for transfers, faulty equipment and poor staff training. "In 1 case, a patient was being transported in the wintertime, but the ambulance heating system didn't work," Dean said, and auditors also documented communication breakdowns between hospitals and dispatch that left patients waiting "30, 45 minutes, an hour." Tanner Cox, lead auditor on the project, said the auditors received complaints from multiple hospitals and providers across the state.

The audit drew a distinction between 911 emergency response (where local governments choose providers) and interfacility transfers (previously licensed by the Bureau of Emergency Medical Services). Auditors wrote that interfacility transfer licenses had remained largely unchanged for years and were often based on historical licensing rather than current performance or accountability metrics. The report highlighted that some EMS agencies rely heavily on revenue from interfacility transfers—sometimes more than 60% of total revenue—meaning changes could affect funding for 911 services.

Auditors recommended giving local governments authority over interfacility transfer providers to strengthen accountability. Dean said that recommendation was taken up during the last legislative session: "Senate Bill 215 . . . gave cities and counties the authority to select their inner facility transfer provider," he said. The audit also recommended improvements to the bureau’s complaint and enforcement processes so hospitals would report problems and the bureau could act.

Darren Bushman, director of the Bureau of Emergency Medical Services (part of the Department of Public Safety), told the committee the bureau has revised its complaint portal and processed 17 complaints since the update. On the question of rates, Bushman said Utah’s statewide rate schedule sets a maximum allowable rate but is not mandatory; however, he said, "all of our private agencies also charge the maximum allowable rate." The bureau said providers maintain backup agreements and operational plans to respond when crews are tied up on transfers or 911 calls.

The audit also recommended clarifying the rate-setting process. Auditors said statute and bureau policy were not fully aligned and financial data used for rate-setting was unreliable, so the bureau had tied increases to inflation in practice. The auditors suggested the bureau should develop a rate-setting approach, present it to the EMS committee and use representative benchmarks. Representative Sam Malloy and auditors noted that House Bill 301 from the last session set an interim mechanism (indexed to a medical CPI) and included a sunset requiring follow-up audit work.

The auditors emphasized differences between urban and rural capacity, noting rural areas often operate at lower staffing or skill levels and cannot easily pay ‘‘costs of readiness’’ for paramedic-level coverage. Committee members asked for follow-up work comparing costs and outcomes if local governments changed how interfacility transfers were organized.

The presentation concluded with auditors saying the legislature had already addressed some recommendations through bills passed this year, and that remaining recommendations were directed at the bureau for implementation. The committee took no formal vote on the audit itself.