Delaware County officials review AMR contract after three years of countywide ambulance service

Delaware County Board of Supervisors heard a presentation on the county ambulance contract at its meeting after Supervisor Gladstone invited County EMS coordinator and deputy director Maggie Wilson to summarize two years of data from the AMR contract that began Dec. 1, 2022. Wilson told the board the county has seen improved response times under the contract and that AMR provides billing, collections and equipment as part of the agreement.

Wilson said the presentation covered December 2022 through Dec. 31, 2024. She explained the county’s new CAD system tracks “patient contacts” — defined as county contract ambulance responses including lift assists, stabilizations and transfers — and reported that the AMR contract’s average response time for AMR responses was 14.2 minutes in the most recent month analyzed. She also said the county ambulances logged about 148,714 miles between Dec. 2022 and Dec. 2024.

The financial picture remains constrained by payer mix. Wilson described the billing rules and government payment rates the county faces: a typical basic life support (BLS) gross charge described in the presentation was about $1,500 per transport while government payers’ allowed reimbursement was reported as $250. Over the roughly two-year period Wilson reported that AMR billed about $2.7 million and the county/AMR collected roughly $1.4 million; overall, the county’s net revenue recovered about 35% of total contract cost, she said. Wilson reported net revenue per transport of about $482.99 in 2023 and $597.21 in 2024. She said AMR performs billing and collections as part of the contract.

Wilson highlighted nonfinancial benefits included in the contract: AMR reportedly provided three new advanced cardiac monitors for the county’s ambulances (presenter stated a monitor cost roughly $32,000 each), spare vehicles and maintenance coverage, and access to statewide pilot programs run by the Bureau of EMS (for example, earlier participation in the ET3 pilot). She also said the contract covered vehicle and building maintenance and that the county had “no break in service” to date.

Board members asked whether the county should pursue a contract extension with AMR or put the service out to a new request for proposals (RFP). Several supervisors and meeting participants noted the operation fills countywide coverage gaps, supports volunteer agencies, and provides continuity where local volunteer staffing has varied. Some supervisors said a rebid could raise contract costs; one presenter warned a new RFP could produce significantly higher starting prices than the renegotiated extension approach. Others said running a new RFP would provide updated market data and that the public safety committee should weigh costs and options before making a recommendation.

Board members raised operational questions that remain unresolved in the discussion. Speakers asked for more granular data on where calls originate (for example, how many responses are to the county seat in Delhi versus to nursing homes), whether regional federal or state reimbursement changes will affect revenues, and what it would cost the county to provide full countywide ambulance coverage if all local services were unavailable. Wilson said she could provide more detailed town- and facility-level breakdowns on request.

AMR staff participated in the discussion but were not named in the transcript beyond titles. One AMR operations representative said the company values the partnership with the county and that crews “like being here very much.”

The board did not take a final vote on contract extension at the meeting; supervisors directed the public safety committee to review the data and return a recommendation about whether to pursue a contract extension with AMR, renegotiate terms, or issue an RFP. The committee will also examine scenarios for adding capacity (for example a third ambulance or a second “fly car”) and provide projected costs for those options.

"To this point, we've had no break in service," Maggie Wilson said during her presentation, summarizing the operational reliability reported under the contract.

What happens next: the public safety committee will analyze the data and cost scenarios and will report back to the board with a recommendation on contract extension versus rebid and whether additional ambulances or flight-car capacity are warranted.