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SALT LAKE CITY — A legislative audit recommends improvements for Utah's emergency medical transportation system after hospital administrators complained about the quality of care patients receive while being transferred between facilities.
Utah's system of emergency transportation gives cities and counties the power to determine who provides ambulance service for responding to 911 calls, but "historical licenses" dictate who provides service for so-called "interfacility transfers" — when patients are transported between medical facilities.
Among other things, legislative auditors recommend lawmakers consider changing state law to give municipalities discretion over providers who transfer patients in hopes of increasing accountability when things go wrong.
"We found that existing channels to hold EMS agencies accountable are available but are not being used by hospitals," the report states. "We also found that these channels could be improved, local accountability could be bolstered, and statute could be clarified to improve accountability for EMS agencies to ensure patients receive the highest-quality care possible."
Hospital staff noted concerns with auditors, including a ground ambulance with wall connections that were not functioning, which meant a patient did not receive appropriate oxygen flow during transport; a wintertime transport on an ambulance with a failed heating system; and "numerous complaints about poor communication from dispatch and long wait times for an ambulance to arrive to transfer a patient."
Auditors reported their findings to the Legislative Audit Subcommittee on Tuesday afternoon, noting that ambulance providers receive up to 60% of their revenue through interfacility transfers. Better oversight of that side of the business is thought to provide a boost to other emergency services.
The report detailed five recommendations for the accountability of emergency services:
- "The Bureau of Emergency Medical Services should make the process for submitting complaints against emergency medical service providers and agencies clearer and more accessible, including providing a clear link on the website, specifying which form to use, and ensuring there is a pathway for submitting complaints against licensed EMS agencies as well as EMS personnel.
- "The (bureau) should clarify administrative rule to ensure that investigations against a licensed emergency medical services agency have a process and potential outcomes that conform to Utah Code.
- "The Legislature should consider granting the (bureau) the authority to levy fines against licensed emergency medical services agencies for the purpose of holding agencies accountable and improving patient outcomes.
- "The (bureau) should provide guidance on the process outlined in Utah Code for agencies to contest and apply for existing licenses.
- "The Legislature should consider changing statute to allow cities and counties to select who performs interfacility transfers within their jurisdictions."
Department of Public Safety Commissioner Jess Anderson agreed in a letter with the recommendations. He set a 60-day timetable for creating a more accessible complaint system, and an approximately 240-day timetable for clarifying the administrative rule on investigations and said the agency would adopt the other recommendations pending legislative action.
A second chapter of the audit focused on the rates ambulance providers charge for services. Auditors said Utah sets statewide maximum rates for providers, which is an uncommon practice nationwide, and said the rates of service in Utah "appear to be higher than national averages and nearby states."
"Utah's rates are generally updated midway through the year, and in 2020, Utah's paramedic rate went from $1,535 to $1,750," the audit states. "In comparison, the national average rate for advanced life support in 2020 was $1,277, a difference of nearly $500 compared to the paramedic rate in Utah."
The U.S. lacks a clear national database for emergency service rates, the audit noted, but auditors said Utah appears to have a higher average rate based on comparisons with nearby states and private insurance company data.
To begin to address the disparity, auditors issued the following three recommendations:
- "The (bureau) should clarify the process for setting emergency medical transportation rates ... and specify which benchmarks and data are to be used in the rate-setting process.
- "The (bureau) should ensure that all emergency agency directors receive training annually on fiscal reporting guides. This training should address potential problems with allocating costs between fire departments and emergency medical services in jurisdictions that have both.
- "The (bureau) should adopt policies for monitoring and ensuring the accurate submission of financial data prior to the next rate-setting cycle and be able to demonstrate an improvement in the qualify of data contained in fiscal reporting guides."
Anderson — whose department oversees the Bureau of Emergency Medical Services — said the bureau would work to implement those additional recommendations over the next year.
