As you read in the last few posts, the 6R plan is something that will help you enhance your operations. The first two foundation blocks of the system, Respect and Response, are what I feel should be dealt with first. They will give you a solid base to work from.

The next piece of the system is reimbursement. The word reimbursement was always a dirty one. It was the elephant in the room and it was usually mentioned behind closed doors. These days, it is more acceptable to discuss the issue as the public perception in most jurisdictions has transitioned to one of understanding how the system works. Some of you may want to “check out” at this point because you feel that reimbursement is not something you have control over. I can assure you that everything you do in the firehouse and on the scene has some affect on the money that comes into your department.
Let me explain; in the firehouse, you work to keep the station that your taxpayers paid for clean and in good order. If they see that you are not doing that, they may not renew your levees the next round or if your levees are locked in, the taxpayers may petition to redo your levees because they think you don’t give a shit about what they have bought you. Either way, you are being lazy if you don’t put the effort in to keep things up. Yes, I will say you are lazy. Don’t kid yourself. If you find yourself in a recliner or in your bunk room before noon, you are not putting in the effort. Everyone talks about training and how you need to have an “all in” attitude, you need to have it for the station and equipment as well. The public can’t come into the station and do it for you so be a good steward of the public dollar and do it for them.
If you are out of the station, you need to give the impression that you are a professional and that you have put as much effort into keeping the equipment nice as they think you have. Shiny wheels and a waxed truck go a long way. A clean uniform and you not looking like a “soup sandwich” help also. It shows that you make an effort. Again, don’t be a lazy ass. In most places, the citizens tax dollars pay for your uniforms. Don’t take that for granted.
We have heard the phrase “be nice” for years now. It is not that hard to do. The hard part is not letting the politics of the firehouse or your personal problems spill out into the street on a call. You never know who your are talking to on a run. The person you are communicating with may be the niece of the mayor or the daughter of an influential person in your community. You rudeness could be the spark that starts the fire of public negativity against your department. That negativity can and will build and grow into nasty animal that will attack the foundation of the department and your livelihood. Think of it this way, will your kids understand what you are saying when you explain to them that you got laid off due to budget cuts which were a direct result of you telling someone to shut up on a medic call or didn’t acknowledge their frantic cries about their iguana that is trapped in their house that’s on fire. It could happen. It has happened. You are not immune to it, no matter what you think.
If your department bills for EMS services, you have an even greater responsibility to be the Knights in shining armor that the public is expecting. The “double dipping” argument is made on a regular basis by citizens. They think that their tax dollars should be ample funding and that you are ripping them off somehow if you charge for service. I have always explained it to them this way; they pay taxes for their water system and in most places, they have to pay a monthly fee for water as well. The tax money is for the system and the fee is for the usage. EMS billing is the same way. Your tax money pays for the system and the billing money pays for the usage. We charge the end user for service to prop up the system. The cost of doing business is usually more than what is recouped from taxes in some systems so the billing money goes a long way to help people stay employed.
EMS billing has been the elephant in the room as well for many years. It was rarely talked about in open forums and was seen as the industry’s dirty little secret for a long time. The tide has changed in recent years as there has been more talk about Medicare and Medicaid in the news. Those discussions led to discussion about ambulance billing rates ad how they are affected by the economy. It has been interesting to watch the shift in attitudes.
I work in Ohio. There are not very many departments in the state that don’t do Fire and EMS . EMS has become a cash cow that keeps people employed. The departments that are still doing Fire only are starting to move toward taking over EMS in their community. Having a dual certified employees gives them flexibility to plug people into any spot and get the performance they need. Like I mentioned, in some communities, EMS billing keeps people employed as the tax dollars received do not fully support the entire operation of the department.
Whether you are a small department or a busy urban department, you attitudes and actions effect the revenue stream. We hear time and time again about the business of the fire service but we rarely hear that the Fire service IS a business and should be run as one. Controlling costs and having a keen eye on the revenue stream(s) is critical n the success of your department. It has been my experience that some departments realize to late that there has been a shift in their revenue coming in. By then, it is usually to late. Helping employees carry items to their car when they get laid off is never fun. I watched it happen in a factory that I worked at. The employees always thought they wouldn’t be out of work, that the company invested to much money to just shut the doors. When the crew came in and started throwing 90 million dollars worth of production equipment into roll off dumpsters, the employees needed grief counselling. They didn’t understand that they were obsolete. They didn’t understand revenue generation and being flexible in their industry. The business had passed them by.
Don’t lose focus on the importance of generating revenue. After all, it is how you make a living!

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