Frustrated with ambulance response times, San Diego plans to take over staffing, billing from Falck

A row of parked Falck ambulances
Falck, San Diego’s ambulance provider, might subcontract with another ambulance company after not meeting the needs of the city. Here ambulances are lined up at the company headquarters on Wednesday, Feb. 15, 2023.
(K.C. Alfred/The San Diego Union-Tribune)

Fire Chief Colin Stowell says fundamental changes are necessary to cut ambulance response times, and plans to shift the city to an alliance model used in the Bay Area.


San Diego plans to fundamentally change ambulance service in the city by taking authority over billing and staffing away from private ambulance provider Falck, Fire Chief Colin Stowell announced Wednesday.

The move comes after many months of Falck falling far short of the staffing and response-time promises it made to the city when it took over ambulance service in November 2021.

The city’s new plan, which Stowell said he’s still negotiating with Falck officials, would give San Diego the power to increase ambulance coverage by hiring multiple companies. The plan could also be a financial windfall for the city.

San Diego isn’t shifting to in-house ambulance service similar to San Francisco and Los Angeles, where city workers operate the ambulances. Instead, San Diego will follow what’s known as the alliance model, created seven years ago in Contra Costa County.

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Falck and other private providers will still own and staff ambulances operating in San Diego, but the city will take control over how those ambulances are deployed. It will also bill ambulance patients and collect payments from them.

Whereas under the current model Falck pays San Diego $9 million a year for the right to charge patients, the city will now pay Falck and other providers fees to operate the ambulances and will have the right to charge patients itself.

While the model shifts financial risk from Falck to the city, proponents of the alliance model stress that state law gives public agencies better reimbursement rates from Medicare and MediCal patients than private ambulance providers get.

Stowell said revenues generated under the new model would be reinvested into the city emergency medical system to improve service.

Critics of the alliance model complain that it eliminates competitive bidding for ambulance services, allowing city fire officials to hand-pick the providers they will use.

Falck is expected to be the city’s primary ambulance provider under the new model, but city officials said they expect to have more than one provider.

“We would subcontract with multiple ambulance providers to ensure we provide the necessary hours for the community,” Assistant Fire Chief Dave Gerboth told the City Council’s Public Safety Committee Wednesday.

When Falck took over ambulance service for the city, it promised 1,008 hours per day of coverage, but during most months it has been providing roughly 930 to 960 hours per day. That’s more than the 840 hours per day provided by the city’s last provider, American Medical Response, before it was replaced by Falck.

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Gerboth said taking control of staffing will allow the city to adjust the number of hours of service based on seasonal increases in emergencies and other fluctuations.

Stowell estimated it would take three to four months to implement the alliance model after he concludes negotiations on the new model with Falck.

In the interim, he said Falck would be required to bring on a second ambulance provider as a subcontractor until the city is ready to take over.

A man in uniform speaks
San Diego Fire Chief Colin Stowell, pictured in 2021, is negotiating a change in its ambulance provider’s contract that would see the city move to what’s known as an alliance model of ambulance service.
(Sam Hodgson/The San Diego Union-Tribune)

Both the alliance model and Falck‘s use of a subcontractor will be part of an amendment to Falck’s contract with the city. The city has leverage to renegotiate that contract because Falck has fallen short of its obligations under it.

Stowell said he expects to present the proposed amendments to the Public Safety Committee in March and hopes to bring it to the full City Council for final approval soon afterward.

“We’re working as fast as we can on some of the language in this amendment,” he told the committee. “There’s a lot of data to review, a lot of financials on the expenditures and the revenues and how best this alliance model is going to play out.”

Falck spokesperson Jeff Lucia said Falck is enthusiastic about the new model.

“It will help further stabilize the emergency medical system,” he said. “We think it’s an excellent example of public-private collaboration.”

Councilmember Marni von Wilpert, chair of the Public Safety Committee, praised Stowell’s new plan.

“I’m happy we have a concrete strategy to move forward and change what’s happening,” she told the chief. “We would not have changed ambulance providers, we would not have done this whole request for proposals, if we were OK with the status quo, which is what we’re getting under this contract.”

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Falck may also soon see an improvement in its struggles to recruit and retain paramedics and emergency medical technicians to staff the 65 ambulances it operates in San Diego.

The company has reached a tentative three-year agreement with the labor union representing its workers that includes 9 percent raises in the first year and 4 percent raises in each of the next two years.

Tony Sorci, leader of the union, said the new deal has been a long time coming for his workers. The roughly 400 members of his union are expected to vote on the new deal by the end of this month. Before the new deal, the starting annual salary for Falck paramedics in San Diego is $57,206.

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Sorci said the alliance model would likely boost morale because there would be more ambulance staff and more ambulances on the road, reducing the need for forced overtime shifts.