Case Studies

Contra Costa County Fire Protection District – Ambulance Service Feasibility Study

AP Triton conducted a fire-based ambulance feasibility study for the Contra Costa County Fire Protection District (population over 1 million). The District covers 304 miles and includes 9 cities and the unincorporated area of the county.  The study’s foundation was developed by determining what the current and past insured and uninsured payer mixes were. These payer mixes were all inclusive which, together with other demographic information, allowed us to determine the maximum value of the system.  The study then analyzed the federal reimbursement programs available and provided estimates for both the Ground Emergency Medical Transport (GEMT) and Intergovernmental Transfer (IGT) programs. The public-private partnership option presented in the study was the recommendation chosen.  Since implementation, Contra Costa County Fire Protection District (CCCFPD) generates approximately $10 million a year that can be reinvested back into the system, allowing for more ambulances on the street and improved response time compliance from 89-90% to 96-97%.  In addition, CCCFPD has amassed a $28.6 million reserve, allowing them to weather the COVID-19 Pandemic while maintaining their response time compliance across all response zones.  

San Bernardino County Fire Protection District – EMS System Valuation / Assessment Study

AP Triton conducted an assessment of the San Bernardino County ambulance system to determine which areas could be subject to competitive bid, the value of the system, the resources needed to provide services to those areas, the cost to implement those services, the time needed to secure equipment, the continued operating costs, and the ability to provide additional services to enhance system delivery.

Anaheim Fire Department – Ambulance Service Feasibility and Optimization Study

AP Triton conducted an ambulance feasibility and optimization study for the City of Anaheim which resulted in the City changing their ambulance system to a model that would provide them with more control over the system.  Additionally, this allowed the Department to increase the number of unit hours available in the system while, at the same time, increasing the revenue above expenses by approximately $3 million a year that can now be reinvested into system enhancement.  It should be noted that the Anaheim Fire Department provides protection to Disneyland.

City of Lincoln Fire & Rescue Department (NE) – EMS Billing Rate Study

AP Triton conducted a thorough billing rate analysis and provided recommendations to the City of Lincoln Fire & Rescue Department for use in evaluation of current and future billing rates and billing and collection processes.  The study additionally included evaluations of the contracts with rural agencies providing ambulance services in the surrounding counties.

Missouri Fire Chiefs Association – Ground Emergency Medical Transport (GEMT) / State Plan Amendment

AP Triton was contracted to write enabling legislation for federal Medicaid reimbursement for public agency ambulance providers in Missouri, and to assist with implementation of the program.  Upon enactment of the legislation, AP Triton then developed the cost reports for the Missouri fire departments to use when requesting federal reimbursement, following all rules and guidelines from the Centers for Medicare and Medicaid Services (CMS). The cost reports take into account a department’s total annual costs for providing prehospital EMS and ambulance services. 

California Fire Chiefs Association

AP Triton serves as the Project Manager for legal issues and Lead Negotiator on all GEMT and IGT programs on behalf of the California Fire Chiefs Association with the State of California Health and Human Services and the federal Centers for Medicare and Medicaid Services (CMS).