When someone calls 911, there must be, and will be, high-quality patient care sent to help, at all times. The issue at hand is about sustainable funding and continuing to deliver high-quality EMS service in the City Fort Worth and the surrounding coverage area. While this matter is being studied, the level of patient care delivered by MedStar will remain high and is of paramount importance. The study will evaluate EMS delivery, including MedStar’s structure, governance and financing, to identify a more sustainable financial model for the future. The EMS model may change from the current structure, but the high level of patient-centric care will not, and cannot, change. That study seeks to identify a better, sustainable, long-term funding model. Under the current system and due to market challenges, MedStar is currently using about $350,000 per month in reserves and needs Transitional Funding to allow it to operate unimpeded through the upcoming study period. For the near term, the City of Fort Worth and other member municipalities will consider approving proportional Transitional Funding for MedStar of up to $1.05 million per quarter for six to 12 months until recommendations from the upcoming study can be evaluated and implemented.

Additional Background

  • MedStar operates as a public utility model, under the direction of the Metropolitan Area Emergency Medical Services Authority, to provide emergency medical services, including ambulance care, to Fort Worth and 14 surrounding cities. The study aims to identify the best possible structure for Fort Worth and partner cities.
  • MedStar funds the majority of its services from fees collected for those services from health insurance and government programs, such as Medicare and Medicaid.
  • Currently between 25 and 30 percent of EMS calls result in no form of payment (lack of insurance or decreased state or federal reimbursement). Combined with supply chain issues and soaring personnel costs on the capacity of the healthcare industry, MedStar is spending more than it takes in to maintain the current level of services.
  • Many other EMS systems are facing similar challenges.
  • Because of funding from health insurance and government programs, the City of Fort Worth, along with other MedStar member cities, has not supported MedStar financially since 2009.
  • As the Authority’s largest customer, Fort Worth accounts for 90 percent of its call volume and is represented by five of nine seats on the Authority’s board of directors.
  • Residents, businesspeople and visitors to Fort Worth do not, and should not, have to worry about quality Emergency Medical Services when they need it.
  • As part of this conversation, City leaders will look at options for a co-located, consolidated dispatch center to eliminate redundancy and ensure clear and timely communications among all first responders.
  • We understand that residents generally care most about knowing an ambulance is coming when they call 911, regardless of funding mechanisms and administration. We are committed to maintaining a highly reliable EMS service to meet the needs of our communities.

Frequently Asked Questions

When does this study happen?

The City of Fort Worth hopes to select a vendor in October 2023 to conduct a system evaluation through the remainder of the calendar year. The intent is to implement recommendations for a new EMS funding model in early 2024.

What does success look like?

Success is a long-term, financially sustainable EMS model that provides quality care for patients for years to come. The study will examine structure, governance, and financing for the EMS system and MedStar. 

What options are there?

All options are on the table. Currently, there are several different models for Emergency Medical Services nationwide. Among them are public utility models like MedStar, hospital-based service, third-party private ambulance service, standalone EMS city department, and fire department-based service. In Texas, for example, Arlington employs a private contractor model, in Austin EMS is a city-run department, and Dallas places the service in the Fire Department. Study recommendations could offer one of these or even a hybrid model that employs the best tactics from different formats.

Are other cities experiencing similar issues with EMS?

The declining financial status of EMS systems is an issue across the country, forcing many municipalities to evaluate their models. According to, “The EMS system is under pressure from various sources and faces significant change in the coming years. EMS agencies face financial pressure from increasing costs coupled with flat or decreasing reimbursement; difficulties in recruiting and retaining personnel to staff ambulances … all coupled with an aging population and increasing number of calls.”

How is the Fort Worth Fire Department working with MedStar and how could this affect the department?

Since 1986, the Fort Worth Fire Department and MedStar have shared the common mission of providing the highest level of care that is in patients' best interests. The Fire Department regularly works with MedStar and remains committed to providing a high level of service to the community. In early June, the Fort Worth Fire Department placed paramedics on seven fire engines who can assist with EMS response. Their crews work closely together daily.

How long has the MedStar Board been discussing fiscal issues and alternatives?

The MedStar Board regularly meets and receives financial updates. Since 2019, MedStar’s leadership team, in collaboration with their Board of Directors, took steps to prevent, or at least delay, the opportunity for expenses to exceed revenue. At the time, the financial challenges MedStar faced were anticipated to take place further in the future, and MedStar leadership and Board of Directors kept member cities aware of the challenges that seemed to lie ahead.

What steps has the MedStar Board and management taken?

  • The first priority remains meeting MedStar’s core mission of providing exemplary, quality, efficient patient care with the highest quality people.
  • In October of 2020, MedStar’s Board and management supported communication, and adoption, of the first increase in fee schedule in over ten years, which was implemented in February 2021 resulting in ~ $3 million of additional revenue.
  • MedStar’s Clinical Department was integrated into the Office of the Medical Director (OMD) in 2015 moving three coordinator positions to OMD. No positions were eliminated in this merger, but reduced training time by approximately 50%.
  • MedStar’s Training Academy was integrated into the Office of the Medical Director in Spring 2020 moving one coordinator and one administrative position to OMD. A manager position and instructor position were eliminated, saving ~$200,000/year
  • In 2019/20 outsourced building and stretcher maintenance resulting in annual savings of ~$100,000/year.
  • Evaluated contractual opportunities for better pricing through consolidating vendors or purchasing from different vendors.  Example- resulted in medical supply savings of approximately $60,000 cost in 2019.
  • Outsourced most of the billing functions reducing headcount and increasing collections in 2021/22. ~$250,000 savings
  • In 2020/21 MedStar requested $700,000 of CARES federal funding allocations from member cities to offset anticipated lost revenue associated with the COVID-19 pandemic. However, actual lost revenue was over $1.7 million.
  • Eliminated three positions FY23 and outsourced and redistributed responsibilities resulting in anticipated savings of $100,000 savings in FY24.
  • Transitioning from diesel to gas ambulances in 2023/24 estimating $500,000-$750,000 savings upon full implementation.
  • Worked with the state and federal legislators to pilot a program that pays for services rendered in the home, which was uncompensated before this change.  We continue to work at the federal level to include this in legislation before the pilot program ends in December 2023. Estimated at $250,000+ annually.
  • MedStar leadership and board continue working diligently to find cost savings while maintaining service levels. 

How will MedStar use the transitional funding to ensure a high level of patient care?

  • Ambulances will continue to respond to 911 calls:
    • There will be as many, or more, ambulances answering calls on daily basis as there have been historically. 
  • The ambulances will continue to be staffed with licensed healthcare professionals and stocked with the best equipment. 
  • Ambulances will be replaced on the same schedule as intended before the potential need for transitional funding. 
  • Medical direction, quality assurance activities, credentialing, and medical oversight will continue to be provided as it was before the potential need for transitional funding. 
  • MedStar will continue to fund the electronic patient care reporting for first response agencies as it has since 2019.
  • MedStar will continue to provide medical supply exchange on a 1:1 basis for supplies utilized by first responders provided doing so will not drop the ambulance below that level which they will be placed out of service for restocking. 
    • In that event MedStar will work with first response supervision to provide 1:1 restocking from MedStar’s central supply. 
  • MedStar will continue to take in medications from first response agencies that are within 90 days of expiration and provide newer medications to those first response agencies.
  • 911 calls will continue to be answered, medically triaged, and required resources dispatched appropriately. 
  • Service will continue as it has, or better, as we work through the review process with the ad hoc committee and the selected consulting group.

How has MedStar operated without city funding until now?

MedStar utilizes reimbursement from private and government insurers, like Medicare and Medicaid, for the services provided.  Because of that third-party funding, member public agencies have not supported MedStar financially since 2009. A third-party cost reporting firm confirmed that MedStar had been the lowest cost provider in Texas from 2012 through the most recent cost report in 2022.  

Why is a change in funding for MedStar needed?

Due to several funding issues in healthcare, including those patients who either cannot or will not pay, MedStar is currently utilizing approximately $350,000 of reserve funds per month to support the EMS system.

How much does the City of Fort Worth contribute to subsidize MedStar?

Since 2009, the City of Fort Worth, along with other MedStar member cities, has not needed to contribute any financial support to MedStar. MedStar has supported itself through fees from health insurance and government programs like Medicare and Medicaid. The COVID-19 pandemic caused extreme decreases in MedStar revenue and other health care organizations such as hospitals and clinical practices. In 2020/2021, MedStar requested federal CARES Act funding through its member cities. The City of Fort Worth allocated a one-time payment of $606,400 in federal CARES Act dollars to MedStar in addition to other member cities collectively providing $20,000 of additional CARES Act funding. 

Is MedStar a private contractor?

No. The City of Fort Worth and its member cities created MedStar as a public utility model, under the direction of the Metropolitan Area Emergency Medical Services Authority. As the Authority’s largest customer, Fort Worth accounts for 90 percent of the Authority’s call volume and is represented by five of nine seats on its board of directors.

What is the long-term plan?

This Fall, the Fort Worth City Council, in cooperation with other MedStar member cities, will consider a Transitional Funding payment to ensure MedStar will continue to deliver a high level of service to residents while a new study is undertaken to identify a sustainable, long-term structure.

How long is the Transitional Funding provided?

If approved, the one-time Transitional Funding is good through fiscal year 2024.