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 evaluated, the level of patient care delivered by MedStar will remain high and is of paramount importance.

Fitch and Associates recently evaluated the EMS delivery system, 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.

The Study 

  • This interim report from Fitch is a comprehensive study of the current EMS system and comparing it to 20 other communities nationwide, looking at governance issues, organizational structure, operations, response times, billing and revenue, and all costs and expenditures.
  • What Fitch has presented so far is a first interim report ONLY and does not include recommendations, which will come later in the study process.
  • MedStar has significant fiscal constraints, including Medicare laws, reimbursement issues and assisting people who were uninsured, but those aren’t necessarily unique or extreme compared to the comparison communities’ EMS systems.
  • The current EMS system did not deploy sufficient resources and had less personnel available to meet the desired response time objectives in 2023. 
  • The system calls significantly exceeded established standards for best practice.
  • If the system were resourced to control for calls, then response time performance could potentially be improved by as much as 5.5 minutes (from the current 13.5 minutes to just an 8-minute travel time for all emergency 911 responses).
  • The City of Fort Worth is actively engaging with member cities and other stakeholders regarding EMS system governance if those discussions recognize Fort Worth’s contributions (in call volume and financially) to the overall EMS system.
  • The next steps in the study process include Fitch’s development and presentation of alternative EMS system models for consideration. Those alternatives will be presented to the City Council and the public in April 2024.

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

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 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.  

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.