Fitch vs Reality

The Shepherdstown Fire Department is opposed to the proposals for a reduction and centralization of Emergency Medical Services (EMS) in Jefferson County. On February 17th, the County Commission was presented a report from Fitch and Associates that included three proposals based on travel time for implementing a separated county organization to solely provide EMS services, thus removing them from the volunteer fire stations that currently provide the service in partnership with county career staffing (JCESA). You can read our full initial statement here.

This analysis is meant as a broad overview of the issues with the Fitch Report.  It focuses on two general categories 1) The faulty assumptions upon which the report is based, and 2) the reductions in service that implementing the plan would create.  As detailed below, the faulty assumptions call into doubt the data presented.  Even ignoring the faulty assumptions, part two shows how the envisioned system would not operate as efficiently as the current system.

Part 1: Fitch Assumption Inaccuracy

As highlighted in the table below, many of these assumptions appear to be unrealistic.  In statistical modeling, bad assumptions lead to G.I.G.O (Garbage in, Garbage Out).  Basically, if the assumptions are bad, the results are unreliable.

Fitch Assumption Inaccuracy’sThe TruthNotes
 Assumes a 1% annual increase in demand for services.Appendix B, page 4 notes that the increase in demand from 2020-2021 alone was 8%.Modeling based on a 1% estimated annual increase in demand makes no sense, when they note an 8% growth.
Report assumes a 2.5% annual rate of inflation.Current Inflation is 7.5% in the Unites States, and climbing.This discrepancy makes every financial statistic in this report laughably inaccurate.
Response DataA total of 37% of records missed dispatch time, 24% missed enroute time, and 31% missed arrival on scene time. (Page 3)As much as 92% of the data had data errors, and yet they continued to use it?
Report assumes a 1% annual increase in transport fees.The rates are set by State and Federal law, not by our desire to make more money.EMS company can’t charge more than 20% of the Medicare-approved amount and any unmet Part B deductible.
Page 9 of the report lists one of the goals as “develop alternatives that align with the CFAI”.CFAI standard of 15 minute response times is GREATER than the current response time in Jefferson County (8.4min)Basically, this statement means, “increase response times but claim we’re going by accredited standards”.
Report suggests only 5 ambulances were needed 14 times.In 2021, over 20 times we had 6 concurrent EMS calls for service, over 45 times we had 5 concurrent EMS calls for service. 139 times we had 4 concurrent EMS calls. 7 times, we had 7 concurrent EMS calls, 5 times we had 8 concurrent EMS calls, 2 times we had 9 EMS calls concurrently.Fitch was not using the most recent data (year) and miscalculated by 1035% in their concurrent call data.
County provided funds to the VFD’s of $3,698,796 and in the 2022 budget, the VFD’s are slated to receive $4,137,498. (Page 3)Absolutely FALSE. VFD’s received just over $70,000 in last years budget, and are slated to receive $82,500 in this current budget. This inaccuracy is another example where garbage in, resulted in garbage out. It’s completely false.

As a result of G.I.G.O assumptions and data sets, the County Commission proceeding based on recommendations in this report is careless, and dangerous!

Part 2: Reduction in service

The report lists several different scenarios based on varying numbers of ambulances, ambulance locations, and initial costs.  It is important to note that in every single one of these scenarios (even the ones which would RAISE the cost of service), the response times are longer than the current averages in Jefferson County.

Fitch Response TimesTruth – Current SystemNotes
The “90% response time” (i.e. 9 out of 10 responses will be at that time or lower)(page 4).90th is not a full picture of the system. Any true comparison of Fitch’s model vs. the current model should compare AVERAGE response times to show how fast response is to the majority of patients. 90% is a single data point that is used to reflect the response time for an EMS system. This does not give the whole picture.
90% response time of between 16 – 16.5 minutes (60-90 seconds of turnout time + 15 minutes of travel time). The 2021 90% turnout/response time in Jefferson County is 14.2 minutes. The average response time “below” the 90% line is 7.5 minutes.Using Fitch’s analysis, the current system (based on response time) beats Fitch’s scenario by 14% – 17%.
The 4 ambulance/2 location scenario would increase response times by approximately 90.5%-96.4% from 8.4 minutes to 16-16.5 minutes.2020 AVERAGE response time for Jefferson County is 10.1 minutes (Appendix B page 6) – using 2021 Data it reduced to 8.4 minutes due to our combination partnership.  We do not anticipate the Commission would consider this as a viable plan. Even Fitch’s best-case proposal increases response time.
Even Fitch’s best-case scenario (8 units/6 locations) would have a 90% time of 11-11.5 minutes.  11-11.5 minutes is 31%-37% higher than the current average.  And that plan would, by Fitch’s own analysis, cost $600K – $1.48M more than the current cost (page 10).

If implemented, the recommendations in The Fitch Report would reduce the service and response times currently experienced in Jefferson County.  Of the three plans presented, only 1 comes even close to the response times currently seen in the county (although still missing the mark).  Further, that plan (according to the report itself) would cost far more than what is currently being spent, and the commission has already stated publicly, they “can’t afford that model.”  

Understanding 90%

We recognize the 90th Percent (90%) approach can be confusing. Here, we try to shed some light on it for you, and why we believe it’s not the best way to review the system. In the below chart you can see a theoretical example of 10 calls using fake ambulances and fake response times.  Using the 90% comparison, the response times can be said to be the same (15 minutes) for both Ambulances 1 and 2.  But using an average comparison, Ambulance 2 has response times averaging 5 minutes faster than Ambulance 1. That means patients are being seen 5 minutes faster by Ambulance 2, yet the 90% Response Time is the same. It’s a flawed calculator to compare plans because it focuses on only a single data point.

Even more concerning, all of the estimates in this report are based on faulty underlying assumptions which do not reflect real-world observations, had absolutely zero input from local subject matter experts, and fail to consider a single time the public health consequence of the delay in service.

The combination system that the Jefferson County Commission has rightfully invested in – a partnership between volunteer and career – where the county provides staffing, and the volunteer organizations provide the necessary infrastructure is the most financially responsible, efficient, and safest for the citizens and visitors of Jefferson County. These proposals are bad for Shepherdstown, bad for Jefferson County, and bad for your families.

Help us fight this

You can help by first, reading the report. Compare it to the data we provided above, and we are confident you’ll agree it’s not the right approach for Jefferson County! Secondly, engage with the County Commission! Send emails, letters, and most importantly, ATTEND County Commission meetings to share your concerns face to face!

This Reduction is Dangerous