What George Church saw happen over May, he wouldn’t have thought possible a year and a half ago.
As a MedStar operations supervisor, he’s had a front row seat to watch the final details of Fort Worth’s takeover of the company’s EMS operations fall into place. Beginning July 1, the city will provide its own emergency medical services, or EMS, within the fire department, instead of contracting to its 39-year-long provider, MedStar.
After a year of logistical, practical and financial challenges to realize the transition, officials across MedStar, the fire department and the union representing its firefighters, IAFF 440, saw many of their efforts begin to come to fruition during May. Leaders expressed optimism that the new branch of the fire department will be fully operational by the deadline.
“You’re seeing a little bit of anxiety from all the parties involved, but things are getting done pretty much on time,” said Church, whose job title will become EMS manager after the transition. “I have been (at MedStar) 35 years, I’ve seen a lot of changes, and a lot of those changes have been small in comparison, but they haven’t gone quite as smoothly as this one.”
Behind the scenes, city staff mass-hired more than 650 MedStar EMTs who are transitioning to new job titles with Fort Worth. Since May 1, the group was gradually sworn into the fire department, signed onto city and union benefits and fitted into uniforms.
The city received its EMS license and started integrating its radio system with MedStar so the two teams could communicate directly with each other.
The new EMS Advisory Board also met for the first time May 8. Representatives from across Tarrant County fire departments who will be receiving services from Fort Worth were briefed on cost estimates, response times and transition information.
If all goes smoothly, residents aren’t going to notice any interruption or change of EMS service, other than improved attitudes, faster call response times, new uniforms and redesigned ambulances, Church said.
In its first year, the new EMS department has a projected $87.6 million annual cost, which will be mostly offset by the roughly $65 million in anticipated annual revenue, according to a presentation at the EMS Advisory Board meeting. The about $22.8 million gap is largely due to the staffing costs, pensions and health care benefits the city will now take on.
For the initial transition, officials are replacing about 26 ambulances. In subsequent years, about nine ambulance replacements and retrofits are expected annually. Fort Worth is also installing oxygen refilling stations in all its fire stations for EMT ambulances.
MedStar’s local operations generated about $60 million in annual revenue — roughly the amount Fort Worth officials expect to continue receiving through the city’s operations. Around 60% was from Medicare or Medicaid reimbursements; 10% to 20% was private insurance; and up to 22% was from out-of-pocket payments, officials told Fort Worth City Council in April.
Fire Chief Jim Davis said it’s nothing new to operate health care services at a deficit. While billing patients and insurance help offset costs, they rarely cover the whole operation.
On May 23, after a day of onboarding an estimated 236 MedStar EMTs, Davis stood in front of the group and led them in taking an oath to Fort Worth. After dismissing them, he told the Report the moment was an important step: asking EMTs to “commit to us, because we’re committing to you.”
“When all this started, we were told, ‘Oh, these people are going to quit. They’re so uncertain,’” Davis said. “They’re here, they’re giving us a chance, they’ve come with us on this journey, and we’re working really hard not to let them down.”
All of the EMT offer letters sent out to MedStar employees were signed and returned, Davis told the EMS Advisory Board.
The EMTs will be represented by IAFF 440, which spent summer 2024 negotiating contracts for the new staff with the city.
Zac Shaffer, president of IAFF 440, said the union has spent the past month guiding the employees through health care benefits and hosting meet-and-greets to integrate them into fire department teams.
Through the union’s mixers and dinners with incoming EMTs, it has tried to reinforce a central message of workplace equality between the two organizations, Shaffer said. He’s trying to be sensitive to a feeling of lost identity among MedStar employees.
“With us, there’s no rank structure — when you come into this office, you’re not a captain or lieutenant or EMS supervisor or deputy chief, you’re just a member,” he said. “When we’re familiar with each other as brothers and sisters, we do much better service delivery on the scene.”
Intentionally breaking barriers
MedStar EMTs, who historically operated mostly from their ambulances, gradually started operating from fire stations. For the EMTs, being around larger firefighter crews and chipping in for mess hall meals is taking getting used to, Church said.
“The fire department has been very outgoing, and they have been inviting us into their stations,” Church said. “They have been introducing themselves, and that has broken the ice — I’ve seen it in our crew’s attitudes.”
The fire department has built MedStar’s history into the new EMS department, which Church says has contributed to staff morale. They have emphasized first responders’ shared mission of public service, and they’ve framed the transition as a merging of two organizations, not a takeover.
He pointed to Fort Worth’s newly designed EMS ambulance as an example — a star reminiscent of MedStar’s logo is on its side.
“They’re not disregarding the fact that we did have almost 40 years of experience,” he said. “That’s what I was afraid was going to happen when I first heard this was happening, I thought, ‘Great. They’re going to disassemble everything that we’ve had.’”
As the MedStar employees left the room where Davis swore them in as Fort Worth employees, their emotions ranged from exhausted and apathetic to excited. Some joked, some held hands and others yawned as they left orientation, suited up in MedStar uniforms, donning utility belts and carrying jump bags.
Missing from the group, at least from Church’s perspective, was pessimism and discouragement — things he’s seen mar past organizational changes.
When Fort Worth first announced the EMS transition, employees of both MedStar and the fire department were skeptical, Church included. But he said the skepticism quickly turned into a “wait and see” attitude as leaders appeared to take on a collaborative approach to the takeover.
The relationship between MedStar and the fire department has historically fallen into an “us versus them” mentality, Church said. Over the past year, he’s seen that mentality slowly dissolve.
But that shift hasn’t happened naturally, and it’s taken an intentional evening of playing the fields, Shaffer said.
“We’ve tried to put (MedStar employees) at ease by being present with good communication and having town hall meetings,” he said. “We’re pushing out information to both sides of the fence, because after July 1, there are no two sides of the fence. There’s only one.”
Drew Shaw is a government accountability reporter for the Fort Worth Report. Contact him at drew.shaw@fortworthreport.org or @shawlings601.
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