By Richard Sullins | richard@rantnc.com
The first of two public hearings to decide who will provide emergency medical services for Lee County through 2031 was sparsely attended Monday, with less than a handful of speakers.
The existing contract was awarded to FirstHealth of the Carolinas in the fall of 2021. Four years later, Lee County government is going through the same process again, but Monday’s meeting of the Board of Commissioners may be remembered more for what wasn’t said instead of what was.
A firm competing with FirstHealth, MedEX, was represented by CEO Dillon Lowe and Chief Operating Officer Jeff White. The company was founded in Hertford County in 2010 and had previously submitted a proposal to Lee County Government for consideration when proposals were considered here in 2021.
Costs to the taxpayers
Both companies submitted responses to questions posed earlier in the summer by Lee County Government, many of them identical to those asked in 2021. Most of the answers submitted this year covered the same ground, seeking information about performance metrics, insurance coverage, size and maintenance of their fleets, and size and qualifications of the units they propose to station in Lee County.
There are some slight differences in how ambulance services would be deployed across the county, but these appear to be small and of the types that might be expected from competing companies.
But the rubber meets the road in the actual proposed costs of those services, and the stark differences in how each sees the level of care 67,000 citizens will need over the next five years as Lee County heads for another growth spurt during the last half of the decade.
The variations aren’t just a few dollars here and there.
The competing companies were asked to provide two plans under which they proposed providing EMS services. The first model would maintain the level of services now being delivered, and also include either rewards or penalties when the level of performance goes outside the standards established in the overall contract.
Option 2 would offer the county a different approach tied to performance metrics that would provide a more efficient and economical means through a hands-on approach that proposes to reduce emergency response and transportation costs at the same time while potentially improving outcomes in the thousands of calls made for emergency help. This model would adjust staffing levels based on historical call volume patterns and calculations to include serving the portions of the county experiencing growth rates that are beyond those across the remainder of the county.
A comparison of the projected bottom line expenses illustrates this point. The first chart shows a comparison of the proposed annual “subsidies” that would be paid to each provider, with a projected increase of five-percent annually built into years 2 through 5.
Here’s a look at the annual subsidy amounts for the first option as projected by MedEX and FirstHealth:
| Contract Year | MedEX | FirstHealth |
| Year 1 | $1,500,000 | $3,525,000 |
| Year 2 | $1,575,000 | $3,850,000 |
| Year 3 | $1,653,750 | $4,150,000 |
| Year 4 | $1,736,437 | $4,500,000 |
| Year 5 | $1,823,259 | $4,850,000 |
The Option 2 proposals submitted by each company are shown in the second chart. These include the same annual increases of five percent year-to-year to cover expected inflationary increases. Additionally, the first year’s starting points differ between the two. MedEX would begin with $1,500,000 at the entry point as a first-time applicant. With the passage of four years since being awarded the contract in 2021, FirstHealth has blown by that amount, so the contract amount in Year 1 reflects the value of their existing contract reflects the amount of its existing contract when it expires on September 30, 2026.
| Contract Year | MedEX | FirstHealth |
| Year 1 | $1,300,000 | $2,525,000 |
| Year 2 | $1,365,000 | $3,450,000 |
| Year 3 | $1,433,250 | $4,450,000 |
| Year 4 | $1,504,912 | $5,050,000 |
| Year 5 | $1,580,157 | $5,450,000 |
The budget numbers tell most of the story, but not all. The most important question on the minds of commissioners and many citizens is about response times – how long it takes for paramedics to get to the scene and start rendering help.
It’s about time
Over the four-year life of its contract with the county since 2021, FirstHealth has provided reams of data that provide a means of measuring the impact of its performance from year to year.
The most recent numbers show that during the 12-month period from January 1 to December 31 in 2024, FirstHealth got one or more of its paramedics to a scene in an average of
7 minutes and 47 seconds. That average time was also lower than that of three neighboring counties where FirstHealth is also the primary means of emergency medical care: Chatham (9 minutes and 54 seconds), Richmond (9 minutes and 54 seconds), and Montgomery (11 minutes and 19 seconds).
Because MedEX has never provided emergency transport services in Lee County, an apples-to-apples type comparison really isn’t possible. But a look at its 13-county service area does provide an average time of 8 minutes and 59 seconds across the 76,000 calls received in calendar year 2024, with much of the terrain being of the rolling hills-type seen across North Carolina’s Piedmont region.
MedEX and FirstHealth each provided evidence that its fleet of emergency response vehicles is sufficient for the task. Almost every vehicle owned and operated by the two applicants is no more than 20 years old, with the vast majority having been purchased and placed into service since 2020.
What’s next?
Monday public hearing was the first of a two-step process in selecting a vendor that will provide services through 2031. At the next scheduled meeting of the commissioners on October 20, a second round of public comments will be heard before a final vote is taken and the awarding of the contract is agreed upon after contract terms are made clear by both sides and the final version drafted and signed.
During the 2021 process of awarding the EMS contract, the meeting rooms were filled with hundreds of people ready to step to the podium.
But it hasn’t been that way in 2025. No more than 25 people showed up at the Dennis A. Wicker Civic Center Monday, and just four of them addressed the commissioners.
The existing contract with FirstHealth actually doesn’t expire until the last day in September in 2026. County staff had asked the commissioners several months ago to allow the negotiations to be completed this year.
The October 20 meeting is planned to start at 6 p.m. at the Dennis A. Wicker Civic Center.