When cities outsource emergency medical services, the public usually hears the same basic sales pitch: professional service, fast response times, lower municipal cost, and modern deployment strategies. But the structure of the contract matters more than the sales pitch.
A contract tells you what a city is really buying, what a private provider is really obligated to do, how performance is measured, and what happens when the service falls short. That is why it is so revealing to compare two STAR EMS contracts side by side: the older ambulance service agreement between STAR EMS and the City of Pontiac, and the new agreement between STAR EMS and the City of Troy.
The comparison exposes something important.
Pontiac’s contract is a classic low-cost private EMS franchise arrangement. Troy’s contract is supposed to be something much more robust and much more expensive. But Troy’s agreement also contains structural features that may undermine the very thing taxpayers likely believe they are paying for.
In plain English: Pontiac’s deal looks cheap because it is cheap. Troy’s deal looks premium because it is expensive. The question is whether Troy is actually getting a premium emergency response system in return.
The Pontiac model: low cost, low control, low accountability
Pontiac’s agreement with STAR EMS was executed in late 2011, with an addendum later extending its duration. The contract requires STAR to provide ambulance service to the city and respond to medical emergencies twenty-four hours a day, seven days a week, subject to Oakland County response time guidelines. It also allows exceptions for weather, accidents involving vehicles, and situations where an ambulance is on a bona fide transportation request.
That language matters.
Pontiac’s contract does not establish a detailed city-specific performance regime. It does not create a tight local response standard like “90% under six minutes by ALS ambulance.” Instead, it largely defers to broader county response time guidelines and allows several practical exceptions.
The contract also requires basic operational standards. Ambulances must meet licensing requirements, be maintained in good condition, and be staffed by at least two licensed personnel. STAR is required to provide reports upon request, including number of responses by priority, dispatch and arrival times, actual response times, and incident summaries by response time. But that reporting is not framed as a proactive public transparency system. It is something the city may request.
That is a recurring theme in the Pontiac agreement: the city has access on paper, but the contract is not built around aggressive enforcement or automatic transparency.
The most revealing provision, however, is the compensation section. Pontiac agrees to pay STAR EMS one dollar for the term of the agreement. STAR, meanwhile, is responsible for collecting fees from the people who use ambulance services. The contract states that STAR is responsible for collecting fees due and owing from persons furnished with emergency ambulance services, and it retains a fee schedule as an attachment.
That means Pontiac is not truly “buying” ambulance readiness in the same way it would buy a staffed municipal service. It is granting STAR the right to operate and collect transport revenue while shifting most operational burden to the company.
This is the private ambulance franchise model in its pure form.
The city pays almost nothing. The provider makes its money from billing. The provider therefore has a natural incentive to maximize transport-based revenue and minimize costly idle capacity. In other words, there is a built-in tension between what is best for a city and what is most financially efficient for a private ambulance provider. A city wants ambulances waiting and ready, even when nothing is happening. A transport-based private provider makes no money from idle readiness.
That does not mean the provider is acting in bad faith. It means the contract’s incentives are what they are.
Pontiac’s model can be summarized this way: low direct city cost, limited city control, modest performance language, and relatively weak built-in accountability. The city saves money, but it also gives up leverage.
In that context, Pontiac’s arrangement makes sense for what it is. It is not a premium-response contract. It is a low-cost outsourced service model.
Part 2: Troy’s model… a far more expensive contract with far bigger promises
Now compare that to Troy.
In August 2025, Troy City Council selected STAR EMS to provide emergency medical services beginning January 1, 2026, and authorized negotiation of a two-year contract with optional annual renewals. The resolution approved a contract amount not to exceed $771,144 in year one and $794,268 in year two.
That alone tells you Troy is not operating under the Pontiac franchise model. Troy is not paying one dollar. Troy is paying serious money. The agreement itself confirms the difference. It states that the City “shall receive and compensate for” Paramedic First Responder units, Basic Life Support and Advanced Life Support ambulances, and other services described in the contract.
So what is Troy supposedly buying?
At first glance, the answer appears clear: Troy is buying a more controlled, more performance-oriented EMS system with dedicated local resources, detailed reporting, enhanced supervision, operational coordination, mandatory monthly meetings, staffing expectations, annual audits, and specific response metrics.
Troy’s contract contains much more elaborate requirements than Pontiac’s.
- The provider must submit monthly electronic reports including response times, dispatch processing times, interagency referrals, call downgrades, and any other compliance data requested by the city or MCA. The agreement explicitly states that non-compliance with the reporting requirement may subject the provider to contract termination through the notice provision.
- The provider must maintain field supervision at all times, including at least one dedicated paramedic field supervisor available 24/7 within the city. That supervisor is supposed to act as liaison to city agencies and respond to specified critical incidents.
- The provider must attend monthly meetings with Troy Fire and Police, investigate complaints and report back in writing, conduct specified employee background checks and drug testing, maintain QA/QI programs, provide police-incident training, support hazmat and tactical operations, provide standbys, maintain communications interoperability, record telephone and radio traffic, maintain recall procedures, provide EMS supervisor representation in the city’s emergency operations center, maintain decontamination capability, and identify bases of operation preferably within the city.
This is not Pontiac’s loose, one-dollar franchise agreement. On paper, this is a much more ambitious arrangement. And Troy’s pricing structure reflects that.
Under Section 9.1, the contract sets out a Dedicated Unit Model based on five units from 7:00 a.m. to 7:00 p.m. and four units from 7:00 p.m. to 7:00 a.m., at a monthly cost of $64,262 in year one and $66,189 in year two. Those numbers align almost exactly with the total contract amounts approved by council. That means the city-approved annual total is based on the dedicated ambulance model, not the cheaper alternative pricing.
And the contract even defines what “Dedicated ALS Ambulances” means. These are units assigned exclusively to serve Troy, stationed within Troy or an agreed-upon distance and location, and not pulled away to serve other jurisdictions unless explicitly agreed upon by the city.
That is a very important provision.
If Troy is paying at the dedicated-unit rate, residents would reasonably expect actual dedicated city coverage.
The structural problem inside Troy’s contract
Here is where the trouble starts.
Even though Troy is paying on the basis of the dedicated ambulance pricing model, the contract also authorizes a very different operational concept: a Performance-Based Tiered Response Model on a six-month trial basis. Under that system, the provider dispatches the closest appropriate medical resource, which may be a Paramedic First Responder, a BLS ambulance, an ALS ambulance, or some combination of those resources, in order to meet response-time benchmarks. At the end of six months, the City Manager or designee evaluates results and determines whether that model may continue or whether STAR must transition to the deployment plan specified in the bid documents.
This is the most consequential feature of the Troy contract.
On one hand, Troy approved a pricing structure based on dedicated ambulances. On the other hand, the contract permits a trial system that uses a closest-resource, tiered-response framework.
Those are not the same thing:
- A dedicated-ambulance system says: these ambulances are for Troy and remain available to Troy.
- A closest-resource tiered-response system says: send the nearest appropriate unit available under current system conditions.
Those two ideas can overlap, but they are not functionally identical. In fact, they reflect very different philosophies.
- A dedicated-ambulance model emphasizes local readiness and guaranteed coverage.
- A tiered-response model emphasizes system efficiency and benchmark compliance.
That distinction is critical because Troy’s response metric is also written in a way that may allow apparent compliance without guaranteeing what most residents probably think they are getting.
Under Section 2.14, for emergency Priority 1 calls, a qualified medical unit must arrive within six minutes for 90% of incidents. But the contract defines a qualified medical unit broadly enough to include a PFR, BLS, or ALS unit. And the contract explicitly states that the first-arriving unit stops the clock. Additional resources are dispatched as needed.
That means the six-minute standard does not necessarily mean an ALS ambulance arrived within six minutes. It means some qualifying medical resource arrived within six minutes. This is not a small distinction. It is the heart of the contract.
A resident hearing “90% under six minutes” may reasonably imagine that this means an ambulance is reaching people within that timeframe. But the contract language allows something else entirely: the timer can be satisfied by the first-arriving medical responder while transport or higher-level ambulance capability may still be minutes away.
That may be operationally defensible in certain cases. It may even be medically appropriate in some settings. But it is not the same thing as promising a dedicated in-city ambulance at the patient’s side in six minutes.
And if Troy is paying dedicated-ambulance money while measuring first-arriving-resource response, then the public deserves to know that.
Why Troy is paying so much more than Pontiac
At this point, the answer to the obvious question becomes much clearer. Why is Pontiac paying essentially nothing while Troy is paying roughly $771,000 a year?
Because Troy is not just granting STAR the right to operate and bill patients. Troy is subsidizing a more managed, more intensive EMS system. It is paying for local supervisory presence, detailed reporting, coordination with police and fire, standbys, training support, compatibility with city systems, readiness for emergency operations center participation, and above all, the availability of dedicated Troy-serving ambulance capacity.
Pontiac’s arrangement is closer to a traditional outsourced franchise: STAR operates, bills, and bears the operational pressure of making the system work through user fees.
Troy’s arrangement is a hybrid. STAR still retains ambulance user fee revenue under the contract’s fee schedule, which includes listed charges for ALS emergency, ALS non-emergency, BLS emergency, BLS non-emergency, and mileage. At the same time, Troy is paying a substantial monthly subsidy.
That means Troy’s contract is not simply outsourcing. It is subsidized outsourcing.
The city is paying substantial public money while also allowing STAR to bill users. That does not automatically make the arrangement improper. But it greatly increases the city’s burden to justify the value being purchased.
If taxpayers are subsidizing the service, then taxpayers should expect more than vague assurances. They should expect clear proof that the contract is delivering the specific readiness and response benefits the city said it was buying.
The core problem with Troy’s contract design
The central issue with Troy’s agreement is not that it has performance standards. It does.
The central issue is not that it lacks operational detail. It does not.
The central issue is that the contract appears to combine the cost structure of a premium dedicated model with the operational flexibility of a tiered-response system and the measurement advantages of a first-arriving-unit clock-stop rule.
That combination creates a risk that Troy can claim success under the contract while residents experience something quite different. To put it more plainly, the contract may allow Troy to say:
- We funded dedicated ambulances.
- We required 90% under six minutes.
- We imposed reporting and oversight.
But because of how the contract is structured, those statements may not necessarily mean: An ALS ambulance based in Troy reached 90% of emergency patients within six minutes.
Instead, the actual result may be closer to: A qualifying first medical resource reached 90% of emergency incidents within six minutes under a flexible deployment model, while transport capability and ambulance exclusivity remained more variable than the public may assume.
That is a big difference.
And it matters because contract language shapes public understanding. If council members and residents hear “dedicated units” and “90% under six minutes,” many will understandably interpret those phrases in the strongest possible sense. The actual agreement is more nuanced and more permissive.
Specific concerns residents should have about Troy’s model
There are several reasons this structure should concern residents.
1. Dedicated pricing does not automatically guarantee dedicated operations
The pricing Troy approved tracks the dedicated-unit model. But the contract still allows a six-month trial under the tiered-response framework, with continuation depending on managerial evaluation.
That means the city may be paying based on one concept while operating under another, at least initially. Residents should want a clear answer to a simple question: during the trial period, are the units truly dedicated to Troy, or is Troy functionally operating under a closest-available-resource system?
2. The six-minute benchmark may not mean what the public thinks it means
Again, the contract allows a PFR, BLS, or ALS unit to satisfy the six-minute requirement, and the first-arriving unit stops the clock.
That may be legally sufficient under the contract. But public officials should not present that standard as though it proves fast ambulance arrival unless they are also disclosing actual ambulance-arrival times.
3. The contract creates room for metric compliance without full service transparency
Troy’s contract is better than Pontiac’s in requiring monthly reports. But monthly summary reporting is not the same thing as independent public verification. The city can receive reports without the public receiving raw dispatch-level data. The agreement does allow audits and inspections, which is positive. But the contract alone does not guarantee the kind of granular public transparency residents may need in order to verify the city’s claims.
4. The trial structure concentrates major discretion in city management
At the end of six months, the City Manager or designee decides whether the tiered-response model may continue or whether STAR must shift to the bid-spec deployment plan.
That means one of the most important structural decisions in the contract is not automatically driven by objective benchmarks publicly spelled out in the agreement. It is driven by administrative evaluation. Residents should ask what exact criteria will be used, what data will be reviewed, whether ambulance arrival times will be separated from first-responder arrival times, and whether the evaluation will be public.
5. The contract may allow the city to blur efficiency with adequacy
Tiered-response systems are often sold as smarter and more modern. Sometimes they are. But efficiency is not the same thing as sufficiency. If a contract rewards the fastest first medical contact while transport resources remain less visible in the public metrics, then a city can end up celebrating response performance while residents still wait longer than expected for the actual ambulance.
Why the Pontiac comparison matters so much
The value of comparing Pontiac and Troy is that it strips away the rhetoric. Pontiac’s contract is honest in its structure. It is a low-cost outsourced model with limited city financial commitment and correspondingly modest leverage.
Troy’s contract is different. Troy has chosen to spend real public money. That means Troy cannot credibly defend shortcomings by acting as though this is just a no-cost private ambulance arrangement. It is not.
If the city wants the benefits of a cheaper, more flexible franchise-style tiered model, then it should be candid about that.
If the city wants the benefits of a premium dedicated in-city ambulance system, then it should enforce that and measure it honestly.
The problem is the possibility that Troy is trying to occupy both worlds at once: paying for a premium system while preserving the operational and metric flexibility of a cheaper one.
That is where public concern becomes justified.
Questions Troy residents and council members should be asking right now
The contract itself suggests a series of questions that should be answered publicly.
First, during the six-month trial period, what exactly is being deployed in practice? Are the ambulances truly dedicated to Troy, or is the city effectively receiving a closest-resource tiered system?
Second, when the city reports compliance with the six-minute standard, is it reporting the arrival of the first qualifying medical unit, the first ambulance, the first ALS ambulance, or all three separately?
Third, what data will the City Manager use at the end of the trial period to decide whether the tiered model can continue?
Fourth, will the city release enough underlying data for the public to verify not just summary percentages, but actual operational performance?
Fifth, if Troy is paying approximately $771,144 in year one and $794,268 in year two, in addition to STAR’s ability to bill users, what measurable level of readiness and exclusivity is the city guaranteeing in return?
Those are not anti-EMS questions. They are accountability questions. They are the kind of questions taxpayers should ask any time their city says it is spending substantial money to secure emergency response performance.
Troy is paying for more, but is it actually getting more?
Pontiac’s STAR EMS contract is a classic example of a city paying almost nothing and therefore exercising limited control. It is a private franchise-style system with corresponding limits.
Troy’s contract is supposed to be different. It is much more expensive, much more detailed, and much more performance-focused on paper. It includes dedicated unit pricing, monthly reporting, supervision, audits, and a six-minute benchmark. But Troy’s agreement also contains a structural tension that should not be ignored.
The city approved dedicated-model pricing, yet the contract allows a trial of a tiered-response model. The city advertises a six-minute emergency benchmark, yet the clock can be stopped by the first-arriving qualifying medical unit rather than necessarily by an ambulance. The city requires reports, yet public understanding may still depend on how much underlying data is actually disclosed.
That leaves residents with a legitimate concern. Troy may be paying for a premium EMS system while retaining operational and reporting features that make the service look better on paper than it feels in real life. If the city is going to subsidize private EMS at this level, then the public deserves more than summary assurances. It deserves clarity, honesty, and proof.
Because once Troy moved beyond Pontiac’s one-dollar model and began spending hundreds of thousands of taxpayer dollars a year, the standard changed. At that point, the question is no longer whether STAR is merely available.
The question is whether Troy is actually getting the dedicated, accountable, high-performance emergency response system it is paying for.