Ambulance board approves, issues request for proposal

Jefferson County Ambulance Service Agency approved and issued a request for proposal Wednesday, opening the bid process to secure a new ambulance provider for the county.

The action was necessitated when co-owners of the current provider, Jefferson County Area Ambulance, submitted a letter of intent to the ambulance board July 5, indicating due to an inability to meet contractual obligations, they will terminate their contract with the county effective Sept. 30. The contract with co-owners Bill Luko and Ray Rex initially was to have been in effect through 2015.

Ambulance board members reviewed an RFP Wednesday issued in 2005, the last time a call for bids was issued. With the exception of the date proposals are due and names of listed personnel, the board voted unanimously to use the same RFP without changes.

Proposals must be delivered in person or electronically by 3:30 p.m. Aug. 24 to Deb Cardin, chief executive officer of Jefferson County Health Center.

Only 74 days remain until the county?s contract with Jefferson County Area Ambulance expires. One big question before the board Wednesday: can an ambulance service provider be located and hired in that amount of time?

?It will take the full 90 days or more,? Matt Weaver, director of operations for the ambulance, said.

Paramedic/training officer Craig Steward reminded the board of the county-wide emergency response drill scheduled for Oct. 6.

?[The new provider] would have to do that drill a week after they have started,? Steward said.

Luko assured the board he already has created work schedules through Oct. 6 and will extend the contract with the county beyond Sept. 30 if additional time is needed to find a provider

Jefferson County Supervisor Steve Burgmeier said taking the time to explore options, seek quality bidders and move forward ?in a way that is smart? is the ?way to go.? The supervisor said he fears using the same request for proposal and hiring another private ambulance service will take the board ?right back to the board table in a few years? to repeat the process.

?Really, what does this mean long term?? Burgmeier said. ?It seems like the ambulance has a time line. It runs pretty good for a few years, and then something happens. We don?t want to be back here again in four years with the same problem.

?If we put out an RFP and we do everything we have in the past, we?re only going to repeating the mistakes of the past,? Burgmeier said.

Characterizing measures to keep the ambulance running for 90 days while a new service provider can be found as ?stop-gap,? co-owner Rex told the ambulance board July 2 changes in reimbursement rates by Medicare, Medicaid and private insurance companies and a significant increase in the number of uninsured patrons using the ambulance service will make it challenging for any ambulance service to be successful.

?The trends I?m telling you about are still there,? Rex said. ?This is a short-term measure. And now with the Supreme Court upholding Obamacare ? I have no hope things will get better. Things will get worse.?

Burgmeier concurred, saying in a phone interview after the July meeting dwindling reimbursements will make turning a profit difficult, if not impossible, for both public and private ambulance services without an increase in county and city support.

?If you want employees to be professional and competent, you have to compensate them with a fair amount of money. Without an increase in the subsidy, I don?t know how any private service could do it, unless they are bigger and have bigger income centers,? he said.

At present, ambulance crew workers in Jefferson County have only vacation and sick days and a 1 percent match on retirement savings. They do not have a health insurance plan available to them. They do receive a cash stipend for insurance, but that money is taxed as regular income.

?We can?t provide them insurance through us because it?s just too expensive,? Luko said.

Burgmeier told the ambulance board Wednesday all things considered, it might be time to explore implementing a publicly operated ambulance service rather than a private model. Burgmeier encouraged JCHC chief financial officer Gene Irwin and Cardin to consider submitting a bid, noting there are several public models in neighboring communities that could serve as a paradigm for JCHC.

By Burgmeier?s own admission, however, even a publicly run ambulance service would have financial difficulties without additional subsidies. Ambulance service providers ? both private and public - are facing what Burgmeier described in July as a perfect storm. Medicare and Medicaid only reimburse 53 and 13 cents on the dollar, respectively, for ambulance charges; seventy-one percent of ambulance calls in Jefferson County are from Medicare and Medicaid patients. Private insurance companies also have lowered reimbursement rates; with the exception of auto and liability insurers, no company reimburses at 100 percent on the dollar.

Further compounding financial pressures is the growing number of uninsured patrons. In the recent past, the number of uninsured patrons using the ambulance service was between 5 to 10 percent; that number now has jumped to 25 percent.

When the rising costs of liability insurance and employee benefits also are factored in, any service provider will have trouble staying afloat, Burgmeier said. Additionally, hospital-based services must hurdle how to staff the service without stretching employees too thin.

Hospitals often try to subsidize ambulance services by putting paramedics to work elsewhere in the hospital when they are not running calls; however, this practice often is ineffective because the hospital must guarantee staff will be present in the hospital to care for patients. Likewise, the ambulance service needs to be guaranteed a crew is available to respond to calls, said Burgmeier explained in July.

?It would definitely be a strain on us,? Irwin said Wednesday.

?It would be an adjustment for the hospital, there?s no doubt about that,? said city administrator Kevin Flanagan,

Ultimately, the ambulance board agreed to wait until Aug. 24 to see how many and what type of bids ? public or private ? are received.

The board will meet at 1:30 p.m. Aug. 29th in the hospital board room to review the bids.