Ambulance policies pitched to Washington County

Washington County Ambulance Director Jeremy Peck pitched a series of policies for the department to the Board of Supervisors in recent weeks, which he said would help relieve a shortage of paramedics.

One item scheduled for Tuesday’s board meeting was a plan to contract a Public Consulting Group (PCG) to increase the ambulance services’ revenue from Medicaid calls.

“They know the ins and outs of the laws and will do the paperwork to get a cost recovery on some things,” Board Member Jack Seward Jr. said. “It’s a service they provide on a contingency basis. If they don’t recover anything for us, they don’t get anything. If they do get us a return, they get us a cut of it.”

Peck said the program would net substantial returns for the county, with a ballpark estimate of $120,000.

“With Medicaid total care, there’s about eight different Iowa insurance companies that basically pay ambulances more or less what they wish,” Peck said. “So we would have a transfer or a call that goes to Iowa City, roughly speaking go for $1200. They would give us $175 and we would have to write the rest off. This (agreement) recognizes that’s not OK.”

Peck said the investment would likely more than triple the department’s returns from those cases.

While the item was tabled awaiting approval from the county attorney, it still sparked discussion. Many board members expressed concern with a system that made them spend money to make the revenue they felt they were owed.

“Some entity outside of Medicare, Medicaid, or whatever, who is a private, for-profit organization, can solicit the government to recoup some expenses … instead of us being able to just say, ‘Pay us,’” Board Member Marcus Fedler said. “We need to pay somebody 9% of the money we would normally get. Am I the only one that sees this as absolutely ridiculous?”

Board Chair Richard Young blamed state and federal legislators for the complicated system.

“They’re making us jump through these hoops … to get money that they should just raise the rates,” he said. “But the state of Iowa Legislature set the rates.”

Despite their criticism of the process itself, board members said contracting the consultant was their best option.

“It’s kind of another example of somebody above us setting the rules, and then we figure out the best way we can to operate within those rules,” Seward said. “This is the way we do it.”

Peck said the money from the PCG could help pay for other department changes that would address a paramedic shortage. In addition to a less paramedic-dependent system proposed last month, Peck proposed a change in pay rates for new hires to the ambulance team.

“When we started, we decided to start all employees, no matter what their years of service were, at the starting wage,” he said. “We’re not able to attract employees that have been at other places, that have had that experience, that have been through their step raises, to come in here and work at starting wage … I’ve had this phone call several times.”

Peck’s proposal would pay new hires based on their years of experience elsewhere the same way it would pay county ambulance employees that had been with the service for that long. It would also slightly increase the pay for the county’s current employees.

“We’re asking with this, for the current employees we have, to try to maintain them so they’re not attracted to other counties” he said. “We value the people that we have, and we want to show them that value while we attract other people in. If I bring other people in and pay them more, because I have to get them, the people that we already have will go elsewhere.”

Again, board members criticized other institutions for conditions contributing to the problem.

“(Hospitals) can hire a paramedic for less than they can hire a nurse … paramedics are leaving the ambulance services to work in a hospital, because why not? It’s air-conditioned, you never have to get rained on or snowed on, and they’re making just as much money if not more,” Young said. ”I hate to keep harping on this. The state legislators changed the law to allow the hospitals to put paramedics in hospitals … the hospitals have a powerful lobby.“

While the wage increase may not compete with hospital rates, Peck said it would still help attract newcomers.

“We’re not anywhere near competing with clinics and hospitals, but there’s a whole different breed of paramedics that works in an ambulance versus those other places,” he said. “Sure, I’d love to pay them the wages that the hospitals and the clinics are paying them, that may be what we have to get to … but I would like to at least start with trying to be competitive with ambulance services and see where that takes us.”

Combined with plans to expand the department, the reforms would require an increase to the ambulance budget. Peck said that could be offset, however, by the PCG, pending board approval.

“Yes, it’s going to come out of our budget because the revenue doesn’t go right back into our budget, it goes to the county budget,” Peck said. “But it will also be made up on the back end. It should pretty much entirely make it up, especially if we put the BLS truck on.”

Comments: Kalen.McCain@southeastiowaunion.com