Ambulance?s letter not what officials expected

While co-owners of Jefferson County Area Ambulance have submitted a letter of intent to the Jefferson County Ambulance Service Agency as promised, the letter was not what officials were expecting.

Although their contract with the county was initially to have been in effect through 2015, ambulance service co-owners Bill Luko and Ray Rex agreed to submit the letter after it became clear financial and personnel problems were making continued operation impossible. After telling the board Monday ?a breech of contract is eminent,? Luko and Rex said they would submit a letter of intent no later than 5 p.m. Tuesday indicating that due to personnel shortages, the ambulance service could not honor its contract with the county. In addition, the letter was to have outlined plans for how the business will operate while the county completes the bid process for a new service.

However, the letter received by hospital officials said only that Rex has resigned from the day-to-day operations at Jefferson County Ambulance effective July 2.

?This decision is being made pursuant to the request of the Board and to provide uninterrupted ambulance service to the community and to allow the Ambulance to meet contractual obligations. Any future contact should be directed to Director Bill Luko,? the letter said. It was signed by both Rex and Luko.

Jefferson County Supervisor Steve Burgmeier said the letter was not what the board was anticipating and he will be contacting Luko to discuss the matter.

?We need to get it resolved,? Burgmeier said.

The confusion surrounding the wording of the letter is another sticking point in a growing list of challenges facing the ambulance board.

Ambulance personnel threatened to resign Monday, asserting cuts in hours and pay and conflicts with Rex had made working for the ambulance service ?too much to bear.? However, they agreed to remain on the job for the 90 days it is expected to take to issue a new contract if cuts in hours and pay were not initiated as proposed and if Rex agreed to step down from the hands-on part of the business.

Characterizing measures to keep the ambulance running for 90 days while a new service provider can be found as ?stop-gap,? Rex told the ambulance board 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 told the ambulance board. ?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 Tuesday 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.

Having a publicly run ambulance service is the other alternative, but Burgmeier said he?s doubtful it could survive without additional subsidies, either. In addition, hospital-based services face the additional challenge of 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 that 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.

?It can put a strain on hospitals,? he said.

Ambulance service providers ? both private and public ? are facing what Burgmeier described as a perfect storm. Medicare and Medicaid only reimburse 53 cents and 13 cents on the dollar, respectively, for ambulance charges; 71 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 are factored in, any service provider will have trouble staying afloat.

?The handwriting is on the wall: we need to look at the amount of the subsidy,? Burgmeier said.

Presently, the county tax levy for the ambulance service is 27 cents per $1,000 valuation. The levy generates approximately $179,000 annually; the ambulance service returns $12,000 to pay for a new ambulance. In addition to this, the county provides an annual subsidy of $25,000. Currently, the city does not subsidize the ambulance service.

?We?ve got a lot before us to work out, but the bottom line is, we?re committed to having an ambulance,? said Burgmeier.

Noting that the ambulance service currently responds to approximately 1,300 calls per year, Burgmeier said not having an ambulance in Jefferson County is simply not an option.

?We will have an ambulance service in Jefferson County,? he said. ?The hospital needs and ambulance, the county needs an ambulance, the city needs an ambulance. We?re going to have ambulance.?

The ambulance board will meet again at 1:30 p.m. July 18 in the Jefferson County Health Center conference room. Burgmeier said he will have a better sense then of the ?direction things are moving.?