Majority of EMS committee members in favor of county run service, no decision yet

MT. PLEASANT - The majority of the members on the Henry County EMS committee would like to see the ambulance service run as a county department as surveyed at its most recent meeting.

On Monday, Dec. 16, the group comprised of more than 20 members met at the Henry County Emergency Management building to discuss the future of the service. The service is currently run by the Henry County Health Center (HCHC) but cannot be sustained due to financial costs. The entity has asked the county to consider taking over.

Michelle Rosell, Chief Operating Officer for HCHC and chairwoman for the committee, said the purpose of the committee was to make a recommendation to the supervisors on whether to transfer the service to county control. During the meeting each member was asked to explain what they felt would be best for the future of the service.

The majority of the group felt the county would be the best fit to take over while a couple remained undecided and one felt it should stay with the hospital. No formal decision was made.

Dan Berner, co-chair of the committee, centralized scheduler for HCHC and a city council member in New London said he was in favor of the county taking over and felt he had a unique perspective on the possible change due to his positions. He said transferring the service would cost the county initially, but encouraged people to think about 'the big picture.” He said if HCHC continued to provide the service it would continue to be a financial burden and could jeopardize the hospital from being able to provide services and stay open in the future.

'In my mind it's kind of a no brainer because it's a county hospital owned by the county. We are all owners of that hospital and we are all owners of that ambulance service,” he said.

Jacob Dodds, secretary for the committee and EMS director for HCHC, agreed and said he did not see any other reasonable way for the service to remain in Henry County. Rosell said the majority of the questions she heard from committee members were concerned as to why HCHC could not sustain the service. The reason, she said, is because it is a critical access hospital.

She said in the late 90s, the government allowed for smaller hospitals to change their designation which would allow for 101 percent of Medicare allowable reimbursement rates, except for public health, OB, nursing home and EMS. The hospital would also have to reduce its capacity to 25 beds.

Rosell said although EMS does turn a profit, because HCHC is a critical access hospital the institution loses funds. Because of these costs, the hospital has already dropped the public health program and announced earlier this year it will drop OB in June 2020. She said when a patients bill is presented, any services relating to the four exempt categories, public health, OB, nursing home or EMS, are reimbursed at a reduced rate. Everything else is reimbursed at 101 percent, causing the hospital to lose out on funds.

Dodds said transferring the service from being hospital run to county run would help the hospital financially, but in the long run, help the citizens of Henry County by ensuring there is medical care available.

'The decisions that the supervisors need to make is based on ambulance operations. Yes, the hospital's overall bottom line increases and improves if EMS is shifted out, but that has to happen or at some point the hospital starts making tough decisions about other departments and services and whether or not it remains viable in the future,” he said.

Dodds said there are 288 licensed ambulance services in the state and 39 are hospital based. Of those, only 19 are based at critical access hospitals and in the last five years three critical access hospitals have discontinued ambulance services. Dodds said he felt the conversation needed to shift from hospital finances to county finances and how a county run service would work.

Last year the expenses on the service came to $1,205,974.00 and the net revenue was $1,284,460 creating a net positive margin of just over $78,000. However, because the service is housed under the hospital umbrella those numbers do not reflect HR fees, building maintenance and janitorial fees he said.

He said the biggest source of revenue are the fees for service. Last year the net collection made up 80.5 percent of the total, the hospitals levy 17.5 percent and noon recurring revenue, such as grants and donations, 2 percent.

When it comes to billing, Dodds said the fees are set by Centers for Medicare and Medicaid Services (CMS). The fees vary across the country and are based on the services the company provides. If the county were to take over, CMS would still set the fees.

He said the service takes about 2,881 calls a year or about seven a day. Of those, 76 percent are transported and 53 percent of those were for 911 responses. Dodds said for the calls the service responds to but does not transport, it does not get paid.

Dodds said transferring the service to the county would come at a fee, but the county could subsidize the amount. The alternative, he said, would be to bring in a private company which he does not recommend because all of his staff has worked for a private company before and have come to work for HCHC for a reason.

Berner agreed with a private company not being a good idea, saying what makes the HCHC ambulance service so successful is the level of service citizens receive from the staff and losing them would be a great loss. He said he personally would rather have a small increase in his taxes to ensure the same employees are taking care of the county instead of bringing in a private company where the level of care could decrease.