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July 16, 2013

EMS in the red Squads look at operating options

Mary Mattingly

Keith Sieverding facilitated the EMS financial meeting at South Ripley Elementary.

Ripley County EMS is in a financial crisis. The four EMS squads know it, but they want the county and city leaders to be aware of it before 2014 budgets are established,. They also want the public to know.

The local ambulance service is something many people take for granted when the need arises, assuming it will arrive in a timely manner with professional trained staff. How it's funded or operated is generally not considered when an emergency occurs. Ripley County subcontracts the local EMS service, and provides tax dollars to do so. Response costs are billed to the individual, insurer or through Medicare/Medicaid.

"The situation is not sustainable for the residents of Ripley County," Keith Sieverding, Rescue 69 board president, said at a meeting Wednesday at South Ripley Elementary. EMS squad directors, EMTs, several fire department staff, paramedics, hospital executives, three commissioners, three county council members (Brenda Wetzler, Ed Armbrecht and DeeDee Kaiser), city leaders and media attended the power point presentation facilitated by Sieverding.

Some key points brought up during the hour-long presentation: they are operating at a $240,000 loss; three of the four squads will go bankrupt in 12-18 months; there are no new monies to replace vehicles, equipment and facilities; no contract raises in 10 years; and only 68 percent of 2012 EMS responses were billable.

Sieverding said after brainstorming with EMS and fire department members came up with nine solutions. "The purpose tonight is to communicate with those in the county and paint the picture of the situation, and propose the next steps," he said.

Rescue 69 serves the southern part of the county, Rescue 30 serves Milan; Rescue 20 is for Sunman and Rescue 10, Batesville. "None of these are in the business to make money, but to provide a service, and they want to do so with adequate equipment. We want to keep the lights on," Sieverding added.

Facts presented at the meeting showed the total 2012 revenue at $1,041,390. The county contract provides 17 percent of the funding, but Medicare/Medicaid is 68 percent. Other revenue comes from fundraisers, donations, etc., and amounts to 14 percent. Considering the operating expenses at $1.2 million, they are operating at a 23.4 percent loss. "All organizations operated on a significant loss," Sieverding pointed out.

The four squads had a total of 3,052 responses last year, and of those 69 percent were billable. The revenue received per response was $341, but the cost was actually $421, amounting to an $80 loss average per response.

Sieverding mentioned a key issue is the payer mix is shifting from private insurance to Medicaid and Medicare. Fifteen percent of the collection revenue is through private pay, but 46.8 percent is from Medicare/Medicaid. "The difference between the billed and allowed amounts must be written off. It is unlawful to bill this amount to a patient," he added.

An example was given to put their financial situation in perspective. A 75-year-old female in Versailles complains of chest pain. She has Medicare but no supplemental insurance. She is taken by ambulance to the hospital. The advanced life support (ALS) base rate, including mileage, is $963. The allowed Medicare amount is $152, plus the $113 for the 27 miles ($4.14 per mile), amounting to $265. Medicare pays 80 percent, or $212, in this case. But, $150 will be billed by Ripley County paramedics, since they were on the scene, leaving $62. If the Batesville squad responded to a similar call at The Waters nursing home, just three-fourths of a mile from Margaret Mary Hospital, they would lose $24 because of the low mileage.

The EMS members and directors came up with nine options. "These groups are committed to serving the people in their areas. They want to operate effectively and efficiently, but they took the opportunity to step aside and see what's good for the county," Sieverding commented on prior meetings with EMS members.

One alternative is to remain as is, losing $240,000 a year. Another is to consolidate, saving $200,000, mainly from personnel costs, "But the service will lose local identity and ties to the local communities they serve. " Plus there will be increased response times in non-peak hours. Another idea is to create an EMS Association to generate additional income, but the revenue will be just around $50,000. Or, they can eliminate billing, removing the $150 charge from Ripley County EMS for ALS responses. However, this would not close the financial gap much.

Increasing funding from the county would mean more than $240,000, but Sieverding said they expect county officials to say an increase in funds is not available. They could return to all-volunteer squads, and that would greatly reduce the personnel costs. "Everyone who works as a volunteer, knows what an impossible situation that is," Sieverding commented. Only Sunman has a few volunteers; the other squads no longer have any.

Several of these options could be combined, but it would require the formal creation of a county-wide EMS work group. Another alternative is to eliminate the duplicate structure that exists, that of sending both a paramedic and ambulance, with squads having their own paramedic, and paying for it out of their fund.

And lastly, realign the county paramedic fee, saving $115,000 annually. However, it was pointed out it won't solve the long-term financial problem.

Members met before the meeting, and rated the options. There was no clear solution, "no silver bullet" as Sieverding said. In the meantime, EMTs say their job is to communicate and educate the public, local officials, and to perhaps, create some temporary funding to buy time, "We can't keep chomping away with this kind of loss," Sieverding said.

Questions were taken after the presentation. Batesville Mayor Rick Fledderman said they may resort to hard billing, going with collection agencies. He said, "When we went with full- and part-time paid EMTs, we didn't expect to make money, but to break even. I could not believe it when we were $82,000 in the hole in 2012."

County council member DeeDee Kaiser said not enough people know about the financial situation, and said communication is important. "The public takes it for granted that everything is great." Versailles Fire Chief Ben Sieverding agrees people need to be more aware. "Ten years without an increase on a contract is irresponsible. I think we need a political ground swell, and make action happen."

The meeting ended with the idea to form a group to develop and implement solutions, with representatives from the hospital, squads, medics and county government.

Napoleon ready for weekend festival

Cindy Ward

The new picnic shelter on the Napoleon Town Public Square will be complete just in time for the Napoleon Fire Department's Annual Fireman's Picnic scheduled for Friday and Saturday, July 19-20. The shelter was made possible by riverboat revenue the town receives. Clerk-Treasurer Karen Rohlfing transferred $15,000 from the riverboat fund to the shelter fund to cover the expense during the July 10 meeting of the Napoleon Town Board, in which all members and town manager, Rod Eaton, were present.

This year's festival will feature music, food and fun for the entire family. On Friday night, the Keith Swinney Band will provide musical entertainment. Beer and fried chicken will be available. Saturday night's entertainment will be country music performed by the Adams Church Boys. Also featured will be a kids tractor pull at 8 p.m. Participant registration will be at 7:30 p.m. Saturday's menu will include the traditional mock turtle soup, as well as pork burgers, hamburgers and more.

There will be Texas Hold 'Em' tournaments going on both Friday and Saturday evening. Registration will be at 6:30 p.m. with the tournaments beginning at 7 p.m. each night. And, for the bronco busters, a mechanical bull will be available to test your skills. Ten bouncy houses will also be set up to entertain the kids.

More picnic tables

There was some discussion about ordering picnic tables for the new shelter. Board member John Snyder checked pricing on vinyl plastic tables. For an eight-foot table, the cost is $350 each and for a six-foot table, the price was $250. Rohlfing questioned whether the tables would be heavy enough to keep them from being carried off. Snyder suggested if they went with the vinyl plastic tables, they could be chained together when not in use. It was decided that Snyder would check into pricing of tables made from wood and recycled material, also. Council is hoping to purchase the tables sometime next year with the help of a grant, but wanted to get a head start on checking costs.

Sewer issues

Board members discussed some businesses with past due sewer and trash accounts. It was decided if payment is not received, trash receptacles will be pulled.

The town will be adding a new sewer hook-up for a new trucking business owned by Charlie Whalbring. Board President Bill Vankirk said he would call Holman's Excavating for an estimate to add a tap.

Rohlfing reported the receipt of sewer and mowing fees collected from an abandoned house on Monroe Street. The town had placed a lien on the property and the new owners settled the bill in full.

Other issues

Eaton reported the flow meter is not working at the lagoon. He said the flow meter is better than 20 years old and has been struck by lightning three of four times over the years. The board instructed Eaton to check on pricing. He also presented an estimate from Brooks and Earl of North Vernon for a new water pump for $38,000. It was decided to obtain quotes and discuss it at another time.

Also discussed was partnering with the Napoleon Fire Department to purchase a bigger tornado siren. The one they currently have cannot be heard by all town residents.

The annexation of seven residents into the Town of Napoleon was finalized.

A new board member will be appointed at the next meeting in August to replace Tim Brancamp who recently moved to Batesville.

Vankirk mentioned a pothole on Harrison Street. Eaton and Snyder will take care of repairs. Snyder reported the snow blade for the tractor came in. Weeds along the creek were discussed. Eaton was instructed to spray them with weed killer.

The next meeting of the Napoleon Town Board will be at 7 p.m., Wednesday, Aug. 14, at the Napoleon Town Hall.

To read these and more articles pick up a copy of The Versailles Republican at your local store or subscribe by clicking on the link above or by calling 812-689-6364.
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