Dr. Thomas Charlton is the medical director for the Northern Michigan Medical Control Authority which oversees the provision of emergency medical services in the region. He is also an emergency room physician with McLaren Northern Michigan Hospital.
When Tom Charlton was a little boy, he loved to mimic the "Wee-Woo" siren noises of local fire trucks and ambulances. His dad was an internal medicine doctor and Charlton said his mom knew "he was hooked" on emergency medical services (EMS) from a very young age.
Sitting in the booth of North Perk Coffee Shop in downtown Petoskey recently, Charlton-- who now serves as an Emergency Department physician at McLaren Northern Michigan-- smiled and shrugged.
"It's in my blood. It's who I am," he said.
Truer words might never have been spoken. As Charlton, who has been living in northern Michigan for two years now, started listing his (very long) list of credentials, there was zero hubris, simply enthusiasm and passion for helping those in need.
Raised in Cincinnati, Ohio, Charlton was a volunteer Emergency Medical Technician (EMT) and firefighter throughout his college career. He is one of the few doctors in the state that has completed an Emergency Medical Services fellowship, and has a master's degree in Health Administration. Listening to Charlton talk is like listening to an audio textbook on the history of EMS, its models, its successes, pitfalls, and needs for the future.
In short, he's the kind of resource that rural areas like northern Michigan rarely get to call their own.
"My wife and I made a very conscious decision when we moved. This is the place we want to raise our family (the Charltons are expecting their first baby in a few short weeks). We may be new to the area, but we already feel very rooted here. This is our home, our community."
In addition to serving as an Emergency Department doctor, Charlton has also taken on the role of medical director for the region's Medical Control Authority. Medical Control Authorities (MCA) are organizations designated by Community Health Departments throughout the state, for the purpose of supervising and coordinating an Emergency Medical Service system.
His role-- and the knowledge he brings-- may become increasingly important in the coming years as Emmet County struggles to find the best way to subsidize ambulatory care in the area (see related article in this week's edition).
As a whole, Charlton explained, the role of MCA's in Michigan has major pros-- and one major con-- in helping communities establish and maintain strong Emergency Medical Services.
"What Michigan did right is create Medical Control Authorities by county/region, and the hospital-- not local municipalities-- selects the medical director. This is important, because it allows the medical director to be a true third party at the table. I can 100-percent advocate for the patient. What the state neglected to do, however, is fund the authority."
Locally, McLaren Northern Michigan makes sure the MCA is "well funded" considering its rural location, Charlton noted.
This is especially true in a time when bad debt and charity care dollars remain on the rise.
"McLaren actually pays for any and all drugs used on an ambulatory run. In other parts of the country, those costs come out of the reimbursement from runs. You can imagine how expensive this can be," Charlton said.
"More and more people have insurance because of the Affordable Care Act, but the truth of the matter is that many only have 'Catastrophic Coverage' with high deductibles," he added. "Many people will have their first payments due as a result of an ambulance ride or Emergency Room visit-- and many don't have upwards of $4,000 to cover their initial deductibles. So, bad debt numbers are still going up. If anything, this results in ambulances being paid even less than before, and we really will need subsidies to keep the doors open."
Charlton said rising costs and smaller reimbursements mean communities need to work together more than ever. As the director of the MCA in this region, Charlton's goal is to increase communication and resource sharing whenever possible.
As an example, Charlton explained that North Central Michigan College's paramedic program has "high fidelity" mannequins for students to practice a variety of life saving techniques on-- these training tools are so lifelike they respond (and can change responses) to exactly what each student is doing. Charlton said it would be great for the county's EMS providers to be able to train on the mannequins as well.
He also noted the area's Central Dispatch is strong and well-funded (by the state). With highly-trained professionals and incredible technology, Charlton said the region has great partnerships already in place.
The hospital itself is so impressive, especially given its rural nature, that Charlton said his goal is to have ambulatory care that matches.
"I would challenge people to go anywhere in the country and find a hospital as strong as ours in a county with 35,000 people. You won't find it. That's part of the reason I'm excited to be here."
Posted: Thursday, May 1, 2014
Article comment by:
As a paramedic and former Executive Director for Allied EMS, I would wholeheartedly agree with Dr. Charleton's assessment regarding the ems funding situation in Emmet County. I would also emphasize that this funding problem is experienced by the majority of ambulance services in Michigan as well as the United States. Federal (Medicare) and state (Medicaid) mandates have resulted in decreased reimbursement to ambulance services. Also, state mandates involving required equipment, license fees, etc. also compound the problem. In short, reimbursements have decreased and expenses have increased. As the Executive Director for an ambulance service similar in size and run volume as that of Allied EMS, we provide ambulance, emergency medical dispatch, and non-emergent transportation services in a rural farming community. Millage dollars received by our service amounts to $313,000. Combined with user fees, we are able to provide a superior service to our constituents. Simply stating, many EMS services have been forced to be more creative in offering services, without compromising the safety and welfare of their constituents. A portion of this strategy is to control administrative costs, i.e. management wages, and operational expenses, i.e. ambulances, cardiac monitors/defibrillators, etc. As a homeowner and taxpayer in Emmet County, I am totally confident that with internal adjustments such as those indicated, Allied EMS can continue to provide high quality prehospital care.