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8/27/2014 12:01:00 AM
County-run EMS being recommended

The Emmet County Board of Commissioners is going to consider forming a county-run emergency medical service (EMS). Its Ambulance Advisory Committee voted on Monday, Aug. 25 to make such a recommendation to the full board after reviewing three options for future service suggested by a consultant.

The board brought in consultant Tim Ladd, director of Big Rapids-based Mecosta County Emergency Medical Services, back in June to study the current system and suggest options going forward for Emmet County.

Ladd presented his written report last week. The Ambulance Advisory Committee moved quickly to go with the county-run EMS option.

The lengthy consultant's report, filled with multiple exhibits and spreadsheets, concluded with three possible options.

The first option was to maintain the existing operational agreement with Allied EMS Systems, Inc and the Village of Mackinaw City with some changes.

Currently Allied EMS provides Advanced Life Support (ALS) transportation (ambulance) services. In turn, Emmet County gives Allied approximately 80-percent of the dedicated Emergency Medical Services (EMS) millage tax revenue. The remaining approximately 20-percent goes to the Village of Mackinaw City for the same services. An additional administrative charge is paid by Emmet County to Allied, according to Ladd's report.

Ladd recommended changes to the funding model, as part of this first option.

"The primary change would be the county establishing an improved revenue capture model," he wrote. He also suggest reevaluating the current service area coverage as shared by the two ambulance providers.

"The Ambulance Advisory Committee (of the Board of Commissioners) should have the ability to review and make changes to the millage allocation to help facilitate complete ambulance coverage for all of Emmet County," he wrote. "A comprehensive review of the two current ambulance providers revenue capture model reveals some room for improvement in obtaining optimal reimbursement from insurers for user fees (ambulance service charges)."

Ladd suggested that improved collections "should result in a significant decrease in the contribution of financial support by Emmet County. Both ambulance services should also adopt an updated fee schedule to take advantage of capturing all revenue that is allowed by the insurance carriers."

The second option suggested continuing the arrangement with the current providers, but with several changes.

"Through these proposed changes the county would realize greater control of the financial support given to each (provider) and decrease the dependency on county funding," Ladd wrote.

Among the suggested changes were:

Adoption of high performance billing practices

A reevaluation of provision of service throughout the county and reallocate dedicated EMS millage funding to the service providers based on ambulance service needs of county residents

Providers would mutually agree to work together to provide better service response to the north central region of Emmet County

Improved financial reporting

An annual line item-type budge for Emmet County-related expenses to be developed and adhered to

Plans for the development and support of Medical First Responder units within Emmet County.

The third option suggested by the consultant was a county-owned and operated Emergency Medical Service. This was the option approved by the Ambulance Advisory Committee.

"The obvious benefit to the county...in owning and operating their own EMS is the complete control of said entity," Ladd wrote. "The Ambulance Advisory Committee could provide recommendations for the establishment of a 'line-item' budget for the EMS Department and thereby retain complete control of the EMS-dedicated millage."

"Location and cost of future buildings and the cost of capital equipment could be controlled by the Board of Commissioners and therefore optimized in consideration of the county's revenue projections."

Among the other "savings" noted by Ladd in having a county-owned EMS were ownership of buildings - elimination of leases/rents; ownership of vehicles and equipment; all revenue generated remains within the county; control of ambulance fees charged to citizens; establishment of a fund balance; realization of economies of scale through utilization of existing county departments and services.

In his summary, Ladd was blunt about the need for something to change when it comes to provision of emergency medical services in Emmet County.

"Allied EMS Systems, Inc. and the Village of Mackinaw City have provided quality patient care to the citizens and visitors of Emmet County for a number of years. However, both ambulance services, in my opinion, have dire financial concerns which require immediate attention."

In his meetings with both providers, Ladd reported significant difficulty in extracting information related to finances.

With regard to Allied EMS, Ladd noted "attempting to obtain basic information...has proven to be very difficult and cumbersome thereby leaving some gaps in the data presented for comparison in this analysis."

As an example of the lack of clear financial reporting, Ladd noted the inability to get the answer to a basic question: "what percent of a call is collected in 30 days, 90 days and 1 year? This information should be clearly documented and monitored on a monthly basis."

Ladd said the billing process and general accounting was understaffed at Allied, in his opinion, and resulted in potential loss of revenue.

In addition to endorsing the idea of a county-run EMS, the Ambulance Advisory Committee also agreed with the idea of expanding medical first responder service throughout the county.

Emmet County commissioner Charlie MacInnis, who represents District 3 which includes the city of Harbor Springs and Little Traverse Township, offered some cautionary notes about moving forward with a county-run service.

"The consultant's report, which can be found on the Emmet County website (www.emmetcounty.org), devotes less than a page to the approved option and offers no guidance as to how the county should go about creating a new EMS department from scratch and transitioning service away from its current providers," MacInnis noted in comments to this newspaper. "Potential startup costs were also not addressed. The county has budgeted $2.5 to $3 million for land, buildings and ambulances. The consultant report did not address the adequacy of that amount. Ambulances cost from $150,000 to $225,000 each and the county will have to purchase enough to cover the county.

MacInnis questioned the advisability of trying to get a county-run service up and running by Jan. 1, 2015.

"Allied's contract with the county expires at the end of this year," MacInnis noted. "It seems doubtful that a new county-run service could be staffed, licensed and ready to operate by January 1, 2015. The county is still seeking land for new ambulance facilities.... The county will need to hire a director to create and run the agency. A billing system will be needed, trained ambulance crews must be hired and state licensure must be obtained.

"The county board may be asked to vote on the recommendation next month. A lot of planning and negotiating lie ahead," MacInnis said.

The next regular meeting of the Emmet County Board of Commissioners is set for Thursday, Sept. 11 at 6:00 pm in the County Building in Petoskey. The next administrative meeting, where much of the discussion takes place on upcoming board business, is set for Tuesday, Sept. 9 at 2:00 pm in the County building. All meetings of the Board of Commissioners are open to the public. For more information, www.emmetcounty.org.

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