Batesville Herald Tribune, Batesville, Indiana

July 23, 2013

What is the future of EMS?

Diane Raver The Herald-Tribune
The Batesville Herald-Tribune

---- — VERSAILLES – Nearly every day, Ripley County Emergency Medical Services personnel from Batesville, Sunman, Milan and Versailles respond to calls ranging from medical emergencies to vehicle accidents. But what is the future of these organizations?

On July 17, EMS representatives and county and town officials gathered at South Ripley Elementary School to learn about the EMS financial crisis and possible alternatives.

Keith Sieverding, Rescue 69, Versailles, president, pointed out, “The purpose of this meeting is just to communicate with everyone in the county, paint the picture of what the situation is, get the facts out there and what the next steps are.

“When I got involved with Rescue 69, it was having a financial crisis. We worked really hard to put a budget in place, but it has been a lot of work to put a good solid foundation under it .... It also became apparent it wasn’t just Rescue 69 seeing those issues. It was suggested that maybe the units better get together and share their stories and see what the situation was from a front-line provider perspective.”

He stressed, “All the units (Batesville EMS 10; Milan Rescue 30; Sunman Area Life Squad; and Rescue 69) are losing money ($244,103 total last year), and everybody knows that’s not a sustainable model .... They do not have a voice at the county level or have input into the budgeting process.”

Some of the key issues are “the payer mix is shifting away from private insurance to Medicaid and Medicare. There is economic pressure on operating costs, including fuel, insurance and supplies. There’s a cost to support the paramedic structure. There are employee wages because the units are staffed 24/7, and there are not accruing monies to replace vehicles, equipment and facilities.”

Sieverding explained the county’s three tiers of care. “The first tier is when EMS goes out with fire department with basic life support (BLS), nontransport. The next level is BLS transport, which is some of what the squads do. They get patients and take them to the next level of care, which could include minor medication or starting IV therapy. The third tier is the paramedic chase vehicle, which has advanced life support capability. They can administer drugs and provide additional lifesaving capabilities.”

First tier runs cannot be billed. In 2012, “about 20 percent of our runs were nonbillable. That means we get nothing.” He also revealed the average cost per EMS response was $421, but the revenue was only $341, an average loss of $80 per response last year.

In addition, Medicare/Medicaid have fixed payment amounts for transporting patients and mileage. The difference between the allowed and paid amount is billed to supplemental insurance if available or paid out of pocket by the individual. However, “most of the time, it ends up in collections,” he reported.

Squad leaders had brainstormed possible alternatives, which included keeping the current operating structure and support, consolidating or sharing response in nonpeak hours, creating a countywide EMS association with dues to offset operational deficit, eliminating paramedic billing ($150 per run) to squads, increasing funding from county contracts, returning to volunteer organizations, creating hybrid organizations (volunteer/paid), operating paramedic ambulances and splitting the paramedic fee based on value, “but there was no clear solution that the team felt was going to solve the problem,” the speaker emphasized.

County commissioner Bob Reiners, Sunman, said, “For the year 2013, we are budgeted for that flat rate for paramedics .... We possibly may be able to reconsider that amount” in the future.

Someone also asked about the county adding a tax for EMS services. Sieverding revealed, “That’s one of the many possibilities.”

Batesville Mayor Rick Fledderman noted, “I think it would be a good idea to get a group together to talk about solutions .... It has got to be a countywide solution, and we all have to work together.” In Batesville, “we don’t do the hard billing. We went to soft billing 12-15 years ago, but I think we are going to have to go to hard billing.”

Batesville Fire Chief Todd Schutte later explained, “For people within the city limits, we have soft billing. We only get what the insurance pays. We don’t send a bill. Outside the city, we will send a bill, but they’re not obligated to pay it.”

County council member Dee Dee Kaiser, Batesville, pointed out, “Communication is important. The public doesn’t know what situation the squads are in and ways they can help. They can write a check to the local squad or send memorials.”

Sieverding added, “We can get a group together to figure out a way to keep the squads in the communities.”

Diane Raver can be contacted at diane.raver@batesvilleheraldtribune.com or 812-934-4343, Ext. 114.