Lee County Ambulance looks at cuts

BY CHUCK VANDENBERG
PCC EDITOR

LEE COUNTY - Reimbursement deficiencies are forcing some logistical cuts, at a minimum, from services provided by Lee County Emergency Medical Services.

Bill Young, executive director of Lee County EMS, told the Lee County Board of Supervisors at it's regular Tuesday meeting, in the next couple weeks the ambulance service will have to stop rotating units when more than two ambulances are needed in the same proximity.

Currently, an EMS ambulance is stationed in Fort Madison, one in Keokuk and one in Donnellson with a standby at the junction of Hwy. 218 and 61 near the middle of the county. When an ambulance leaves the city or a second ambulance is required in a city, the EMS dispatches another ambulance to the junction on standby.

Young said in coming weeks, that replacement unit will no longer be sent, which could increase service times to parts of the county during heavier call times.

"Every time one of the city units goes out we send an ambulance to standby if there is another call," he said.

"That adds about 500 in extra mileage per week which was just over $100 in fuel for that move, or about $5,400 per year."

According to a spreadsheet Young presented to the board, Lee County EMS charges $13 per mile and is reimbursed through Medicare at a rate of $6.09, which is 80% of the Medicare's allowed charge of $7.62. On a straight Medicaid bill, in Iowa the managed care provider reimburses the $13/mile rate at $2.61/mile.

The mileage to replace the standby is absorbed by the company.

Young said in just about every county in southeast Iowa, counties are dealing with ambulance services and how they are provided.

He said Washington County is moving to a county-provided service. Henry County is now looking at how that county's service will be provided because the Henry County Health Center is moving away from providing the service. Young said Jefferson County is using a private provider out of Des Moines.

"One of the biggest in the Quad Cities is now trying to become a government entity. It's the reality that there is a crisis in EMS reimbursement right now. We're not being reimbursed at the cost of the services we provide on a daily basis," Young said.

He said Medicaid is the biggest problem and when the state moved to managed care providers two years ago, they eliminated billing for secondary insurance and eliminated payments if Medicaid is the secondary provider.

For example for a call for service to someone who has Medicare and Medicaid as a secondary insurer, EMS will be reimbursed at the federal Medicare rate, which represents about 59% of submitted charges and 80% of allowable charges. However, with Medicaid as the secondary insurance, EMS doesn't get the remaining 20% co-insurance from Medicaid, and Young said they aren't allowed by law to bill for that 20% either.

"So we're out that 20%," he said. "And this area of the state is a very high Medicaid area."

Kelsey Young, who's the business manager for Lee County EMS, deals with billing and said in just one week's time in November, she wrote off $2,200 the company would have recovered three years ago.

"Before they changed the rule Medicaid used to pay the co-insuracne and copays that Medicare would leave, and then they changed the rules when they switched to managed care and they no longer pay those so we have to write them off."

Supervisor Ron Fedler said this was a result of the state switching to privatization and those companies denying claims.

"That's how they were saving the money - by basically not taking care of the people that used to be taken care of," Fedler said.

Under the current contract between Lee County EMS and the county, taxpayers are contributing $429,000 per year to help subsidize costs of providing the service via the county's general fund. Young said that number may have to increase as part of the new contract.

Supervisor Matt Pflug asked Young what the bottom line was.

"Bill, what's the solution? You need more money? It looks like the trend is not just Lee County, it's everywhere."

"Obviously, that's something we're going to have to talk about," Young replied.

He told the board that ambulance services in Iowa are not categorized as essential services, which means that if he decided, in theory, to leave the area and not provide service, the county has no legal requirement to provide that service by state law.

He said that, along with reimbursement rates, are the two big issues that need fixed legislatively. Because it's not an essential service as defined by the state, the county can't levy a tax specifically to provide that service.

Supervisor Chairman Gary Folluo said Young has agreed to renegotiate his contract and continue services in the county, but some changes will need to be included in the next contract.

"We're not leaving and we're not going anywhere on the 30th," Young said. "But we may need help to do that."

He said the company is also working on some dramatic internal changes as well, including dispatch services, to help offset costs.

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