BY CHUCK VANDENBERG
LEE COUNTY – Proposals from Keokuk and Fort Madison fire departments to provide countywide ambulance service were waived off Monday by a committee putting together recommendations for the county.
The committee, comprised of two county supervisors, a Keokuk physician, and several members of rural county fire and rescue departments, and co is leaning toward a proposal from American Medical Response, a subsidiary of Global Medical Response out of Dallas, Texas. AMR owns AirEvac, the aerial medical provider with a base behind Fort Madison Community Hospital.
The company is asking for $450,000 annually in supplemental funding from the county to bring a 3-ambulance service to Lee County starting July 1. A meeting has been set for Friday at 11 a.m. to question AMR on their proposal. That meeting is open to the public and can be accessed by calling 1-312-757-3121 using access code 128-262-933.
The committee also received proposals from Lee County EMS Ambulance, which currently provides service in the county, and both Keokuk and Fort Madison fire departments.
Lee County EMS Ambulance said they will need $900,000 next year starting July 1, to continue service, but said even that would require a review six months into the contract.
Committee member Dr. Phillip Caropresa, a Keokuk surgeon, said the city’s proposals weren’t as professional, but more importantly, city councils in those cities can vote the proposals down. Supervisor Gary Folluo said Tuesday he was expecting a single proposal.
Fort Madison Fire Chief Joey Herren said he’d told Folluo that the proposals would be submitted together, but would require a 28E agreement, because the cities are independent of each other, and separate federal and state licensing would be required for each city.
Keokuk City Administrator Cole O’Donnell, included a letter with the Keokuk proposal indicating although the submission is on behalf of the city of Keokuk, it was being submitted in conjunction with Fort Madison’s proposal.
Herren said the committee isn’t understanding the proposals from the city’s are a combined proposal. He said billing for Medicare and Medicaid requires different licensing as does the state Department of Public Health, but the service would be a combined county service.
“I turned them in together, but we’re two separate worlds.” Herren said. “We would sign a 28E and it would be no different from our fire agreement now where they would come help us and we go help them.”
Herren said the city’s will have start-up costs that are close to a million dollars for the ambulance rigs, cots, and equipment and the proposals require initial loans to cover those costs that would be paid back over five years.
A budget prepared by city officials for north Lee County would be $1.7 million annually.
Herren said he looked at a city service 12 years ago and he said those costs are what scared city officials back then. But he said the two cities and the county can come up with a plan.
“If we would have all three sat down, Keokuk, Fort Madison and the county, just got in a room and done this as a partnership instead of just throwing it out there with no rhyme or reason – I’ve put a lot of man hours into this.”
The Fort Madison proposal would require a $966,720 annual county subsidy to Fort Madison in a five-year agreement, which he admitted was a large number.
“That seems like a rather large number, but it is important to remember that approximately 40% of Lee County’s General Fund budget is paid by the citizens of the cities of Fort Madison and Keokuk,” Herren wrote in the Fort Madison proposal.
He also pointed to a program called Ground Emergency Medical Transport under the Iowa Department of Human Services, that allows publicly owned or operated emergency ground ambulance transportation providers to receive supplemental payments that cover the difference between a provider’s actual costs per transport and the Medicaid reimbursement.
He said that program, after two years of billable records, could bring that annual cost to the county in line with what Lee County EMS is asking for now. Herren said he questions how AMR can turn in a proposal with such a low commitment from the county.
“I don’t think they’re looking deep enough in the weeds there,” he said.
Lee County Ambulance is suffocating under the weight of poor Medicare and Medicaid reimbursements, as well as heavy write-offs. The state legislature was looking at a bill to make ambulance services essential in Iowa which would then trigger an option for county’s to assess for those services. The bill was left on the table when the legislature dismissed under the pandemic.
The committee asked each group submitting a proposal a series of 32 questions focusing on staffing, working with rural fire departments, dispatch plans, and other general questions, but Herren said no formal Request For Proposals (RFPs) were handed out by the current committee.
Supervisor Rick Larkin, who also sits on the committee, said it’s difficult for proposals to be asking for money at this time.
“Were not flush with funds to increase the amount of money we’re giving to the ambulance service. And that’s always on our horizon, too – how much are we going to have,” Larkin said.
“With the pandemic were going to get less money from other sources. We’re in a tight spot.”