Letter to the Editor – County is turning its back on Lee County ambulance

Dear Editor,

The speed at which this County turned its back on such a loyal company is baffling and shameful. The day the County was contacted by the Youngs that they were unable to meet payroll, I was there. The office was frantic, and in sheer panic. All of us felt sick. Fearful of how the service they have been running for, what, nearly 25 years, would be able to take that next call. And just like that, news article after news article, I had to sit back and watch as the County turned its back on a loyal, committed, locally owned company. From day one I could tell the County has no intentions of staying with Lee County EMS. It was meeting after meeting behind their backs, slandering their names! How many times did they meet with the Youngs to discuss where to go from there? What about the employees? How many years did Lee County EMS have a contract with the County? How often did Lee County EMS ask for their contracted money to be raised? And in that time, what other places covered by the county asked for more money because costs were going up? Common sense would reason that as costs were rising, the Ambulance Service would need more money. If they did anything wrong, it was not asking for additional funds annually as their costs were going up, and insurance payments stopped coming in. Also, taking psych transfer after psych transfer for the county. Many of them to the other side of the state. Most insurances won’t pay mileage if it is any further than Iowa City. The business was eating the cost of those. The County has NO IDEA what it takes to run the Ambulance Service! They have no idea the cost of equipment! Of supplies! Bill got in over his head. But no one saw him, day after day, making cuts wherever and however he could, just to get supplies and make payroll. Do you think he wanted to not pay the IRS? He was between a rock and a hard place. The way I see it, he knew he had a decision to make; pay his employees and continue keeping the county cared for, or pay taxes. Can any of us really say what we would do in such a situation? I just cannot fathom how quickly everyone turned on Bill! Making him out to be a terrible man, a criminal!? Bill Young cares about this county, its residents, and also his employees. He is extremely involved in this community. Many of the employees still work at Lee County EMS because they are loyal to that company, and to Bill. Several of them have been there 15-20+ years! Are they worried about their jobs? ABSOLUTELY!! Many of them rely solely on their income from Lee County EMS, being the only source of income in their home. The anxiety is running high. After 20+ years of service to our county, they have no idea if they will be back to job hunting, in a world where there are no jobs to be had. Lee County EMS employees have been coming to work every day, saving lives, while risking theirs amidst a pandemic. All the while the County and news stations have been making Lee County EMS seem like the lowest of the low. Even the cities were talking about taking over. They were in way over their heads. Do you know how much vent circuits cost, much less the vent itself? How about cardiac monitors? ECG pads for those monitors? Cots? An ambulance itself? That’s not even counting the lights and decals. The cost of supplies and equipment would do more than just raise eyebrows! And are most of these bids just under the assumption that they can and will get equipment and supplies from Lee County EMS? 
I guess I’m just not sure why? Why has the County not just made the effort to work with the ones that have been here serving our county for well over two decades. Nearly a quarter of a century! Why has this all been thrown in the trash at the first sign of trouble? And who was supposed to stand up for Lee County EMS? The ones the county falsely accused of embezzlement?
The news has advertised many of the bids that were made. This company the County sounds like they are leaning towards, Global Medical Response, they knew exactly what they needed to bid in order to slide in and take over. A single google search will show you that this company has a terrible reputation. They bid low now, but what happens in 6mo when they ask for more money? I’ve read that they have a tendency to just close the doors when they’re not making money. Our county is not a money maker! The county will only be in a worse position than it is now when they get a 911 call and find out they closed their doors at midnight with no notice, as they’ve been known to do. Not even a notice to their employees! 
Lee County EMS consists of your friends, your neighbors. The compassion the crews have shown during these trying times has to mean something. Lee County EMS’s many years of dedication to this county surely must mean something?!! Supplying crews to races, rodeo performances, 4 ambulances at the rodeo parade (while still covering the south of the county), and football games at all 3 high schools. Going to schools to speak to children, children touring our bases, etc. The service also paid or helped pay for many of their employees training and always covered the cost of keeping the training. Then there are the behind the scenes people. Dispatch, office staff and billing personnel. Lee County EMS cares about this county, and I’m certain they’ve likely saved the life of at least one person you know. Maybe even someone you love. Now it’s the time to step up and save theirs.

Ann Sutcliffe,
Fort Madison

3 thoughts on “Letter to the Editor – County is turning its back on Lee County ambulance

  1. SPRINGFIELD, Mass. — Dozens of American Medical Response paramedics and EMTs mustered outside the company’s Cottage Street headquarters early Monday morning to protest workplace issues including what union representatives call “not livable” wages.

    Most were clad in red as a show of unity, employees said. While the protest was extremely public, most workers, including union stewards, were reluctant to speak to a reporter, citing fears for their jobs.

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    “Right now the wages are not livable, they’re barely above minimum wage,” said one union representative who said his name was Colt. “And we’re saving lives every single day in the city of Springfield.”

    He declined to be specific about their hourly or annual pay rates. Other employees privately said many are paid an average of less than $14 an hour. (According to Paramedic Training Spot, the average hourly EMT pay in Springfield based on a 40-hour work week is $15.54 and paramedics earn on average $19.70.)

    Union representatives said they mounted a similar public protest three years ago amid contract negotiations over wages and other gripes, but carried signs.

    “It was considered picketing because we had signs, so we got a cease and desist letter from the company,” Colt said.

    This time around, they lost the signs but stood on Cottage Street, drawing honks of support from passing motorists. Their contract is up for renewal in June, union representatives said.

    The Republican/MassLive.com has a request pending for comment from AMR officials.

    While there is a shortage of paramedics across the state, Colt said there is a particular squeeze in Springfield because of high 911 call demands, plus employees jumping ship to join other ambulance companies that pay higher wages.

    Employees said both their workplace satisfaction and the quality of service to the city took a dive when AMR bought rival MedCare in January, thus absorbing its employees and its transfer contract with Baystate Medical Center.

    Ambulance transfers get patients where they need to go, for instance, shuttling between varying Baystate facilities, a hospital spokeswoman said in January following the merger.

    AMR employees said response times to 911 calls have suffered since, morale is down, burnout is up and new EMT’s received far less training on how to handle emergency calls. The company has begun offering EMT’s $50 “incentives” to show up for their shifts and installed a popcorn machine at the office as a peace offering, according to one worker.

  2. Posted by medic15alOct 20, 2019 at 11:26 AM

    Anytime AMR steps in a place where Ambulance companies run 911 the quality drops. They place more emphasis on non-emergency contract calls to keep profits up, which is understandable as they are a for profit company. Corporate EMS needs to die off and return to regional providers thqat can respond to specific demands.

  3. NOV 27, 2017 MORE ON AMBULATORY CAREAmbulance rides often result in surprise bills. One patient got a $3,660 bill for a 4-mile ride, another was taken to an out-of-network hospital without her consent.
    Melissa Bailey, Kaiser Health News

    One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could. Still another found herself marooned at an out-of-network hospital, where she’d been taken by ambulance without her consent.

    These patients all took ambulances in emergencies and got slammed with unexpected bills. Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. But these laws largely ignore ground ambulance rides, which can leave patients stuck with hundreds or even thousands of dollars in bills, with few options for recourse, finds a Kaiser Health News review of 350 consumer complaints in 32 states.

    [Also: Ambulance company owner, brother sentenced in $6 million healthcare fraud case]

    Patients usually choose to go to the doctor, but they are vulnerable when they call 911 — or get into an ambulance. The dispatcher picks the ambulance crew, which, in turn, often picks the hospital. Moreover, many ambulances are not summoned by patients. Instead, the crew arrives at the scene having heard about an accident on a scanner, or because police or a bystander called 911.

    HIMSS20 DigitalLearn on-demand, earn credit, find products and solutions. Get Started >>
    Betsy Imholz, special projects director at the Consumers Union, which has collected over 700 patient stories about surprise medical bills, said at least a quarter concern ambulances.

    [Also: Diverting ambulances raises risk of death in heart-attack cases, study says]

    “It’s a huge problem,” she said.

    Forty years ago, most ambulances were free for patients, provided by volunteers or town fire departments using taxpayer money, said Jay Fitch, president of Fitch & Associates, an emergency services consulting firm. Today, ambulances are increasingly run by private companies and venture capital firms. Ambulance providers now often charge by the mile and sometimes for each “service,” like providing oxygen. If the ambulance is staffed by paramedics rather than emergency medical technicians, that will result in a higher charge — even if the patient didn’t need paramedic-level services. Charges range widely from zero to thousands of dollars, depending on billing practices.

    The core of the problem is that ambulance and private insurance companies often can’t agree on a fair price, so the ambulance service doesn’t join the insurance network. That leaves patients stuck in the middle with out-of-network charges that are not negotiated, Imholz said.

    This happens to patients frequently, according to one recent study of over half a million ambulance trips taken by patients with private insurance in 2014. The study found that 26 percent of these trips were billed on an out-of-network basis.

    That figure is “quite jarring,” said Loren Adler, associate director for the USC-Brookings Schaeffer Initiative and co-author of recent research on surprise billing.

    The KHN review of complaints revealed two common scenarios leaving patients in debt: First, patients get in an ambulance after a 911 call. Second, an ambulance transfers them between hospitals. In both scenarios, patients later learn the fee is much higher because the ambulance was out-of-network, and after their insurer pays what it deems fair, they get a surprise bill for the balance, also known as a “balance bill.”

    The Better Business Bureau has received nearly 1,200 consumer complaints about ambulances in the past three years; half were related to billing, and 46 mentioned out-of-network charges, spokeswoman Katherine Hutt said.

    While the federal government sets reimbursement rates for patients on Medicare and Medicaid, it does not regulate ambulance fees for patients with private insurance. In the absence of federal rules, those patients are left with a fragmented system in which the cost of a similar ambulance ride can vary widely from town to town. There are about 14,000 ambulance services across the country, run by governments, volunteers, hospitals and private companies, according to the American Ambulance Association.

    For a glimpse into the unpredictable, fragmented system, consider the case of Roman Barshay. The 46-year-old software engineer, who lives in Brooklyn, N.Y., was visiting friends in the Boston suburb of Chestnut Hill last November when he took a nasty fall.

    Barshay felt a sharp pain in his chest and back and had trouble walking. An ambulance crew responded to a 911 call at the house and drove him 4 miles to Brigham and Women’s Hospital, taking his blood pressure as he lay down in the back. Doctors there determined he had sprained tendons and ligaments and a bruised foot, and released him after about four hours, he said.

    After Barshay returned to Brooklyn, he got a bill totaling $3,660 — which is $915 for each mile of the ambulance ride. His insurance had paid nearly half, leaving him to pay the remaining $1,890.50.

    “I thought it was a mistake,” Barshay said.

    But Fallon Ambulance Service, a private company, was out-of-network for his UnitedHealthcare insurance plan.

    “The cost is outrageous,” said Barshay, who reluctantly paid the $1,890.50 after Fallon sent it to a collection agency. If he had known what the ride would cost, he said, he would at least have been able to refuse and “crawl to the hospital myself.”

    “You feel horribly to send a patient a bill like that,” said Peter Racicot, senior vice president of Fallon, a family-owned company based outside Boston.

    But ambulance companies are “severely underfunded” by Medicare and Medicaid, Racicot said, so Fallon must balance the books by charging higher rates for patients with private insurance.

    Racicot said his company has not contracted with Barshay’s insurer because they couldn’t agree on a fair rate. When insurers and ambulance companies can’t agree, he said, “unfortunately, the subscribers wind up in the middle.”

    It’s also unrealistic to expect EMTs and paramedics at the scene of an emergency to determine whether the company takes a patient’s insurance, Racicot added.

    Ambulance services have to charge enough to subsidize the cost of keeping crews ready around-the-clock even if no calls come in, said Fitch, the ambulance consultant. In a third of the cases where an ambulance crew answers a call, he added, they end up not transporting anyone and the company typically isn’t reimbursed for the trip.

    In part, Barshay had bad luck. If the injury had happened just a mile away inside Boston city limits, he could have ridden a city ambulance, which would have charged $1,490, according to Boston EMS, a sum that his insurer probably would have covered in full.

    Very few states have laws limiting ambulance charges, and most state laws that protect patients from surprise billing do not apply to ground ambulance rides, according to attorney Brian Werfel, consultant to the American Ambulance Association. And none of the state surprise-billing protections applies to people with self-funded employer-sponsored health insurance plans, which are regulated only by federal law. That’s a huge exception: 61 percent of privately insured employees are covered by self-funded employer-sponsored plans.

    Some towns that hire private companies to respond to 911 calls may regulate fees or prohibit balance billing, Werfel said, but each locality is different.

    Insurance companies try to protect patients from balance billing by negotiating rates with ambulance companies, said Cathryn Donaldson, spokeswoman for America’s Health Insurance Plans. But “some ambulance companies have been resistant to join plan networks” when insurance companies offer Medicare-based rates, she said.

    Medicare rates vary widely by geographic area. On average, ambulance services make a small profit on Medicare payments, according to a report by the U.S. Government Accountability Office. If a patient uses a basic life support ambulance in an emergency, in an urban area, for instance, Medicare payments range from $324 to $453, plus $7.29 per mile. Medicaid rates tend to be significantly lower.

    There’s evidence of “waste and fraud” in the ambulance industry, Donaldson added, citing a 2015 study from the Office of Inspector General at the U.S. Department of Health and Human Services. The report concluded Medicare paid over $50 million in improper ambulance bills, including for supposedly emergency-level transport that ended at a nursing home, not a hospital. One in 5 ambulance services had “questionable billing practices,” the report found.

    Most complaints reviewed by Kaiser Health News did not appear to involve fraudulent charges. Instead, patients got caught in a system in which ambulance services can legally charge thousands of dollars for a single trip — even when the trip starts at an in-network hospital.

    That’s what happened to Devin Hall, a 67-year-old retired postal inspector in Northern California. While he faces stage 3 prostate cancer, Hall is also fighting a $7,109.70 out-of-network ambulance bill from American Medical Response, the nation’s largest ambulance provider.

    On Dec. 27, 2016, Hall went to a local hospital with rectal bleeding. Since the hospital didn’t have the right specialist to treat his v, it arranged for an ambulance ride NOV 27, 2017MORE ON AMBULATORY CAREAmbulance rides often result in surprise billsOne patient got a $3,660 bill for a 4-mile ride, another was taken to an out-of-network hospital without her consent.
    Melissa Bailey, Kaiser Health News

    One patient got a $3,660 bill for a 4-mile ride. Another was charged $8,460 for a trip from one hospital that could not handle his case to another that could. Still another found herself marooned at an out-of-network hospital, where she’d been taken by ambulance without her consent.

    These patients all took ambulances in emergencies and got slammed with unexpected bills. Public outrage has erupted over surprise medical bills — generally out-of-network charges that a patient did not expect or could not control — prompting 21 states to pass laws protecting consumers in some situations. But these laws largely ignore ground ambulance rides, which can leave patients stuck with hundreds or even thousands of dollars in bills, with few options for recourse, finds a Kaiser Health News review of 350 consumer complaints in 32 states.

    [Also: Ambulance company owner, brother sentenced in $6 million healthcare fraud case]

    Patients usually choose to go to the doctor, but they are vulnerable when they call 911 — or get into an ambulance. The dispatcher picks the ambulance crew, which, in turn, often picks the hospital. Moreover, many ambulances are not summoned by patients. Instead, the crew arrives at the scene having heard about an accident on a scanner, or because police or a bystander called 911.

    HIMSS20 DigitalLearn on-demand, earn credit, find products and solutions. Get Started >>
    Betsy Imholz, special projects director at the Consumers Union, which has collected over 700 patient stories about surprise medical bills, said at least a quarter concern ambulances.

    [Also: Diverting ambulances raises risk of death in heart-attack cases, study says]

    “It’s a huge problem,” she said.

    Forty years ago, most ambulances were free for patients, provided by volunteers or town fire departments using taxpayer money, said Jay Fitch, president of Fitch & Associates, an emergency services consulting firm. Today, ambulances are increasingly run by private companies and venture capital firms. Ambulance providers now often charge by the mile and sometimes for each “service,” like providing oxygen. If the ambulance is staffed by paramedics rather than emergency medical technicians, that will result in a higher charge — even if the patient didn’t need paramedic-level services. Charges range widely from zero to thousands of dollars, depending on billing practices.

    The core of the problem is that ambulance and private insurance companies often can’t agree on a fair price, so the ambulance service doesn’t join the insurance network. That leaves patients stuck in the middle with out-of-network charges that are not negotiated, Imholz said.

    This happens to patients frequently, according to one recent study of over half a million ambulance trips taken by patients with private insurance in 2014. The study found that 26 percent of these trips were billed on an out-of-network basis.

    That figure is “quite jarring,” said Loren Adler, associate director for the USC-Brookings Schaeffer Initiative and co-author of recent research on surprise billing.

    The KHN review of complaints revealed two common scenarios leaving patients in debt: First, patients get in an ambulance after a 911 call. Second, an ambulance transfers them between hospitals. In both scenarios, patients later learn the fee is much higher because the ambulance was out-of-network, and after their insurer pays what it deems fair, they get a surprise bill for the balance, also known as a “balance bill.”

    The Better Business Bureau has received nearly 1,200 consumer complaints about ambulances in the past three years; half were related to billing, and 46 mentioned out-of-network charges, spokeswoman Katherine Hutt said.

    While the federal government sets reimbursement rates for patients on Medicare and Medicaid, it does not regulate ambulance fees for patients with private insurance. In the absence of federal rules, those patients are left with a fragmented system in which the cost of a similar ambulance ride can vary widely from town to town. There are about 14,000 ambulance services across the country, run by governments, volunteers, hospitals and private companies, according to the American Ambulance Association.

    For a glimpse into the unpredictable, fragmented system, consider the case of Roman Barshay. The 46-year-old software engineer, who lives in Brooklyn, N.Y., was visiting friends in the Boston suburb of Chestnut Hill last November when he took a nasty fall.

    Barshay felt a sharp pain in his chest and back and had trouble walking. An ambulance crew responded to a 911 call at the house and drove him 4 miles to Brigham and Women’s Hospital, taking his blood pressure as he lay down in the back. Doctors there determined he had sprained tendons and ligaments and a bruised foot, and released him after about four hours, he said.

    After Barshay returned to Brooklyn, he got a bill totaling $3,660 — which is $915 for each mile of the ambulance ride. His insurance had paid nearly half, leaving him to pay the remaining $1,890.50.

    “I thought it was a mistake,” Barshay said.

    But Fallon Ambulance Service, a private company, was out-of-network for his UnitedHealthcare insurance plan.

    “The cost is outrageous,” said Barshay, who reluctantly paid the $1,890.50 after Fallon sent it to a collection agency. If he had known what the ride would cost, he said, he would at least have been able to refuse and “crawl to the hospital myself.”

    “You feel horribly to send a patient a bill like that,” said Peter Racicot, senior vice president of Fallon, a family-owned company based outside Boston.

    But ambulance companies are “severely underfunded” by Medicare and Medicaid, Racicot said, so Fallon must balance the books by charging higher rates for patients with private insurance.

    Racicot said his company has not contracted with Barshay’s insurer because they couldn’t agree on a fair rate. When insurers and ambulance companies can’t agree, he said, “unfortunately, the subscribers wind up in the middle.”

    It’s also unrealistic to expect EMTs and paramedics at the scene of an emergency to determine whether the company takes a patient’s insurance, Racicot added.

    Ambulance services have to charge enough to subsidize the cost of keeping crews ready around-the-clock even if no calls come in, said Fitch, the ambulance consultant. In a third of the cases where an ambulance crew answers a call, he added, they end up not transporting anyone and the company typically isn’t reimbursed for the trip.

    In part, Barshay had bad luck. If the injury had happened just a mile away inside Boston city limits, he could have ridden a city ambulance, which would have charged $1,490, according to Boston EMS, a sum that his insurer probably would have covered in full.

    Very few states have laws limiting ambulance charges, and most state laws that protect patients from surprise billing do not apply to ground ambulance rides, according to attorney Brian Werfel, consultant to the American Ambulance Association. And none of the state surprise-billing protections applies to people with self-funded employer-sponsored health insurance plans, which are regulated only by federal law. That’s a huge exception: 61 percent of privately insured employees are covered by self-funded employer-sponsored plans.

    Some towns that hire private companies to respond to 911 calls may regulate fees or prohibit balance billing, Werfel said, but each locality is different.

    Insurance companies try to protect patients from balance billing by negotiating rates with ambulance companies, said Cathryn Donaldson, spokeswoman for America’s Health Insurance Plans. But “some ambulance companies have been resistant to join plan networks” when insurance companies offer Medicare-based rates, she said.

    Medicare rates vary widely by geographic area. On average, ambulance services make a small profit on Medicare payments, according to a report by the U.S. Government Accountability Office. If a patient uses a basic life support ambulance in an emergency, in an urban area, for instance, Medicare payments range from $324 to $453, plus $7.29 per mile. Medicaid rates tend to be significantly lower.

    There’s evidence of “waste and fraud” in the ambulance industry, Donaldson added, citing a 2015 study from the Office of Inspector General at the U.S. Department of Health and Human Services. The report concluded Medicare paid over $50 million in improper ambulance bills, including for supposedly emergency-level transport that ended at a nursing home, not a hospital. One in 5 ambulance services had “questionable billing practices,” the report found.

    Most complaints reviewed by Kaiser Health News did not appear to involve fraudulent charges. Instead, patients got caught in a system in which ambulance services can legally charge thousands of dollars for a single trip — even when the trip starts at an in-network hospital.

    That’s what happened to Devin Hall, a 67-year-old retired postal inspector in Northern California. While he faces stage 3 prostate cancer, Hall is also fighting a $7,109.70 out-of-network ambulance bill from American Medical Response, the nation’s largest ambulance provider.

    On Dec. 27, 2016, Hall went to a local hospital with rectal bleeding. Since the hospital didn’t have the right specialist to treat his symptoms, it arranged for an ambulance ride

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