Staffing woes, billing have ambulance panel’s attention

County EMS has about $450,000 in outstanding billing


FORT MADISON – Area officials have some concerns with service being provided by the Lee County Ambulance, while members of a committee overseeing the operations say things are going as well as can be expected for the 8-month-old public service.

At Monday’s meeting of the Lee County EMS steering committee, the panel talked about quality metric tracking, and Fort Madison Fire Chief Joey Herren asked for quality measures to include response times and availability of ambulances.

Herren said he had concerns about several recent incidents where fire departments were told an ambulance wouldn’t be able to respond, or ambulances weren’t running fully staffed.

“I don’t know how we track that, but I’ve done some research myself and they’ve told us that, they’ve told Keokuk that, and I believe they’ve told Jackson Township that,” Herren said.

“I think we need to see how many ambulances are available in the county during a 24-hour period. And how many times we’re supposed to be a paramedic service, and how many times we’re sending out an ambulance with two EMTPs on it. Those are things we need to track, too, because we are running into that.”

Herren also asked that the committee monitor service times. Committee chairman Jim Steffen said an overview of response teams means very little in terms of quality metrics because LeeComm doesn’t use a priority dispatch.

“Its very hard to look at a flat response time. But if the county wants to track that, I’m perfectly fine with it,” Steffen said.

Herren said he was puzzled by that response because in his experience everything has always been about response time in medical calls.

Lee County Ambulance Director Dennis Cosby said staffing issues have forced the county to run shifts with just two ambulances at times. He said transfers from both county hospitals have also put pressure on the system, and at times has had the county declining transfer requests because there is insufficient staffing to back up the transferring staff.

The committee discussed possible mandatory on-call shifts that would have to be paid, but Steffen said staff is working 24 hours on and 48 hours off and likely would not respond well to mandates that they be home to back up in the event of transfers.

Cosby said the county had 34 transfers over the last 10 days for just over three per day. If those transfers are to Iowa City or Quincy, those are three to four hour trips at a minimum, which leaves the county with two ambulances in service.

Herren said some days you may have to mandate staff come in to cover the service, as is the case in the paid fire departments.

Steffen said there’s no way to mandate staff to come in and cover transfers, when the county is doing three to four a day.

“Once you have a day off, you can’t mandate someone come in to put in five or six hours just for a transfer. They will revolt, they will flat out revolt. I know paramedics and it won’t work,” Steffen said.

Cosby said he’s looked at multiple ways to incentivize, and staffing is to the point that most will generally will step up and fill overtime shifts.

“But mandating someone to come in on a day off because we have a transfer would be very difficult,” Cosby said.

Steffen said incentivizing the coverage could work, calling it the ‘carrot rather than the stick’.

The lack of the third ambulance in service is a concern of Herren’s.

“I just don’t think we have enough rigs. I would imagine that most of the time there are only two rigs covering the whole county and that affects response times. I think response times are something you just have to look at. I was puzzled by their response to that,” Herren said.

Herren, along with Keokuk Fire Chief Gabe Rose, put together a proposal to run the service when it became apparent the private ownership wasn’t going to continue. The original steering committee went with the recommendation for the county to take over the service, rather than the fire department’s picking up the operations.

Cosby said the staff has had 12 people with COVID in January and he said once in a while they have to staff a Basic Life Support truck.

“I think we’ve done that twice and then there’s been a few hours here and there we didn’t have enough to staff three trucks so we went down to two ambulances,” he said.

In other action, the panel got an update on progress of the ambulance service moving to a professional billing service as outstanding billing approaches half a million dollars.

The County is currently contracting with Burlington Fire Department at a rate of 6% of billables. According to county figures, the county currently has $450,073 outstanding in service bills when Medicare billing is figured in. Medicare pays at 85% of billable services. However, the panel was aware that the county would have to fund the service at the outset.

But Cosby said he’s getting concerned about the time span of the billing.

“We’re still not really billing through them (what does THAT mean?!) and we’re at about eight months and I don’t want to run out of time and have to write off revenue because of the way it’s billed,” he said.

Steffen asked if the county could take on the billing in-house as was discussed during the transition.

“Have we looked at doing our own billing?” he said. “Our initial thoughts were we would use a billing company and then after a while revisit when we wanted to move to in-house billing using public health as the base, and then compare the cost of that.”

Cosby said he favors moving toward the professional company who can also help with reporting when the county is eligible for Ground Emergency Medical Transport subsidies from the Iowa Department of Human Services. The county has already approved moving to a professional billing company. Cosby said he’s waiting on guidance from Lee County Attorney.

“At this point, we need to look at a professional billing company. This would be a much, much better system. If a couple years from now, we want to bring billing back in-house I’m not saying we couldn’t look at that,” Cosby said.

“But I think we stand to lose a lot of revenue if we don’t use someone that’s able to keep up with these things. Rules change continuously and it’s very difficult to keep up.”

The county would have a 90-day out on the current contract.

Despite the billing and staffing issues, Steffen said at the end of the meeting that the service is running as well as can be expected at this point in the county’s ownership.

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