EMS consultant says county has opportunities

LEE COUNTY – An independent auditing firm looking into the county’s EMS ambulance service said the future for publicly-owned ambulance services isn’t rosy, but it’s the trend of the country and the county’s a little ahead of the trend.
Todd Sheridan, a junior partner with Fitch & Associates, talked with the Lee County Board of Supervisors in a recap of a six-month review of Lee County EMS. Fitch & Associates is an EMS consulting firm out of Platte City, Mo.
The review came at the request of Lee County Auditor Denise Fraise this spring and cost the county about $33,000 including travel expenses for Tuesday’s review.
Sheridan told the county the trend in ambulance service is transitioning to public-owned services, especially in rural areas, and many governmental agencies are suffering trying to figure out what Lee County has already figured out.
He also said increased revenues are going to be an issue of policy, and not federal and state funding.
The county ambulance service began in 2021 when the private service being provided by the family of Bill Young, who was the director of the former Lee County EMS Ambulance Service, got into fiscal trouble due to poor reimbursement rates.
The current annual budget is showing a projected income of about $3.66 million, while expenses are at $5.72 million, causing just over $2 million in subsidies from the county. The $3.66 million includes the $1.3 million the county gets from the voter-approved Essential Services Levy. Labor accounts for about $4 million of the expenses, or about 71.4%.
Sheridan said a new fee structure, or charge master, that included a 250% increase in the Medicare rate would shrink the deficit by about $177,000 and an increase of 300% would generate an additional $400,000.
At the current rate, the county is subsidizing each transport unit by about half a million dollars each year. A fully staffed advanced life support ambulance costs the county about $1.4 million per year.
Lee County EMS Director Mark Long said the county hasn’t increased fees in more than two years and that is an option that would require a hard look.
“I think the biggest takeaway is we’re on the right track. Obviously, there are some areas where we have room for improvement. Looking at what we charge and the possibility of adding a truck for some staffing in Fort Madison and some of those things may be cost-prohibitive, but we need to make sure we’re giving them (supervisors) the information they need to make the right decision for the community,” Long said.
“I’m hesitant to say what will happen with that, but I do think we haven’t increased it for a while, so we are due for some increase. I don’t know if it would be necessarily as big as they are suggesting. But it’s also important to consider hardship waivers so we continue to take care of our population that is uninsured and can’t pay their bills. “
Sheridan said the county needs to have a set policy on waivers, so they have better direction at waiving charges for those who have no resources.
He also said the EMS staff needs representation on the county’s Public Service Answering Point (PSAP) board. Currently Jason Dinwiddie sits on the board as a member of the Montrose volunteer fire department and is Long’s No. 2 at EMS. But the department itself isn’t officially part of the LeeComm board and Sheridan said it was Fitch’s recommendation that change.

Some other key findings were that Sara Helenthal, the department’s part-time administrator, needs to be full-time, and the maintenance person is nearing retirement age.
Chairman Garry Seyb said over the last couple years he’s begun to wonder if the county was investing too much for what they were providing the citizens.
“What I heard tonight was that we just barely made it to where we're hitting that 15-minute response time and that our staff was doing a good job,” Seyb said.
“It makes me feel good in a way that we were able to do that. But what worries me is forging ahead with some of the things he talked about.”
One of those was the current pay structure, which ultimately could incentivize staff to leave after six years and come back at a higher rate of pay.
“That’s something we have to address. We don’t want to lose any personnel, and we sure don’t want them to do that for financial reasons and then cost us more when they come back,” he said.
“We’re creating the culture, so let’s not make it bad thing. If we’ve created a culture where everyone is getting along, then what do we have to do to tweak that?"
Sheridan also pointed out that the county is getting a really good deal on a medical director who donates a lot of time to the service, but he said there needs to be a succession plan there that could cost the department another expense. Dr. David Wenger-Keller is the current medical director, but he’s also the medical director for Lee County Health Department.
Other suggestions included:
• adding another peak-time unit with staff in Fort Madison
• establishing a contract with area hospitals for transport services
• establishing a countywide EMS plan that would create directives for who is responding to which calls
• considering a maintenance bay at the new Fort Madison location
• lobbying for increases in EMS Essential Service funding from state and federal sources. The county is currently maxed at the .75/$1000 essential services levy.