County EMS forging through difficult first year


COVID, staffing, billing woes plague ambulance operations through first six months


LEE COUNTY - COVID had a multi-faceted impact on the first six months of the Lee County Ambulance operations under county ownership.

Lee County EMS Director Dennis Cosby said the pandemic has hurt the operations budget in the form of increased costs and inventory of supplies, but it has also put a crimp in staffing.

An issue that exacerbates an already-tight healthcare labor supply.

The county took ownership of the ambulance service July 1, 2021 under the leadership of Cosby, Assistant Director Jason Dinwiddie, and an advisory panel that reports to the Lee County Board of Supervisors.

Cosby said the staffing crunch has been the biggest hurdle.

"It seems like every time we get to fully staffed something goes wrong," Cosby said. "We had one EMT spot open that we got approval to fill and had been interviewing since before the holidays. We had planned to get that filled and then just last night another EMT put in their resignation."

The shortage isn't unique to just Lee County however. Cosby said he's hearing from the Des Moines metro area and CARE Ambulance working out of Fairfield, Iowa City, and Waterloo and they are all discussing the same thing.

"With the fact that so many people are out ill, some staff have opted to look for different jobs. In an ambulance you're three feet away from someone with COVID and there's very little ventilation. We're all hoping we're on the down side of this and things can start to get back to normal," he said.

Illness has also been a challenge as anyone presenting with cold-like symptoms is immediately sent home or told not to come in to work. Cosby said the department has been fairly fortunate to be able to staff three ambulances per shift, but a shift last week had to be run with just two rigs because of staffing.

"We were able to keep that to just one shift. We thought it might be two, but we were able to get it staffed," he said.

That staff a lot of times comes with offering overtime pay. That's one part of the budget for the first six months that is out of projection.

According to a re-estimated budget submitted with the 2023 Fiscal year budget last week, the department is looking at close to $53,000 in additional overtime for the year.

However, the re-estimated budget is being projected at $139,000 under the previous year, despite the increased OT. Most of that reduction is moving a $200,000 ambulance replacement to 2023 and changing the replacement to a remount at a savings of about $40,000.

The 2022 budget was projected at $3.23 million and was re-estimated before last week's budget presentation to the Board of Supervisors at $3.13 million. The 2023 projected expenses total $3.09 million.

Revenues for 2022 were projected at $2,503,049 million and re-estimated at $2,514,757. Revenues for 2023 are projected at $2,515,049.

However, according to the prepared budget, the county has only received $33,814 or 1.35% of budgeted revenues through Nov. 30, 2021. Those revenue figures show no payments to date from Medicaid or Medicare.

The county gave approval for Cosby to switch billing services from Burlington Fire Department who has been handling billing, to a PCC Ambulance Billing Service out of West Bend, Iowa. Cosby said the switch hasn't been made yet, and Medicare payments have started to come in since Dec. 1. But Medicaid still hasn't been billed.

"It's one of the concerns we have right now," Cosby said.

"We haven't signed on with PCC and we still haven't given Burlington any notice yet. The logistics of the situation is our biggest hurdle there. The advisory committee already had the BFD thing in the works before I was brought on. I didn't think it would be an issue, but it turned out to be a little more of an issue that we thought."

County staff has to make twice weekly trips to Burlington to deliver billing documents and Cosby said a few things have gotten lost in the shuffle, but were recovered electronically.

"We were trying to look for something where we didn't have to take anyone out of place. Now it's just Jason and I, and Sara (Helenthal, Administrative Assistant), and she works for several departments and does a lot. We just didn't realize how long it took you out to be out of the office twice a week to deliver."

Both billing entities charge the county 6% of billables, but Cosby said PCC would be able to do everything electronically, which would result in cost and time savings for the county.

The rest of the budget seems to be tracking according to projections. Cosby said there has been a 7 to 10% increase in general for disposable supplies, most likely to to supply chain pinches that other industries are looking at as well.

"For the most part, I can't say that I've had a ton of surprises. I will say we struggled more with staffing than I thought we would, especially knowing that we had added to the salaries to attract candidates at the beginning, but others around us did as much," Cosby said.

He also said he doesn't foresee any rate increases in 2023 other than increasing the price per loaded mile.

"We'd fallen behind everyone else there, but other than that, I don't see any rate increases this year."


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