Voters to decide EMS levy Tuesday

LEE COUNTY - A critical levy vote will take place on Tuesday in a special election in the county.

Voters will go to the polls to decide whether the county will be able to assess a levy to help offset the costs of the county-owned ambulance service.

If approved, the measure will allow the county to collect up to .75/$1,000 of assessed valuation to help offset what's currently about a $2 million annual deficit in spending. The law allowing the measure was created by the state last year, and allows county supervisors to designate ambulance services as essential services and levy for budget support.

The law also requires a panel to convene to determine the exact amount of funding needed under the levy allowance.

According to Lee County EMS Director Mark Long, the proposed budget for the ambulance service for the budget year starting July 1, 2023, will be close to $4.5 million, with revenues projected at about $2.4 million.

"That leaves $2 million we've gotta find somewhere. This will provide anywhere from $1 million to $1.2 million depending on (state) rollback changes," Long said.

He said the EMS service is struggling like everyone with increased costs, but they are also suffering from low reimbursement rates in a high Medicaid/Medicare service area.

He said the county gets 18% to 22% of what's billed through Medicaid for services. An advanced support ambulance call currently gets billed at $735, but Medicaid only pays $127.

Lee County EMS bills mileage at $21/mile and Medicaid pays $2.61 per mile.

"Costs are high and that's a part of it, but it's also we're not getting paid for the services we're providing," Long said.

"The biggest chunk of our patients are Medicaid. Medicare pays a little better but not much."

He said there are a lot of private pay patients that the county never sees a dollar from.

Long said there are no plans for expansion, and the funds won't be used in that respect, but this levy would help sustain current services. He said the county subsidized the ambulance operations at about $900,000 in fiscal year 2021 before purchasing it at the start of fiscal year 2022.

We're back in the ballpark now where we were at at the end of that service. And now we have a service that the county has more control over.

Long said he was concerned that if the ballot measure were to fail, there would have to be some cuts.

"I don't see a model where we could provide the same level of service that we do now. We'd have to cut and I don't know if that means training, staff, equipment or a little bit of all three. There’s going to have to be cuts somewhere. We’re just not going to be able to maintain the level of service we have right now.”

Long and Director of Operations Jason Dinwiddie said they have been out speaking publicly about the levy, and Long said he’s seen mostly support for the measure.

Dinwiddie said one of the things that has surprised him the most is the number of people who don’t understand it’s a countywide ambulance service.

“There’s a lack of understanding of how the ambulance service works. We hear them refer to it as the Fort Madison ambulance or the Keokuk ambulance or Donnellson ambulance,” Dinwiddie said.

“They’re all Lee County ambulances we’re just referring to where they are stationed at. If there are three calls at the same time in Fort Madison, you’re getting three Lee County offices. One will come from the Fort Madison station, one from Keokuk, and one from the Donnellson station. The three closest ambulances.”

Long said historically, the ambulance service has done a nice job of staying under the radar.

“Right, wrong, or indifferent. Other than the Donnellson building, none of the other buildings are sitting out front with a sign,” he said.

A company out of Michigan is looking at reopening the hospital in a yet-to-be determined capacity. Insight, out of Flint, Mich., has toured the abandoned facility in Keokuk, but has still yet to commit to plans or an opening date.

Long said even if the hospital is reopened it doesn’t change the situation for the EMS service.

“Patients are probably going to go there, be stabilized, and then go to another hospital to be admitted. For an ambulance side of things, what it’s actually doing is making one transport, two transports for us,” he said.

“It’s not going to decrease our need for resources, really, at all.”

Dinwiddie said the closure of the Keokuk hospital didn’t result in an uptick of calls.

“Our call volume didn’t increase dramatically, with the lack of the transfers out of the facility, it equaled out. The problem we had was that the transport times from the time of the tone, until the time that ambulance was ready for the next call, went from 30 minutes to almost an hour and 30 minutes,” he said.

“Now you have that drive time from the tone to get the patient and then 20 miles up the road and 20 miles back when you’re back in the zone for the next call. That’s where it's really stuck it to us. To be straight up and honest, there were a lot of times where we didn’t have enough ambulances to answer calls.”

Polls are open throughout the county until 8 p.m. Tuesday.