By Stephanie Casanova
Manhattan Mercury - March 27, 2017
In an attempt to collect more money from ambulance bills, avoid a significant increase in management costs and give the county more direct control over the Emergency Medical Services Department (EMS), Riley County leaders are considering moving EMS under the Emergency Management Department.
Emergency management currently oversees emergency preparedness and the county fire department and pays for maintenance and equipment for 911. Earlier this year, county commissioners asked Pat Collins, emergency management director, to come up with a plan to consolidate EMS into his department.
The county pays Via Christi Hospital to manage EMS. The hospital has charged the county a $45,000 base management fee, which hasn’t changed in at least 13 years. The county and the hospital are estimating the base fee to increase fivefold to approximately $200,000, though that amount is not set in stone.
Jennifer Goehring, chief nursing officer for Via Christi, said the base fee would increase because costs to manage EMS have gone up in the 13 years she’ s worked there.
“Times have changed since then and that (the fee) hasn’t gone up,” Goehring said. “That doesn’t meet all the expenses that we’re putting forth in that (EMS) currently.”
The base fee pays for recruiting positions to help manage EMS, marketing, billing and workman’s compensation, among other expenses, she said.
Riley County also pays salaries for 30 EMS fulltime employees and 25 parttime employees, including administrators, paramedics and emergency medical technicians. The county budgeted about $1.4 million for ambulance costs for the 2017 fiscal year. Revenue from ambulance bill payments and the $1.4 million goes toward salaries, the management fee and write offs when people or insurance companies don’t pay the full amount of an ambulance bill.
While each ambulance ride costs $1,000, most departments have some form of charity care, which reduces the cost based on a person’s income and inability to pay the full fee. Insurance companies have contractual agreements to pay a portion of the fee. When a person has the means to pay their bill but they still don’t, the hospital writes it off as bad debt.
Collins said Via Christi collects on average between 39 percent and 43 percent of all billable revenue.
“The hospital is a catholic faith-based organization so we are confident that we are not capturing all of the revenue that we should be able to capture,” said David Adams, director of EMS. “The write offs are higher when you’re working with a nonprofit health corp organization versus working with a county-funded operation.”
The county’s Budget and Finance Department looked at similar- sized counties in Kansas, including Dickinson, Leavenworth and Butler counties, that manage EMS themselves and determined that they could collect between 50 percent and 60 percent of billable revenue.
“We have done comparative studies with other counties like our size and we are confident that we would have better revenue capture if we were not part of a catholic health-based organization,” Adams said.
If the county moves EMS under emergency management, there will no longer be a base management fee. Most other expenses would remain the same. Collins has proposed adding three full-time employees and one part-time employee and restructuring the administrative duties within the departments.
Those positions are one full-time employee and one part-time employee for billing, one assistant EMS director and one assistant fire chief. The increase in revenue from billing and the money the county now uses for the base management fee would offset those costs, he said.
The Emergency Management Department currently has Collins working part-time as fire chief, part time as emergency management director and an assistant fire chief managing most of the fire department. A clerical assistant divides her time between helping with the fire department and helping with emergency management.
EMS employees would become county employees and get a paycheck directly from the county instead of from the hospital. Goehring said her goal is to make that transition easy for their employees.
Collins is also suggesting that commissioners replace the current ambulance fund with a special taxing district, taxing property owners up to 3 mills for the service. A mill is $1 in tax for every $1,000 in assessed, taxable property value.
A special district could raise about $1.8 million to run EMS, Collins said. The special district could include all of the city of Manhattan or part of Pottawatomie County, he said. Riley County’s ambulance services cover part of Pottawatomie County, up to Lake Elbo Road. Wamego’s ambulance service covers the area east of Lake Elbo Road.
“What I would suggest, if we’re going to do this, is let’s go ahead and make this district whatever is gonna be covered. And these people pay that 3 mills,” Collins said. “Now, Pott County may say, ‘Well we don’t want to do that. We’ll just expand our own ambulance service over there. We’ll cover it.’ OK well that’s fine.”
Commissioner Ben Wilson said county-run ambulance services have different write off policies and have less taxpayer money supporting ambulance services, meaning more of the cost would fall on ambulance users.
“We don’t have anything against the hospital,” Wilson said. “They’ve been doing a pretty good job running it, but they have asked for some significant increases in recent years, and I think it would make more sense to have it under the direction of the county if we’re paying for it.”
Wilson said it also made sense to restructure the Emergency Management Department because Collins will be retiring soon.
“Our direction to him was primarily for his department,” Wilson said. “Figuring out planning for his department once he leaves.”
Goehring said she understands that the county is looking at what’s best for the taxpayers.
“We’re in favor of whatever the county needs to do,” she said.
The commissioners said they are still in the planning stages of restructuring the department.
“We’re just exploring it and trying to get that done,” Commissioner Marvin Rodriguez said. “It’s not anything that has been finalized yet. We’re just looking at how can we make this work.”