Caledonia Argus

City reconsiders ownership of ambulance service

Posted: 5/27/03

by Jane Palen
Managing editor

Financial difficulties may force the city of Caledonia to give up control of its ambulance service to another provider.

The city has held several meetings with Tri-State Ambulance of La Crosse to determine whether an arrangement whereby Tri-State would take over the local ambulance service would work for both parties.

Never a money-making enterprise, rural ambulance services are being squeezed even more by a federal law that went into effect in April of 2002 which forbids ambulance services to bill Medicare patients for the difference between the Medicare reimbursement and the actual charge for the service. Between April, 2002 and the end of the year 2002, the ambulance service lost $25,000 due to inadequate Medicare reimbursement. This year, according to the co-director of the ambulance service, Mary Bubbers, the city is on track to lose $33,000. That figure, Bubbers noted, does not include those private-pay individuals from whom the ambulance service cannot collect.

ìItís an uncertain feeling about whatís going to happen,î said Bubbers. ìWe have been preparing for financial disaster. We just didnít know when it was going to go into effect.î

The Medicare reimbursement problem is compounded by a loss in local government aid that will hit cities this year.

ìThis is a huge financial burden,î Bubbers commented.

The Caledonia Ambulance Service has been in operation since 1969. Its service is known as EMT-B for Emergency Medial Technician-Basic, and has several variances so its EMTs can administer glucagon and epinephrine, start IVs, and perform advanced techniques to maintain an open airway. Some of the EMTs on the Caledonia Ambulance Service have training as paramedics, but the ambulance service doesnít have the equipment or tools that would allow them to perform all the advanced techniques, and it would require a change in licensure to have those services, Bubbers explained. The city has an agreement with Tri-State Ambulance for interceptions when advanced life-saving measures are needed en route to the hospital.

Rural ambulance services such as Caledoniaís are in especially difficult circumstances because they have an aging population, which means that more of the patients it serves are on Medicare. In fact, about 60 percent of ambulance runs in the serviceís district are for Medicare recipients, Bubbers estimated. The ambulance goes on about 300 runs a year. The ambulance service also accepts Medical Assistance (MA) assignments, but MA pays better than Medicare, Bubbers noted.

The ambulance service has about 20 EMTs on its roster, with a core group of about 7-10. Another challenge that the service faces, said Bubbers, is that many people work out of town and are not available for calls during the day. Also, not all employers are willing to let employees leave at a momentís notice to answer calls. Ambulance personnel are paid for their on-cal time and for the calls they answer.

ìI donít know how anyone is going to do it,î said Bubbers, referring to the discussions about transferring ownership of the service to Tri-State. ìBetween the financial hardships and trying to find staff, it is a crisis.î

The ambulance service is not in a position to cut any expenses since it really doesnít have much of a budget anyway, said Bubbers. They do a lot of their own training, and their expenses are for necessary items. She said she knows the city council doesnít want to change the service, but it is facing a possible loss of local government aid, and is unable to raise levy limits. Bubbers said she hopes whatever decisions the council makes are ones that will work out in the long term.

But whatever changes may be in store, it is Medicare, not the city, that is at fault.

ìMedicare is socialized medicine,î said Bubbers. ìMedicare is creating problems. As the base of people paying into it is getting smaller, private pay people have to make up the difference.î

If Medicare paid a higher rate, said Bubbers, it would mean lower costs for everyone.

Paul Fisch, the city councilman who first suggested looking for options in the ambulance service, said that he knows of other cities that have handed over control of their ambulance service. In Caledonia, if such an arrangement was made, it would save the city about $80,000 per year. He said he isnít sure how the arrangements work elsewhere, but thought it was an idea worth exploring. He emphasized that he and the other city council members believe that the Caledonia Ambulance Service is an excellent service and well-run, but that the current budget crisis is making it necessary for the city to look for cost savings anywhere it can.

ìWe are looking at everything,î said Fisch. ìI thought maybe they would let us raise the levy limits, but it appears now that they are not going to let us.î

With ownership of the ambulance service under Tri-State or another service, the city would be able to maintain the quality of its service, but the liability would be someone elseís.

ìNo one on the council wants to go backwards,î said Fisch.

Fisch said no ambulance service can collect more than the Medicare assignments, but said he believes a paramedic service may be able to charge and be reimbursed at a higher base rate. Those are the things that are being discussed now, he said.

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