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 Who pays for emergency response? Ambulance service audit reflects rising costs and limited funding

By: Jeremy D. Wells
Carter County Times

The Carter County Emergency Ambulance Service continues to struggle with payments and refusals, and inadequate funding. But according to John Clevenger with Griffith, DeLaney, Hillman & Lett, CPAs, the firm performing the service’s audit, the service’s management is acting in a fiscally responsible manner and is paying bills and meeting obligations as required. 

The largest portion of cost, and one that continues to grow with no expectation of ceasing, is the local contribution to the state pension system. 

“That’s never going to go down,” Clevenger told the ambulance board, unless there are some fundamental changes with the way retirement is funded from the state level. 

The audit showed that the local contribution grew from 12.42% in 2016 to 13.95% in 2017, then held steady until 2019 when it jumped again, to 14.42% of total contributions. The biggest jump, however, occurred in 2020, when it grew by around 50 percent, from 14.42% to 22.11%. 

According to ambulance service director Rick Loperfido that number has now grown to around 26% of total contributions. 

While these numbers are from an audit of the service’s 2019 and 2020 fiscal year, they reflect an ongoing issue for the service – namely how to get paid when they provide service to individuals and organizations that refuse the call once they arrive or simply fail to pay bills. 

Loperfido noted in his report that the service is seeing a “gradual increase in our run volume each month,” and while a number are still COVID related, other types of calls are beginning to increase as people return to normal activities. 

Loperfido also noted that the service is experiencing a growing number of individuals who only require assistance getting up from a fall, or who refuse treatment and transport once stabilized. Because of this, they can’t bill the patient’s insurance. They still have to cover the cost of the crew, the fuel, and go through decontamination protocols after each call though. 

The service’s financial report noted that payroll for October – at $218,243.06 – was $40,899.60 over budget and $23,105.22 more than the same period the previous year. Valerie Nolen noted that one reason for this was the difficulty with getting part time employees to cover those hours as they have done in the past. 

At the same time payroll costs are increasing, the number of “dry runs” or refusals are also going up, meaning the service is spending more time responding to calls that they can’t bill for. While they had a total of 535 calls for the month, only 399 of those were billable. Of those unbilled calls 81 were individuals who refused treatment and 27 were cancelled calls. Another eight were evaluated with no treatment, and five were assists or standby calls. Fifteen of those calls were DOA. Of the billable calls 356 were for transport, and 43 were treated and released. But even those they can bill don’t always result in full payment. 

For instance Loperfido also noted in his report that the service was still having issues collecting payment from the county jail for inmate medical transports. In some of those cases, Loperfido said, a judge was granting the inmates a medical bond, which means they are no longer classified as inmates of the county jail at the time of transport and the jail believes they are not responsible for their transport costs. Instead the cost should be charged to the individual’s insurance, they claim. But if they have individual insurance, Loperfido said, they still often have issues collecting because the insurance company believes the jail is responsible for the transport costs. 

On top of that, ambulance services often don’t receive full compensation on any Medicaid funded runs. Instead, Medicaid pays at a reduced rate. 

In the cases that were not bonded out the jail was responsible for the transports, and jailer R.W. Boggs told the fiscal court on Monday evening that he has submitted payment for those transports. 

That payment, however, is a fraction of what the ambulance service billed. Boggs explained to fiscal court on Monday night that the jail was utilizing a new service provider for their medical bills, and they have reduced the jail’s payouts by – among other cost saving measures – determining that the jail can payout at the reduced Medicaid rate on some transports rather than paying full price. The company had reduced the amount paid out for medical billing from hospitals like King’s Daughters from more than $81,000 to around $8,000 Boggs said. For ambulance transports provided by the county’s ambulance service, he said, the company had reduced the amount they paid from more than $20,000 – which ambulance services billed – to around $6,300 paid out. While it’s a cost saving measure for the jail, it means the ambulance service was paid less than a third what they billed the jail for their services. 

It’s an issue that doesn’t have an easy answer, but it’s one that Loperfido said he has met with representatives from the jail and the county treasurer to try to resolve. 

Loperfido also provided updates on repairs to vehicles, insurance funds to be received from a truck involved in an accident, and the chance that more American Recovery Act funds may be funneled to the service through fiscal court. Loperfido said he is working with Compass Group, out of Lexington, to document the ambulance service’s funding losses during the COVID-crisis period. 

Loperfido also reported on the possibility of hiring another full-time paramedic, the need for an urgent care facility that can handle emergencies in the Grayson area, and investigations into federal mandates related to vaccine requirements for healthcare workers. 

Contact the writer at editor@cartercountytimes.com



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