By Stephen Smoot
Across the nation, the inflating costs of purchasing, equipping, and maintaining ambulances has skyrocketed. At the same time, most insurance companies, as well as Medicare and Medicaid, balk at covering all of the costs of transport.
Also adding to the strains across the nation is the Baby Boom generation bringing the effects of its population bulge into the seniors years, the rise in chronic illnesses and conditions, and other factors contributing to increased need.
Finally, mandated trainings all too often take place in areas far from this region. Someone must pay the cost of travel and other accommodations.
According to EMS World, in an article printed in August of last year, the “intricate web of readiness behind . . . response . . . involves substantial costs.”
It went on to state that “there’s less focus on what each EMS incident costs the provider. These expenses extend far beyond the visible efforts of our paramedics and EMTs and include the readiness of staff, facilities, equipment, and supplies.”
As the article states, with revenues from all sources stagnant or declining and with services facing the same economic pressures as other industries, “the math doesn’t add up, and while the solution isn’t simple, acknowledging and addressing these financial gaps is crucial for the future of EMS.”
And one of the countless areas where that rubber meets the real world road was at the Hardy County Emergency Ambulance Authority meeting last week as they discussed budget constraints and how to best address them.
The meeting started, in the spirit of God before country, with an invocation by Paul Lewis, Hardy County emergency services coordinator. In it, he prayed that the proceedings “be in the best interest of the county as a whole.” Then attendees stood and recited the Pledge of Allegiance.
A standing room only crowd of attendees heard Derek Alt provide a presentation on issues affecting the service. He gave much focus to the budget.
Alt laid out information on revenue and costs, sharing details, and stating that the Authority would have to absorb an 11 percent decrease in expected expenses. With staff costs serving as a major expense, he explained that the service would likely have to eliminate a full time position and restrict staffing in some instances.
Later in the meeting, Alt shared that the average financial loss to the service per call was $512
Steve Schretom, Hardy County Commission representative to the board, questioned Alt, asking, “what kind of flexibility would be possible from this point . . . if a different budget was proposed or put back by Commissioners.”
Alt responded that the cuts would likely still involve personnel, including the need to eliminate a full time position.
Later on, the Board voted to defer scheduled major maintenance on one of the ambulances due to funding cuts. With changes in rotation, this would have no immediate effect on service. While inflation will push the cost higher when repaired, the Board found it fiscally prudent to wait at least two years.
The budget of HCEAA versus that of West Hardy entered the discussion as well. The former has a budget of approximately $1,352,000 while the latter operates on about $838,000. Board members described comparisons between the two as “apples and oranges,” then explained that while West Hardy responds to more calls, HCEAA’s zone involves a larger territory with many calls in remote areas. This adds to costs such as fuel and maintenance and also often means that calls take more time.
One of the areas that would help considerably would be full, or even near full, compliance by county residents in paying the related fee. Fran Welton, Board member, explained that even many who the County took to court for non payment still refused to pay the fee. Attendees also heard that the county could not treat the fee the same as a tax in terms of enforcement.
An attendee who had moved in from New York State asked if the ambulance services had requested donations from local businesses to make up the shortfall. Jean Flanigan, Board member, explained that “businesses pay a fee based on the number of employees here.”
Schretom added that the County Commission “is in the middle of updating that fee for businesses. It will make a bit of a difference” and would likely result in “an increase to businesses in general.”
Welton followed by saying that unless Medicare, Medicaid, and insurance covered much more of the cost of transport, that levies and/or fees were vital to keep the services running effectively, but also “people need to know why they need to better support services.”
Steve Miller, a wrestling coach for East Hardy, brought up potential issues if the State mandates ambulance presence at all athletic events, or even just for contact sports, including the fact that “there are some areas of this state where ambulances hardly exist.” He added “I understand why they are doing it. You have to have them there,” but he also asked what would happen if ambulances had to answer calls and none were available.” He said that if the state mandates that “there must be a funding source.”
Alt then provided a treasurer’s report, which is a different document and agenda item than the budget. In January, expenses ran to $110,991.85 with revenues totaling $113,632.79. Reserves in the checking account came to $22,506.12 and after a deposit that day, the savings account total rose somewhat above $9,000.
The agencies supporting Hardy County reported that West Hardy responded to 106 calls in January, HCEAA 84, and Wardensville Volunteer Rescue Squad 35.
