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Second EMS station now up to council

Six additional EMTs would have to be hired

September 07, 2011
A proposal to add an Emergency Medical Services station at Carefree will be presented to the Crawford County Council Tuesday, after the three-member board of commissioners Thursday night voted unanimously to support it.

John Gott, who was hired as the director of the county's EMS last spring, recommended adding the satellite location. Not only would it provide better service to resident on the east and south ends of the county, but it would add stability to the department's scheduling, he said.

"This is my analysis of an issue that was brought to me when I was hired, the overtime," he said.

Gott said that the current system of having just one ambulance on duty at the EMS station at English, with another on-call, is creating an excessive amount of overtime.

"As you know," Gott read from a letter he wrote to the commissioners, "the crews are currently scheduled on 24-hour shifts, every fourth day. After completion of their on-duty shift, they then are on-call for the next 24 hours. In the average two-week pay period, they are scheduled 48 hours each week, thus automatically putting them into overtime for eight hours each week.

"When on-call, they are called in each time the on-duty crew is called out on an emergency run," he continued. "With an average of 1,000 responses per year, the crew is getting called in roughly three times per shift, resulting in four to six hours of potential overtime per day. The average payout of overtime per pay period has been $2,298.72 since I began as director in March of this year."

The current system also doesn't provide residents with the best possible service, Gott said.

"Currently, when the on-duty ambulance crew responds to a call, it can take up to 30 minutes to get another unit available to respond to the next call," he said. "When a second back-to-back call is received, this often causes a significant delay in getting emergency medical care to those in need."

Gott presented the commissioners with three options for their consideration. The first, which he said he didn't see as viable, was to continue with the current system. He projected that would cost the county $75,000 in overtime pay and $18,250 in on-call pay for 2011. Combined with the salaries for the department's eight full-time emergency medical technicians, the total annual cost, not including benefits, would be $281,806.16, he said.

The second option — the one preferred by Gott — would add a second 24-hour crew in the Carefree area. He said it would have several advantages, including eliminating the on-call system, providing better service by having a second ambulance always available, decreasing response times to the southeast portion of the Carefree-Leavenworth-Alton area and reducing crew fatigue — and associated liability — from working busier shifts.

The main disadvantage, Gott said, would be a "significant cost increase." Another six full-time EMTs would have to be hired, and, while overtime would be reduced, it wouldn't be eliminated, he said. He estimated the total annual cost, not including benefits, would be $394,241.12.

"So, you're talking another $120,000," he said.

The third option also would add a satellite station, but EMTs would work 12-hour shifts instead, Gott said. While it would completely eliminate scheduled overtime (unscheduled, incidental overtime caused by late runs, etc. still would be possible) and on-call, the overall personnel cost, without benefits, would be $472,034.36.

Gott estimated — though he admitted it was purely a guess — that building a station would cost $75,000. He said the former Small Bros. garage at Carefree, owned by Lloyd Arnold Jr., is available for rent at $1,000 per month.

District 1 Commissioner Daniel Crecelius added the health care facility that the county has studied building in that area possibly could include an ambulance station.

Gott noted the additional costs would be offset in part by the increased run collections since the county outsourced its billing earlier this year. Collections for 2011 are at $260,000 ($190,000 since the billing was outsourced), compared to $136,000 for all of 2009 and $115,000 for 2010, he said.

That amount is likely to increase, as the commissioners, per the recommendation of the billing company, earlier in the meeting made changes to the ambulance service's fee schedule.

Despite the Medicare Allowable Rate for BLS (Basic Life Support) non-emergency transfers being $209.23, the Crawford County service had no rate, Gott said. In addition, the service's ALS (Advanced Life Support) II rate was $500, $75.38 less than the allowed Medicare rate, meaning the county wasn't billing the government at the full level it could, he said.

The following is the new fee schedule: BLS Non-Emergency, $300 ($0 former fee); BLS Emergency, $600 ($500); ALS Emergency, $650 ($500); and ALS II, $750 ($500).

Gott said he wasn't able to compare them with those of area facilities because of legal reasons. Still, he said, he is comfortable with them.

"I think these are reasonable rates," he said.

Before the commissioners voted 3-0 to approve the new fee schedule, Crecelius asked Gott what percentage of the bills are private pay. Gott answered that is a small percent of the total population.

Jim Schultz, president of the board, asked if payment plans exist for low-income people without insurance. Gott said such plans do exist, adding that part, or all, of a bill may be forgiven for persons with no ability to pay.

"Looking at the big picture, it's probably the best thing to do," Crecelius said of adopting the new fee schedule.

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