The long run

Published 4:49 pm Sunday, December 29, 2013

WINDSOR – Each day seems to be a return to a sense of normalcy with Bertie County’s Emergency Medical Services. The county has taken over its day-to-day operations from the previous provider.

Now that the county has weathered the storm of First Med’s abrupt departure from being Bertie’s private emergency services provider, the county now has to take a hard look at the emergency medical service it will provide for its citizens in the future.

At the Dec. 18 meeting of the county’s Board of Commissioners, they heard an overview of one of the alternatives: the way EMS operations are handled in neighboring Washington County.

Washington County EMS Director David Clary appeared before the board with an overview of how his county has handled its emergency medical service operations.

Washington CountyEMS is the sole provider of Paramedic pre-hospital services to the entire population of the county with a coverage area of roughly 332 square miles. According to the county’s EMS website, call volume averages approximately 1,800 EMS calls and 1,200 Medical Transport calls. Medic units are staffed with one or two personnel that respond to emergencies to assess and treat patients and also transfer patients to other tertiary facilities.

Washington County also provides a non-emergency Medical Transport service that provides transportation of its county residents for out-patient procedures, physician follow-ups, and doctor’s appointments.

Clary, who came to Plymouth from Cleveland County, supervises a staff of 14 full-time EMS personnel and 4 full-time Medical Transport personnel with 16 EMS personnel that provide additional coverage for areas in the eastern portion of the county and Tyrell County, which is also served under Washington-Tyrell CountyEMS.

Clary, who will be retiring from his post at the end of this year, and hopes to have a future as an emergency services consultant, told the Bertie Commissioners that operating one’s own emergency medical services could be painstaking.

“It’s a very painful process for any county to start up a county-level service at the paramedic level,” he began. “I just want to give you some ideas and things that you need to be supportive of these guys down the road.”

Clary began his career in Cleveland County, in the western part of the state, in 1990 and after rising through the ranks there he landed in Washington County in 2010 which, at the time, had considered privatizing its emergency medical services. He said he was in Windsor to share some of his insight, particularly with reference to future planning.

“I can give you some options,” Clary added. “Mitch (Cooper, Bertie County EMS Director) did a good job purchasing the ambulances from MedEx; however you still have to look at the equipment.”

During the transition state of emergency period, the commissioners authorized the purchase of five ambulances at $9,000 each.

“When I walked into Washington County they had one ambulance to cover their whole county,” Clary said. “You can imagine the response times were terrible.  The first thing I commend you folks automatically is you put up four trucks county-wide; that helps you with your time.”

Clary stressed the economics of running a system, saying be aware of the costs of running a 9-1-1 system (Bertie’s EMS system is linked into the 9-1-1 system of the county’s Sheriff’s Department); of workman’s compensation claims, and equipment from ambulances to cardiac heart monitors.

“I’m just giving you some options for absorbing all of this start-up cost,” he emphasized. “You keep hearing thousands and thousands and thousands of dollars, how’re you going to gain that back?

“If you’re running 9-1-1 only you’re never going to gain it back,” he surmised. “All you’re going to do is keep subsidizing out of the general fund every year.”

What Washington County EMS has done, Clary said, is to branch out into medical transport and inter-facility.

“What this is going to come down to is there’s going to be a competition there,” he cautioned. “You’re never going to run profitable with 9-1-1 services only. You’re going to have to expand the medical transport.”

Clary says with Medicaid considering Medicare the primary service provider in cases of low-income counties, when it comes to 9-1-1 ambulance service payment versus basic necessities, the basics are going to win.

“What more than likely is going to happen in the end is the good, honest people might write you a check for five dollars a month because it’s all they can afford, or you’re eventually going to have to write that off,” he said. “There’s no money to be made in 9-1-1.”

Clary suggested the three nursing homes in Bertie County could subsidize the entire EMS system and pay for the entire system over a year if investing the money in equipment.

“Don’t expect to see the profit within one year because of the start-up cost,” he cautioned. “You need to expand to medical transport and work with Vidant Bertie (Hospital) on getting all their inter-facility transfers.

“You’ve got to find a way to counter 9-1-1 or you’re not going to survive.”

Clary said the Washington-Tyrell system receives about $200,000 just on the EMS Medicaid report.

“And that’s just in addition to what you collect from EMS billing,” he said.

Clary said compliance with the regulations and rules as far as documentation is also critical; nothing must be amiss.

As he wrapped his presentation, Clary said there would be some contentiousness.

“Nobody wants to go out of business, nobody wants a turf war,” he cautioned. “But I can tell you if you continue to allow the private ambulance companies to take your medical transport, inter-facility and outer-facility hospital transport, then the taxpayers better pull their pocketbooks out, because you’re going to have to go up on the tax base to fund just 9-1-1 only.”

Clary said without the medical transport, his department would have a nearly $300,000 shortfall. Also, some ambulance franchise contracts in Washington County have been, or will be, revised in the future.

“If you don’t come up with some type of franchise charge or agreement, or take it over yourself with the number of transports you’ve got then the county is going to be the one hurting in the end,” he said.

A board of commissioners, he pointed out, can set franchise limits within the county; that controls in-county medical transport.

Clary says he supervises a Washington transport and Tyrell transports; a Washington EMS and a Tyrell EMS.  Bertie County, if it adopted this system, would only have a transport and an EMS.

Commissioner John Trent asked Clary about non-collection which Clary said is about 18 percent for his county.

Clary closed by saying he was just here to give guidance; but that it would be the commissioners who would have to eventually decide on Bertie County’s emergency medical future.