Commonwealth Journal

April 25, 2013

A call to reason

Former EMS director weighs in on city’s decision to leave county and start own ambulance system

by Heather Tomlinson
Commonwealth Journal

Somerset —

A former Somerset-Pulaski County EMS chief is weighing in on recent disagreements between city and county officials concerning a shortfall in the EMS budget. 
“I spent half my life building an EMS for the city and county government and needless to say I’ve been awfully disappointed,” said Billy Miller during Monday’s Somerset City Council meeting. 
Miller, who served as EMS chief between 1983 and 2003, and helped build the ambulance service into what it is today, appeared before both city council and Pulaski County Fiscal Court this week to encourage that officials work the matter out before the EMS service is restructured.  
“Why do we want to take months out of people’s lives and battle this thing back and forth, spend needless tax dollars doing it, and then end up having duplicate services?” Miller asked during Tuesday’s fiscal court meeting.
Miller said he was reluctant to join the fray, which began back in January after city officials asked that the county contribute $982,907 to go toward losses incurred due to what they said were billing changes through Medicare and Medicaid.
Miller on Tuesday said he didn’t understand that reasoning. He pointed out that his department budgeted for “uncollectibles “ — bills that they would never be able to collect on — yearly to ensure they didn’t go into the red.
Uncollectibles result after Medicare and Medicaid are billed. Those programs don’t cover all of the cost of an ambulance run, but the remaining bill cannot be sent back to the patient. That must be written off as a loss. 
Private insurance sometimes won’t cover the entire cost, and Miller said often times the EMS service cannot recover those leftover bills either. 
“I had them (uncollectibles) for 20 years,” Miller said on Tuesday. “Neither the city or county picked up my uncollectibles.”
Girdler told Miller on Monday that, aside from the Medicare and Medicaid changes, EMS has found it nearly impossible to collect on V.A. runs. 
Miller questioned why nothing was done until the shortfall had grown to around $1 million. 
“Why didn’t someone bring it to the government’s attention, the public’s attention, back when it was $50,000 in debt instead of $1 million in debt?” Miller asked during Monday evening’s city council meeting. “Who waits until something is $1 million in debt and then brings it to everybody’s attention?”
Girdler responded that city officials had approached the county several times in 2010 and 2011 about the growing shortfall. 
“We’re not dissolving anything,” Girdler said. “ ... What we’re doing is a way to resolve the issue. I don’t think the city or the county wants to do anything disruptive, but we have had a contractual issue that’s been going on since ... 2009, 2010, 2011.”
Girdler last week sent Pulaski County Judge-executive Barty Bullock a letter notifying him that the county should be poised to take over its own ambulance service outside the city limits by the end of this fiscal year in June. 
But Girdler on Monday emphasized that the letter is just a “formality,” and he said it’s only in the event that a new inter-local agreement isn’t worked out between the two entities.
Somerset City Council in March voted to terminate a 1995 inter-local agreement the entities had been operating under that established funding for the service. The county had been providing around $1.2 million yearly to EMS from occupational tax revenue. As “overseer” of EMS, the city provided additional funding and manages the operations of EMS. The agreement also stated that additional occupational tax funds would need to cover “unanticipated” shortfalls in the EMS budget. 
The council terminated the agreement after fiscal court expressed some reluctance to cover the $982,907 shortfall, stating that there wasn’t enough documentation to warrant payment. 
After being provided documents from the city’s most recent audit, the county in early April began the process to secure those funds. 
“We’re making certain that the city of Somerset’s protected in the event we don’t reach an agreement in a certain period of time,” Girdler said. “ ... Unfortunately, when we have to write letters back and forth, that becomes negotiations in the paper and that’s not behind the scenes.”
Girdler said earlier Monday in a budget workshop that the city and county had met about creating a new inter-local agreement, and the city had offered a figure of $1.6 million to be paid by the county annually to the city, which would take over operations of EMS. The county would “contract out” EMS operations with the city, essentially. 
“If we have a shortfall, then we have to eat it and we won’t be able to go back to the county,” Girdler said. 
That figure was also noted in Girdler’s letter to Bullock. 
Girdler during Monday’s city council meeting also stated that the county could agree to an occupational tax restructuring, during which the city could use a larger chunk of the occupational tax revenue to go toward the EMS service. 
And, if the county chooses, it can create its own ambulance service. 
“If they (county officials) agree to the $1.6 million ... everything’s fine, there’s no issue and everybody goes home,” Girdler said. “It is up to the fiscal court to come back to us about which option they want to take.”
Several city councilors had similar thoughts.
“We’re not here for that (to dissolve EMS), Bill,” said Ward 4 Councilor Jimmy Eastham. “It’s in their (fiscal court’s) hands, as we speak.” 
Miller relayed those sentiments to fiscal court on Tuesday. 
“Some of them (city councilors) spoke up and said the ball’s in your court, and you’re going to tell me the ball’s in their court, but the matter is there’s going to have to be statesmen on both sides,” Miller said. “You all are going to have to be willing to sit down and work this thing through.”
And Miller said the reported collection rate for EMS — around 84 percent — is exceptional. 
“That’s pretty good considering all the write-offs you have to automatically give,” Miller said.
No matter where the shortfall came from, Miller said both entities need to work out a new agreement and ensure the EMS service remains unchanged. 
“If they (the city) are going to ask you for more money, they ought to be able to sit down and show you why they need that money,” said Miller to fiscal court. 
Miller said the EMS service must be run efficiently, and he said another facet of the terminated 1995 agreement — an EMS advisory board made up of medical professionals and county and city officials — should come back into play. 
“ ... I don’t know if there is an avalanche of true debt out there that is killing the ambulance service ...,” Miller told fiscal court on Tuesday. “The EMS is both your all’s responsibilities ... but you also need to have oversight and make sure things are being run efficiently,” 
Girdler during Monday’s budget workshop expressed a willingness to form some type of advisory board to “work out policy issues.”
4th District Magistrate Glenn Maxey on Tuesday asked if Miller would serve as mediator between the city and county if the entities sit down to work out a new agreement. 
Miller said he’d “be glad” to do so.
“It’s ridiculous to have two services in this county,” Miller said. “ ... It’s ridiculous to start tearing those things apart and try to do them on your own.”