Commonwealth Journal

May 9, 2013

EMS deficit is projected at $585,000 for coming fiscal year

System could lose some Medicaid funds

by Heather Tomlinson
Commonwealth Journal

Somerset —

City officials are projecting another significant shortfall for Somerset-Pulaski County EMS in the upcoming fiscal year, and although a new contract be-tween the city and county is still up in the air, they’re empha-sizing that EMS service won’t suffer for it.
“We’re very proud of EMS and the level of service for the city and county,” said Somerset Mayor Eddie Girdler during a Monday budget workshop meeting. “I don’t think anybody goes to sleep at night wondering whether or not they’re going to be provided service.”
Tentative budget numbers for a number of city departments, including EMS, were presented during the meeting. Before officials dove into the EMS numbers, Girdler told the councilors that he, after speaking with Somerset City Attorney Carrie Wiese and Pulaski County Attorney Martin Hatfield, decided to adopt the original 1995 interlocal agreement — termi-nated by the council in March over a disagreement with county officials on who was to cover a $982,907 shortfall in the current fiscal year.
“I’ve decided the best way to approach this is to live with the current contract we have with the county,” said Girdler. Girdler’s words echoed an announcement he released last week about the situation. 
Girdler said he had “extensive discussions” with Hatfield and Wiese, and he thanked Hatfield for his help with the situation, saying the county attorney had been “extremely helpful.”
But Girdler stated that he had yet to hear a formal response from the county. 
A call placed late Wednesday afternoon to Pulaski County Judge-executive Barty Bullock and Hatfield were not returned by press time. 
The disagreement began in January after city officials asked that the county cover the shortfall. Questions were raised about who was to cover what in regards to EMS operations — guidelines of which were established through the 1995 agreement. As per the agreement, the county had provided around $1.2 million yearly to EMS from occupational tax revenue. As “overseer” of EMS, the city provided additional funding and managed the operations of EMS. The agreement also stated that additional occupational tax funds would need to cover “unanticipated” shortfalls in the EMS budget. 
Not long after councilors terminated the agreement, the county began the process of securing those funds after obtaining financial documents from the city. 
Billy Duncan, acting EMS chief, presented his budget requests for the 2013-2014 Fiscal Year on Monday. Included in those numbers was an expected shortfall of $585,000 — a result of changes in Medicaid and Medicare, according to Duncan and Girdler, which led to this year’s shortfall as well. 
City Budget Manager Jimmy Hogg said he and Duncan came up with the shortfall after averaging out the collection rates for Medicaid and Medicare from the last several years.
“That’s about as good a projection as we could come up with,” Hogg said. “We’re hoping those numbers are pretty close.”
“That number will be given to the county,” Girdler said. “Really nothing’s changed except we want to provide services now and determine who pays later.”
The city has proposed a new agreement that would entail the county paying $1.6 million yearly to the city to ensure any shortfalls are covered — and anything beyond that the city intends to cover itself. But so far, no agreement has been reached on any new contracts. So instead, the city has opted to re-establish the terms of the 1995 agreement until new contract terms are worked out.  
“ ... The county would still come out $200,000 better by accepting that (new) proposal,” said Girdler. 
EMS has a collection rate of around 87 percent — considered a relatively good rate — but that hasn’t stopped the shortfall from developing. 
Duncan said EMS will soon lose upwards of 10 percent of the money Medicaid does provide because dialysis services, something that currently requires transport from home, may be provided “in-house” for patients. 
“Nobody’s got money,” said Duncan. “Everybody’s broke.” 
Duncan said he spent six months acting as a “squeaky wheel” in securing around $26,000 out of $76,000 currently owed to EMS by the state’s veterans’ affairs cabinet. 
Duncan said he plans to remount one of the EMS vehicles to better equip it for transport of obese patients, and he plans on trading in a vehicle that isn’t used due to mechanical issues to help cover that cost. 
Drug costs increased significantly, and Duncan told councilors that the cost of one advanced life drug — one required by the state to be kept in the ambulances — went up 35 percent. 
And Duncan said the new Health Care Reform Law, slated to take effect fully in 2014, will impact EMS as well.
“It’s just going to get worse,” said Duncan. 
Girdler said he hopes the city can establish some type of board to oversee EMS operations. The board would regularly communicate with city and county officials both to ensure issues, such as shortfalls, are recognized quickly. 
“We will try to establish lines of communication,” said Girdler. 
The councilors praised Duncan for his and his employees’ dedication during the last several months of uncertainty. 
“Even through this confusion and turmoil you all have provided outstanding service and you continue to do so,” said Tom Eastham. “I know it’s stressful on you and your employees, but you have absolutely shown your true colors and I appreciate that.”