When you call 911 for a medical emergency in Brown County, chances are that an ambulance will be dispatched.
Sometimes all that the caller needs is for someone to help them up from a chair to get to the restroom.
Other people call 911 with medical conditions, but then decline to be taken to a hospital. This means that the county picks up the bill for that ambulance run rather than the person’s insurance paying for it.
The county is coming up short by about $20,000 to pay for ambulance runs in 2018, but the total bill amount isn’t final yet.
Of the 1,832 ambulance runs in 2018, about 1,544 — 84 percent — were emergency runs. But of those emergencies, about 50 percent of the patients refused transport to the hospital.
At the Jan. 2 Brown County Commissioners meeting, commissioner Diana Biddle reported that the initial billing for this year’s ambulance service with Columbus Regional Hospital was $486,000. The commissioners had budgeted $445,000 so that their overall budget would be funded.
The county receives a bill for 90 percent of what CRH expects to spend at the beginning of each year, and at the end of the year, the remaining 10 percent is billed after insurance money is collected. The year before, the county actually received $881 back from CRH because its billing estimate ended up being higher than the actual cost. That meant they also had money to roll over into the next year, because they had expected to spend even more than that.
The rollover helped with the budget shortfall for ambulance service this year, but it did not cover all that was due. Biddle said they have time to figure out how to pay for it.
“I informed CRH that we were a little bit short. They said, ‘No problem.’ They will work with that, then, at the end of the year when we do the other 10 percent of the billing, then we’ll see where we have money and pull from the available funds,” Biddle said last week.
The county is in year four of a five-year contract with CRH for ambulance service.
One suggestion CRH made to bring down costs in the future was to go down from two ambulances to one in the county, Biddle said. A second ambulance could still be called in from Bartholomew County if needed, but only one would be stationed in Nashville.
But she said she will not cut emergency services if there’s any way the county can make it work.
“I don’t want anyone not to call an ambulance when they need one because they think it’s costing us money. I don’t want that at all,” she said.
“If you need an ambulance, you need an ambulance. That’s why when they made the recommendation we drop down to one full-time ambulance instead of two, I’m like, ‘No.’ … Sometimes when you need one (ambulance), you need three. When it hits the fan, you want to know that there’s somebody there. … If there’s any way we can make it, we’re going to make it work.”
She said one idea to help bring ambulance costs down would be for the county to fund patient transport vehicles for the volunteer fire departments, allowing those volunteers to take on the non-emergent calls, like lift assists.
That idea comes from when the ambulance service first started in the county in the 1970s with Chet Kylander.
“We had EMT classes, then we had EMTs, then the EMTs rode the ambulance,” Biddle said.
“If there was a way we could fund transport vehicles for all of the fire departments and the fire department could take some of those non-emergent calls, then, yeah, that would cut down on our ambulance costs, but then the fire departments have to figure out a way to fund it. It’s certainly not a simple, easy solution, but it’s an option.”
The county’s emergency management department is doing a Public Safety Training Institute that recently graduated its first class of EMTs.
Currently, Cordry-Sweetwater Volunteer Fire Department has an ambulance it can use to transport patients in that area to a hospital and a crew of volunteers trained to do that. However, not all of the county’s other five volunteer fire departments do.
In April 2016, the Brown County Volunteer Fire Department, based in Nashville, decided to quit doing medical runs because of fatigue and lack of personnel. In June 2017, the department’s eight members opted to resume doing them, but they remain short of staff and financial resources, Chief Nick Kelp told the Nashville Town Council earlier this month. His crew of 10 volunteers finished 2018 with 615 fire, accident and medical runs, the most they’ve ever had, he said.
The county controls the contract with CRH, and county leaders are the only ones able change it, said Kelsey DeClue, public relations manager for CRH.
She said CRH transports, on average, two patients a day in Brown County to the hospital.
To help cut costs with the ambulance service, the county also pays for the ambulances’ gas.
One of the reasons the county has seen an increase in the cost of ambulance service is due to changes in insurance reimbursement, like with Medicaid and Medicare.
“Last year it changed because there was a change in the way insurance was reimbursing the hospital and they got more reimbursement. Then that changed again and now they’re getting less reimbursement. We’re back to the same formula that we had before,” Biddle said.
READ MORE ABOUT HEALTH CARE:
http://www.bcdemocrat.com/2019/01/29/checkup_brown_co…_year_of_service/
http://www.bcdemocrat.com/2019/02/01/checkup_iu_health_expanding/
