Now that Bay Medical Sacred Heart is a private hospital, should the county take over ambulance service? That's the question Bay County commissioners are considering and they're getting conflicting opinions.
Commissioners made it clear during 2012 lease negotiations with joint venture partners Sacred Heart Health System and LHP Hospital Group they would not renew its Certificate of Public Convenience and Necessity (COPCN) to operate EMS once the hospital became a private, for profit facility.
In July of last year, the county's emergency services chief, Mark Bowen, recommended bringing the ambulance service in-house and said it could be operated as a "revenue neutral" system – meaning it would pay for itself.
According to C. R. "Corky" Young, Director of Emergency Medical Services for Bay Medical, ambulances respond to about 27,000 calls annually and about 19,000 of those responses require patients to be transported to a hospital. Patients are given a choice between Bay Medical Sacred Heart and Gulf Coast Medical Center. If they have no preference, they are taken to Bay Med.
Young said he maintains seven Advanced Life Support ambulances – each staffed with a Paramedic and Emergency Medical Technician – at all times. An eighth ambulance is added for a 12 hour shift during peak hours of the day. The service operates a fleet of 14 ambulances and six support vehicles, Young said.
Services are billed based on the level of service provided: $800 for a basic care level response in a non-life threatening situation; $1,200 to provide care if the patient faces a life threatening condition; and, $1,500 for a critical life threatening response.
"It pays for itself now," Young said. "I don't see any reason why it couldn't as a unit pay for itself if it needed to be moved."
In the months since Bowen's presentation to the board, commissioners have extended the COPCN twice while they study the pros and cons. The county recently hired Fitch & Associates, a leading EMS and public safety consulting firm, to analyze the current operation and assist in determining whether a county-run system makes financial sense.
Fitch & Associates concluded the county could operate a "viable and sustainable" program and projects revenues to exceed operating expenses by $600,000 to $1.2 million. The firm said it based its conclusions on call volume, pre-established rates tied to the cost of providing service, a reasonable payer mix, appropriate levels of productivity and low overhead.
The Fitch report projects monthly revenues to begin exceeding expenses within eight months and estimates it will take about 18 months to recover startup costs.
Click on the link (right) to view the Fitch report.
But Bill Kinsaul, the county's Comptroller and Clerk of Court, conducted a separate analysis and sees things differently. He and members of his staff researched the financial statements of counties in Florida (Okaloosa, Leon and Collier) and Missouri (Cole) that already operate their own EMS systems and were referenced in the Fitch report.
"What we found consistently across all of these counties when we would go back to actual numbers is they have huge accounts receivables and they're writing off large amounts of debt because they can't collect it," Kinsaul said.
All of the counties subsidized EMS service through taxes and special assessments, prompting Kinsaul to warn commissioners there is a "very high probability Bay County would experience a negative financial impact" if EMS is transitioned to the county.
Click on the link (right) to view the Kinsaul report.
The counties included in Kinsaul's analysis charge lower rates for EMS than currently charged by Bay Medical Sacred Heart and have been supported by taxpayers from the outset, leading County Commissioner Guy Tunnell to take a skeptical view of the clerk's conclusion. "I don't know that it's an exact apples for apples comparison," he said. "I think [a county run EMS] will pay its own way."
Tunnell said establishing a revenue neutral system is the goal, not turning a profit or creating a taxpayer subsidized operation. "You don't get into the law enforcement business or the fire protection business or the emergency medical response business expecting it to be a moneymaker," he said. "If it looks like it's a losing proposition, there's no reason why we couldn't bid this out to a third party."
Chairman George Gainer said he's confident the board would never agree to increase taxes to pay for county-run EMS. "If [Bay Medical] has been making money, then there's no reason to believe it can't be run at a profit," he said.
Commissioners must decide how to fund startup costs and bank financing has been mentioned as one option. Transitioning the EMS system from Bay Medical Sacred Heart to the county would likely involve the county's purchase of the existing equipment and transfer of the current staff to the new operation.
"If that were to occur, I don't see any effect in the level of service at all," Young said. "I would be surprised if anybody even realized what happened other than looking at the side of the truck and instead of it saying ‘Bay Medical Center' it says ‘Bay County.'"
Young said there may be differences of opinion on money matters but everyone is on the same page regarding the EMS mission. "Patient care [and] taking good care of the community... that's everybody's bottom line here," he said.
Gainer said he hopes the board will be in a position to make a final decision on the future of EMS within the next 30 days.