Costs key in Heartland's ambulance decision [St. Joseph News-Press, Mo.]
(St. Joseph News-Press (MO) Via Acquire Media NewsEdge) Oct. 06--After about 33 years, times change. The local hospital says it can't continue to operate an ambulance service. It loses too much money.
Heartland Health's community-based board of directors focused on the future of its ambulance program and came to a decision.
It was a reluctant but unanimous vote by the community board to end ambulance service in July 2014, said Tracey Clark, a spokeswoman for the hospital. The regional ambulance authority reported that it spent $8.8 million in 2012, while revenues were about $7.1 million.
The board's decision was logical, said John Wilson, Heartland's chief financial officer, in light of that $1.7 million loss.
The board and the hospital staff have to keep an eye on the mission. That goal is to provide the right care in the right place at the right time, said Dirck Clark, Heartland's chief strategy officer.
"We want to make sure the outcome is second to none," he said.
Continued and rising losses could threaten the hospital's future, Mr. Wilson said. In the next 10 years, about 1,000 hospitals will be closing, Mr. Clark said.
Heartland fought for some 10 years with the federal government to get a designation as a sole source provider, which currently provides the hospital with an additional $20 million a year. The designation was one of the best ways to offset losses.
That money helps offset losses, but can't cover everything. The board has to focus on the whole hospital, and there happens to be three services that don't pay for themselves: obstetrics, hospice and pediatrics, Mr. Clark said.
When looking at the future, the Affordable Care Act, or ObamaCare, is having an impact. Looking at the millions that hospitals gave away in the effort to create ObamaCare played a role when losses were projected into a fiscal reality, Mr. Wilson said.
The ObamaCare cuts totaled $94 million, Mr. Clark said.
"When everything else is said and done, Heartland's getting out because Missouri's legislature turned down the federal (ObamaCare) money for Medicaid expansion," said Dwight Scroggins, Buchanan County prosecutor who co-chaired the Community Ambulance Response to Emergencies committee that studied the ambulance issue.
But Mr. Scroggins also thinks people have missed the point.
"Heartland has done a service at a loss longer than any other hospital service for the community," Mr. Scroggins said. "And it's a good thing that it would."
Heartland has made it clear they can't continue the loss, Mr. Scroggins said. City and county officials worked together and created a local committee to study the problem.
The Community Ambulance Response to Emergencies, or CARE committee, included community leaders who volunteered their time to look at the problem and find solutions. The committee looked at bringing a private company in to operate an ambulance service.
Only two companies bid the project. The proposal from one company would have had the St. Joseph emergency call center for dispatching ambulances located in Independence, Mo. The cost of ambulance service also was projected to rise.
Bidding for a private company also reaffirmed the validity of Heartland's figures, Mr. Scroggins said.
After several months of study, the CARE Committee unanimously decided that Buchanan County should take over the ambulance service. The committee recommended the county use a half-cent sales tax to fund and maintain the operation.
A sales tax means anyone who buys in St. Joseph will be helping to pay for the service, said R.T. Turner, presiding county commissioner.
With a property tax, the burden of paying the extra cost would have been borne by property owners only, said Dan Hausman, eastern district county commissioner.
The county wants to have a small reserve to assist with rising costs, but all three commissioners believed the half-cent tax was too much. Looking at the current losses, projected losses and other areas where the county can save money convinced the commissioners they could provide a smooth transition with a lesser rate -- one-fourth of a cent.
"That will be adequate," Mr. Hausman said.
The commissioners also insisted on hearing what voters think. Voters will have to decide Nov. 5 if they like the professional service that's currently available, Mr. Turner said.
After voters speak
If it's a yes, the county will begin the transition process.
The county will arrange to acquire the existing Regional Emergency Medical Service Authority, or REMSA, to operate the ambulance service. And the county will use the same third party billing agency to manage ambulance accounts.
County commissioners and city officials nominated community members to become board members. Heartland would become a temp agency for ambulance employees.
Initially, current ambulance employees would continue to work for Heartland, Mr. Turner said.
The county will adjust its budget to provide start-up funds until sales tax receipts catch up with the costs, Mr. Hausman said.
The county also hopes to save money in one of the major cost areas.
The county negotiates purchase agreements for fuel. Because Buchanan County is a government agency, it can buy fuel at a cheaper cost, said western district commissioner Ron Hook.
The county also will begin looking for hospital dispatch locations to ensure quality response times, Mr. Turner said.
Current thinking is that over a five-year period, the county would buy new ambulances. At that point, the county will own all the ambulances.
Heartland Health has agreed to use its purchasing power to continue to buy at cost all medical supplies needed to stock each ambulance.
On the other hand, if voters don't approve the tax, the county will step back because it can't operate an ambulance service without a way to recoup expenses, Mr. Turner said. That's just a reality of the situation, he added.
Marshall White can be reached at email@example.com. Follow him on Twitter: @SJNPWhite.
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