The Moffat County Commission rejected a proposal last week to bring in an outside agency to review the county’s EMS operation. Commissioners Tom Gray and Tom Mathers voted against the proposal while commissioner Audrey Danner provided the lone vote in favor. The decision drew criticism from Danner and George Rohrich, chief executive officer of The Memorial Hospital in Craig.

Photo by Joe Moylan

The Moffat County Commission rejected a proposal last week to bring in an outside agency to review the county’s EMS operation. Commissioners Tom Gray and Tom Mathers voted against the proposal while commissioner Audrey Danner provided the lone vote in favor. The decision drew criticism from Danner and George Rohrich, chief executive officer of The Memorial Hospital in Craig.

Moffat County Commissioners forgo county EMS review

Advertisement

Quotable

“I don’t understand how the (Moffat County) Commission could vote against free information. I was kind of hoping we could have this evaluation done by outside experts with a fresh set of eyes, and now I am not really sure what to do next to improve the EMS system in Moffat County.”

— George Rohrich, chief executive officer of The Memorial Hospital in Craig

In November 2007, when the Moffat County Commission signed off on a voter-approved mill levy for construction of a new The Memorial Hospital in Craig, it was done with an understanding health care services would not be affected, including EMS.

At least that was commissioner Tom Gray’s interpretation of the agreement.

However, TMH has been maintaining EMS each year at a net loss.

George Rohrich, TMH chief executive officer, said it costs the hospital $100,000 to $200,000 more a year to operate an ambulance service than the program generates in revenue.

Three factors play a role in the hospital’s inability to generate enough funds to maintain EMS self-sufficiency: employing a trained staff of emergency medical technicians, low call volume and collection rates of about 40 percent.

Unfortunately, low call volume and collection rates come with the territory in a rural setting, said Rohrich, who conceded TMH could offset the majority of its EMS deficit by transitioning to a volunteer EMT workforce.

“But, it adversely affects your response time,” he said. “I have trained employees 10 or 15 feet away from an ambulance waiting to respond to a call. If it were volunteers working jobs all over town, it would take a lot longer.

“We’re not willing to sacrifice that level of care.”

It’s not uncommon for ambulance providers in rural settings around the state to receive local government subsidies to augment the costs of EMS operations.

Currently, TMH subsidizes its ambulance service out of pocket.

In an effort to examine deficiencies in ambulance service as a whole, Rohrich and Tom Soos, director of the county’s office of emergency management, sat down Jan. 12 with the Moffat County Commission to discuss bringing in state experts to evaluate the county’s EMS system.

The service is provided by Emergency Medical and Trauma Services, a branch of the Colorado Department of Public Health and Environment.

An EMTS consultative visit examines 15 elements of an EMS system as established by the 1996 National Highway Transportation Safety Administration and costs $15,000 to $25,000.

However, grant funding is available through the Statewide Emergency Medical and Trauma Services Council for up to 100 percent of the assessment cost.

Although the evaluation is readily available, EMTS must be invited by the county’s governing body to conduct the EMS assessment.

Last week, Soos presented county commissioners with an invitation letter for approval. It was denied by a 2-1 vote.

Gray and commissioner Tom Mathers voted against the invitation letter.

“The Memorial Hospital is in better fiscal shape than they have been in my memory,” Gray said. “To some degree, it begs the question why now? Is this a solution looking for a problem?

“It’s a tried and true methodology in government to have an expert tell you you have a deficiency and the solution is typically more money.”

Commissioner Audrey Danner, who voted in favor of the EMTS assessment, took issue with Gray’s comments.

Because of ambiguity in state statutes, Danner argued it’s not any one entity’s responsibility to provide ambulance services and the burden of financing an EMS system should be done collaboratively.

“I can’t fault someone for doing their job, but I think it’s something to consider because we are already funding ambulance service outside of the Craig proper area,” Danner said. “And I take strong exception, Tom, that just because the hospital is doing well, then this is something they should continue to fund.

“The thing that sticks out to me is the fact that we as a community get the final say as to whether or not we implement the recommendations. I don’t see how I can vote against information that addresses EMS services in Moffat County.”

Mathers said he agrees it would be up to the county to decide whether to implement EMTS recommendations, but he fears potential public backlash of not revising the EMS system post assessment.

“They could say we need an ambulance with a full-time staff in Maybell and Dinosaur and an extra one here in Craig,” Mathers said. “If they recommend it to us and we don’t do it and we have some major catastrophe, how do we deal with that?

“I just see this as costing us extra money.”

Mathers said he was torn in his decision.

“I oppose this hoping we can have a conversation to see how we can really fix this problem because I think this can be fixed internally between the county and the hospital,” he said. “I’d rather do that than have an outside source come in and tell us how they think we should fix it.”

After the meeting, Rohrich voiced his disappointment with the commission’s decision.

“I don’t understand how the commission could vote against free information,” Rohrich said. “I was kind of hoping we could have this evaluation done by outside experts with a fresh set of eyes, and now I am not really sure what to do next to improve the EMS system in Moffat County.”

Comments

Sage_Sam 2 years, 9 months ago

“They could say we need an ambulance with a full-time staff in Maybell and Dinosaur and an extra one here in Craig,” Mathers said. “If they recommend it to us and we don’t do it and we have some major catastrophe, how do we deal with that?

So Tom and Tom are afraid of hearing information that may prevent a catastrophe? I don't understand it, They want to not hear info so they can cover their butts if a hypothetical scenario might occur? It makes no sense.

0

Cole White 2 years, 9 months ago

Most of those transfers result in an ER visit which brings money into the hospital. Most of those visits result in an x-ray, ct, or labs which brings money into the hospital. Many of those visits result in the hospital having a patient spend the night which brings money into the hospital.

Before the hospital took over the EMS services it was run by an EMS manager that didn't care to bring patients to TMH. Randy Phelps saw the lost revenue from those patients going to YVMC and down to Junction rather than coming to TMH. That is why Randy was willing to take EMS on....not because it was a big money maker in itself, but because the County run EMS didn't like bringing patients to the County owned hospital.

EMS would make more money on each run if they took the patient to YVMC or GJ because of the distance. If you carve EMS back out of TMH, what is going to stop that EMS director from just taking patients to YVMC or GJ because they have a problem with the hospital? It will cost more for the county to run EMS if they pull it out from under the hospital's wing. Billing, accounting, budgeting, supplies, etc. will all cost the county more money.

A lot of services a healthcare providers does for the community loses money, but you continue providing them because you provide health care and EMS services are a component of that care. Take a page from histroy.....Randy Phelps knew that EMS was better served under the hospital because the money was leaving the County. The County and the Hospital would be smart to leave EMS with the hospital even if it does lose money.

0

David Moore 2 years, 9 months ago

I have to ask Hiway1340, were you ever a member of the ambulance service, at any time? I was, and was a member when it was taken over by TMH from the county. You are correct in your revenue generating statements, but not so correct in others, with all due respect. From what I remember, we took people to YVMC, then Routt Memorial, because we did not have a CT machine, they did and those transfers stopped when TMH purchased a CT machine. We took people unable to fly, or not emergent enough to fly, to St. Marys (and hospitals in Denver) because they needed a higher level of care than TMH could provide. I don't ever remember taking people to a different hospital because of a personal grudge, as far as I know, that would be illegal. EMS I believe is required to take people to the closest hospital in the area. Why would we take someone to YVMC because we wanted to? I'd like to know the name of this manager who you claim would prefer not to bring patients to TMH, would be interesting to know. TMH fixed the problems by purchasing a CT machine and later on an MRI. They offer more service and a higher level of care than ever before. Unless you were a part of this service when it was transferred from the county to the hospital, and know something I don't, I believe you are wrong on those points. I am for open discussion, not name calling or arguing. Please, continue as you have peaked my curiosity.

0

xrsareus 2 years, 9 months ago

Mathers and Gray need to listen to the people they have hired to oversee positions in county government. Talk about micro managing. Tom Soos has an incredible amount of knowledge about the workings of a efficient EMS system and the Commissioners should take his recommendations and believes that the county's EMS system needs fixing. It is obvious from the article there is a problem. Gray and Mathers want to stick their fingers in their ears and say LA LA LA. If memory serves me right, before the new hospital was built the ambulance was staffed 24/7 now I think it is only staffed 6am to 6pm on week-day's and all volunteer the rest of the week. If you read the newspaper records of emergency calls , sheriff, police, EMS and fire. The fire department is requested to assist the ambulance more and more. While the main object is to help the citizens of Moffat County in a emergency, there is a burden to firefighters because of there being no fulltime firefighters. There is also the cost to the fire district. I don't think the hospital reimburses the fire district for their service to assist the ambulance. Volunteerism is becoming a thing of the past. Look at civic club's in town, look at the fire department and look at county appointed boards. Nobody wants to volunteer anymore and this is a known problem thru out the USA. Why would two of the commissioners not welcome help from an outside source that deal with problems in rural areas of the state all the time, for free???? Why would they not look and the figures on the loses shown by hospital officials??? Why not try to fix the EMS problems before they get worse???? Why?

0

leroymcgee 2 years, 9 months ago

These commissioners are like the parent who doesn't want the doctor to tell them that there kid is deaf because then they'd have to deal with it. Ignorance is bliss, and there are at least a couple blissful fools in the Commissioner's office.

0

Cole White 2 years, 9 months ago

Dave - Its not illegal. Regs have always said that a patient is to be taken to the most appropriate level of care. EMS can by-pass any ER they want in favor of another based on perceived need. Also I would encourage you to read the board minutes from this period where it was discussed at length the fact that EMS chose to by-pass TMH and taking them over would help stop that.

Also, George Rohrich fired Tom Soos from the EMS Manager position. Why does he have so much confidence in him now? The assessment won't change the fact that the EMS service should stay with TMH and Tom and Tom feel that is where it should stay and no assessment will convince them that the County or the FD should take it over. And since the County owns the hospital why would they take over EMS to keep the hospital from losing a $100,000 just so the County can lose twice that much?

0

Colette Erickson 2 years, 9 months ago

"....there are at least a couple blissful fools in the Commissioner's office." Agreed.

0

David Moore 2 years, 9 months ago

highway1340, Thanks for the reply. Wasn't sure if there were regulations regarding which hospital to take people to, must just be an unwritten rule to take them to the nearest one. When Tom was manager, TMH had aquired the ambulance service years before him, I left in 1994, we were part of the hospital for a year or two before that, heck, I still have the first "TMH EMS Response Team" jacket hanging in my closet. Tom was not the manager back then and we did not transport people to YVMC or St. Marys simply to bypass TMH, we did so because they needed a different level of care or needed some testing we did not provide. The reasons I remember were that the county did not want the responsibility anymore and felt it would be more appropriate for the hospital to run an ambulance, which makes sense. Randy jumped at the chance and we have what now today is a state of the art service, complete with Paramedics, something we did not have in those days. I personally have watched TMH grow from one surgical case every other day to several each day. From flying just about everyone out to keeping a larger percentage of those patients. I remember when we had no CT, MRI, Arthroscopic surgery, and ventilator patients happened once a year. All of that has changed now, Randy was a starting point, but George has made it happen, I am happy to see him standing by his efforts. For the life of me I just don't remember bypassing TMH ED, we always went there first, and if needed, yes, they got taken somewhere else. I think what is being said is that they wanted to regain the market of what they were losing in those transports, which I believe they have done to a certain point. We still fly patients out, mostly head injuries and people who require a higher level of care, however the hospitalist program has taken back a lot of those that were transported away and is working just as the Administration had hoped.
All I am saying is that according to your previous post, during the time I was a member of MCAS/TMH EMS RT, is that until Randy took us over we were taking people to YVMC and other ED's besides ours, which I just don't buy. As usual, no offense intended, just trying to understand your statements is all. At any rate, thanks highway1340, and I'll look into those minutes.

0

TiredofSSDD 2 years, 9 months ago

Don't forget the Hospital will cost about 100 Million with all the interest and etc. over the period of the loan. Interesting how things change when there is an opportunity to learn what can be done to help reduce the costs. It would be good to have someone outside look at this with "new eyes".

0

Ray Cartwright 2 years, 9 months ago

“I don’t understand how the commission could vote against free information,” Rohrich said. I wonder what free information he is talking about as the article said something to the effect that the review would cost between $15,000 to $25,000. I guess that is free in some people's eyes.

0

David Moore 2 years, 9 months ago

"However, grant funding is available through the Statewide Emergency Medical and Trauma Services Council for up to 100 percent of the assessment cost."

Grants, that's how it is free.

0

carn 2 years, 9 months ago

Please look into RETAC, as well. I don't think Moffat County, sadly, is a member. I think Routt County is. Kind of a scaled down SEMTAC (Regional Emergency Trauma Advisory Council). Grant money available through RETAC. Also, look at some models of cities and towns your size and smaller. My city combined Fire and Ambulance years ago. Every engineer is at least a Basic EMT (most are EMT-I's). There is an engineer oncall 24/7, with a 'volunteer' force. The volunteers are mostly fire/ems, and there are two of them on call - plus the engineer - every day. Most are basics, some just first responders working on their basic. They willingly take at least one 24 hour call shift per month (most take at least 3). We are always staffed, and have 40 active responders. For a town of 7,000 people, that is pretty darned good . . . In fact, there is a waiting list to join. Hampered mainly due to equipment availability. They are paid minimum wage if they go on a call (minimum 1 hour). Our county is large (45 miles x 75, just guessing). QRT's in some neighboring towns.

Response times? Usually the volunteers are on scene before the ambulance (they drive POV unless it is an out of town call). I would say generally less than 5 minutes. If they DO get there before the ambulance, they are well trained and can initiate vital treatment (start CPR!) I think your commissioners are a bit in the dark here. Maybe they should listen to advice from an expert. Just saying . . .

0

truthhurts 2 years, 9 months ago

Just do the inevitable and ask the Fire Department to take it over and hope they are crazy enough to do it.

0

Rebelgirl 2 years, 9 months ago

The hospital does have a representative in RETAC. The reason they were looking into an outside agency to assess the local EMS agencies is to see if there was a way to subsidize the money involved. Dave and Highway you are both wrong to a point. A patient can refuse to be taken to the TMH ER if it is not trauma related. State statutes require all trauma persons be taken to the nearest facility. If it is a medical person they have the right to refuse transport, as long as they sign a waiver. With signing person agrees to pay the bill however. Insurances will not pay for a transport to an hospital that is at a farther distance when the closest one is capable of taking care of them. To my knowledge the EMS here has never bypassed the local hospital for no reason or just becuase they can. People need to realize these EMTs are risking their lives just as much as the persons when they are transported to a hospital outside of the county. If you stand by your word then please provide proof as here say does not count (even though it seems to be good enough for most). As for the hours you really need to do some research before making a statement of which you have no knowledge of. The operating hours of the EMS is 9am - 9 pm 7 days a week. There was 24/7 hour coverage but it had become to costly to maintain that. Not sure who told you the 6 - 6. All you would have to do is call the hospital and ask I am sure someone could have told you that. The rest of the time from what I have found is staffed, just not in the hospital. These EMTs are scheduled time slots and are responsible for answering the calls. As for EMS making more money for making a longer transport I ask that you provide proof. Insurances only cover so much and there is an increasing amount of people with no insurance at all. I am pretty sure a trip to TMH is a lot less expensive than one to YVMC or St. Marys. So again please provide proof for the claims that you make or keep your guesses and misinformation to yourself

0

Requires free registration

Posting comments requires a free account and verification.