Commentary on Moffat County Commission’s EMS decision
February 8, 2012
I've been made aware of the decision of the Moffat County Commissioners to refuse a request by county emergency management director Tom Soos and George Rohrich, chief executive officer of The Memorial Hospital in Craig, for a study of Moffat County's EMS.
This came to me via the Colorado Hospital Association's weekly newsletter.
I was then astonished when I read some comments that referred to the rationale that underpinned my decision in the early 1990s to accept the local EMS as a department, and I felt I needed to clarify things.
I believe it's very important the reason for the change in management authority of the EMS operation that took place circa 1990 be clarified.
At that time, the EMS physician advisor announced he was resigning, and a new physician had to volunteer and be appointed to fill that role.
The state stipulates each EMS program have a physician leader.
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The medical staff at that time rendered a decision that the only circumstance by which any of them would assume the role was if the EMS was a "department" of TMH.
Given the choice of not being able to sustain the operation of the service or embracing EMS as a department, my decision was simple.
The board of trustees supported the decision. It really had nothing to do with capturing revenue for the hospital, although I would say I was not resistant to the idea because there were opportunities to improve the quality of equipment, care and service that I believed I could champion as hospital administrator.
I don't remember being motivated to make a change because ambulances weren't coming to our emergency department. It was established protocol they come to TMH first, and further, I remember learning of patients who refused to be delivered to the TMH ER and EMTs insisting they had to come to TMH first.
Of course, I do not know what commitments were made in 2007 with respect to the EMS continuing to be wholly financially supported by TMH, and I'm not certain that is even germane to the request for the examination by Rohrich and Soos.
It's rare that a hospital operates an ambulance department in rural Colorado and there's good reason for this.
I'm confident George has explained this to the commissioners and I currently have this same conundrum here in Gunnison.
TMH and this hospital are licensed Critical Access Hospitals. That means our presence is vitally important to the health and welfare of our community and as such, we are paid 101 percent of our Medicare allowable cost for the care we provide to Medicare patients.
All costs, including all overhead, associated with operating the ambulance service are disallowed by Medicare. Therefore, our hospitals receive less reimbursement for the inpatient care provided because of the operation of the ambulance service.
Our estimate here is that it costs this hospital $100,000 per year in lost Medicare revenue because we operate the EMS as a department. That's $100,000 in federal funding our community deserves and that can be brought into our respective counties for the benefit of the health of everyone.
It does not surprise me TMH would have much more to gain because TMH has twice the Medicare revenue.
So, Moffat County and Gunnison County need to examine carefully the possible alternatives for operation of EMS so all citizens benefit and the quality is maintained.
This does not necessarily mean the county or fire district has to take responsibility. Here, I am toying with the idea of a separate non-profit for the operation of all of our departments that are disallowed as costs by Medicare (including EMS).
The board of trustees can serve as the non-profit board so there is governance and operational integration but financial separation.
Of course, Moffat County should come up with its own ideas and, to my way of thinking, this is a strong justification for the requested study.
In our case, we understand we are still going to be responsible for the direct operating losses, but at least the total loss will be offset by the improved reimbursement by Medicare for other services we provide.
This is a complicated subject that requires focused study.
That is what I perceive has been recommended.
So, I urge commissioners Tom Gray and Tom Mathers to reconsider their decision in the context of exploring the opportunity to enhance the federal funding that could be brought to Moffat County in support of TMH with no new strings attached, particularly in view of the changes that are coming in health care reimbursement.
Randy Phelps served as chief executive officer of The Memorial Hospital in Craig from 1987 to 2005. He is currently the CEO of Gunnison Valley Health in Gunnison.