County EMS committee continues to process data before plotting route forward
Editor’s note: The spelling of Memorial Regional Health spokesperson Becky Forney has been corrected in this story.
The Moffat County EMS committee has only begun to scratch the surface of the data collected to help determine what will be needed to continue Emergency Medical Services.
After the committee requested ambulance call data and financial information from all the entities currently providing EMS in Moffat County, they have the start of what will be needed to determine the next steps for financially sustainable services.
Eventually, the goal of the county-ordained committee is to determine how to move forward taking the service out of the hands of the hospital, which has said it cannot afford to keep running EMS at the estimated $600,000 annual loss it currently runs. A ballot measure to create a Health Services District failed last November, and the committee is working to find another way to ensure long-term ambulance service for the whole county.
Financial information was requested from Memorial Regional Hospital, Maybell EMS, and the Office of Emergency Management EMS reserve, to do a five-year side-by-side financial comparison. The committee also compiled financial statements from Memorial Regional Health dating back to 2013 in order to better understand financial trends for EMS services prior to COVID-19.
Sean Durham, CPA and committee representative from Hamilton, organized the financial information for the task force to conduct a more detailed review. Durham said at the committee’s meeting Wednesday that these financials may not necessarily answer all of the questions at this point, but they will give a clear understanding of what questions need to be asked.
Durham noted there was a significant change in the type and style of reporting between 2018 and 2019. Becky Forney, MRH representative to the committee, said that in 2018 and 2019 the hospital moved from Athena to Epic reporting software, which could account for the change in reporting.
According to the MRH financial review, as presented by Durham, there was a steady increase in gross revenues for EMS services until 2018, and, since 2019 there has been a steady decrease in gross revenue.
“As a business person, I have to ask myself, what changed?” Durham said.
The items where revenue losses occurred were contractual adjustments, purchased services, and personnel. Forney said that contractual adjustments are the amount of billed services that aren’t paid. From the financials, it appears that prior to 2018, those unpaid billed EMS services were not recorded, so now are showing a loss.
Karen Burley, a longtime EMS administrator and committee member, suggested the committee request a review of the billing company to make sure that everything that can be billed is being billed.
“There is an art to ambulance billing. It might be helpful to understand if the billing company is any good,” Burley said.
The committee agreed that Forney will help facilitate answers to all additional financial questions with MRH Chief Financial Officer Brittany Johnson before the next meeting time.
Personnel expenses have increased $160,000 since 2019, which EMS Manager Justin Doubrava, who co-chairs the committee, explained was the result of adding a second ambulance and 24-hour EMS services.
The committee wanted to better understand how the second ambulance and crew are being paid and dispatched. According to Doubrava and EMS staff, the first ambulance is a 24-hour crew consisting of one Advanced Life Services (ALS) provider and one Basic Life Services (BLS) provider. The first crew primarily covers 911 calls, transfers, and is the first dispatched.
The second ambulance, typically consisting of two BLS providers, is staffed from 9 a.m. to 9 p.m., depending on staffing availability, to do transfers and 911 calls when the first ambulance is already on call. The second crew is on hospital payroll and helps out in the ER, the medical-surgical area and other hospital back-up when they are not on a call.
The second batch of information, requested from the state of Colorado, reflects the numbers and types of EMS calls that have been served in the last five years by all of the providers.
The information can be used to determine the types of services needed and level of skill that will be needed to maintain demand for EMS across various sectors of the county. The report reflects the number of calls that came in when the second ambulance crew was staffed and when it was unstaffed or outside of the staffed hours, which will help to understand the level of staffing needed.
There has been an increase in the number of calls in Maybell and Craig since 2017. For Maybell in 2017 there were 26 ambulance calls, five refusals, no cancellations, and 21 transports. One call was a flight transport. In 2018, Maybell has the same number of calls with a very similar breakdown and 18 transports. In 2019, there were 24 calls with 12 transports. In 2020, the number of calls jumped to 48.
The volume of calls in Craig is much higher, between 1,000 and 2,500 calls per year, with more than 500 of the calls requiring an ALS level of care. The state reports are broken down further into whether it was a trauma call or whether cardiac services were needed.
The numbers also reflect the number of calls for EMS to perform inmate intake at the jail.
According to Doubrava, EMS was contracted to provide medical intake for inmates in 2017, then stopped providing jail intakes in April 2020 due to COVID-19, but has since resumed doing jail intake when staffing allows.
Jail intake includes taking a medical history, review of medications and assessment of physical and mental health. There were questions among the committee members about whether EMS services should be utilized for jail intake, what liabilities are concerned for the jail, and how the EMS crews are dispatched for jail intake.
EMS call information was received for Memorial Regional Hospital and Maybell EMS. The committee has not yet received call numbers for Dinosaur, which is currently provided by Gold Cross dispatched from Vernal, Utah, and based in Salt Lake City.
EMS taskforce co-chair Dan Bingham said he has reached out to Gold Cross both by email and phone several times since the last meeting and has yet to hear back regarding call numbers coming from Dinosaur.
Additional information was presented by Bingham and Burley regarding previous hospital bonds passed in 1988 and 1989 that are still in effect. Still more information is needed on the amount of taxes levied and how that money is getting distributed.
The hospital has also offered to provide the results from the survey conducted by MRH after ballot measures 6A and 6B failed to pass in November. The committee is still determining whether that survey will be useful for their purposes, but said they are willing to consider any data that’s available to them.
The committee plans to continue to meet every other week in order to get through the large amounts of information that need to be processed. The next meeting is scheduled for Thursday, March 24 at 6 p.m.
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