Leader staff writers
With Medicare reimbursement cuts now in full force, Cabot, Lonoke and Sherwood must help subsidize Metropolitan Emergency Medical Services (MEMS) or look elsewhere for coverage, effective Jan. 1.
In the past, Medicare, private insurance and individual customers picked up the tab.
Sherwood and Cabot this week both agreed to pay more for the service.
MEMS asked Sherwood for $28,000 in support for next year, and the city council Monday quickly said yes.
“In light of what MEMS is asking other cities to pay, I think this is excellent, and we need to say yes before they change their minds and charge us more,” joked Alderman Becki Vassar.
Alderman Sheila Sulcer said the service the city has received from MEMS has been excellent. “We get what we pay for, and I want us to keep getting MEMS,” she said.
Aldermen Steven Fender said he was surprised that it took MEMS this long to ask cities to supplement its service.
“The amount that Medicare pays has dropped drastically over recent years and operation costs have gone up. I’m surprised it took MEMS this long to come forward,” Fedner said.
A resolution will be drawn up and the council will officially vote on it at their November meeting.
Cabot City Council members have unofficially approved rerouting unused funds in a maintenance account to pay the $50,000 annual subsidy MEMS has asked for beginning in January to continue providing ambulance service.
The proposal was passed to the full council Monday night by members of the budget and personnel committee, but the discussion beforehand involved every elected official able to attend the meeting.
All the council members present – Eddie Cook, Teri Miessner, Becky Lemaster, Tom Armstrong and Ed Long – agreed that the proposal should be voted on next Monday during a special council meeting that had already been called to discuss insurance for city workers.
If it passes as expected, half of the $100,000 or so in property tax revenue that now goes for maintenance of the health department, library and senior citizen center will go into a public safety fund to pay the MEMS (Metropolitan Emergency Medical Service) subsidy. The service needs the subsidy because the cost of providing service to Cabot is more than the income.
By working smarter and more efficiently, MEMS forestalled for several years the all-but-inevitable subsidy requests, MEMS executive director Jon Swanson has said.
But now MEMS has asked Lonoke for $87,000 for 2008, Cabot for about $50,000, Sherwood $28,000 and further west, Maumelle $63,000—each based upon projected revenues and expenses for its specific area.
As a department of the city of Little Rock, MEMS cannot operate at a deficit, according to Swanson, but it won’t abandon the towns that decide to look elsewhere.
It will charge a monthly subsidy equal to one-twelfth of the annual subsidy until the town gets a new provider, Swanson said.
Lonoke Mayor Wayne McGee said he’d been trying to contact some of the other ambulance companies “to explore our options,” but said Cabot’s bad experiences with two other area services is worrisome.
Lonoke, like other cities and counties in the state, is in the process of preparing its 2008 budget. As for figuring out how or whether to afford the new $87,000 a year expense, “We’re just getting to that,” he said.
“That’s a pretty big number.”
McGee said that Swanson and Jim Parks, Lonoke County’s representative on the MEMS board of directors, would visit soon with the city council to explain the situation in Lonoke in specific detail.
But McGee said he doesn’t doubt the ambulance service’s need for the money. “With all the cuts that’s coming down to them—that’s what they have to (do) to function.”
The volume of ambulance calls in the Little Rock, North Little Rock and Conway areas is sufficient for the service to break even there without subsidies, according to Swanson.
When the Medicare cuts began taking effect in 2002, Swanson visited the various city councils to warn them that eventual subsidies were nearly inevitable.
“In the late 1990s, Medi-care put the whole medical world upside down with its new reimbursement schedule,” said Swanson, but it wasn’t fully implemented until 2006. We estimate we get $1.4 million a year less since the rules changed, he said.
As a department of the city of Little Rock, MEMS cannot operate at a deficit, Swanson said.
MEMS’ creative cost-containment measures have drawn interest and visits from those running ambulance services around the country, he said.
They installed “black box” technology in the ambulances that lets MEMS officials record instances when the ambulances are driven too fast, corner too fast or are out of control. That measure has reduced accidents and has reduced insurance premiums by about 32 percent, he said.
MEMS has reworked schedules to be more efficient and now sends only emergency medical technicians (EMTs), not the more expensive paramedics, on routine transfers.
The service has started its own schools for EMT and paramedic certification and has purchased FEMA trailers for outlying posts such as the one at Lonoke, instead of paying rent.
The service is debt free to contain interest costs and for 10 years, starting pay for both EMTs and paramedics has been frozen at $18,105 and $24,260 respectively.
The board has voted to increase the starting pay.
For around-the-clock coverage, MEMS has 93 advanced life support crews and five basic life support crews spread across its coverage area, including Sheridan, Conway and Faulkner counties.
The metropolitan area averaged 918 annual runs per ambulance crew, compared to 594 for Sherwood crews, 490 for Cabot crews and 422 runs per Lonoke crew.
That’s twice as many runs per crew in the metropolitan area than in the Cabot area, showing that each run is more expensive in the less urban areas. System-wide, crews made an average of 720 runs a year.
