TOWER — Members of the Tower Ambulance Commission discussed ways to move to a higher level of emergency care, called Advanced Life Support, at their April 4 quarterly meeting, but not before Greenwood Township’s newest representative immediately broadcast a few complaints, then abruptly left shortly after the meeting began.
The commission was set up to deal with the purchase of new ambulances, but in recent years has seen itself playing a more advisory role as the ambulance service has struggled with financial problems. The commission includes one member from the city, Bois Forte Band, and townships in the state-mandated ambulance service area.
Even before the commission had approved its agenda, Greenwood’s new representative, Rick Stoehr, began asking about financial issues. Then he asked about funds that a City of Tower audit had shown had been taken from the ambulance service’s operating fund in previous years.
Tower Mayor Dave Setterberg, who was present but not on the commission, said the city is still reviewing the information.
“We still don’t know what the total is,” Setterberg said. “We are working on that.”
Eagles Nest representative Larry McCray reminded Stoehr that the commission’s job was to oversee the rig replacement.
Ambulance supervisor Dena Suihkonen reiterated that none of the funds eventually transferred came from the platform replacement fund.
“I made a commitment to the people of Greenwood to serve their best interests,” Stoehr said. “It’s unfortunate that you have the issues you are having. We’re happy to work with you, but I can’t commit to anything now.
Stoehr was also upset with the draft Ambulance Subsidy Agreement contract for 2022 which made changes to an indemnification clause inserted at the request of the Township of Greenwood last year.
“Greenwood Township paid a lot of money for the indemnification clause,” Stoehr said.
Tower commission representative Kevin Norby said the city attorney wanted to change the clause and said the two attorneys could talk to each other to resolve the issue. The city attorney felt the clause was too broad and assigned too much liability to the city, even for liability that might not be directly related to the ambulance personnel on the scene. The city presented a draft text that called for mutual compensation. The agreement also calls for the city itself to maintain general liability insurance for its services and to include the townships and band as additional insureds. The contract was presented as a draft and not as a final document.
Greenwood resident Lee Peterson, a frequent critic of the ambulance service, then asked why the ambulance service had not presented a business plan to the commission, which it had planned to do the year last.
Peterson was told there was to be no public comment at the meeting, and at that point Peterson and Stoehr left.
After Stoehr left, Setterberg noted that the business plan the city was working on, with outside help, was almost ready for revision.
The Commission members, minus Stoehr, then engaged in a lengthy discussion of issues related to the ambulance service.
The service is currently facing multiple challenges, including:
• Funding for a new ambulance.
• Financing of the cost of paid on-call duty 24 hours a day, 7 days a week.
• Increase the level of care offered (ALS service with paramedics) to meet the demand of an aging population.
On a positive note, Suihkonen said the department is currently well staffed with paramedics and EMRs, and also receives support from trained first responders from Eagles Nest and Greenwood Townships.
Suihkonen told the commission his staff were getting far more serious medical calls, including active heart attacks, strokes and diabetic emergencies.
“Ambulances are great,” she said, “but without the people who can operate the equipment, they’re just pieces of metal.”
By all accounts, the department has been busy, with a record number of calls in the first quarter, and also logged more than 90% of its hours with two on-call staff. But the push for the department to be fully staffed 24/7 comes at a cost, with on-call employees being paid $11 an hour, far more than the on-call rates paid in other small departments. neighbors.
While the staffing plan has helped the department avoid missed calls this year, it’s also operating at or below break-even.
“Our balance is low right now,” Suihkonen said. “But we have $114,570 in the ambulance replacement fund.”
More than 85% of service calls are paid for through Medicare or Medicaid, which pays a flat rate much lower than that paid by private insurers. The service won approval to charge a flat rate of $150, paid by Medicare, for calls that only require on-site treatment, such as lift assistance, and the city approved the rate increase for private insurance patients from March this year.
The service analyzed the financial impact of transfer calls, when patients are transferred from one hospital to another, usually when they require a higher level of care. The service will only respond to a transfer if there are enough staff remaining in the tower to respond to a 911 call.
The miles put on ambulances for these non-emergency calls were an issue with commission members, who demanded the city pay a rate of $1.66 per mile into the ambulance subsidy account for transfer miles recorded. This charge was an additional financial brake on the service’s net result. Suihkonen noted that the service has not made these payments so far in 2022 because the income is not available. At the current rate of transfers, the fees would total approximately $20,000 per year from the service’s general fund to the platform’s replacement account.
Suihkonen said the service mainly supports transfers involving local patients and does not make any long-distance trips. The service has made 14 transfers so far this year.
Upgrade to Advanced Life Support (ALS)
McCray noted that it was not the commission’s job to plan for the future of the service, but said he wanted to offer some ideas. McCray is a retired firefighter and paramedic and currently serves as the Eagles Nest Township Fire Chief.
He urged the group to look forward, not backward.
“Where are we going to be sitting in three to five years?” he said. “Are we still going to sit here figuring out how to get from $15 to $16 per capita, are we still going to fight with Tower about the dollars they lost years ago? I will be honest. What I’m really thinking about is a service SLA and how we’re going to get there.
McCray said such a move would be difficult, both financially and personnel-wise. Area ambulance services that provide ALS services are struggling to keep trained paramedics on staff, as many leave for higher paying positions in urban areas. Another challenge is reducing response times, which would mean staffing ambulances in other parts of the service area besides Tower.
“You’re going to have to think before you get there,” he said.
The first step would be the creation of a regional ambulance commission with joint authority, he said.
“It would make the service something we could all be proud of,” he said.
Funding should also be done differently, he said. A small tax levy based on property value would provide additional revenue, as it would not be tied to the number of full-time residents.
He said such a move would ease the burden on just one city.
“I don’t want to steal anything from Tower,” he said. “But if we’re going to grow this thing, it has to be bigger than what the city can generate.”
It would be possible to train current paramedic staff to the paramedic level with mostly in-house efforts, others said.
The members of the commission decided to return to their boards of directors to launch the idea of forming a regional commission, and possibly to create a new ad hoc committee to work on the idea.
“We would have more ambulances, better equipment and could do more rescues,” Suihkonen said. “If we can start from scratch, all the old stuff goes away.”
“We have to change the narrative,” said Vermilion Lake Rep. Frank Zobitz.
In other cases, the commission passed a motion seeking information from manufacturers for the purchase of a third ambulance with a new chassis, refurbished box and automatic loading bed. Suihkonen said the first all-new ambulance could be available in 2024, but a refurbished model will be available in 2023.
The commission seemed unwilling to waive the $1.66 per transfer mile requirement.
“When we have to pay for 24/7 coverage,” Suihkonen said, “transfers help us pay salary costs.”
She noted that the EMSRB study carried out on the service last year recommended stopping this charge, which they say has not been seen in other ambulance services they have had. studied.
“The EMSRB report indicates that the per capita amount needs to be increased and the $1.66 needs to be eliminated,” she said. “He said we need to look at our overall funding for operations, not just capital purchases. If we all worked together to make sure the service is the best it can be, we’d be better off than arguing.
Suihkonen said she was bothered that the service could not afford the $1.66 fee on the account. “We can’t make money out of nothing,” she said.
Norby said the service was running as little as possible.
“Our employees take great pride in their service,” Suihkonen said. “But when people walk out of the meeting not listening…it’s the people who look down and say you’re not doing enough.”
“We are here for our community,” Suihkonen said. “We need our community to be there for us.”
The next regular Ambulance Board meeting has been set for Monday, June 27, a week earlier due to the first Monday falling on July 4.