Critical condition: What’s ailing the Summit County Ambulance Service
July 23, 2013
Editor's note: This is the first in a three-part series dealing with the financial problems currently facing the ambulance service, as well as the implications of and possible resolutions to the shortfall. Part two will deal with the impact of the budget crunch on local emergency medical personnel and the agency. Part three will cover a potential merger between the ambulance and fire services and other proposed solutions to the problem.
FRISCO — It's 3 p.m. and paramedic Billy Hanley is securing an elderly patient in the back of an ambulance, using Google translate on his iPhone to communicate with the man, who speaks very little English.
It's an improvised solution, but it's working and the patient is grateful.
He tells Hanley he is an excellent specialist.
But being able to roll with changing circumstances, like having a patient who speaks little or no English, is a crucial aspect of his job, particularly in a place like Summit County where so many people are visiting from somewhere else.
"That's a key component in being a good EMT, is common sense, street smarts and good communication skills," he says as he attaches electrodes to the chest, and sets up an IV to deliver potassium to his system. "You meet really cool people in the back of an ambulance."
The patient is suffering from colitis, a painful condition that causes an inflammation of the bowels, and Hanley has to be able to monitor his vitals and make him comfortable for the next hour, ensuring he receives the same level of care he would in a hospital.
This is a long-distance transport to Lakewood.
It's the kind of call that used to be the Summit County Ambulance Service's bread and butter, generating more than $3,000 in revenue — nearly double the income from a ride within Summit County.
"In theory this would be how you would make money to sustain an ambulance service," Hanley said. "But times are changing."
The recession, changing health insurance policies and a new, more capable hospital facility in Summit have taken their toll on the once self-sustaining government agency.
SCAS is one of the last remaining ambulance services on the West Slope that operates as an enterprise fund, meaning it's run by the county government but financed like a business. For a long time, the model was successful. SCAS's collection rates once dwarfed those of other counties, with the agency recouping nearly 70 percent of its billings while other services struggled to hit even 50 percent.
But then the economy changed directions. Fewer people came to vacation in Summit County and call volumes dropped in the High Country. A rise in unemployment meant that even when calls did come in, more patients were uninsured or underinsured.
In addition, a growing number of people — roughly 15 percent of those SCAS transports — have health care coverage through Medicare, which pays out only 28 cents on every dollar billed by the ambulance service.
"By accepting Medicare, we are legally obligated to completely write off the remaining 72 cents and cannot bill the patient for the balance," SCAS director Marc Burdick said in an email to the Summit Daily.
And revenue from SCAS's long-distance transports began to evaporate after St. Anthony's Summit Medical Center opened its doors, eliminating the need to take many patients to hospitals on the Front Range.
"The hospital opening was an extremely good thing for our community. It's exactly what our community needed," Burdick said. "But it affected us."
Burdick has found ways to continue to deliver the same level of service with far less money. Training budgets have been slashed, equipment and vehicles that would otherwise have been replaced have been allowed to age and positions have been eliminated.
But in 2012 SCAS faced a $347,000 budget shortfall, and had to receive a taxpayer subsidy from Summit County government. This year, the shortfall is expected to hit $430,000.
In the next few years, the gap is expected to approach $1 million, and county leaders are confronted with a difficult decision: how to save emergency services.
"This is largely due to continued increased expenses and a need to get back on track with capital," Burdick stated. "Also, the certainty of healthcare and reimbursements is not known and, given efforts to control costs, will only result in reduced revenues for ambulance."
The Summit Board of County Commissioners commissioned a study of the issue — dubbed the Almont report, which has not yet been released to the public — intended to explore a number of possible solutions, but officials say they won't be making a decision on how to deal with the budget shortfall in emergency services in the near future.
"All the communities around us have gone to some sort of tax support underneath in order to solve this problem successfully," Commissioner Thomas Davidson said. "But I don't have my mind made up yet. We're going to go slowly. We're going to be very careful and thoughtful with this."
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