Increases cause Jackson to ponder EMS contract

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Increases cause Jackson to ponder EMS contract

fr EMSjackson When a funding request for Emergency Management Services came in for more than double what Jackson County is paying now, commissioners were taken pretty far aback, asking lots of questions about the justification for the $821,000 leap and setting the issue aside for a few weeks to investigate the options.

Ultimately, they decided to fund most of the $1.4 million request from Harris Regional Hospital — $1.16 million a $568,000 increase — as well as the full $1 million request from the Glenville-Cashiers Rescue Squad. The increases required a property tax hike of 1 cent per $100 of property value.

It’s a lot of money, commissioners were quick to acknowledge, but they felt stuck between the proverbial rock and hard place when deciding whether to come up with the extra money or deny the funding requests.

“I think we would be criticized more if we didn’t approve the additional requests than if we left them alone and didn’t approve them,” said Commissioner Vicki Greene.

The request from Harris stemmed from a three-fold cause. First of all, the EMS unit’s vehicles were getting old and in need of replacement, so Harris had asked for $450,000 to move all seven vehicles to a leasing system that would bring new vehicles to the squad. Secondly, no ambulance was stationed in the Qualla area, and Harris CEO Steve Heatherly told commissioners that current call levels warranted stationing a vehicle there to improve response times. Finally, after Harris gave all employees raises last year — including the paramedics — staffing costs increased. The hospital needed more money to pay its employees, as well as to add four full-time positions to go with the new truck in Qualla.

“It’s meant to do our job in terms of notifying the county as far as where there may be an opportunity to improve services, and we all together have to weigh the costs and benefits of doing so,” Heatherly said of the request. “To me that discussion is no different than if the county were operating EMS and the EMS director said, ‘These are my observations.’”

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Rather than operate its own EMS department, Jackson County contracts with Harris to provide ambulance service alongside the hospital’s medical transport service. It’s a win-win for the two organizations, with Jackson getting ambulance service for a cost markedly lower than what neighboring counties budget to operate their own and Harris enjoying a greater ability to operate the medical transport side. Given the rural nature of Jackson County, it’s questionable whether the economy of scale would be there to make hospital transport financially feasible without collaboration with the county.

Commissioners recognize they’re getting a deal through their partnership with Harris but discussed what they could do going forward to protect themselves from unnecessary costs.

“We’ve got a pretty good service out there now,” said County Manager Chuck Wooten. “It’s just we need to continue that service.”

“The other option is to do it ourselves,” said Commission Chairman Brian McMahan. “And the cost to do that — we don’t know what the cost is.”

It’s looking like commissioners are going to try to find the answer to that question. Rather than renewing their contract with Harris for five years, as they’d done before, they signed it for four years, which is the same length of time that the ambulance leases will last. Commissioners expressed interest in spending the interim looking at how much it would cost for the county to run EMS.

That doesn’t necessarily mean they’re hoping to do it more cheaply than the hospital does. Jackson’s neighbors, Haywood and Macon counties, both operate their own EMS services and pay much more than Jackson’s contract with Harris — $4.6 million and $3 million, respectively.

There could be benefits to a county-run service beyond pure cost, however. For instance, it’s not uncommon for newly hired paramedics in Jackson to move across county lines to Macon County once they get some experience, where the county-funded positions offer state retirement, health care and 401k match benefits.

“They come here, get some experience and then they go elsewhere,” Wooten said.

Commissioners pondered whether a county-run ambulance service could address that issue.

Paramedic pay in Jackson, however, is currently a good deal higher than what it was a year ago. After Duke LifePoint purchased Harris, it adjusted pay for all employees and then handed out a second round of pay raises to paramedics, who LifePoint found to be still underpaid compared to similar positions in the region. But that decision was largely responsible for the $164,000 budget shortfall Harris realized in its EMS services last year.

In the future, commissioners said, shouldn’t the hospital consult them before handing out pay raises that would ultimately affect what the county is asked to pay?

“I understand the reasoning behind the shortfall, but in some ways the shortfall was self-inflicted because they gave raises,” McMahan said. “The shortfall would not have existed if they had not given raises.”

Going forward, McMahan said, the hospital should present major spending increases like the raises to commissioners before making the final decision.

“We ought to have some voice in that,” McMahan said, “because in essence they’re going to make those expenditures and we’ll have to pay for it.”

In a way, Wooten said, the hospital did only do what it had to, as the organization was in a “state of turmoil” before Duke LifePoint took over.

“The only way to retain them (paramedics) was to pay them,” Wooten said. “Should they have come to us? Absolutely.”

Another part of Heatherly’s request had included a yearly “true-up,” in which the hospital and the county would sit down to compare revenues and expenditures for the year. The agreement is designed to come out break-even for the hospital, Heatherly said, with the county’s contribution plus revenue generated from ambulance and medical transport offsetting expenses. To carry out that intention, the two parties should review the books each year, he said, with the county paying for any shortfall and the hospital handing back any profit.

Keeping it break-even should indeed be the goal, Wooten said, but that policy should include protections for the county.

“My only concern there is I think we ought to cap expenditures because I don’t want to give somebody a blank check,” he said.

Perhaps a better arrangement would be for the hospital and the county to split any money that’s left over at the end of the year, giving the hospital incentive to curb spending.

“That seems to be a better approach than sitting here figuring out expenses and revenues and if there’s a shortfall we just write them a check,” Wooten said.

Glenville-Cashiers Rescue to add a crew

At the same time that Harris Regional Hospital is saying the ambulance service needs an extra $568,000 to do the job, the Glenville-Cashiers Rescue Squad is asking for a $379,000 increase to its budget to add a second ambulance crew.

According to Jeremy Stewart, the rescue squad captain, the second crew would alleviate overtime spending — which this year came in at $111,000 — while also allowing the rescue squad to move to a scheduling system similar to surrounding counties, making it easier to secure part-time help.

Adding the second crew would also improve call times, as now so much of the slack has to be picked up by on-call employees who might be 20 minutes away when they get the call.

“If that happens to be a heart attack call, there’s not that much we can do when we get there,” Stewart said.

For now, Stewart is planning to house the second crew at the existing rescue station. However, the rescue squad is in the process of planning and fundraising toward a new substation in Cashiers. Ultimately, the second crew would move there.

“All of it will come from donations,” Stewart said. “We’ll do some fundraising and get that word out as soon as we know our goal.”

The project is currently in the pre-planning stage, with no design or ballpark cost yet decided on. However, Stewart is hoping to see the project completed within a year or so.

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