Lewis County Medic One has reported a steep drop in revenue since the beginning of 2014 due in part to recent healthcare reforms, as well as reductions in local call volume.
Discussed during the Oct. 21 meeting of the Medic One Interlocal Board, officials reported average collection rates for ambulance transportation have dropped from $702 per transport last year to $575 per transport this year, which has been compounded by a reduction in call volume experienced since July.
Operations Chief Grant Wiltbank said the drop in per-transport collections has been primarily a result of continued reductions in reimbursement rates from MedicAid, as well as the wider use of insurance companies with low reimbursement rates made available through the Affordable Care Act.
"Healthcare reform has allowed more people to pick other insurers that reimburse at lower rates," he said, adding he feels, "It's almost like the government put an un-funded mandate on us."
If current trends persist, Wiltbank continued, Medic One may experience a $95,000 shortfall in next year's budget, and officials are currently attempting to find a solution before they submit their 2015 budget to the state by the end of next month.
One cost-saving strategy Medic One has chosen to pursue is an amendment to an agreement with Napavine's Lewis County Fire District 5, which contracts for services from Medic One along with fire districts in Onalaska and Salkum.
Currently, Medic One responds to Advanced Live Support (ALS) and Basic Life Support (BLS) calls within District 5 and has agreed to pay $100 per call to the district while keeping any revenue generated from billing the patient.
Wiltbank said, between reduced collection rates and call volume, this current agreement is leading to an expected $42,000 net loss to Medic One this year, and it was proposed District 5 begin paying Medic One $630 per ALS call and $25 per BLS call while assuming the responsibility to collect from the patient. (It was noted these terms would be the same rates Onalaska and Salkum are expected to pay.)
Present at the meeting were District 5 Commissioners Kevin Van Egdom and Lyle Hojem, who explained, in light of the proposed change in the contract, District 5 has begun exploring alternative options for ambulance service so they can compare Medic One's terms to others available on the market.
Both Van Egdom and Hojem said they had not found reason to be displeased with the services Medic One provides, but said it remains their responsibility to spend taxpayer money prudently.
"We have no problems," said Hojem to the interlocal board, stating he feels Medic One has retained "excellent" personnel. "Everything works very well. But we are obligated to examine every possibility there is out there, and that's what we're doing."
Hojem also asked if District 5 was essentially being required to assume the same net loss Medic One is experiencing in collecting from patients, which Wiltbank said they were, while Business Manager Diane Wallace added Medic One is currently collecting an average of $542 per transport from District 5 compared to the $630 per ALS transport they would be asked to pay.
Acknowledging the need to move forward on the issue, the interlocal board voted that night to amend the contract to allow for the new payment structure, while District 5 commissioners met Oct. 23 and took no action regarding the amended contract and are continuing to explore alternatives.
Other budget-balancing proposals included the possibility of increasing fees for service to make up for lower collection rates, which Wallace said would more than likely result in increases to un-collected accounts rather than greater revenues.
It was also stated the agency could consider eliminating one of their eight paramedic positions, which Wiltbank said was not off the table but also was not an option he would like to single out, stating such a decision would have to involve conversations with the paramedics' bargaining unit.
It was also discussed by the board a significant source of revenue in the past had been interfaculty transports for local hospitals such as Morton General, which Wiltbank said Medic One is not in a position to pursue at this time.
Wiltbank additionally clarified the budget being proposed for 2015 is based on year-to-date figures, stating an increase in call volume in the coming weeks may provide more optimistic projections.
"I don't expect this to be a continual drought," he said, adding it would not yet be appropriate to craft next year's budget based on anything except present figures.
The projected $95,000 shortfall next year takes into account expected annual contributions from Lewis County Fire Districts 2 and 15, in Toledo and Winlock respectively, of $50,000 each through 2016, as well as a proposed contribution of $15,000 from Cowlitz-Lewis Fire District 20, in Vader and Ryderwood.
Commissioners in Districts 2 and 15 each agreed last November to the $50,000 per year contributions in an effort to help Medic One maintain a ninth paramedic position. While this ninth position was subsequently eliminated in August, Wiltbank said the contributions from the two districts, which their commissioners have indicated will continue as had been agreed, will be contributed instead to the general operation of the agency.
As for the $15,000 contribution from District 20, Commissioner Terry Williams told the board he does not believe such a contribution would be feasible as their 2015 budget had already been set and $15,000 would be nearly one quarter of their overall fire and EMS budget.
Wallace said the figure was meant to be preliminary and the interlocal board was expected to discuss their options before arriving at an approved budget, adding the total of $15,000 had been arrived at when taking into account the percentage of calls within District 20 as well as their ability to contribute funding.