By Lon Anderson
Confusion over the recent actions and discussions of the County Commissioners concerning the ambulance service seemed to dominate the January meeting of the Hardy County Emergency Ambulance Authority at its meeting in Baker on January 15.
Just a week before the HCEAA meeting, the President of the County Commissioners, Harold Michael, proposed moving part of the Ambulance Authority’s billing and collections functions to the County Courthouse and criticized the cost of those operations. Additionally, the three Commissioners voted to put a referendum on the ballot in May to change the current Ambulance Fee paid annually by residents to a levy that would make it a tax and become part of property tax bills.
“Anybody read the newspaper article (about the Commissioners’ actions)?” asked Authority Member and Secretary, Doug Coffman. “It’s a real can of worms…I get the feeling they think we made some bad decisions,” he continued.
“That’s what they are insinuating,” responded Paul Lewis, Authority President, noting “that this leaves the
Authority’s receivables program up in the air.”
At the Commissioners’ meeting, Michael, who also serves as the Commission’s representative on the Ambulance Authority, said “the $35,000 we have already spent for (ambulance fee) collections is exorbitant. It seems way out of line.”
Derek Alt, HCEAA’s Emergency Director, explained to the Commissioners and reiterated to the Authority meeting that only about half that amount was for collections because the cost of the mailing the bills countywide was included.
“It’s most important for us to know what it has cost us to do the billings and what for collections,” Coffman said.
“I agree we need to breakdown the costs,” added Authority Member Fran Welton. “That’s how we should be getting the reports each month.”
“The computer system has a lot of this (information),” Alt responded, “I can give you some, but I just haven’t figured out how to pull it all down. Next year we’ll need to do more detailed breakdowns.”
As for moving part of the operations to the Courthouse, there was a lot of skepticism.
“It’s going to cost a lot more,” Alt explained, because they’ll have to add employees.
“They gave us this responsibility (billings and collections),” Coffman said. “Either it’s our job or it isn’t.”
Lewis agreed (the Commissioners) shouldn’t just take part of the operation. If they’re going to make this change, “I feel they should take the whole kit and kaboodle.” He then noted the problem of exemptions to the fees means it’s more than just clerical work. “The person working on them has to research each one and that they (the exemptions) have to be renewed annually by the (Commission) President.”
Further, he noted, the fees for businesses have to be hand-done each year because the fee is based upon the number of employees the business has.
There seemed to be agreement that, given the complexity of the operations, dividing up the location would be problematic and more expensive.
“It started three to four months ago,” explained Welton, who was referring to the Commission’s actions. “All of a sudden Harold wants to change things.”
“In the end, I believe our decision (on how to do billings and collections) was responsible and a good way for us to move forward,” Coffman said.
Discussion then turned to the difficulty and expense of seeking court judgements and then being able to collect from citizens not paying their fees.
“You get the judgments and then you can’t collect,” Alt said.
“Ideally, when you get a court order, they’ll see it’s real and pay up,” Lewis said, “although it will be different (results) for in-state and out-of-state (property owners). Probably most difficult will be the out-of-state (owners).”
There was also discussion about what chart software system they should be using in the future. This software creates and organizes electronic patient care reports.
Their current provider, Alt explained, is changing the system, and that’s requiring everyone to examine their options. Initially, Alt said, several jurisdictions were going to migrate to another system, but Fraley (Ambulance Service) has already backed out, Clark County has backed out and so has Grant. He noted that “now Fraley is going to another system, one that we’re looking at.”
“What are the costs?” asked Welton.
“$2,000 plus a fee for each chart,” Alt responded.
“Do we really want to get into managing another system?” Welton asked.
Alt said HCEAA will continue evaluation and discussions with other counties, and said will have more information in February.
The Authority is also considering revising guidelines for where one is transported (which hospital) in response to emergency calls, Alt told the meeting.
“Technically, insurance will only reimburse for transportation to the nearest hospital that can treat the patient,” Alt explained. Should the patient want to go to a different hospital that is further away, “the patient may have to make up the balance.”
“This is the general policy for everyone, but we can make exceptions,” he said.
“Aren’t you opening a can of worms with exceptions?” Coffman asked.
“Do we have legal counsel (for this)?” asked Welton. “I’d run it past your legal counsel.”
“Fraley’s has done this for years—taking patients to the nearest hospital that can handle the (medical) issue,” Lewis explained.
“What’s this change? It still sounds like a lot of judgement calls,” Coffman noted.
Alt indicated that the policy changes to the transport guidelines would be reviewed further before moving forward with them.
In other business before the Authority:
• Alt reported a large water bill is coming because a commode in the ladies’ room ran from November to January. The chain was catching, and the flapper was stuck open.
• Members voted to accept the only bid received for the sale of parts from one of their ambulances;
• There were no patient transports for the newly instituted “Home for the Holidays” program. That program was to allow the Authority, over the holidays, to transport patients in nursing homes to their local family homes at no charge. No one who was eligible applied, Alt explained.
• A motion was made and passed to pay the pending bills.
• Lewis reported that the County 911 Call Center is in chaos. He said the phone system is being upgraded.