While a private ambulance company has bowed out of discussions with a citizens group, some residents believe the county has missed an opportunity to provide better service at less cost.
“The relationship … has to be a mutually acceptable agreement,” said John Byers, adding he commended the company for their position.
But the company had offered to take over the county’s ambulance service at no cost to the county. They offered to hire county employees, possibly at higher wages than offered by the county. And, they offered to pay the county the value of the equipment and assets for the department.
“This county could have another $1.2 million in the bank to spend,” said Tom Reigle.
Cumberland County Mayor Allen Foster said the ambulance service is operating at almost a break-even point from an operational standpoint; however, and the county is working on opportunities to increase revenue.
“Last year, we spent a little over $4 million and we collected a little over $4 million,” he said. “If we’re not operationally break-even, we’re right at it.”
The county has been funding capital purchases above the operational costs, such as new ambulances and more equipment.
Foster noted the Cumberland County Commission budgets very conservatively.
“We make sure that we’re not going to over run our expenses, and we make sure we don’t overestimate our revenue. If you do either of those things, you’ve got problems at the end of the year,” he said.
In December, the commission approved a resolution asking the state to increase funding for ambulance services provided to TennCare patients. Currently, TennCare pays about half the rate Medicare pays for ambulance services. EMS Director Chris Miller has been working with a coalition of ambulance directors to craft a resolution to present to the Tennessee General Assembly in January.
“That would be between $175,000 to $200,000 a year for our county. That’s a truck [ambulance],” Foster said. “We’ve improved the financial aspect of our service. We’re working on the response times.
“We’re not done.”
The county commission will begin working on its 2020-’21 budget in the next few months. Foster said he and Miller are still evaluating 2019 EMS data and will make budget recommendations based on the data.
Cumberland County hired a third-party billing company in 2014 to help process payments for services. That’s helped the county collect more revenue.
“We’re staying mostly caught up on the billing,” Foster said. “That’s been an important aspect of doing better financially.”
The county also removed more than $14 million in uncollected revenue in 2014 from the books. That followed a recommendation from the Tennessee Comptroller, Foster said.
“You have debt accumulate on the books that should be written off,” he said.
Much of the balance included the amount billed left unpaid after insurance payments were applied. Medicare and TennCare provide reimbursement and then bar the county from seeking the difference in charges and payment from the patient.
“It’s called ‘accept assignment,’” Foster said. “You are not allowed to charge the patient for that.”
The county removed $8.9 million in insurance balances that were more than a year old deemed uncollectible, $4.3 million in patient balances deemed “bad debt,” and $650,000 of legacy balance less than one year old but that had an estimated 10% return on the balance.
Foster was on the budget committee at the time.
“You look at it and think, ‘Wow, where’d this come from?’” Foster said. “But when you dig into it, you see it’s money we weren’t going to collect.”
Miller has been successful in bringing grant funds to the county to help pay for new equipment needs.
The county received a grant that covered 90% of the cost of purchasing battery-powered stretchers in 2018. The county covered the remaining $16,000 for the purchase.
He’s also applied for a grant to purchase a new power loading system.
“That’s going to become mandated,” Miller said.
Another grant provided $383,494 toward the purchase of 12 cardiac monitors and batteries. Cumberland County Cardiac Pulmonary Rehabilitation Alumni Inc. provided funding from donations, and a Volunteer Energy Cooperative CustomerShare grant purchased video laryngoscopes for all the ambulances.
That was critical equipment for the department, Miller said, noting securing a patient’s airway is one of the most important elements of emergency medical response.
Future needs include a device that mechanizes CPR, allowing the paramedic to monitor the patient and administer medication while ensuring chest compressions and breathing continues.