Charles City, Floyd County approve 3-year AMR ambulance contract

By Bob Steenson, bsteenson@charlescitypress.com

It’s taken almost a year, but Charles City and Floyd County now have a contract with AMR ambulance that settles a number of questions regarding service, cost and coverage.

The three-year contract calls for the city and the county to evenly split subsidy payments to AMR of $150,000 for the first fiscal year, which begins July 1, $175,000 the second fiscal year and $200,000 the third year, for a total of $525,000.

That’s $262,500 each for the city and county over the three years, to be paid in monthly installments.

Council members and county supervisors have said they are satisfied with the service AMR provides, they just wish they didn’t have to pay subsidies to support it, instead of the service being self-supporting through fees it charges to people it transports, as it had been for decades.

The new contract says that American Medical Response (AMR) will provide at least one advanced life support ambulance with a crew having a paramedic and at least one basic life support ambulance with emergency medical technicians (EMTs), that will be available 24 hours a day, seven days a week.

AMR will also do hospital-to-hospital transports for the Floyd County Medical Center, including using the advanced life support (ALS) ambulance when medically appropriate.

The agreement was worked out over the last year between AMR and the Floyd County Ambulance Commission. The commission is a group that was formed in 1982 with representatives of Charles City, Floyd County and what was then known as the Floyd County Memorial Hospital, but it had not been very active until last summer.

Charles City Administrator Steve Diers has done most of the work negotiating with AMR to come up with the contract.

Last spring 2019 the question of ambulance service suddenly was thrust into the spotlight when AMR said it could not afford to continue providing service without support and while still paying fees to the city and county for various services.

Lower reimbursement rates from Medicare and Medicaid, and lower reimbursements from private insurers such as Wellmark Blue Cross/Blue Shield were not covering the cost of providing service, AMR said.

Mark Corley, then AMR’s regional director, said at a meeting last summer, “We’re upside down. We’re losing money every month.”

Charles City signed a contract with AMR for the 2019-20 fiscal year, agreeing to pay the ambulance service $50,000 and cutting almost $24,000 in fees AMR had been paying for ambulances to be housed at the fire station, for dispatch services and for firefighters to drive the ambulance to emergency calls within the fire district of St. Charles Township.

At the time, there was concern that the contract required the ALS ambulance to always be available in the Charles City and the St. Charles Township, meaning it sometimes was not available for emergency calls in the county or for transporting patients from Floyd County Medical Center who needed a higher level of care in a larger hospital.

At one point the ambulance commission sent out requests for information to about half a dozen regional ambulance companies, asking if they would be interested in providing service in Floyd County.

AMR responded that it was “very interested” in continuing to offer service in the area, and Area Ambulance Service, which provides service in the Cedar Rapids area and to Buchanan County, said it was interested in further discussions, but could not be ready for about another year to provide service in Floyd County.

None of the other ambulance services had any interest in expanding into Floyd County.

The Charles City Council passed the new AMR contract at its meeting Monday evening, and the Floyd County Board of Supervisors passed it at the board’s regular meeting Tuesday morning.

Included in the contract is a provision that the city of Charles City will provide additional space for AMR to use for its offices. Currently the company leases space at 801 Grand Ave., and the contract says that the city, county and AMR will split the $1,000 monthly cost of that lease for up to three months to give the city a chance to decide where AMR will be located.

The potential cost is $333.33 each per month for the city and county, or up to $1,000 each if it takes three months.

As part of the contract, AMR agrees to provide financial information including revenues, expenditures, total trip numbers and hospital-to-hospital transfers trip numbers to the City Council and Board of Supervisors, with an agreement that they will keep that information private as proprietary information unless ordered to disclose it.

Diers said Monday at a supervisors workshop meeting, “We’re putting money into this – direct dollars – so we really need to be able to see what those financials are to see how that all comes together so we can justify our financial commitment both from the city and the county.”

Keith Starr, a Charles City Council member and chairman of the ambulance commission, had said at an ambulance commission meeting last week, “I don’t know if I can sell it to the council without that.”

Supervisors also expressed concern that AMR does not accept assignment from the state’s largest insurance provider, Blue Cross/Blue Shield, meaning that if the insurance company doesn’t cover the entire cost of an ambulance bill — which it often doesn’t — the customer is billed for the remaining cost.

Diers said AMR said if they wanted the company to reduce its service charges it would require an even bigger subsidy.

The contract contains a list of AMR service rates for various services, with the note that prices will increase 5% per year over the three years.

For example, the lowest rate for a transport, a basic life support (BLS) non-emergency transport, is listed at $1,101, plus $28.11 per mile. Transport in the advanced life support (ALS) ambulance starts at $1,495, plus $28.11 per mile.

The most expensive transport, specialty care transport or neonatal transport, costs $1,692 plus $28.11 per mile.

Those are all the basic rates. Additional services, procedures or supplies are additional, ranging from $14.28 for a nasal airway supply (plus $156 to use oxygen) to $326 for a rapid intubation procedure (plus $364 for the ventilator).