By Kelly Terpstra, email@example.com
The future of critical life-saving ambulance service in Charles City and beyond is in limbo.
The fate of the service rests on decisions to be made in the coming months between the city and AMR ambulance, which saw its latest contract run out this past June.
“Bottom line, we need an ambulance service in Charles City,” said Marty Parcher, an AMR paramedic and Charles City firefighter.
What will happen if a new deal is not reached?
“That’s the big question,” Parcher said. “I don’t know.”
Parcher is one of two paramedics on staff for AMR (American Medical Response) in Charles City. AMR has provided ambulance service within the city limits and the surrounding area for more than 20 years.
The ambulance service continues to operate until a new contract is reached, but negotiations have stalled.
“We need to find some type of resolution here in the next two or three months, I would say,” said Charles City Administrator Steve Diers. “AMR needs to know what the plan is because right now they’re losing money providing the service. That’s something they’re not going to do forever. We’re trying to address a need that’s had a severe cost change.”
AMR is losing money because of increased costs and reduced reimbursements from the state’s privatized Medicaid system. AMR Regional Director Mark Corley told the City Council in August 2015 that the ambulance service operations in Charles City were predicted to work at an $87,000 deficit by the end of that December, well over three years ago.
AMR is now asking for a $125,000 subsidy from the city to continue its service in Charles City.
“It’s abysmal,” Corley said about the reimbursement rates from the managed care organizations (MCOs) that now run the state Medicaid system.
“It’s probably the primary driver for how we evolved to the point where we made the subsidy request,” he said.
Diers has suggested that the city and Floyd County could join to pay some amount, probably less than the $125,000 requested, but neither the city nor the county has decided on or approved a payment to AMR.
“We’re waiting right down to the wire here,” said Parcher.
There are many options that have been mentioned as a solution to keep ambulance service going in Charles City should there be no new contract reached between the city and AMR.
“Everything needs to be on the table,” said Diers. “Do we bid out the service? Maybe we should. Do we look at doing it in-house?
“We’re limited from the city side from a funding standpoint because we don’t have any additional levy authority to generate funds to pay for the ambulance,” Diers said. “So we have to figure out how we can try and work some of that into the existing budget — which is an incredibly difficult task — and/or look to partner with other entities to provide the service. That adds additional cost.”
Under the expired contract, AMR paid the city $25,000 yearly to keep its ambulances at the Charles City Fire Department, rent office space from the city and pay for radio dispatch services. The dispatch payment ultimately went through the city back to the county, which pays for countywide law enforcement, fire and EMS dispatching services through its general fund.
“You’re talking about a paradigm shift … from receiving $25,000 to having to pay $125,000,” Diers said. “That’s an incredible, large change. You can’t absorb that in one year. Essentially we’re looking at a $150,000 swing in the other direction.”
Diers has suggested that the city and Floyd County each pay AMR $25,000, but that hasn’t been an official offer.
“One of the things we’ve talked about early in negotiations is doing some type of ramp-up in that cost, to start doing something,” Diers said. “Maybe that’s where that $25,000 number in my head came to.”
Parcher, who is the Fire Department’s assistant fire chief, has been involved in emergency medical services for 32 years and a paramedic for 23.
“I don’t know of any other ambulance services that pay to be in a community. There may be some, but they’re not to my knowledge anywhere around here,” said Parcher.
Charles City is now the only city in Iowa where AMR operates. It used to provide service in Iowa Falls, but at the end of this month that city will run its own ambulance service.
The Iowa Falls City Council authorized spending up to $1 million to start its new service there.
Dawn Staudt, AMR station supervisor, said there are 19 crew members on staff in Charles City. She is the other paramedic alongside Parcher. There are four EMTs, two of those with advanced training, who work under Staudt and Parcher.
AMR responds to 911 emergency calls and also does transfers around the area. The transfers are not in the city’s contract that ran out this past June.
Diers said there are different ways to provide ambulance service. He said in many areas the county or a local hospital manages the service. Various cities run an ambulance service in-house or contract a private provider.
“I don’t know if there is a common setup,” said Diers. “That’s something that’s been at least discussed.”
This isn’t just a Charles City problem. The struggle to function in the black and make money is a uphill battle that ambulance services across the nation are dealing with.
Todd Prichard, Iowa’s House minority leader who represents District 52 in Charles City, said the lack of reimbursements for ambulance services is troubling.
“One, they’re not getting paid for Medicaid services; they’re having trouble getting paid for a lot of those transports. Two, the reimbursement rates haven’t been adjusted appropriately, to reflect the true cost of providing the service,” said Prichard. “This has been a particularly troublesome thing for rural emergency services. We’re going to continue to see more of this until the Legislature does something.”
Parcher said, “Technically, the city does not have to provide an ambulance service.
“It’s political suicide if they let it go away, I’m pretty sure,” he said. “This service has served two-thirds of Floyd County for 25 years. There needs to be some dialogue to figure out how to make this keep going.”
Prichard and some other Iowa legislators are trying to make it so ambulance services are considered essential services — meaning they would be required to be in operation in towns. Police and fire departments are examples of essential services in Charles City.
Diers said making emergency medical services a mandate in cities is fine in theory, but “then they have to give us the ability to fund it.”
“You get unfunded mandates that say ‘well, you shall do this,’” Diers said. “OK, well, let me do it.”
Prichard said the privatization of Medicaid has been a death knell for many ambulance companies in Iowa. He said the MCOs are “writing their own rules for what they want to pay.”
“It’s just wrong, and I’ve been talking about the lack of accountability in the system for years now,” said Prichard. “At some point we’ve got to restore accountability, otherwise we’ve endangered the whole health care system in rural Iowa. That includes hospitals, first responders, health care providers, and even routine, non-emergency services.”
Corley oversees nine AMR ambulance services in Kentucky, Missouri, Illinois and Iowa. He said he is optimistic a contract can be reached in Charles City. The current unknown in his mind is what the expectations will be for service here.
“My sense is that the city and the county and perhaps the hospital are having discussions about where do they want EMS to be in the future,” Corley said.
“These are always community decisions. They aren’t choices I get to make,” he said. “If the community wants to choose to do it themselves, then there you go. If they want to choose to have us do it, all we’re trying to do is to get them to see that it needs community support.”
How long can the current situation with the city and AMR last?
“How long do you want to lose money?” Diers said.