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Calhoun citizens have been fortunate to have prompt ambulance service, while several regional counties rely on part-paid and volunteer staffing to respond, often causing delays, or in some cases limited ambulance service has been provided by companies that stations ambulances in rural counties.
Minnie Hamilton Health System has stepped-up to the plate after the default of Calhoun EMS, providing ambulance service with trained crews from multiple stations, issuing the Calhoun Commission monthly statistics regarding their operation.
Those statistics indicate continued improvement with response times. MHHS has purchased two new ambulances, expanding the ambulance fleet from three to five ambulances and maintaining 24-hour crews at both stations.
The renewal of the 5-year levy on Feb. 1, which does not increase taxes, long supported by county voters, will give MHHS some funding to continue the level of service.
MHHS CEO Steve Whited said, "MHHS has made a promise to the county that we would step up and provide necessary ambulance services for the citizens."
The levy has been to fund the county's fire departments, ambulance service, law enforcement (deputy), and a small amount for holding elections and supporting the Office of Emergency Services.
The Feb. 1 levy has been renamed Emergency Services and Criminal Justice Levy, with a re-allocation of levy money to help pay a full-time prosecuting attorney, whose felony caseload has increased 300% in five years.
MHHS is facing at least two big financial challenges providing ambulance service to the county.
About 18% of the calls made by MHHS are not eligible for any kind of reimbursement.
Calhoun citizens, unlike several regional counties, are accustomed to calling ambulance service for well-being checks, "fallen and can't get up" calls, the ambulances providing stand-by services for numerous emergency situations, in addition to numerous other occurrences.
The ambulance service funding, which has been reduced from the former levy call to about $85,000 annually, will help support the broad delivery of service which helps citizens.
Another major concern is discovering that Cost-Based Re-immbursement for hospitals has glitches, and that many calls made by MHHS are not eligible for a higher rate of reimbursement. (See explanation further in story)
CHALLENGES FACED PROVIDING EMS
Steve Whited, Minnie Hamilton CEO, provided the following information about the facilities EMS efforts:
The billable calls are those in which the patient is transported to a receiving facility or destination. There are several variable to receiving payment for services.
The patient must have insurance coverage that includes ambulance services. In the event of private pay (no insurance), many patients cannot afford to pay for services.
The payer mix for medical insurance coverage is highest for Medicaid and Medicare, with private insurances (BC/BS, PEIA, etc.) being the lowest.
Mileage charges are billable, but must meet certain rules. Patients are free to choose their health facility to be transported to, but insurance/Medicaid/Medicare reserve the right to only reimburse mileage to the nearest facility.
So, if all of your health treatment has been in Charleston and you wish to go there, we will take you there. But, if MHHCC or Roane General can provide the treatment, insurance will only reimburse the shorter mileage to the local facility.
In order to bill for ambulance services, patients must be deemed as medically requiring an ambulance. This means that they could only be moved by a stretcher and could not stand, sit, or ride in a car. Otherwise, MHHS will not be reimbursed for services provided.
Reimbursement is for a flat fee and mileage only. Equipment and supplies used are not recoverable costs. For example, a patient with a headache that receives a smooth, quiet ride to the hospital might o be reimbursed the same as a patient who could be bleeding to death and requires numerous bandages, drugs, IV's, and heart monitoring.
Of course, this depends on the level of care necessary and provided, but you see the point.
Non-billable calls are ones in which the patient is not treated or transported. Examples included situations in which a patient is not found, did not require an ambulance, or refused services.
This also includes situations in which the patient may be deceased on scene or is transferred to a helicopter from the scene and was not actually transported by ambulance.
(Non-billable calls include well-being checks or the ambulances responding on stand-by for responders at emergency situations.)
In some of these cases, equipment and supplies were utilized but cannot be billed to the patient for reimbursement.
Operating an emergency medical service is not a profitable venture for any agency to undertake.
However, it is a necessary service that must be available to ensure the continued life safety for individuals in an emergency situation.
There are many costs that simply cannot be passed on to the patients or their insurance providers. This includes vehicles (new ambulance is around $100,000), equipment (approximately $40,000 per ambulance), staffing, operational bases (rent, utilities, etc), preventive vehicle maintenance, fuel (approximately $2,000 monthly), and supplies (estimated at $3,000 per month).
As it stands now, nearly one in five calls cannot be billed for services provided.
But, in the event of an emergency, we all need the reassurance that someone will come to assist us, even if we are not significantly injured.
Now, with the implementation of the Affordable Care Act, there are more questions than answers regarding the reimbursement for emergency medical services.
Minnie Hamilton Health System has made a promise to the county that we would step up and provide necessary ambulance services for the citizens.
To date, we have done everything that has been asked of us and exactly what was promised. We have invested in the ambulance service by purchasing two new ambulances and strategically placing them in areas of the county that provide the best access and response times to citizens and visitors.
We have expanded the total fleet of ambulances from three to five in less than six months time. We have built a relationship with elected officials, law enforcement, 911, and fire departments in order to provide the best possible services to everyone, regardless of their needs.
The levy money provides a base for operations that enable us to continue to meet the needs of the citizens today and in the future.
It is a vital component to the continued success and stability of our operation.
Currently, our operation is configured to provide the maximum amount of ambulance coverage in a financially feasible manner. Much consideration has been given to operations and public safety. We continually evaluate our progress to identify our strengths and improve our weaknesses.
Without the levy money, the provided ambulance services may certainly face a time in which we simply cannot meet our patient care goals or the expectations that many in the County have come to appreciate.
Cost Based Reimbursement:
As a Critical Access Hospital, we are able to recover our true and actual cost incurred for all Medicare and Medicaid patients due to our rural designations.
However, there is a separate "35 mile rule" for ambulance services to be reimbursed their cost, meaning that there cannot be another ambulance station within 35 driving miles of any of MHHS stations.
This has disqualified our ambulance service from cost based reimbursement, meaning that we are at a severe disadvantage from other state ambulatory services that operate in a much more urban environment due to the volume of calls.
There is a specific amount of fixed costs that come with running this service, and without our cost based reimbursement, it would be near impossible to operate a fully functional 24/7 ambulance service without some additional sources of revenue.
We are hopeful that county voters understand that levy money is now needed to help us maintain our commitment.
See CALHOUN VOTERS ASKED TO RENEW LEVY ON FEBRUARY 1 - Levy Will Not Increase Taxes | 
