Keeping a local ambulance service operating, but halting the drain it has on the hospital, was the major focus of the Fulton County Hospital Board meeting Dec. 17.
A working committee consisting of hospital board members Danny Perryman, Vicki Fowlkes and hospital board chairman Barry Aldridge will put together a proposal to be presented to the Fulton County Quorum Court asking the county to reassume the oversight of the Fulton County Ambulance Service.
Aldridge, told members he had addressed the Fulton County Quorum Court Dec. 10 about the possibility of the county taking the ambulance service back over. Aldridge said he would like to see the county become the governing entity with the hospital retaining the administration services for a small fee from the county.
"The hospital could work out a lease with the county, where we would handle the billing for the ambulance service," Aldridge said. "A separate computer and software as well as a person to handle the billing for the ambulance would have to be put in place. That's what the management fee from the county would cover. We are hoping to find that fine line where it's profitable enough to pay us our lease for the management fee and also make the county a little bit of money."
"We do not want to put a burden on the county," Aldridge said. "I think the hospital should set up a contingency fund to assist the county with its fees. It may be we would have to assist the county for one or two months until the Medicare, Medicaid checks come in and the ambulance is back in the black. Then that money would come back to the hospital in the form of the management fee."
Aldridge said that by restructuring the ambulance service into an entity separate from the hospital, the ambulance service and the hospital could both profit.
"I think the two organizations should try to work together. Basically it's a matter of paperwork. The government allots money to rural hospitals and rural ambulance services and the way we have are system set up now, having the two combined, we're missing or leaving, $220,000 or more per year, that the government is willing to give Fulton County. It's been that way for the last four years," he said.
Fowlkes said that there would have to be some numbers estimated that could be shown to the quorum court. "In reality, unless we can show on paper, in black and white, what the county as an independent entity is going to be able to collect, than nobody's going to want it," she said.
Discussing the possibility of a private ambulance service for the county, board member Albert Roork said that in almost all cases where a private ambulance service is used, a subsidy is in place to help pay for this service.
"In Izard County, they bill Medicaid, Medicare and private insurances, but every household down there is taxed $50 (a year for ambulance service). The way that works is, in my understanding, if you need an ambulance in Izard County, if you are a member of that household, your trip within 60 miles is free. They do not bill you. (The $50 fee) is for one time or 10 times. They're allowed to bill your insurance, but they're not allowed to bill you," he said.
"That's probably a pretty good deal. A lot of us are members of Air Evac and we pay our membership fee each year, and if we need them they fly us wherever we need to go. Instead of having a $12,000 helicopter bill, we don't have anything additional. It's a good deal if you need it. But, I don't think a private service is going to provide the service without a subsidy," Roork said.
"(A private ambulance service) provides the service, but they are not going to provide the level of service that our local paramedics provide. (With our own ambulance service) you are getting just a little bit more brother-in-law care," Roork said.
Aldridge said another important aspect to look at when considering a private ambulance service is the fact that a contract would have to be renewed every couple of years. "We've all read about what kind of a nightmare that is. Every two years they're looking for another service to come in. Those people won't know the area like our people do, they won't give the service like our people do," Aldridge said.
"Another thing we have to consider in this, as well as letting the Quorum Court know as well, is that your ambulance service as of right now, is one of the top companies in line to provide ambulance service to one of our bordering counties in Missouri. And that county has a huge tax revenue set up and allotted right there for the ambulance service. It could be a very profitable situation for the county," Aldridge said.
"I don't know if an ambulance service is going to be profitable, but if we could get it to break even, I would be happy," Roork said. "Historically, those things are not profitable."
Fowlkes said that the quality of care to the residents is a main concern but, "if the county doesn't take back the ambulance, we cannot afford to run the ambulance. Then, we may have to look at leasing it out. We know and understand, that if we do that, more than likely it will not be the quality of care that we have with our own people running it. But, we may not have another option to keep an ambulance service."
Roork pointed out that if an ambulance subsidy is needed it would have to go before the people and that would take time, possibly a year. "Time is money for us," Roork said.
He suggested that the board talk with a private service such as AET, which covers Izard County, to see what is available. Aldridge said he would like to pursue the arrangement with the quorum court.
"I'd like to see us keep our Fulton County money here, and not send it to another state, which is where most of these big private ambulance services come from," Aldridge said. "If we can get the ambulance service separated from the hospital, back into the county, there could always be a subsidiary looked at later. It could be a volunteer subsidy that people could add to their taxes if they wanted. I've heard about places doing that to generate some funds."
"The ambulance service is not the hospitals'. We've managed it for the county for a number of years and we've suffered the financial downfall because of it," Aldridge said.
"The bottom line is," Roork said, "we've got to have that thing (ambulance service). Everybody here knows someone whose life has been saved because of it. We've got to keep it going 24-hours a day."
In other business, the financial statements show that the hospital had a revenue of $879,510 for the month of November, up by $41,831 from November of 2006. Bottom line shows the hospital at a $12,783 profit for the month of November. The hospital now owes $207,363.26 to the Bank of Salem through a line of credit issued to the hospital. This figure is down from last month's total of $264,363.26.
The hospital's billing cycle has been reduced again and is now at 60 days. Accounts payables for FCH have also been paid and reduced to a 30 day cycle.
The doctor's report for November shows: Dr. Griffin Arnold admitted 33 patients and made 124 emergency room calls; Dr. Jim Bozeman admitted 20 patients, with 98 ER calls; Dr. Michael Moody, 0; Dr. Rebecca Phillips admitted 6 patients and made 109 ER calls; Dr. David Kauffman, 0; Dr. Kuzas, 47 ER calls.
Emergency room visits are up from 346 in November of 2006 to 411 in November of 2007.
Ambulance trips showed a substantial increase over last year with 102 in 2007 and 51 in 2006. Of those calls, 30 were emergencies to FCH; 22 emergencies to other hospitals; 4 transfers were made to nursing homes; 23 to other hospitals; and 23 to other facilities or homes. A total of 7,600 miles were logged by the ambulance service in November, compared to 3,610 in November of 2006.
A total of 56 patients were admitted to the hospital in November, down from 79 patients one year ago. Of those 56, 44 were Medicare patients, 7 private insurance (Medicare), 2 insurance, and 3 cash customers.
The new addition is continuing ahead of schedule, however, a problem with asbestos in the glue on the original hospital flooring has been found. Board member Jerry Blevins said an additional $5,000 will have to be used to fix this problem before the remodeling of the hallway adjoining the new and current addition can be completed.
Co-interim administrator Dona Hodges said that contrary to rumors being circulated there have been no employees laid off at the hospital. She said that employees were asked to make more efficient use of their scheduling hours. She said by doing this, they have been able to cut back on a large amount of overtime hours being paid. Hodges said there have been a few positions where an employee who has quit has not been replaced.
At 8:23 p.m., the hospital board went into executive session to discuss an applicant for the administrator's position as well as another personnel matter. Aldridge said Tuesday that Denice Innis had stepped down as co-administrator.