City mulls options whether to keep operating ambulance department or not
In a work session the Nome Common Council discussed again whether to retain the city-run volunteer ambulance department or if it makes sense to hand the service over to Norton Sound Health Corporation,
which is eager to take on the task.
Although NSHC declined to meet with the city and ambulance volunteers, NSHC’s CEO Angie Gorn in a letter to City Manager Glenn Steckman addressed concerns that had come up in the previous work session, one being billing and coverage area. NSHC would continue the same area that NVAD currently covers. She said the billing would vary based on mileage and that the amount of out-of-pocket costs would be dependent on if the patient has insurance or would meet the sliding scale criteria. She added that the city has continuously pushed NSHC to answer the billing question and that “although you have shared your charge with the public, you have failed to mention to the public the support NSHC has provided for years at no cost, which has allowed you to charge below costs.” Indeed, Steckman said in the meeting that NSHC covers medical supplies, and medications needed in the ambulance vehicles, which represents significant savings.
With the city’s Finance Director Nickie Crowe present virtually, the council chewed on some numbers and it became clear that the ambulance department is run at a loss.
A significant number of ambulance runs are billed to Medicare or Medicaid, which only pay a set amount and the city is not billing the patient to cover the balance. Steckman presented the concept to transition the volunteer department to a professional department, staffed by five to eight EMTs to alleviate the strain on the volunteer force.
This would bring the budget up to over $800,000 per year for a fully staffed, professional ambulance department.
“How are we going to pay for it all?” asked council member Scot Henderson. If the call volume would go up, Steckman said, the city could bill more. Emergency Service Technician Rose Reale was in the audience and reported to the council that during the COVID-19 pandemic ambulance call volume went down. Prior to the pandemic, NVAD responded to about 700 calls annually, this year, they don’t even break the 300-call barrier, she said. Sometimes patients get themselves to the hospital, sometimes the police provides transport to the hospital. And lesser call volume translates into fewer billable responses.
Henderson said that if the city were to hire a fully-staffed ambulance department the rates would need to go up, and that, he said, was one of the public’s concerns if NSHC were to take over the ambulance.
Members in the audience were invited to voice their opinions. Danielle Slingsby, a 15-year volunteer with NVAD, said that it is a significant time investment to become an EMT and stay current on training and certifications. She said a staff of five EMTs and a few volunteers who only need a CPR card to be able to fill in as drivers would set the department on a good course. She was concerned that NSHC would staff their ambulance department with itinerant hires. “Most of the time we know who we are taking to the hospital,” she said, adding that the level of care locals provide may not be the case from out-of-town staff. Speaking for NSHC, Medical Director Mark Peterson responded, “Initially, we may have some itinerant staff, but our staff for the ambulance service will be full time in town, people. And that’s what it’s going to be. And people are excited about the opportunity to work these jobs. So we’re not going to be using any kind of longterm month-on, month-off staff. I brought that up last time. And I addressed the same question, from the same individual. And so I’m just making that clear: We’re not going to be using itinerants for any long period of time.”
Adam Lust commented that based on his efforts to try to find out from NSHC what the costs would be, he said, “If balance billing becomes a thing, I will say that based on the non- responsiveness of the hospital so far, not providing any kind of insight or information, I would have a much greater amount of faith in the city of Nome to run a lean efficient operation that is of the best value to the citizens of Nome.”
Ken Hughes commented that he appreciated the discussion out in the open and in this council setting and said that NSHC is a much more “closed system that doesn’t have any real public response other than the bottom dollar.” He also wasn’t opposed to raising the fees to recoup the costs to provide the service that the electorate supports.
Chuck Fagerstrom had a different view. He stepped to the podium and said: “A $159,000 loss? Does that mean anything to you? I say the city cannot afford it.”
In the end, Mayor John Handeland said he’d like to see a formal budget including a projections for a revenue stream and rates, as well as numbers on a department that may have five or eight full time EMTs on staff.
The next work session on the topic is planned for January.
Council member Henderson urged the council to make a decision soon and not kick the can down the road.