The Edgar County Board has scheduled a special meeting April 22 to decide if the five-year contract for the seven-township service area is awarded to the Edgar County Special Service Area Ambulance (ECSSAA) operated by Eric and Nichole Shaughnessy or the Horizon Health Ambulance based at Paris Community Hospital. ECSSAA currently provides ambulance service in the designated area.
County board member Derrick Lorenzen asked to table the decision at the Wednesday, April 10, county board meeting. He said discussion of the issue during the Monday, April 8, study session revealed board members still have questions and some more time is needed to reach a decision. The board voted to table the decision until 9 a.m. April 22.
A special service area consisting of Hunter, Stratton, Elbridge, Symmes, Grandview, Buck and Paris townships was formed late in the 20th century and the ambulance was operated for a while by Paris Community Hospital until hospital management asked to be relieved of the responsibility because it was too expensive. Residents in the special service area pay a tax to underwrite ambulance service.
The bids opened April 3 outline how each agency can provide ambulance service and how much tax money is needed to do so. Horizon Health’s proposal claimed an ability to provide the service without the use of tax money. The Edgar County Special Service Area Ambulance asked for $381,101 in year one of the contact and $386,116 the second year, $392,626 the third year, $396,145 the fourth year and $401,159 in the final year.
Public comment during the April 8 study session did not support awarding the contract to Horizon Health.
“You are required to take the lowest responsible bid,” said Kirk Allen. “The key word is responsible.”
He acknowledged board members are faced with an enticing offer of not taxing for an ambulance service while claiming that is not a responsible action because the ECSSAA will close if the contract goes to Horizon Health. Allen, who is the Kansas Fire Chief, claimed the departure of ECSSAA will hurt all emergency response because Horizon Health is not as well equipped as the present ambulance service. ECSSAA has five ambulances and two paramedic response vehicles based in Paris.
Allen presented official findings from an outside review critical of the hospital’s emergency room response and suggested coupling ambulance service with the hospital is not keeping the best care of patients in mind.
“Please don’t take ambulances out of this county,” said Allen.
Special service area resident Dale Muchow also had reservations about the hospital assuming emergency response with its ambulances. He said currently Horizon Health has two ambulances that handle transfers from the hospital to other facilities and ECSSAA responds to emergency situations.
Muchow expressed concern situations may arise where both of the Horizon Health ambulances are out of town doing transfers and not available for emergency response.
The bid specifications require the ambulance organization providing service to have three ambulances, with a minimum of two ready to respond 24 hours and day, seven days a week with the third as a backup. A paramedic response vehicle is also required by the contract.
Horizon Health employees responded to the issues raised during public comment.
Samantha McCarty is the hospital’s critical care unit manager and oversees the ambulance operation. She said the current business model for the Horizon Health ambulance is providing patient transfer, and winning the contract will require changing the business model to one where emergency response is the main responsibility. She added it may be necessary to temporarily contract with another ambulance to do transfers until such time as the Horizon Health ambulance can get fully reorganized.
Horizon Health CEO Ollie Smith did not dispute the findings Allen left with county board members while stressing Paris Community Hospital was one of only two hospitals in Illinois recently honored by the Rural Healthcare Association. He stressed management at Horizon Health is not the same as in the past, noting the Horizon Health ambulance will operate under the same oversight and protocols from Carle Foundation Hospital as the ECSSAA currently does.
County board member Phil Ludington asked about Horizon Health’s financial status.
“Are you so financially sound, you can turn down tax dollars?” asked Ludington.
Smith replied the hospital is Horizon Health’s main service and having its own ambulances is a way the hospital can help the community.
“It’s not just a matter of numbers anymore,” said Smith. “We get graded on quality for Medicare reimbursements. If we can run the ambulance without taxes, that is better for the people.”
Ludington expressed concern at some point, without tax underwriting, Horizon Health might find it necessary to charge so much for an ambulance call it either becomes a financial burden for the patient or the hospital will again want to drop the service. The discussion that followed by the Horizon Health representatives and Eric Shaughnessy revealed an ambulance can not randomly set charges because run costs must be justified to Medicare and the insurance industry based on actual expenses.
Early in the discussion, Shaughnessy confirmed the ECSSAA will close if it does not get the contract and tax subsidy to help with operating expenses.
Ludington asked Smith if Horizon Health will keeps its ambulances if ECSSAA gets the contract, and Smith said the hospital-based ambulances will remain in service regardless of the outcome.
“That (keeping both ambulance services in operation) seems the best service to residents,” said Ludington.
“The option here is to give taxpayers a break,” replied Smith.
County board member John Chittick questioned how much that tax break is likely to be. He said the tax liability for an average house in Paris is only $25 annually to support the ambulance. The tax rate on farm ground is calculated differently but is less than $1 per acre, he said.
“As a farmer, I grumble about taxes, but I also know that farming is the second most dangerous occupation in the United States and if we get hurt we are in the most isolated areas,” said Chittick.
Multiple other issues were raised during the discussion such as response time, what happens when people can’t pay the ambulance bill and if Horizon Health will take a patient to another hospital if that person does not want to go to PCH.
It was confirmed the patient, with some exceptions, has the right to dictate which hospital is the destination. One exception is trauma cases where oversight protocols for ambulance and hospital care requires direct transportation to the nearest trauma center even if that bypasses a local hospital like PCH.
The U.S. is also divided into hospital areas and PCH is in the same hospital area as Union and Regional at Terre Haute, Ind., so a patient in Paris can direct the ambulance to any of those three facilities. A patient in Paris cannot be taken to Carle in Urbana on the initial response because Carle and Paris are not in the same hospital area. A subsequent transfer to Carle after initial treatment is another matter.