By Nancy Lindsey
LifeCare Medical Transports offered a proposal for addressing emergency medical services (EMS) problems to the Patrick County Board of Supervisors June 27.
The supervisors took no action following the presentation by Joey King, LifeCare vice president, and Ken Franklin, chief operating officer.
Board members have asked representatives of county rescue squads to present their problems and potential solutions at the July 11 meeting, and wanted to postpone a decision until after hearing those recommendations.
King said LifeCare, which operates out of Pioneer Community Hospital, is proposing to provide “a consistent level of service at the ALS (advanced life support) level,” with an EMS team consisting of an ALS provider, a BLS (basic life support) provider, and a certified driver.
The proposal includes placement and use of a “modern LifeCare ALS ambulance licensed by the Virginia Department of Health, Office of EMS.
“LifeCare maintains a registered operations location in Patrick County, Virginia with authorized operating authority from the Patrick County Board of Supervisors,” the proposal states.
It also outlines the modern EMS equipment maintained by LifeCare, routine safety inspections of ambulances, vehicles and equipment, compliance with “the EMS/Fire Command Structure for Patrick County, and association with the Western Virginia EMC Council.
King told the board that the hourly rate for an ALS-staffed ambulance and personnel is $60 per hour. If the board wanted the LifeCare ambulance to be staffed from 6 a.m. to 6 p.m. seven days a week, the cost would be $720 per day or $262,800 per year.
The schedule could also be adjusted as the board chooses, such as having the ambulance on call three days a week, King said.
The proposal also addresses response and billing information.
“Regardless of the patient’s ability to pay, LifeCare will respond to calls without delay, provide emergency care and transport to the appropriate hospital,” the proposal states.
“LifeCare will collect patient data and billing information,” the document says. “LifeCare will bill applicable insurance coverage for services rendered in accordance to Medicare guidelines. Co-pays will be the responsibility of the patient and/or responsible party. LifeCare will implement billing procedures consistent with Patrick County’s Standard Operating Guidelines, as long as the procedures are consistent with Medicare guidelines.
“It seems to me that it’s not cost-effective to run an ambulance for $60 an hour,” said Dan River District Supervisor Roger Hayden, board chairman.
“That’s less than half of the rate we charge” as a medical transport service, Franklin said.
Peters Creek District Supervisor Rickie Fulcher asked if it would be possible for the volunteer squads to share information about typical schedules so they could know, for example, if no one was available at a certain squad.
King said the squads should have a close working relationship and the ability to work together in that way.
Smith River District Supervisor Crystal Harris, captain of the Smith River Rescue Squad, asked if the volunteers could “jump in and help” LifeCare when the situation calls for it.
“Our doors are open for volunteers to step in and help,” King said. “Anyone and everyone can help out.”
In case of a serious accident or major emergency, the paid people and the volunteers would be partners with the focus on patient care, King said.
Harris said she had worked as a paid EMS provider for 10 years and a volunteer for 30 years, and had seen a lot of changes in standards and requirements. Steve Allen, emergency management coordinator, has been helping her catch up with her skills since she went through brain surgery last year, she said.
“You can’t stop and think about it,” Harris said. “It has to come automatically.”
Harris said having EMS skills reassessed on a regular basis “are to make us better providers, not to punish anyone.”
Developing a good relationship between a paid service and volunteers is a necessary step, Hayden said.
King agreed. “Volunteers should be admired and treated with respect,” he said. “They provide a critical service.”
Mayo River District Supervisor Lock Boyce said he thought the cost is “very reasonable” and the service would help cover emergency needs in the county.
“We have recruitment and retention problems,” Boyce said, “but we appreciate the volunteers for who they are and what they do.”
Blue Ridge District Supervisor Karl Weiss said the rescue squads have some of the “best equipment out there” and are just lacking enough volunteers.
“For nine years, I’ve been advocating a paid service to back up the squads,” Weiss said, noting that large numbers of patient calls have been missed due to volunteers not being available.
“We don‘t need to miss calls,” he said. “Someone could die.”
The paid service would need to be backed up by the volunteers also, in case of a major, catastrophic event, King said.
“In a case like that, you need hands,” King said. “It doesn’t matter if they are paid hands or volunteer hands, you’re just glad when they show up.”
Weiss expressed concerns about whether LifeCare would use “soft” or “hard” billing. Soft billing, which is used by most of the rescue squads in the county, means that a patient is sent up to three bills and, if he is unable to pay the charge, it is forgiven.
Hard billing generally means that the charge goes through the patient’s insurance company, and if it is not covered, it goes to a collection agency.
King said the charge may eventually be dropped if “hardship” can be proven.
The LifeCare proposal addresses the question in more detail: “…To overpursue and take the last few dollars from an elderly patient or out-of-work family is also unfair…LifeCare has created a highly sophisticated system employing people, processes and technology to ensure that every reasonable effort is expended to collect the amounts owed in a compassionate and respectful manner…
“After transport, a claim for ambulance fee reimbursement is submitted to the patient’s health insurance. Our billing system automatically bills the patient up to three times for any remaining 1-pays and/or non-covered charges, and we work closely with patients and families to establish practical payment plans for patients who have a fixed income or who may be indigent,” the proposal states.
