New tax would end EMS bills for Putnam County residents

Emergency medical service is a public good, just like police or fire service.

That’s the belief of Putnam County EMS Chief Kelly Russ.

“My biggest battle when I started going through grad school for public safety, my biggest goal was to make people realize that EMS should be a service like police and fire,” Russ said. “You should not receive a bill when you call the police. You should not receive a bill for your house burning down. You also shouldn’t receive a bill for EMS service.

“No one should ever have to think about how much an ambulance could cost them when they need it, or not calling one when they need because they think they can’t afford it,” she added. “Access to EMS should be exactly like access to any other public services, without additional worry in an already worrisome situation.”

That goal could be just around the corner based on a recent action from the Putnam County Council, which voted in principle last week to approve a new EMS local income tax (LIT).

Coupled with the new tax will be the new policy of not balance-billing Putnam County residents for services rendered by Putnam County EMS.

This means that county residents who utilize Putnam County EMS will have their insurance companies – including Medicare and Medicaid – billed by EMS, but no further bills sent to the patients themselves.

“If we submit an EMS tax rate, anyone who lives within Putnam County will never receive a bill if that day comes that you need an ambulance,” Russ told the council in December.

However, Russ said that what people are paying is an up-front “membership fee,” which is proposed at an income tax rate of 0.1 percent. For someone making $30,000 a year, for example, that would be a yearly fee of $30, and on up for higher-level earners.

“What we need to do if we implement this tax is let people know that by paying an extra $30 a year on up, you’ll never have an ambulance bill,” Russ said.

According to numbers Russ presented to the Council, the proposed LIT rate, plus insurance revenue, would bring in an estimated $2,460,740.87 annually, which falls about $253,716.13 short of the 2023 EMS budget of $2,714.457.

While this is still a shortfall, it is a far cry from the approximately $1 million estimate without the tax. The new tax should create far less of a stress on the county general budget.

Additionally, the actual rates charged by EMS – both to insurance companies and out-of-county residents – are set to increase significantly based on a separate action from the Putnam County Commissioners.

In reviewing rates, Russ said she found that Putnam County EMS was charging, on average, 92 percent less than other EMS agencies throughout the state. As such, she proposed rate increases of about 42 percent to bring in additional revenue.

“By raising the rates, we’re not raising the rates on Putnam County citizens, but on the insurance companies and people who we respond to emergently that live outside Putnam County,” Russ said.

Russ said the concept of not balance-billing local patients is a relatively new one that was pioneered in the Washington, D.C., area but is especially new to Indiana.

“It’s rare that EMS doesn’t balance-bill,” Russ said. “I think we’re one of the first – if not the first – in the state to do this.”

It’s part of a shifting landscape for providers in which government reimbursement rates have decreased in recent years, though a patchwork approach to EMS really goes further back. While police and fire protection have long been considered a public good to be provided by local governments, EMS did not emerge until the 1960s and 1970s, and even then under a variety of models — for-profit companies, nonprofit organizations and both municipal-backed and county-backed agencies.

Even in Putnam County, the nonprofit Operation Life served county residents until the end of 2019, when Putnam County EMS took over its operations. To this day, Roachdale-based nonprofit PMH serves the residents of northern Putnam County and further out on mutual aid calls.

For-profit STAR Ambulance also has a base in Greencastle.

Russ also noted that while the rate increases will help with insurance billing, the lack of charges to local residents won’t make a big difference, as patient pay was just 6.4 percent of total income for the agency in 2021.

“It is minute the amount of revenue we bring in every year of patients paying their bills directly,” Russ said. “It was so miniscule.”

Instead, EMS will have a more steady source of income, which Councilman Phil Gick in particular noted prior to approval as being a necessity. In the end, Councilman Jay Alcorn made the motion to institute, which was approved unanimously.

However, the action is not yet official, as the tax will be subject to public advertisement in the Banner Graphic as well as a public hearing.

After this, the council will have the chance to formally approve the matter.

Should the tax ultimately pass, Russ is hopeful about what it means for the future of her agency. On a basic level, it could help with wages as well as funding new equipment without financing.

Her bigger goals include adding a fourth truck in the Heritage Lake area – trucks are currently housed in Greencastle, Cloverdale and Bainbridge – as well as a community paramedicine program.

Such a program would be a proactive approach to health care that would, ideally, help with the over-utilization of emergency services.

Staffed by a team that would ideally include a paramedic, a social worker and a law enforcement officer, such a program could do home visits for high-risk patients, postnatal visits for new moms and babies and address mental health and substance abuse needs, as well as administer vaccines.

This last need was actually addressed similarly during the COVID-19 pandemic with in-home vaccines administered through the Homebound Hoosiers program.

Russ sees it as a back-to-basics approach to health care.

“Increase coverage and go back to old-school home visits,” Russ said.

For now, though, the first step is cleared, with Putnam County EMS awaiting formal approval from the County Council.