OL, PCH look for solutions
Following a recent disagreement over ambulance coverage in the county between Putnam County Operation Life and Putnam County Hospital, flared tempers were expected at a recent meeting between the two sides and Putnam County Commissioners.
Instead, cooler heads prevailed at the Monday, Dec. 12 meeting, with officials discussing the constraints facing medical providers in the current climate and seeking input from the commissioners on their expectations for the local ambulance service.
Commissioner Rick Woodall, who represents the commissioners on the Operation Life board, had called the meeting after the most recent OL board meeting. That meeting came following a particularly high-volume day in which Operation Life declined to perform an interfacility transfer for the hospital.
The refusal angered a number of hospital associates, who attended the board meeting to express their displeasure.
“It seems to me there’s a division that’s been driven between the hospital and Operation Life,” Woodall said in opening the meeting. “We need to get back to where we’re working together and not working parallel.
“I don’t want to do what we did last meeting,” Woodall continued. “I want to keep it civil and no finger pointing or anything like that.”
A relatively small crowd — 13 attendees not counting county of press officials — obliged, with PCH Executive Director Dennis Weatherford and OL Executive Director E.J. Claflin doing much of the talking.
Weatherford sits in a unique position in the discussion, as both PCH executive director and president of the board for OL. He explained that for the OL board, the current goal is to find the expectations of its various stakeholders.
In providing $80,000 in annual funding through the county hazardous waste fund, the commissioners are a significant stakeholder.
As federal reimbursements for Medicare and Medicaid runs continue to decline, a major problem facing ambulance services is simply finding a financial sustainable plan, both in the short and long term.
In doing so, Weatherford explained that Operation Life must prioritize the various services it provides. He said these fall into three categories.
The first 911 calls. As emergency calls from people who have not yet seen a doctor, these must remain OL’s top priority.
“We can’t leave the county uncovered,” Weatherford said. “We understand that.”
The second class of runs are interfacility transfers — mainly taking patients in emergency situations from PCH to other facilities where they can receive more advanced or specialized care.
While these remain extremely important, the fall below 911 calls in importance if only because the patients are already in a relatively stable environment and in a doctor’s care.
The third class of services are non-emergency transports between care facilities. These can include transports to and from nursing homes and are often for elective services.
Given current financial constraints, Weatherford said this sort of service is currently off the table for OL.
“We’re trying to set that aside as a board for right now and concentrate on the other two,” Weatherford said.
The problem is that even in concentrating on the first two, 69 percent of Operation Life calls are for Medicare or Medicaid patients. As the number of people on Medicare and Medicaid continues to grow and reimbursement falls, the situation gets worse for ambulance services.
Claflin explained that up until 2009, Operation Life had three ambulances staffed 24 hours a day, seven days a week. Additionally, there was another unit staffed in daytime hours that concentrated solely on transfers.
Finances have forced a reduction of these services. Now there are only two 24-7 crews and a third that is staffed for 18 hours a day, six days a week.
While such an arrangement works much of the time, it provides much less margin for error and pushes resources to their breaking point much more easily.
“The county needs three ambulances, 24 hours a day, seven days a week to ensure sufficient 911 coverage for the county,” Claflin said.
Claflin said that to get back to a third 24-7 unit would require $137,000 annually just in personnel costs, never mind additional vehicle costs due to wear and tear.
With that seemingly out of the question at this time, the question facing OL and its stakeholders is, at what point is it acceptable to potentially refuse a hospital transfer? With no devoted transfer unit, should OL decline a transfer that would make the last available ambulance unable to respond to a potential emergency elsewhere in the county?
The question was addressed by multiple parties, with commissioners David Berry and Woodall emphasizing that while the hospital should not be shortchanged, the top priority should remain emergency 911 service.
“I think we should always have an ambulance available to the county,” Woodall said. He added that he wasn’t sure what the determining factor should be if the transfer is also an emergency situation.
Through all these questions, one bigger one lingered over the meeting.
“Can Operation Life, as it operates now, sustain itself?” Woodall asked.
“We can tread water,” Claflin answered, “but the model as it stands now is not sustainable.”
Claflin added that the state is approximately 600 paramedics short, which puts a small operation like OL at risk of losing medics to larger, better-paying firms.
Weatherford added that the goal of the meeting was not to solve anything at this time, but to make the commissioners aware of the issues facing OL.
“They have provided exemplary care,” Weatherford said. “That’s in jeopardy. We’re going to need some additional resources to keep that going.”
Where those resources come from remains an open question.
Woodall said he attended a recent meeting of county commissioners from around the state, and asked fellow commissioners from around the state how much of the county budget went toward emergency medical service.
Answers ranged from none at all to hundreds of thousands of dollars.
Woodall said that Clinton County, which compares fairly well to Putnam as a rural county with the small city (Frankfort) at the center, pays more than $800,000.
Even so, where would such money come from with county government already strapped for cash? The public safety local option income tax, economic development income tax and hazardous waste fund all seem possible, but much of that money is already spoken for.
Municipalities helping with funding or even providing their own ambulance services — as fire departments do in some cities — was also mentioned.
These are all remain questions that may need to be addressed further down the road.
For now, the goal of the commissioners is for Operation Life to continue providing the best emergency service possible to the people of Putnam County.
“I still think it’s OL’s job to maintain 911 service,” Woodall said.