Okaloosa EMS continues to face many challenges

Feb. 11--The $800 base rate charged to each patient transported in an Okaloosa County Emergency Medical Services ambulance likely will not be reduced anytime soon, county officials say.

The County Commission approved the rate in July 2013. The revenue helps cover the costs of the high-priced ambulances as well as the life-saving medical equipment and highly trained paramedics and emergency medical technicians on board, Commission Chairwoman Carolyn Ketchel and Deputy County Administrator Kay Godwin said Thursday.

"We're not in a position to lower the fee," Ketchel said. "So many people have asked us to do that."

Ambulance fees and staff shortages are among a slew of issues county officials continue to examine to improve EMS operations. For example, Ketchel said she hopes a possible voluntary ambulance insurance program that could reduce the sticker shock of an ambulance ride will be implemented by this summer.

In addition to the $800 base rate, a patient who is taken by ambulance is charged a mileage fee of $15 per mile. But just because the county charges those fees doesn't mean it receives them. Its fee collection rate is only about 37 percent, Godwin said.

"Many people cannot afford to pay" even if they are put on monthly payment plans, Ketchel said.

Godwin said the low collection rate is a big factor why EMS is not self-sustaining.

Another major problem is an 85 percent staffing shortage.

"Our turnover in EMS is with the paramedics and EMTs," said Godwin, who noted that currently 12 of the EMS' 82 full-time positions are vacant. Seven of the vacant slots are EMT positions and five are paramedic positions.

The county has 11 EMS stations and 11 ambulances. Each ambulance has a crew of two, with either two paramedics on board or one EMT and one paramedic. In the latter scenario, the EMT is the driver and support technician and the paramedic is the primary health care provider, Godwin said.

A county report prepared for the County Commission's Jan. 31 workshop on EMS issues cited job burnout caused in part by long shifts and excessive overtime as a big reason for the employee turnover.

That turnover and the fatigue of remaining employees has led to other challenges.

"With the staffing shortages right now, we can't do all of the inter-facility transfers that we would like to," Godwin said.

An example of that type of transfer is moving a patient from a nursing home to a hospital. Many of these transfers are high-mileage/high-cost moves from local hospitals to specialized hospitals, such as to a burn center in Augusta, Georgia, as well as to other facilities in places such as Gainesville, New Orleans and Birmingham.

"For those types of transfers, our collection rates are higher," Godwin said. "We want to provide that service. Right now, many of those transfers are going to other providers. We could improve our revenue if we could do them ourselves."

The report for the commission's recent workshop said the county is redirecting about $250,000 each quarter to outside agencies to handle the transfers. County EMS Chief Tracey Vause on Thursday said those agencies include the Lifeguard Ambulance Service in Santa Rosa County, which provides flightsfor long-distance trips.

The report also noted the county had to carry over $1.5 million in general fund revenue from last year's budget to help sustain this year's EMS operations. That's not uncommon, Godwin said.

"In recent years we've had to add general fund money to augment EMS," she said. "Our goal is to make it self-sustaining."

Another change to the EMS Division caused by its staff shortage occurred last October. That's when the division began using eight ambulances, instead of 11, during less busy periods.

"We have 11 ambulances that we can put on the road, and that's our goal to achieve that every day," Vause said. "Our target is not eight. But sometimes, by virtue of our staffing status, we can only achieve eight. If we went below that, our on-call policy is activated to get us out of that deficit."

He said officials know they can go as low as eight ambulances without reducing wait times for patients.

"Our average response time is still within six to seven minutes," Vause said. "That's still well below the established maximum, which is 8 minutes, 59 seconds."

He said the maximum response time is a nationally accepted standard, but not a law, that was established by the National Fire Protection Administration.

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