BENTON COUNTY — Fire chiefs met Thursday with county officials to seek help responding to medical calls outside their cities.

Ambulance services paid for by city taxes provide coverage to residents of small towns and rural portions of the county, with little or no compensation. Making those runs outside of the cities puts pressure on the ambulance services, sometimes lengthening response time within the cities, fire chiefs said.

Now some city fire chiefs who oversee ambulance services are in talks with county officials about who will provide service outside cities and who will pay for it.

“We’re in the county every day,” said Tom Jenkins, chief of the Rogers Fire Department. “Ultimately, the county doesn’t pay. There’s a county sheriff’s office. There are rural volunteer fire departments. But there is no ambulance solution.”

It’s too soon to tell what a solution might look like, those involved in the talks said. Jenkins said he would favor a subsidy from the county to help pay for the ambulance services.

Matt Garrity, manager of emergency services for Benton County, said a subsidy is one possibility. But officials should keep an open mind toward other solutions, such as creating new ambulance services, he said.

“We all want to serve the citizens,” he said. “We all want to do it for the biggest bang for the least amount of buck.”

County residents could end up paying a fee or tax to support the ambulance services, he said. But he said it’s too soon to say how much that might be or what the solution will be.

County Judge Dave Bisbee said he recognizes the problem faced by the cities.

“We’re trying to figure out how to get the best service to everybody without unfairly burdening the cities,” he said.

Patchwork

Benton County is covered by a patchwork of ambulance services. Some are operated by cities, some by nonprofit groups paidfor with membership dues. Some are staffed by paid paramedics, some by volunteer emergency medical technicians.

The Bentonville, Rogers, Siloam Springs and Springdale ambulance services are part of those cities’ fire departments. Those services - along with the Bella Vista Ambulance Service, a nonprofit group run in cooperation with the city fire department - provide advanced life support ambulances in Benton County.

Medical helicopters also provide advanced life support, but they have limited resources and can be grounded by bad weather,Garrity said.

Advanced life support ambulances are staffed by paramedics. Emergency medical technicians staff basic life support ambulances.

The paramedics can provide a higher level of medical care, administering medication and inserting breathing tubes. Basic life support is first aid on the way to the hospital - defibrillators, bandages and CPR.

The Pea Ridge, Gravette and VAS ambulance services provide basic life support, relying on the larger departments to provide help for emergencies that require advanced life support, such as heart attacks or head trauma.

Pea Ridge and Gravette are paid for with a combination of city money, membership dues and bill collection. VAS Ambulance Service, which made the switch last year to paid EMTs, is paid for by bill collection and membership dues that are collected with county property taxes from residents in the VAS service area.

VAS covers the northeastern corner of Benton County, including Avoca and Garfield.

Representatives from departments that provide basic services said an upgrade to advanced life support would be ideal but expensive.

Frank Rizzio, chief of the Pea Ridge Fire Department, said upgrading to an advanced service would costabout $200,000 per year in salaries, plus the cost of more expensive equipment and medication.

VAS representatives have been considering an upgrade to advanced life support since 2008. But the service’s accountant, Cris Jones, projected the service will end the year at a $30,814 deficit, even though voters in 2007 approved an increase in membership dues from $15 to $40 per year.

Board members are looking for ways to trim expenses, and hope collections will increase with the help of a new collection agency.

Cris Henry, a VAS board member, said he would like to see VAS provide advancedlife support by June 2011. The board does not have an estimate for how much that would cost, but the price would include tens of thousandsof dollars of new equipment and higher salaries for paramedics, Henry said.

But he said the service may be able to cover the cost because it could charge more for advanced life support care.

David Smith, chief of the Gravette Fire Department, said he would like that city’s ambulance service to be able to provide advanced life support, but he said it is too expensive a proposition for the time being.

Robert Mahmens, owner of Decatur Pawn, said he hopes Gravette continues to provide his area with ambulance service. He’d like the Gravette ambulance to upgrade if possible, he said, although he’s usually leery of new taxes.

“I guess I wouldn’t mind paying something though, as long as it’s reasonable,” he said. “At some point in my life, I imagine I’ll need an ambulance.” ‘It Robs Resources’

The fire departments in Rogers, Siloam Springs and Bentonville collect some revenue from charging for ambulance runs, in some cases charging more for runs outside the city. But most of their money comes from their cities’ general fund or other money collected from city residents.

For example, Bentonville’s fire department, including the ambulance service, has a budget of about $6.09 million, with revenue of $1.2 million, said Denise Land, the city’s financial manager. The rest comes from the city’s general fund, which includes sales taxes, franchise fees and property taxes.

Bentonville charges a $450 base rate for runs inside the city and a $600 base rate outside the city. Rogers charges a base rate of $400 or $550 inside the city, depending on the level of care, and $775 outside the city.

But Jenkins said the department often collects less than it bills, especially from Medicare and Medicaid, which have legal limits on payments for different services.

Because the ambulance services are part of the fire departments, with firefighters doubling as paramedics and ambulances housed in fire stations, there’s no way to tell how much the ambulances cost to operate, chiefs said.

The city fire chiefs discussed at a meeting Thursday some options for calculating the cost of providing rural ambulance services, based on factors including the percentage of ambulance calls outside the cities, how many of the departments’ calls are for ambulance runs, and how much city residents pay for the services.

Their rough estimates showed Bentonville, Rogers and Siloam Springs are providing $2.8 million of ambulance service per year outside of their city.

The chiefs of those cities and other smaller departments plan to meet April 7 with county emergency officials to further discuss the situation and begin crafting options to present to the county and city governments.

Fire chiefs say medical care has become an increasingly large part of their business, thanks to growing populations and improvement in fire safety.

Jenkins estimated about 80 percent of the Rogers department’s runs are for medical emergencies. Runs outside of the city were 26.2 percent of the department’s ambulance activity in 2009, up from 19.7 percent in 2005, according to figuresprovided by the department.

The total number of runs outside the city increased from 639 in 2005 to 1,012 in 2009. The population growth of Benton County and its cities, along with the increasing cost of medical equipment, has put pressure on the municipal services, Jenkins said.

In the same time period, the department’s budget has grown from $5 million to a projected $7.3 million this year, Jenkins said.

When one of the city’s ambulances is responding to an incident in the county, another ambulance, stationed farther away, must respond to problems in the absent ambulance’s coverage area.

That can sometimes delay the arrival of an ambulance in the city by up to five minutes, Jenkins said.

“(Rural ambulance calls) rob resources from the city to protect people in the county,” Jenkins said.

Dan White, chief of the Bentonville Fire Department, said the increase in out-of-city runs has not put too much pressure on his department.

“But it would be nice to get some help from the county,” he said.

Jimmy Harris, chief of the Siloam Springs Fire Department, said the department always has covered areas outside the city and has always lost money doing so. But it wasn’t as much of a problem before the population boomed, he said.

“Times have changed,” he said. “We’re all feeling the crunch and we’re just trying to find ways to produce income.” Washington County

Benton County could look to its southern neighbor for some examples of how to pay for rural ambulance service.

Springdale has already made some efforts to recoup costs for operating outside the city. Springdale fire and finance officials struck deals with officials in Lowell and Bethel Heights, billing each city on a per-call basis. Every time an ambulance transports a patient in those cities, $400 is charged to the city. If no patient is transported, there is no charge.

In unincorporated Benton County, Springdale adds a $400 fee to all transports. Often, though, it can’t be collected, said Kevin McDonald,assistant chief. Patients on Medicare or Medicaid can’t be charged more than the federal reimbursement costs, which range from $300 to $515 depending on the type of call. Patients without medical insurance aren’t likely to pay an ambulance bill of $800 quickly, if ever, he said.

“It’s not an effective way to recover our costs for runs in rural Benton County, but right now, we haven’t got any other method of doing it,” McDonald said.

Washington County is covered by only two ambulance services, Springdale and Central EMS.

Springdale charges Washington County based on total ambulance costs divided by the percentage of calls in the rural area. The county pays the city based on what portion of the total calls come from small towns and rural areas. The county covers costs for unincorporated areas and for Elm Springs and Tontitown.

An agreement between Central EMS, Washington County and each of the cities in the coverage area provides subsidies for the ambulance service. Under the agreement, the county pays $15 annually for each resident in unincorporated areas, and each city pays $4 per capita.

“Everybody thinks it’s unfair one way or another, but it really helps everyone,” said Becky Stewart, administrator for Central EMS. “The county needs the call volume Fayetteville generates to help defray the overall cost of service, and the city needs the extra resources we’ve built to take county calls in case the calls in the city spike.”

Dan Craft contributed to this report.

By the Numbers Ambulance Services

◊$200,000: Estimated cost to upgrade to advanced life support ambulance service.

◊$2.8 million: Estimated cost of ambulance service provided outside city limits by Bentonville, Rogers and Siloam Springs.

◊$30,814: Estimated deficit at end of year for VS Volunteer Ambulance Service.

◊26.2: Percent of Rogers Fire Department ambulance activity outside the city in 2009.

◊$400: Fee Springdale Fire Department adds to bills for runs into unincorporated Benton County.

Area, Pages 9 on 03/31/2010