Decision time nears Voters to decide fate of rural ambulance plan

BENTON COUNTY -- Benton County officials will learn Tuesday whether they can move forward with their plan to pay for rural ambulance service or need to start over after four years of work.

The county has worked with ambulance service providers to find a funding formula for the past four years. The cities, citing a provision in state law prohibiting municipalities from extending service beyond their boundaries without an agreement on payment, have asked the county to cover the cost of making the service available.

The Quorum Court in September created an emergency medical services district with an $85 fee for households outside cities and not in the Northeast Benton County Emergency Medical Service District. The fee would pay the county's cost to make service available.

All of the cities have said if a patient is transported by ambulance they will bill Medicare, Medicaid and private insurance, if available, or bill the patient for the service.

The justices of the peace hosted a series of forums on the election where several questions and criticisms were raised. People questioned the cost of ambulance service in general, how the cities arrived at their costs, the proposed funding mechanism and whether county residents paying city sales taxes should be factored into the question of compensation to the cities.

The county commissioned a study of ambulance service from the Ludwig Group. That study examined the county's situation and detailed national trends, but noted "there is no national consensus of the true cost of running and operating an EMS system."

A number of factors influence how the cities calculate costs for ambulance service. The Gravette and Northwest Benton County Fire Department ambulance services are largely staffed with off-duty firefighter/emergency medical technicians from other departments, which reduces personnel costs. Siloam Springs pays for its service from utility revenue. Other departments are paid from general funds, which receive revenue from many sources including sales tax, millage and fees.

The Ludwig report listed options the county could consider, including continuing the current system, hiring a private ambulance provider or operating a county system. The report also looked at funding mechanisms and a possible budget for a county system.

Arkansas counties have adopted a variety of ambulance service systems, said Wes Fowler, director of government relations with the Association of Arkansas Counties.

"We've got several counties that contract with hospitals for ambulance service," Fowler said.

"We've got counties that contract with private companies. We've got counties that have a sales tax to fund ambulance service and some that have enough money they can fund it out of their general fund. It's a pretty good mix. There's no one set way that it's done across the state."

Marshal Watson, county emergency services administrator, said the Quorum Court and county administrators debated three options: Continuing with providers, contracting with private providers and a county-run service.

The most current estimates show a county ambulance system would require about $2.9 million to start and $2.4 million to operate in the first year, Watson said.

"We spent literally hundreds of man-hours looking at those options," Watson said.

"Ultimately, the court decided that continuing with the existing providers is the choice that is in our best interests at this time."

The county budgeted $100,000 to divide among providers in 2011 and increased that to $150,000 in 2012 and $300,000 in 2013. That doesn't reflect the cost of the city operations, just the amount the county elected to pay in those years, said County Judge Bob Clinard.

"After our 2013 budget was set we started getting calls from the cities saying we needed to ramp this up, that it was taking too long," Clinard said. "I made the decision we needed to get something in place by July so we asked the cities for their numbers for costs in 2013 and beyond. We got estimates for 2014 and 2015 and they said that after that they think it will plateau.

"I've heard the complaints that the cost has tripled from 2013 to 2014. I guess you can put it that way, the amount has tripled. But that's not their costs, that's just what the county has been paying them."

The county has estimated the $85 fee would generate $1.2 million annually.

The county originally budgeted $950,000 for 2014 to pay the cities. The justices of the peace removed the proposed fee from the 2014 budget after learning of the election. They reduced the amount to $236,000, which will pay the cities through March.

If the election blocks the proposed fee, the Quorum Court would need to find another source of money or end the payments.

Rogers and Siloam Springs have told the county they will discontinue service if some agreement isn't reached.

Springdale officials have said they will not continue ambulance service indefinitely without resolution.

Rogers Fire Chief Tom Jenkins said county residents aren't paying for the service alone. He said city residents bear a cost for ambulance service, in addition to being billed if they use the service. He said taking the operating budget and dividing it by the city's population shows a per-capita cost of about $135 a year.

Rogers has asked the county to provide money to hire and pay six firefighter/ EMTs to man an ambulance at the city's Station No. 7 on South First Street. The station would be heavily involved in calls for rural service. The amount needed was put at $209,302 in 2014, with that increasing to $317,125 in 2015 and 2016.

Jenkins said arguments city residents or others traveling through the area are responsible for many or most of the ambulance calls in the county are not borne out by his department's records.

He said 80 percent of the calls his department responds to in the county occur at homes.

"They (county residents) may argue they're protecting those who travel through that area and don't reside there, but the overwhelming majority of calls is for them," he said. "Of course even calls on roadways are much more likely to be (county) residents than non-residents a majority of the time."

On one recent day, Rogers responded to calls in the Arkansas 12 corridor six times, with three calls for traffic accidents and three calls for medical emergencies not related to weather, Jenkins said. At one time during the day, he said, the department had three of its four ambulances on rural county calls.

Rogers' coverage area influenced his department's decision to ask for money to cover the cost of adding and ambulance and staffing it in the station best suited to serve the rural areas, Jenkins said.

"There are about 4,800 structures out there," Jenkins said. "We've got the highest population of any of the areas with 9,474 residents. We've also got some issues with the size of the area. It about 100 square miles. Our city is only 38 square miles so that almost triples the amount of landmass we have to cover."

Fire Chief Greg Neely of Siloam Springs said his department's costs are also heavily influenced by the area they are asked to serve. Siloam Springs is asking for $335,000 in 2014, increasing to $427,243 in 2015 and $459,106 in 2016.

"If you look at the factors that influence the costs, Siloam Springs is No. 1 or No. 2 in every one of them," Neely said. "That includes road miles and population served. I would also submit the condition of the roads also plays into it. We also have to consider the ratio between the number of calls we make versus the number of transports. There's a large number of calls out to the county where we don't transport anyone. We don't realize any reimbursement from those calls."

Neely said ambulance service isn't a source of revenue that offsets the cost.

He said his department's budget for 2013 was $3,719,530.

The department initially billed for $1,293,555, but $358, 352 of that was a contractual reduction related to Medicare, Medicaid or agreements with insurers. Neely said the department can't collect that money, bringing the amount down to $935,202. Of that, the department collected $446,003.

"That's for all of our calls, but that history would be reflective of our county experience," Neely said.

Jenkins agreed ambulance service reimbursement doesn't pay for the cost of the service.

"Last year we basically had an $8 million budget and we received about $1 million in reimbursement," Jenkins said. "So do we receive money? Yes. Does it in any way, shape or form come even close to breaking even? Absolutely not."

Bentonville Mayor Bob McCaslin said the question of county residents paying city sales taxes was raised when the discussion first began.

He dismissed the argument then and does now.

"That's irrelevant," McCaslin said.

"If you're going to use that logic then, if you travel, I guess you're entitled to something from every city that you pay sales tax in. What they get for that sales tax is our public safety -- police and fire services -- our infrastructure that allows them to travel here, shop and to enjoy our parks and other amenities. If anyone is in our city and needs it, that sales tax just paid for them to have top-notch medical attention and hopefully to preserve their lives."

McCaslin said the law is clear, pointing to the section of the Arkansas Code stating the cost of ambulance service "shall be borne entirely by patient and user fees or subsidies provided by the patient, municipalities or county to whom those services are rendered.

In no event shall the city extending ambulance services beyond its boundaries be required in any manner to subsidize or otherwise extend financial support to render those services."

"The county has the responsibility for keeping their citizens safe," he said.

AT A GLANCE

POLLING LOCATIONS

Benton County will have 15 polling locations open for the Feb. 11 election on the Emergency Medical Services District. Polls will open at 7:30 a.m. and close at 7:30 p.m. on election day. Voters unsure of their polling place can call the County Clerk's Office at 479-271-1013. Precincts 1, 2 and 4: Gravette Civic Center, 401 Charlotte St. SE, Gravette Precincts 3 and 50: Monte Ne Baptist Church, 1610 Monte Ne Road, Rogers Precinct 5: Prairie Creek Association Community Center, 14432 Arkansas 12, Rogers Precincts 6, 7 and 15: Total Life Community Center, 13710 S. Arkansas 59, Siloam Springs Precincts 8, 11, 16 and 17: Siloam Springs Community Building, 110 N. Mount Olive St., Siloam Springs Precincts 18, 19, 20, 39, 68 and 70: Cave Springs Community Building, 117 S. Main St., Cave Springs Precincts 22, 60 and 72: Centerton Fire House, 755 W. Centerton Blvd., Centerton Precincts 21, 23 and 25: Hiwasse Fire Station Community Building, 13690 Fire House Lane, Hiwasse Precincts 30, 31, 32, 63 and 66: Bella Vista Church of Christ, 989 N.W. McNelly Road, Bentonville Precincts 14, 28, 29, 33 and 58: First Baptist Church of Pea Ridge, 1650 Slack St., Pea Ridge Precincts 34, 36, 59, 61, 62 and 64: Bentonville Church of Christ, 811 N. Walton Blvd., Bentonville Precincts 12, 35, 41 and 53: Cornerstone Assembly of God, 4055 N. Second St., Rogers Precincts 45 and 51: Bland Chapel (Rocky Branch), 8530 Twin Coves Road, Rogers Precincts 48, 49 and 67: Lowell First Baptist Church, 409 Johnson St., Lowell Precinct 57: Hickory Creek Fire Station, 15645 Arkansas 264 East, Lowell

SOURCE: BENTON COUNTY BY THE NUMBERS

AMBULANCE SERVICE AREAS

Eight ambulance services cover rural Benton County, with each being assigned responsibility for an area.

Square Road Residential Department Miles Miles Structures Population

Bella Vista 10.5 27.8 454 577 Bentonville 75.9 231 2,941 5,675 Gravette 147.5 320.6 2,158 5,221 NEBCO 107.3 281.7 2,920 7,143 Pea Ridge 30.3 82.3 858 2,447 Rogers 98.2 297.8 4,799 9,474 Siloam Springs 148 341 3605 9,260 Springdale 61 103.3 1,533 3,523

SOURCE: BENTON COUNTY

General News on 02/11/2014