The Colusa County Board of Supervisors received confirmation last week that the current ambulance system is financially unsustainable.
Colusa County officials – when they contracted with AP Triton two years ago to complete an ambulance valuation study – had already learned from Enloe Medical Center that, in rural communities, the cost of providing one ambulance – much less two – is a losing proposition because there are not enough paying customers to spread the overall cost of the unit around.
Scott Clough, of AP Triton, who presented the second study on the feasibility of providing ambulance services to the board on Nov. 9, said low call volume, and low reimbursement rates for Medicare and Medi-Cal programs, are essentially bankrupting the system throughout rural California.
“The finances that we looked up; the valuation that we came up with for your county actually was almost exactly to what the ambulance provider, which is Enloe, has put down as what their revenues are,” Clough said.
Clough said Enloe has been straightforward in alerting the county, which is legally responsible for providing emergency medical services, that the Chico-based medical center is still subsidizing ambulance services, even after they cut back from one full-time and one part-time ambulance to just one ambulance, based in Colusa County, operating 24-hours per day.
Clough said the reduction in the number of advanced life support (ALS) ambulances throughout the region is what creates a domino effect whenever a single ambulance is in service when another call – or multiple calls – come in.
After multiple meetings with stakeholders, local fire chiefs, and Sierra-Sacramento Valley Emergency Medical Services Agency, which manages ambulance services in Colusa, Butte, Glenn, Nevada, Placer, Shasta, Siskiyou, Sutter, Tehama, and Yuba County, Clough said they are really no closer to finding a solution to the ambulance crisis, which would allow the overall system to “break even,” until more discussion on held with the fire chiefs and the public.
Because the majority of ambulance calls serve mostly Medicare and Medi-Cal patients, raising the rates would not result in additional revenue because the state and federal reimbursements are set, Clough said. That leaves limited solutions to make up for the approximate $500,000 annual shortfall, which AP Triton confirmed by the study.
Supervisors said they may ultimately have to decide whether the county subsidizes ambulances by reducing public services in other general fund agencies (Library, Public Works, Public Safety) or whether they ask the voters of Colusa County to form a tax assessment district.
Before they do, county officials said they will need all fire department agencies to come together with the AP Triton to determine exactly what it is going to take to develop a sustainable plan for emergency ambulance responses, before they reach out to the public to determine how they want to fund it.
“The public needs to know what they are missing out of this, what the risks are, and decide what that’s worth to them,” said Supervisor Kent Boes. “We can’t do that until we give them specific numbers and say, ‘if you want two full time ALS ambulances from a private company, this is, what it’s going to cost, whether it’s a sales tax or a parcel tax, whatever we could put forward.”
According to county election archives, the Board of Supervisors first considered forming a countywide service area (Communities Facilities District), in conjunction with the cities of Williams and Colusa, more than 30 years ago when ambulance shortages (due to increasing costs) were just starting to affect public safety whenever the community experienced diminished ability to provide rapid response, during times of multiple incidents.
The board called for a non-binding advisory measure to be placed on the Nov. 3, 1987 gubernatorial election to gauge voter support for a tax assessment district to fund services with two EMTs at approximately $106,000 per year (then), after an initial investment of $75,000.
The measure received a 60.8 percent favorable vote, enough at that time to have passed, had it been binding. However, the board did not follow through with a tax measure, which, at the time, would not have required two-thirds (66 percent) voter support, unlike today.
While Colusa County does not typically have multiple incidents at the same time, or situations when an ambulance is unavailable entirely, they do exist, officials said. Recently, Colusa’s basic transport unit responded to load a critical patient, along with Enloe’s paramedic, when the ALS ambulance had a flat tire enroute from Williams to the Colusa Medical Center – when no backup ambulance or helicopter were available.
Boes said that while the addition of basic ambulances, which Colusa and Maxwell have, are possible solutions, they also come at a cost to the fire districts or cities, so that the public would also need exactly what those service costs might be.
“Whatever the case might be, we have to bring those scenarios to them so they know exactly what they are voting for and what they are committing themselves to,” said Boes, should a tax measure be proposed.
County officials said sustainability of ambulance services will require the creation of a more stable revenue stream if the county is to be positioned to deal with future changes in health care and any transitional financial changes that may take place.
Williams Fire Protection Chief Jeff Gilbert said conversations will need to continue and education of the public will be necessary for a sustainable system to be developed.
“The problem is only going to get worse,” Gilbert said. “It’s not just a problem here…Long term, I think we need to get the public education out, but we need to get a group with a couple of supervisors and local fire to start working on this immediately. Do we want to look at building an ambulance district here in the county so the county has control over it? That is what I think. Then we need to look at the funding mechanism.” ■