City says ambulance does well in first year

By Dave Gragg

City officials say they have been able to run the ambulance service cheaper without sacrificing quality after taking over the service from a private company last year.
The city had contracted with Tucumcari EMT for four years to run the ambulance service for $89,500 a year. The company was owned by Tucumcari physician Dr. John Faith, who says the city has not been able to maintain the same level of service it had when he owned it.
When the contract was set to expire last June, Faith offered to renew the contract for another four years, but raised the price to $148,500 a year.
Faith said he was losing $8,000 to $10,000 a year on the service. The additional increase was to pay for a new ambulance.
Rather than renew the contract, city officials decided to put emergency medical services under the city’s auspices and bought out Faith’s two ambulances and other equipment.
City Manager Richard Primrose said the city subsidized the ambulance about $108,000 last year. While the amount was more than the $38,000 the city had anticipated losing, it was less than the $148,000 the city would have spent by contracting Tucumcari EMT, Primrose said.
At the same time, he said the city has been able to maintain the same level of service citizens were receiving with Tucumcari EMT, he said.
Faith disagreed, saying a number of the Trigg Hospital emergency room doctors were unhappy with the city’s ambulance service, particularly in regard to transporting patients to other hospitals.
Faith said the ambulance service has either refused to transport patients or taken hours to do so.
“They’re saying they can’t take people because they’re too critical,” Faith said. “When I had it we never refused. If they turned bad (en route) we called the helicopter.”
City ambulance service director Larry Rigdon said the city had criteria established by the ambulance service’s medical director, Dr. George Evetts.
If the ambulance crew does not feel a patient meets those criteria they tell the doctor what needs to happen for the patient to be stable enough to transport, Rigdon said.
“We can’t refuse a patient,” Rigdon said.
Rigdon said the crew would not transport a patient because he was too unstable. That patient died 45 minutes later — which wouldn’t have been enough time to get the patient to a hospital in Amarillo.
Delays can be caused either because there isn’t an ambulance available or because it takes time to get a crew for a transport, he said.
Rigdon said much of the problem was a lack of communication between the ambulance crews and temporary ER doctors, which have now been taken care of.
“Any problems, we now talk directly to the doc,” he said.
The city has averaged 23 medical transports a month and already done eight in July, Rigdon said.
Faith also said the city did not pay the ambulance crews enough.
“I don’t want to sound like sour apples,” he said. “I don’t want the ambulance service back. That was a thousand pounds off my chest. But if the city wants it, they should maintain the quality of service and you can’t get good people unless you pay them.”
Faith said he kept four paramedics — the highest level of emergency services technicians — on staff during the four years he had the service.
Rigdon said the city had three full-time paramedics and another they could call up from Clovis if they needed.
He said while ambulance crews were paid differently while they worked under Faith, the yearly amount is comparable and the city benefits are better.
The city has billed $325,000 as of July 1, $207,000 of which has been processed by Medicaid, Medicare and private insurance, City Finance Director Marty Garcia said.
Of the $207,000 processed, the city has collected $169,000. The rest was denied by Medicaid and Medicare, which do not pay all of what is billed.
The city will always have about $100,000 in bills waiting to be processed because of a lapse between when the bills go out and when the city actually receives payment from insurance and the two government agencies, he said.
There has also been about $6,000 collected from individuals.
The city had originally planned on taking care of billing for the ambulance service itself, but soon realized it would take a full-time person to keep up with the changes in Medicare and Medicaid.
In October, the city contracted with High Plains Medical to do the billing. The Clovis company keeps 5 percent of the money collected.
The city had not collected any money for the three months prior to awarding the contract to High Plains.
“If we could have hooked up with them from day one we would have been better off,” Primrose said.
He said the city has to make sure it collects the money so it can afford to buy new ambulances and equipment as needed.
“We’re real happy with the income and the amount the city has had to subsidize,” said Fire Chief Mike Cherry. “And next year will be even better.” Cherry said it was only a matter of time before the service operated without a subsidy from the city.