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Elkhorn EMS improves its operations as it maintains service to rural communities

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Stan Milam
September 17, 2012

— With help from a private billing company, the Elkhorn rescue squad is digging out of a financial hole.

"Our problem was that we were not being paid for our service," Elkhorn Fire Chief Rod Smith said. "We were billing for ambulance calls but not collecting."

It was creating a financial crisis, Smith said. In January 2011, the service was reporting nearly $500,000 in uncollected ambulance charges dating back three years.

"Bill collecting is not what we do, and it is not what we're trained to do," Smith said, "but we needed to be paid for our services, so the decision was made to get some outside help."

EMS Medical Billing Associates in Milwaukee was called in to handle the division's billings and collections. That decision has dramatically improved the division's bottom line.

"We don't have complete figures for 2012, yet, but in 2011 we saw operating revenue exceed expenses," Elkhorn City Administrator Sam Tapson said. "We expect to see an improvement in that this year."

The report will detail how much of the previous debt of nearly $500,000 has been collected and how the division is faring now that collections have been turned over to EMS Medical Billing. Tapson said he expects the report to indicate "significant" improvement.

That's not to say that the EMS division is a for-profit operation.

The positive revenue-expense ratio comes after money is set aside for equipment replacement, Tapson said. Additional revenue is used for other division needs such as maintenance.

"That's why it is so important to keep up with collections," Smith said. "We have fixed costs and ongoing expenses that must be met."

'Appropriate care'

Once a stand-alone unit, emergency medical service in Elkhorn was folded into the fire department about five years ago, Smith said. It is now the emergency medical service division of the Elkhorn Fire Department, often referred to as the Elkhorn rescue squad.

Before the merger, the EMS division was suffering staffing shortages.

"By bringing the EMS division into the department, we were able to address the staffing issue," Smith said. "We are a volunteer, paid-per-call department. By having the EMS in our department, we were able to cross train our volunteer staff."

Smith said about half of the volunteer firefighters are cross-trained for EMS duty.

The division has three ambulances and one command vehicle.

"We rotate the ambulance units to make sure they are always being maintained properly and to hold down the mileage," Smith said. "We can do some routine maintenance, and we contract with an outside company for major work."

Despite financial and staffing problems, ambulance service has always been provided, Smith said.

"Nobody has gone without ambulance service, and no patients have gone without appropriate care" he said. "If we are out on another call or if we can't get someone in here, the call is sent to Paratech Ambulance Service."

Paratech is a private ambulance service providing paramedic as well as EMT service. It is called to assist Elkhorn when paramedics are needed at the scene. Two other units—Med Ex Ambulance Service and the Delavan Rescue Squad—also are able to provide backup.

"We are responsible for a large service area," Smith said. "In addition to the city of Elkhorn, we serve the town of Sugar Creek and about 75 percent of the towns of Geneva and Lafayette."

The division receives 1,000 to 1,200 calls for ambulance service annually, Smith said.

"We average about three calls a day," he said. "We can't afford to be sidetracked trying to be a collection agency."

No tax support

EMS Medical Billing takes care of billing and collections on a commission basis, Smith said.

"Our calls start at $750 and increase depending on mileage and special equipment that may be needed," he said. "Obviously, we don't get all that when EMS billing is paid, but compared to what was happening, we are seeing a significant improvement in collections."

Smith said collections had dipped to as low as 40 percent of billing.

"I don't have the final figures, but it's safe to say we're way above that, and we are now in the area of 75 percent or more of billing is being collected, and we are improving," he said.

The city has made a decision to keep ambulance service off the property tax rolls.

"The council has decided to maintain what's called an enterprise fund system," Tapson said. "No tax dollars are used to operate the ambulance service. That's why is was critical that we improve collections."

If the $750 per call rate seems steep, it's a bargain in one respect, Smith said.

"The private services are close to double what we charge," he said. "Some communities charge less by funding some of the cost, if not all, with property tax dollars. We have decided to keep this a true user cost."

Smith and EMS Assistant Chief Dave Fladten are preparing a report for the city that will detail those improvements.

"We don't have all the numbers yet, but we hope to report to the city by the end of the month or early October," Smith said.

"I can say there's been improvement in both volunteer participating and the bottom line as a result of cross training and contracting out for billing and collections."



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