Presentation says EMS millage is vital

By TOM LAVENTURE

tlaventure@yourdailyglobe.com

Ironwood — Members of the Gogebic County Ambulance Committee outlined the purpose and need for renewing a two-year emergency medical service millage this week at events in Watersmeet and Ironwood.

Gogebic County Board Chair James Lorenson, who also chairs the county ambulance committee, said that county officials cannot encourage people to vote yes or no for any ballot item. The EMS millage presentations were to educate voters on the purpose and need to support rural EMS.

“The ambulance services currently provided are high quality and fiscally responsible,” Lorenson said.

In addition to 911 calls and transports, EMS provides CPR training, he said. The EMS assists at residences and nursing homes, along with law enforcement, including search and rescue, and provides standby support for public events.

The ambulance millage was proposed and approved in 2018 when the county determined that Beacon Ambulance Service Inc. could not continue to provide countywide service without support. There is a nationwide crisis, with more than one-third of rural emergency medical services in danger of closing, according to the National Rural Health Association.

“It is increasingly difficult for ambulance services to respond to emergencies, due to lack of employees, reduced volumes and declining reimbursement,” Lorenson said. “Without additional financial support, stand-alone ambulance service is ultimately unfeasible.”

County voters will consider the ballot item on Nov. 2. The proposal is for the continuation of the current one mil per $1,000 in property value that would be used for support and oversight of countywide ambulance services through an authority through 2024. The millage may also be used for the purchase of equipment and in planning for the future of county EMS.

It’s important to distinguish the millage as continued support for countywide emergency medical services and not a direct financial subsidy for Beacon, Lorenson said. The millage keeps ambulance service viable, and without it, the EMS services would likely discontinue, putting added pressure on police and fire departments and residents in emergency situations with fewer responders with less training and equipment.

Michigan does not require municipalities to provide 911 and ambulance services, he said. Without the millage, the providers would not be able to operate without assuming significant financial losses.

“We will not be able to operate without the millage,” said Joe Simonich, chief operating officer of Beacon. “I would hate to see the county lose a paramedic service and end up with a basic service. It’s so different.”

If Beacon received 100% payment from its charges, there would be no need for additional support, Simonich said. The company on average receives about 32% of billings to Medicare and Medicaid and it varies by insurer from that point.

“The typical fee for local paramedic service is about $1,200 to $1,500 depending on the mileage,” Simonich said. “I bill that to Medicare and I’m going to get about $320 in total. So I write off $1,000.”

With an aging population, a lot of the billing is going to be to Medicare and Medicaid. Much of the working age population is either uninsured, underinsured or has a $5,000 deductible, which makes it difficult to recoup all costs, he said.

There has not been a significant increase in Medicaid reimbursement for around 30 years, he said. The federal government is talking about a 2% to 3% increase in ambulance rate reimbursements right now but that is not near enough to make a difference, he said.

During his tenure, Simonich said he said the company will use millage funds to attract more staff and once in place to spread them out more efficiently across the county to improve response times. The funds have been used to replace older ambulances and fit them with new monitors, ventilators and infusion pumps.

The millage helped to ensure that staff were paid throughout the pandemic, when hospitals were not transporting or admitting non-emergency patients, he said. That meant staff were available for emergencies when needed, despite losses in revenue from medical transportation services.

“That’s been a tremendous help to us and now, with the gas up to almost $4 a gallon, it’s quite crippling,” Simonich said.

The Gogebic County Ambulance Committee has oversight of EMS services and may audit Beacon operations as it receives public funds, Lorenson said. A feasibility study is being planned to determine how to shape the future of EMS service in the county, he said. 

Beacon is licensed to operate in Wisconsin and has contracts with the individual cities and towns of Iron County, Wisconsin, Simonich said. On the Michigan side, the contract is with Gogebic County as a single entity, but the units are able to interact across borders when needed because of the dual licensure. 

There were more than 1,800 emergency calls served in Gogebic County between Dec. 16, 2020 through Sept. 2, 2021, according to the presentation. The bulk of the service is in the more populated western end while Watersmeet and the eastern end of the county accounted for 219 calls.

The further east into Gogebic County the bigger the challenge for response times with smaller populations that are distributed over larger areas, Simonich said. A Beacon ambulance is based in Marenisco, and the company is exploring the potential of locating an ambulance in the city of Wakefield that would be staffed by local volunteers as first responders until paramedics arrive. 

“People deserve quick service, but sometimes it’s just geographically impossible to achieve with what it is right now,” Simonich said. “On a good day, it’s a 15-minute ride with lights and sirens. I mean, a lot can happen in an hour.”

Beacon has the first option to accept transfers and defer to Aspirus MedEvac when needed or when additional crews are unavailable. Aspirus currently has one ambulance ordered for replacement for the Iron River and Crystal Falls base that currently serves the Watersmeet area.

Iron River Aspirus currently responds to Watersmeet because of the greater distance to the nearest Beacon base, he said. If Watersmeet can identify volunteer responders to staff an ambulance, then Beacon EMS could intercept the ambulance en route to complete transportation, he said. 

“We’d be more than happy to help Watersmeet out,” Simonich said. “If they can find the staff, we’ll provide an ambulance down there.”

The Watersmeet responders could choose to intercept with Aspirus MedEvac in Iron River or choose the closer Eagle River Hospital in Wisconsin that had operated under Ascension Health, which was not licensed for ambulatory response in Michigan but is now owned by Aspirus along with its ambulance rigs and helicopter.

“That will help, because right now whoever they have coming over there is not licensed in Michigan, and that’s why it has to come from Iron River,” Simonich said.

In the presentation, Lorenson said EMS is also crucial for community development. A lack of EMS would be counterproductive to the region’s efforts to attract tourism and industry, he said.