As county commissioners struggle with next year’s budget, the debate over how to provide EMS services continues with Stokes County Medical Director Dr. Darrell Nelson warning that privatization may not be a good solution.
During a public hearing on the proposed budget last week, Stokes County EMS Director Greg Collins read a letter from Dr. Nelson in which the medial director said he did not think privatization would work in a rural county.
The county is currently trying to figure out how to deal with a shortage in advanced life support paramedics which could result in having to close one of the county’s five EMS stations.
County Manager Rick Morris has proposed a change in shift schedules which would make working for the county more attractive but could also cost the county close to $500,000 each year in additional salaries. A number of county commissioners have asked about privatizing the system to save money.
Dr. Nelson said the shortage of paramedics was the result of several factors including an institutional inequity in pay between public health nurses and paramedics.
“In Stokes County the starting salary for a public health nurse is $45,258 yearly and they have a 150 hour work period, whereas a paramedic’s starting salary is $34,253 a year and they have a 218 hour work period,” he said in his letter. “Our paramedics are performing complex assessments and procedures well beyond the public health nurse’s role, yet they are compensated much less. Other services have paramedics working less hours for more salary, making recruiting extremely difficult. Area hospitals also see the enormous value paramedics can bring and are now employing paramedics full time in emergency departments creating even more competition.”
Nelson said he had some strategies which could possibly save the county money while still providing the same level of service, but said his professional opinion was that privatization would not be a good a solution.
“In my expert medical opinion , privatization of the EMS system will absolutely decrease the quality and scope of care,” he said. “Privatization can work in some parts of the country, mainly large metropolitan areas. I feel this will not work in rural areas. Privatization will come with a company expecting to make a profit. In order to generate that profit, medical services provided will not measure up to the caliber of care that we now provide. The few private companies in North Carolina providing EMS services do so with large subsidies provided by county government. So, in effect, the taxpayer subsidizes the profit of a private company.”
He said that given uncertainties surrounding the future of the county hospital, maintaining a quality EMS service was critically important for the county.
“Stokes County EMS is essentially the county’s main provider of care for the acutely ill and injured,” he said. “While the medical infrastructure in the county is at a period of great unknown, Stokes County EMS is an absolute emergency life net for the citizens of this county. Living great distances from a major medical center has health implications, especially when dealing with critical injury or illness. The people who most need a robust EMS system live in rural America.”
On Monday, commissioners heard more about the possibility of privatization from Greg Kirby, the founder of American TransMed, a company providing a variety of contracted EMS services in North Carolina and South Carolina.
Kirby told commissioners, based on a very limited amount of data, that he thought his company could provide EMS services in Stokes County and would welcome participating in a request for proposals (RFP) process.
He said his company provided services in about 25 South Carolina counties and also had a contract with FEMA to provide emergency services in the case of disasters.
“I would suggest asking for RFPs and find out what areas different companies are able to cover,” he said. “I feel like our company would likely be one that would bid for that. There are probably a lot of other people who would be interested in bidding on this.
“One of the things I would suggest to you is to look at what response times different companies can offer,” he said. “That is a measurement tool that you need to hold the service to. We are all in the business to save lives and you want to have people there in under 10 minutes.”
While the discussion with commissioners was very informal, Kirby said his company currently runs 24/48 hour shifts with one paramedic and one EMT on each ambulance. He estimated that his company could charge the county $250,000 per year for each ambulance they provided. When asked if any of the revenues generated by the service would be returned to the county, Kirby said that would depend on the level of collections and the call volume.
“We are a for profit company,” he said. “If we are not wanting to make something, then we would not want to be here, but at the same time we would not want to rob you.”
He said if his company bid on offering services, that bid would likely include paying the county fair market value for existing equipment and then leasing the existing EMS locations from the county.
He noted that his company had not run a rural EMS service before, and said he could not guarantee that the county would not have to subsidize the company in order for it to provide service.
Kirby said his company focused on cost containment, both by purchasing in bulk and by using cost effective staffing patterns.
“We try to make sure we provide adequate staffing, but we don’t want it to be cost prohibitive,” said Kirby. “I think that most systems that look at privatization are looking to save dollars and that is what we look at and that is how we operate.”
But Kirby said his company also focuses providing quality service, noting that call logs are reviewed daily and if problems show up in those logs they make sure staff get additional training.
He added that if his company eventually offered EMS service in Stokes County they would likely seek to hire staff from the existing EMS service, noting that transitioning to a privatized system could take between 60 and 90 days.
Nicholas Elmes may be reached at 336-591-8191 or on Twitter @NicholasElmes.