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La Grande Observer 11/28/14

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By Alice Perry Linker

Observer Staff Writer

At the request of some staff members, Grande Ronde Hospital is looking at ways it can raise revenue to support continued ambulance operation.

Janet Wright, director of hospital patient care services, told the Union County Ambulance Advisory Committee Monday night that two or three options are being investigated, but no decision has been made.

The hospital and the City of La Grande have been meeting for the past several months to study the feasibility of moving ambulance service from the hospital to the citys fire department. The negotiations will continue during Wrights research.

The final decision on an ambulance provider for Union County will be made by the county commissioners.

Originally, the hospital board was expected to vote on the proposal in October, but that action has been delayed at least a month and maybe longer.

Wright said the hospital is investigating ways to increase ambulance revenue.

The hospital may offer ambulance transportation instead of air transport to some patients who are being sent to Boise hospitals. In some cases, when a patient is stable, ground transportation is as acceptable as air travel, Grande Ronde Hospital President Jim Mattes said. The final decision is always the doctors, he said.

Wright said she has not yet calculated the amount that could be earned through ground transportation.

If the hospital begins an ambulance transport service, it must organize a stand-by staff that would be paid to be on call. The hospital now relies on casual employees who volunteer to be on call but are paid when they report to work.

The hospital could bill Medicare patients for ambulance calls not covered by Medicare. Wright said that Medicare has established a list of types of ambulance calls that it will pay, and the hospital has not been billing Medicare patients when the federally backed insurance does not pay.

Mattes said that to bill the patient, the hospital must notify the patient and insurance companies of its intent to bill before the ambulance is used if Medicare does not cover the cost.

If we dont give notice, we cant bill, Mattes said. Our policy has been not to bill.

A change in staffing might affect revenues. The hospital now staffs its first-response ambulance with two paramedics. Mattes said that if the hospital continues to provide ambulance service, it probably will change the staffing to one paramedic and one EMT-intermediate, paying a second staff to remain on call.

Paramedics usually receive a higher salary than EMT-intermediates.

While the hospital looks at ways to increase ambulance revenue, which Mattes has estimated to be between 48 and 49 cents per dollar of ambulance charges, the city continues to try to develop an ambulance budget.

Fire Chief Bruce Weimer said earlier that with Medicare reductions scheduled to go in place within the next year, it has been difficult to prepare a detailed budget.

City Manager Wes Hare said during Mondays meeting

that he expects revenues to exceed expenses by about $70,000 annually.

We probably can go higher, he said.

If the city takes over ambulance service, two jobs one firefighter and one paramedic will be lost, Hare said. The city has said it will hire four paramedics, giving hospital employees priority. The hospital has a staff of five paramedics. The city will lay off a junior firefighter should the change take place, he said.

The hospital has stated on several occasions that Medicare reimbursements will be going down as a result of the federal Balanced Budget Act. The reimbursement change has been delayed by the Health Care Financing Administration, but Congress is expected to eventually push for full enactment of the law, resulting in a possible loss of 40 percent of Medicare reimbursement.

A draft report on ambulance service predicts that the hospital could lose about $170,000 a year as a result of these cuts.

Hospital ambulance service is not paid for separately by most insurance companies and Medicare, Wright said, but is bundled with all other hospital services into one payment. If the fire department runs the ambulance, that service will be paid separately, which could result in a higher return.

The hospital and city have set a joint public information meeting for mid-October.


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