Minutes matter: Cape fire chief pushes to add ambulance service to department

Call 911 with a medical emergency in Cape Girardeau and there's a good chance the people who show up first won't arrive in an ambulance.

They'll be in a firetruck.

"Listen to the scanner," Cape Girardeau fire chief Rick Ennis said. "Most of the time the firefighters are on the scene before the ambulance arrives."

That's fine, Ennis says. It's part of the job for the city's 60 firefighters, all at least trained as emergency medical technicians and 11 as fully qualified paramedics.

What Ennis doesn't like -- what he hasn't liked since he took over as chief seven years ago -- is watching as his officers do all of the initial patient treatment only to have the private ambulance company swoop in to transport the patients to the hospital.

Matt Mittrucker, firefighter and EMT with the Cape Girardeau Fire Department, sorts through items in the medical gear compartment of engine 1 at station 1 Thursday in Cape Girardeau. The medical gear compartment contains items such as a defibrillator, stair chair and a pediatric care kit.LAURA SIMONlsimon@semissourian.com

"I'm frustrated that we're out here doing the bulk of the work and not being able to recoup our costs," Ennis said.

The city doesn't see a dime in revenue for its work, but the private ambulance company does. Cape County Private Ambulance, which formed in 1968, is able to bill the patients, Medicare, Medicaid and private insurance companies for services rendered, Ennis said.

According to federal law, the key is in the transportation -- only the agency that transports patients is able to collect money for services. It doesn't matter who provides preliminary treatment or how much of that treatment is given by whom.

Ennis wants to add an ambulance service to the fire department in a move that he says would provide a good service, improve continuity of care and be fiscally responsible.

Since he was hired, Ennis has asked city leaders to allow him to create what he calls "fire-based" ambulance service. The department would buy two or three ambulances and hire seven or more personnel to staff them with trained medical personnel who also had the ability to fight fires.

It would mean getting the patients to the hospital faster, Ennis said. The department arrives at a scene within five minutes 85 percent of the time and within six minutes 92 percent of the time. Having the same set of hands treat the patient from start to finish, he said, would improve continuity of care. The plan also would allow the city to replenish some of the money to implement the program, he said.

But Dr. John Russell, president of Cape County Private Ambulance Service, said they are already providing quality ambulance service to city and county residents.

Russell doesn't think Ennis' plan would cause his business to fold, but it would cause the fees to be increased in Jackson and the county to compensate for money the ambulance service would lose in Cape Girardeau.

"Fire departments are beating this drum across the country," Russell said. "But their personnel costs are higher, and that's true in St. Louis, in Kansas City and for about every other place that does this."

For as many cities that are trying to implement such a plan, there are others that are trying to get out of them, Russell said. The ambulance service charges for each trip, Russell said. Depending on the level of care provided, patients can expect to pay between $365 and $720 for emergency transportation. Mileage charges are also incurred for each ride.

But because Medicare doesn't fully reimburse each cost, each trip operates at an $80 to $100 loss, Russell said. He predicted the city would see a loss of $100,000 to $150,000 a year.

"In my opinion, the city will lose money if they do this and that money will have to come from the taxpayer," he said. "I understand where the fire chief is coming from. With the decrease in fire calls, he's trying to justify his high level of staffing."

The private ambulance service covers more than 570 square miles in the county. The county commission pays it a $225,000 annual subsidy.

Putting aside any lost money from future operation, the big hurdle for city officials has been coming up with money to get the operations started. Buying each fully equipped ambulance and staffing it would cost about $500,000, and Ennis thinks having two would be a starting point.

There would be a lag time before any money would come in from treatment reimbursements, he said, although eventually the service would generate $500,000 annually in fees.

The program would cost about $1 million each year after that to maintain, he said -- half of which would be reimbursed from billing.

The money has been a sticking point for city leaders, who have heard Ennis make several pleas over the years to make the numbers work.

City manager Scott Meyer said he encourages all departments to look at ways to provide more efficient and more effective services. He said the city is not in a position to get the ball rolling just yet. But Meyer sees the merit in the plan.

"When you look on the face of it, our responders go out, stabilize the victim and do whatever is necessary," Meyer said. "And then somebody else transports. It feels like there's a duplication of services and there may be room for efficiency. But whether that works out or not, I don't know."

'Nothing imminent'

Whatever happens, Meyer said, city leaders are not going to do something that costs residents more money. Any new program would have to cost the same or come with a savings, he said.

"There's a lot to be worked out," Meyer said. "We don't have a plan right now to do that. But I think it's important any time an opportunity presents itself to find efficiencies, we look at ways to do it. But there's nothing imminent here."

Mayor Harry Rediger said he's noticed fire engines and ambulances going out at the same time to the same call and it's struck him as inefficient, as well.

"But this is not on the front burner right now," Rediger said. "It's a desire of the chief's and it's a desire of me to be more efficient than we are now. ... But it would require funding that just isn't available right now."

But Ennis has thought of that, too. Considering that more than 70 percent of the department's 4,000 calls annually are for medical responses, he thinks this plan -- which works elsewhere -- could work here.

For example, the state allows ambulance districts to be formed to implement property taxes to pay for fire-based ambulance service. There was a move a few years ago in Cape Girardeau County to create an ambulance district here, but Ennis didn't fully support it because he felt it wouldn't really improve the situation for the department. The move, which required an initiative petition to get on the ballot, faded out.

Just as well, according to Ennis.

"As a taxpayer, why pay additional taxes to start another duplicate agency?" Ennis asked. "The trend in the nation is to try to downsize and consolidate. Let's just complete the circle as opposed to start a whole new agency."

Completing the circle, he said, would mean starting an ambulance district in the city limits of Cape Girardeau or in conjunction with another public entity such as other cities or fire districts in the county. Then the work could be contracted out to the fire department, he said.

The property tax would mean that residents within such a district would not have to fork over a "copay," or whatever portion insurance doesn't pick up, Ennis said. They would pay the tax and that, in conjunction with insurance, would pick up the tab.

"The attorney general has ruled that the property tax they pay would serve as their copay," Ennis said.

Those who use the ambulance service who live outside the city would be billed for amounts that weren't covered by insurance, which would boost the revenue stream.

The law allows ambulance districts to eventually shift away from property tax to sales tax, but Ennis favors keeping this a property tax.

"I know property tax increases are taboo around here," Ennis said. "But I think, as a government, we've gone to the sales tax well too many times. To me, the property tax seems to be a fair way to improve our service."

While it's an idea that doesn't seem imminent, Ennis believes it's a good one. He thinks residents would embrace the idea if it was explained to them properly and they see the ultimate goal is to transport people in need of medical attention to the hospitals and the doctors who can help them.

"It's only a matter of minutes," Ennis said. "But if it's a matter of life safety, minutes make a difference."

smoyers@semissourian.com

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Pertinent address:

1 S. Sprigg St., Cape Girardeau, MO