Copyright 2005 Knight Ridder/Tribune Business News
By MIKE CORPOS
Aberdeen American News (South Dakota)
After a two-year hiatus, Aberdeen Fire and Rescue is returning to the business of long-distance patient transfers.
Fire Chief Bill Winter said that two years ago, when the city opted to quit providing the service, it was a staffing issue - there were not enough paramedics.
Now that Winter has beefed up his paramedic staff, he said the city is once again able to offer the out-of-town transfer services.
With 20 paramedics on staff and six or seven on each 24-hour shift, Winter said he’s got the numbers to justify the service.
“Now we have paramedic staffing to where we want it, but we were still not interested in doing (long-distance) transfers,” Winter said. But Winter said he was encouraged by Avera St. Luke’s Hospital to provide out-of-town transfers.
“At Avera St. Luke’s, we have recognized the need for other avenues for ground transport of patients to distant locations for those times when the use of Careflight is not appropriate. We are pleased to hear that Aberdeen Fire and Rescue is looking into offering this needed service for our region,” said hospital spokeswoman Patty Kirkpatrick.
When the city was not doing the lucrative out-of-town transfers, most were done by the private Aberdeen Ambulance Service.
But lately Aberdeen Ambulance has only been able to do one transfer a day because of staffing limitations, forcing St. Luke’s to look to Sioux Falls and other ambulance services for transports to hospitals in that city.
Dan Mielke, co-owner of Aberdeen Ambulance, said the city’s return to out-of-town transfers will impact his company’s business.
“I don’t personally agree with a public entity getting into private business like this,” Mielke said. “But we do need help taking the Sioux Falls trips.”
Recently Doug Glaser, Mielke’s business partner, had expressed interest in hiring city paramedics part-time to boost his numbers. City officials said no, citing liability concerns.
Mielke disagreed with the city’s reasons for not letting its paramedics work
Winter said the fire department was not getting back into the transfer business to compete with Aberdeen Ambulance, but to help fill a need.
“I feel we can co-exist with the private service just fine,” Winter said.
As for not allowing city paramedics to work for private services, Winter said it creates liability concerns, particularly in the realm of malpractice.
Should a city employee be allowed to work for Aberdeen Ambulance, or any other private service, and a malpractice suit was filed against that worker, the responsibility would likely fall to the entity that provides that person’s training, Winter said. In this case that would be the city.
So it’s really about protecting the taxpayers, Winter said, adding that there is also a concern about keeping the city workers fresh for their primary duties with the city.
Because it takes three hours to get to Aberdeen from Sioux Falls, Winter said St. Luke’s told him it would prefer to have someone in town available to do the transfers for non-critical patients.
“We’re looking at helping the hospital,” Winter said. “That and most of the people (being transferred) are residents of Aberdeen.”
With enough paramedics on staff now, Winter said the fire department is happy to provide help in filling a need.
Using off-duty personnel, the chief said the fire department is looking at providing at least one transfer a day, although none have actually been done yet.
He added that any personnel involved in the transfer services are volunteering to do so, and it is not a requirement. Those who do the transfers, however are paid overtime, Winter said.
Karl Alberts, city finance officer, said the highest-paid city paramedic would be paid about $ 25 an hour - including benefits - for doing out-of-town transfers.
Lucrative business: Winter also said long-distance transfers are a lucrative business for any ambulance service.
The city’s ambulance service tends to operate at a net loss because emergency services are not reimbursed by insurance companies at the same rates as transferring patients from Aberdeen to another hospital.
On an emergency call, Winter said the city isn’t even reimbursed for the cost of supplies used, much less salaries and vehicle depreciation.
According to the city finance office, on an emergency call with basic life support - minor injuries and no drugs administered - the city charges $ 525. If the patient is on Medicaid, the state only reimburses the city $ 68. It’s a similar story with Medicare.
In October, the city billed Medicare $ 29,054, and of that only $ 14,901 was reimbursed. The remainder the city is forced to write off.
That, Winter said, is why the ambulance service tends to run a deficit.
Doing the long-distance transfers will allow the ambulance enterprise fund to recoup some of its expenses and get closer to balancing the books.
Winter said a typical transfer to the heart hospital in Sioux Falls costs the city about $ 600.
That’s calculated at eight hours of overtime at the highest pay scale for two city paramedics, gas at $ 3 per gallon and 10 miles per gallon, plus vehicle depreciation.
Generally he’ll have at least one paramedic and an emergency medical technician in an ambulance, although often it’s two paramedics.
In the case of transporting an extremely critical patient, Winter said he’d send three people, including the driver.
For the most part, the hospital will only send a critical patient by ambulance if the Careflight helicopter and fixed-wing aircraft can’t fly.
On that same run to Sioux Falls, Winter said Medicare reimburses the city about $ 1,700.
That’s a profit of $ 1,100, which goes into the city’s ambulance service enterprise fund.
“If they have supplemental insurance, it pays even more than that,” Winter said.
Right now, Winter said he’s looking at going as far as patients need to go. That includes Sioux Falls, Fargo, N.D., the Mayo Clinic in Rochester, Minn., or the University of Minnesota in Minneapolis.
“We used to go to Rapid City as well,” he said. “But I don’t see that happening in the near future.”