County grills EMS director on practices, procedures

Feb. 01, 2013 @ 06:50 PM

The Union County Board of Commissioners met Tuesday to discuss renewing a contract with Carolinas Healthcare System to provide ambulance service.

The contract expires this year, so the county hired a consultant agency to determine the county's emergency medical needs. One of the first steps of renewing the contract was to get caught up on the way Union EMS provides service to the county. Union EMS Acting Director Scott Shew gave the board a short summary of the organization's history and function.

Union EMS has provided ambulance service to Union County longer than the county operated it, Shew said. The county contracted with CHS in 1997, he said, and that contract has been renewed and amended several times through the years.

When talking about the county's EMS service, it is best to look at it from a resident's perspective, he said.

"If you're calling 911 and you need an ambulance then you're going to be concerned about the clinical excellence, you're going to be concerned about response time to liability, how long it takes that ambulance to get to you," Shew said.

But as a taxpayer, the cost for service will be a major concern, he said.

A factor to consider is how much control the county wants over ambulance service. CHS holds all assets, equipment, permits and employs all the workers. The county subsidizes the gap between expenditures and revenues. If the county wants more control, it needs to consider what areas its wants control of and any liability taken on as a result, Shew said.

Medicare and Medicaid do not pay Union EMS what they charge for service.

"In our business, there's two numbers when you talk about volume," Shew said. "There's the number of dispatches, when someone calls 911 and we come out, obviously we don't transport every patient for which we are called."

The other number is billable transports, where someone uses Union EMS for medical treatment. Transports make up about 70 percent of all calls, Shew said. There has been a 162 percent increase in transports over the last ten years.

The number of employees has gone from 61 positions about 16 years ago to 89 positions this year, Shew said. In 1997, Union EMS had eight ambulances that responded from nine bases throughout the county. Now it has 11 ambulances online during the day and nine operating at night, responding from ten different bases.

In response to the county's population boom, Union EMS planned a five-year expansion plan that would increase the number of employees and resources, Shew said. But the economic downturn of 2008 caused most services to shrink instead of expand.

When the county's private non-emergency ambulance service provider left, the county delegated transport of patients from hospitals and nursing homes to Union EMS, Shew said.

Some private ambulance companies inquired about taking over that service, but the agreement between the county and CHS requires a county franchise to operate. The inquiring companies were encouraged to contact the county about possibly providing service, but did, Shew said.

That means that all Union EMS ambulances equipped with emergency medical equipment runs routine, non-emergency calls, Shew said.

"Seems like to me we're wasting a lot of money taking people to doctors appointments," Commissioner Frank Aikmus said.

When Union EMS took on non-emergency transport, it could easily absorb the additional call volume, Shew said. Plus, the extra revenue from non-emergency calls helped finances. But paramedics and ambulances are busier now than they were several years ago.

Employee turnover is also high, Shew said. Because Union EMS is a partnership between Union County, Carolinas Healthcare Systems and Carolinas Medical Center - Union, EMS employees often have "employer identity crisis," Shew said.

"The employees struggle sometimes with, wait a minute, if I'm a Carolinas Healthcare System employee, then why is compensation based on county funding. So there's a little bit of confusion, so a lot of them begin to ask, 'Who am I?'" Shew said.