County Considering Privatizing Emergency Medical Services

Several members of Emergency Services of Door County attended the monthly meeting of the county’s Administrative Committee on March 19 to hear two agenda items related to the service.

The first was a modification of the health insurance plan for the 18 full-time paramedics. Currently the county pays $1,808.15 per month for all county employees with family plans. The employee pays $319.09 per month. Single employees pay $127.63 per month, and the county pays $723.26 per month.

Under the proposed change, which must go to the full county board,  EMS members only would pay a higher deductible with unlimited out-of-pocket expenses.

The second discussion involved discontinuing the county emergency-services program and contracting instead with a private firm.

“I don’t think anybody’s been more supportive of this whole system as I have been in the last 25, 30 years,” said committee member Dan Austad. “The problem I see happening, it’s starting to spiral out of control. Somewhere we have to draw the line. We can’t have a paramedic at every corner of the county. If the average person saw what EMS costs us, it’s unbelievable.”

County Administrator Ken Pabich advised the committee to consider drafting a Request for Qualification (RFQ) for approval by the full board and then posting it to see whether any private providers are interested in serving the county. The county would lease its facilities and equipment to a private firm, and then the county would only have to worry about maintaining the facilities and vehicles. The county would pay a flat fee to the provider, and the provider would determine rates for service.

“What would be the advantage of doing that at this point in time?” asked committee member Ken Fisher.

Pabich answered that it would remove the county’s largest expense: personnel.

Committee Chair Dave Lienau asked Pabich what the next step would be, and he responded that he and Corporation Counsel Grant Thomas could come up with an RFQ and see whether any entities responded.

“We may or may not get responses,” Lienau said.

Austad pointed out that, besides the personnel costs, the service is good now.

“It’s expanded for the betterment of everybody,” Austad said, and wondered what would happen if they didn’t like the way the privatized service was being run.

“It’s a managed service,” Pabich said. “If you think the service is deficient, you negotiate with them.”

Committee member Susan Kohout warned that proceeding with an RFQ should not be taken lightly.

“I hope we can do this without blowing up the dam here and getting people needlessly upset here,” she said. “I think we have people who work hard, put their all in this and do the best they can to give us good information. I don’t feel like slapping them in the face.”

However, Brandon Schopf, president of the Door County Emergency Services union, said it definitely feels like a double slap in the face.

“It hurts,” he told the Pulse. “On a personal level – and this is just my own view – what bothers me is that I believe this is borne out of the fact that we’re negotiating [a new contract] right now, and for some reason they feel we’re not negotiating fairly.”

All but Kohout voted to send the health package to the county board.

“They voted to financially harm us by increasing our deductibles, taking the limits off our out-of-pocket expenses,” Schopf said. “They didn’t change our contribution or the county’s contribution, but they redesigned our health plan so that if one of us gets injured, it will cost us significantly more money than in the past.”

He also noted that the health-plan change is only for the 18 full-time medics he represents. He also mentioned that because the premiums paid have not changed, the reported 13 percent savings will be in the county’s health fund.

“If this isn’t an attack on our unit, why did the county give all the employees, including our unit, a refund on our health insurance?” Schopf asked. “For one month [December 2018], we didn’t have to pay our health insurance premiums because our health fund is doing so well. But now it’s apparently not doing so well? Doesn’t really make sense to me.”

Regarding the RFQ for private service, Schopf wondered whether the county really wants to lose control of the service.

“Right now the county has the ability to dictate – most importantly to the taxpayer – ambulance costs,” he said. “If you look across the state, the cost of our service when you get an ambulance transport is fairly low. A private may be able to come in here and say, ‘Hey, we can run this service for less than the county is paying, but we’re also going to charge you $3,000 for an ambulance call.’”

Then, he pointed out, there are the write-off calls.

“We do, quite frequently, pick people up who have fallen. The county doesn’t charge for that,” he said. “If your grandma falls out of her chair, and she calls 911, and we come out to the house, lift her up, check her vital signs and make sure she’s OK, there’s no charge for that. But if a private company comes in, there’s no way of stopping a private from charging that person anywhere from $300 to $500 for that call. It’s all about profit for a private – period. Right now the county has the option to write off ambulance calls. A private will not write off ambulance calls.”

The committee voted to have the RFQ drawn up, with Austad and Kohout voting no.

Emergency Services of Door County

2019 budget:  $4.3 million

The service consists of:

1 service director

2 captains

2 billing/coding specialists

18 full-time paramedics

6 part-time paramedics

45 part-time EMTs

150 emergency medical responders

Prior to the captains being added a year ago, the service director and a deputy director managed more than 200 employees. Now the service director and two captains manage this number.

Call Volume/Responses for 2018

A total of 3,550 incidents.

A second ambulance was dispatched out of the central (Sturgeon Bay) station 250+ times.

A second ambulance was dispatched out of the north (Sister Bay) station 100 times.

A third ambulance, which is off-duty personnel responding from home, was asked to respond to an incident 25 times. This number does not include the number of times off-duty personnel were asked to report to the station for standby because all other ambulances were on calls.  

To cover the service area, an ambulance moved out of quarters 500+ times, which is not included in the total number of incidents.

Due to recent changes, the service has also been providing more emergency transports out of the hospital, which takes one of the trucks out of service for approximately three hours.

They have also been transporting 911 calls to Green Bay more frequently to provide cardiac, stroke and trauma patients with a higher level of care more quickly. This is in the best interest of the patient, which, again, takes a truck out of service for two to three hours. Ninety transports to Green Bay were made in 2018.