On Tuesday night, Decatur County commissioners unanimously approved a contract with EMS Grady of Atlanta for the company to privately operate the county’s ambulance service.
Decatur County will pay EMS Grady $250k annually beginning in September 2014 The contract term will be for 5 years; the contract can be renewed or modified or not at that time.
The new privately-run department will operate as Decatur Emergency Medical Services (no “County” in the name). The new department is expected to have 27 employees, a mix of full-time and part-time EMTs and paramedics. Current employees will have to interview and re-apply for a position with the new agency. Current EMS staff met with Grady EMS officials Tuesday morning to make acquaintances.
New ambulances will be brought in for use while Decatur County’s existing ambulances will be refitted over the first 2 years of the contract. Ambulance “boxes” are good 10-15 years, however the trucks wear out after 4-5 years, according to Breedlove. The refurbished trucks will still belong to Decatur County and be leased to Grady EMS for a nominal fee, the county administrator said. Grady EMS is proposing to buy gas for use in ambulances using Decatur County’s wholesale gas rate; Grady EMS would pay the county a five-cent administrative fee on top of the wholesale rate.
Other contract requirements:
- Grady EMS keep records, provide county with data such as response time, certifications
- Grady EMS is required by the contract to have three ambulances ready to go at all times. County Administrator Gary Breedlove said he discussed with Grady EMS staff that having three ambulances “ready to go” also meant that at least one backup ambulance needed to be in place.
- Grady will have to carry multiple $1 million-plus liability insurance policies, with Decatur County government named as an additional insured party.
- Grady will have to carry workers compensation insurance
Decatur County upgrade EMS facility to meet local building codes and provide adequate EMS housing. County Administrator Gary Breedlove says work needed on the EMS building on Airport Road.
Commissioner Oliver Sellers said he believed the county’s volunteer medical first responders were important in a large county and wanted to know whether the private ambulance service would still work with the volunteers. Grady EMS Vice-president Bill Compton said he met with Fire and Rescue Chief Charlie McCann Tuesday and said he hoped to continue that relationship with first responders. The contract was later amended to reflect that desire to continue the relationship with the county’s first responders.
Compton said one of the things he discussed with McCann was that the new EMS would strive for common equipment purchases, so that EMS equipment like stretchers etc. matches what firefighters have, for the sake of familiarity. Compton said he would like to be able to use first responders to drive a private ambulance if needed and be insured to to so.
Since the county’s ambulance service will now be private, it will be up to Grady EMS to set transport rates and collect money on those bills, which had previously been the county’s responsibility. County Attorney Moseley said the contract still gave county commissioners some leverage.
“We’re trying to come up with a rate fair to the ambulance service, not place an undue burden on patients and not be totally beyond our control,” Moseley said.
The contract just specifies that any rate Grady EMS sets for ambulance transport should not exceed 250 percent of Medicaid reimbursement rate.
Compton spoke about how Grady EMS would set rates going forward. He said he wanted commissioners to be able to explain to citizens that even if the dollar amount of the rate increases after September, patients will not face a larger out-of-pocket cost.
Compton explained that there are 4 types of patients: those covered by Medicare, Medicaid, commercial insurance or who have the ability to self-pay with cash and the uninsured.
“We need the flexibility to set rates according to changes in the market rate,” Compton said.
For example, if the county’s ambulance rate was $400 and the Medicare rate for our area was $250, then Grady EMS would only be able to collect the $250 and have to write off the remainder. However, commercial insurance companies often pay 80 percent to 100 percent of any charged ambulance fee. An insurance company might be willing to pay $600-$800 for an ambulance ride, but if the billed amount was lower, that money “would be left on the table”, according to Compton.
To reach a compromise between turning a profit and keeping rates affordable for citizens, Grady EMS plans to offer uninsured patients a discount of between 50 to 70 percent off the billed rate, factoring in the poverty rate set by the federal government.
County Attorney Brown Moseley: “In our view, Decatur County has maintained good response time. We want to keep the average response time from doubling or tripling.”
The contract specifies average response times Grady EMS will have to maintain, based on the distance of the call. If Grady EMS could not maintain good average response times, they wouuld be notified that they were in breach of contract and have to fix the issue within 60 days, Moseley said.
According to the contract, neither Grady Health Care shall not build a hospital or other medical facility in Decatur County other than what is needed for EMS during the contract term. That requirement was included in the contract to address concerns brought up at a previous county commissioners’ meeting. Billy Walker, CEO of Memorial Hospital, had voiced concern that a private ambulance service could open up the door for a private company to expand its medical services within Decatur County. He said Tuesday night that he was satisfied with that language.
County commissioner Dennis Brinson asked whether Decatur County would keep its state-issued license to run an ambulance service. County Administrator Breedlove said that license had recently been renewed for two years and would retain the option to revert to a publicly-run ambulance service if the private contract ended.
Breedlove thanked the county attorney for his hard work in drafting up the contract.
County Commission Chairman Frank Loeffler said he believed that Decatur County has “a tremendous contract with a great company.”
While Seminole County was not included in this deal, as it had previously voted its preference for a different private EMS company, Breedlove said Decatur County was still open to partnering with Seminole County on a joint ambulance service run by Grady EMS.