Rushville Republican

January 17, 2013

City ambulance service discussed

Melissa Conrad
Rushville Republican

RUSHVILLE — The Rushville Common Council, Rushville Board of Public Works and Safety, the Rush County Council and the Rush County Commissioners met Monday to discuss the city’s plan to provide emergency medical services and ambulance service through the Rushville Fire Department within the city. The ambulance service is currently provided by Rush Memorial Hospital.

Brad Smith, CEO of Rush Memorial Hospital, and some RMH board members were also in attendance.

Attending for the city, in addition to Mayor Mike Pavey, were Board of Public Works and Safety members Darrin McGowan, Gary Cameron, Angie Barton and Don Jarman and Rushville Common Council members Craig Smith, Brian Conner, Brad Berkemeier and Brian Sheehan. Council president Bob Bridges was absent.

Attending for the Rush County Commissioners were Bruce Levi and Ken Masters. Mark Bacon was absent.

Attending Rush County Council members were Gerald Mohr, Warren Norris, Charles Smith, Janet Kile, Marvin Hedrick and Kevin Spilman. Jerry Kent was absent.

The purpose of the meeting was to get everyone together and have an open discussion, said Mayor Pavey.

“It gives us an opportunity to talk back and forth, and I think probably get the most useful, honest information we’ve got,” Mayor Pavey said

Pavey shared an EMS timeline that spans from Feb. 1, 2011, covers at least 29 steps, and continues into 2013.

The city, following discussions and a detailed business plan preparation which they have shared throughout the fall, is now asking other government officials to speak now or at least before the city makes its decision on whether to move forward with EMS services.

“There’s questions we have to get answered, and try to figure out exactly how we move forward. At the end of the day, the city has to make a decision,” Pavey said. He also noted that the city has to make a decision on, “Is this something the city wants to move forward with if the county says, ‘We don’t.’”

Pavey opened the meeting to conversation to see where people attending stood on this proposal.

“I would rather people talk tonight in this meeting than leave the meeting and hear that it went a different direction tomorrow. Some of the dialogue from our point of view, we’d rather hear information that maybe we don’t want to hear, but I’d rather hear it here than us moving down the road and six months later hear, ‘Oh did you know you offended so and so and that type of thing.’”

Reedy Financial from Seymour initially analyzed information from RMH in the county’s EMS report in developing the city’s business plan.

The plan affirmed that the RFD plan is reasonable interpretation of anticipated costs and revenue if the city provided ambulance services to city residents.

Essentially, because of the higher population, inside-the-city-limits providers make money with ambulance services, but outside the city there aren’t enough people to separately support a profitable service. Currently, the areas are combined.

The city said they are also open to providing for the combined area as well.

The financial advantage is realized because RFD maintains ready, on-duty firefighters who would have the medical training to provide Basic Life Support. Because firefighters are already on duty and thus on call for fire or emergency runs, the cost is reduced.

A sponsoring hospital is required for the city to offer Advanced Life Support Services and the city has expressed an interest in meeting with the RMH Board of Directors to discuss RMH sponsoring the city’s services, as they currently supervise their own EMS program.

The city is taking these steps for several reasons and at the urging of RFD Chief Chuck Jenkins.

A wage study revealed that RFD wages are lower at the top levels than similar communities. In studying the issue, the city learned that many communities are going to a combination of full-time and volunteers firefighters.

“Communities our size were starting to go away from the full-time, full-staff fire department. And we knew that at some point we were going to have to look at it,” Pavey said.

The mayor said being able to maintain a professional fire department is a consideration. How seriously a professional fire department can impact economic development, for example, is still in question.

“I can tell you that when we negotiated with the ethanol plant that was a requirement. They were only coming to communities with full-time, paid firefighters,” he said.

“At the end of the day, people can walk out of here today and say, ‘You know what? The city can go ahead and pay for their firefighters.’ And we can, for awhile. It becomes, how long is awhile? Right now, we are of a size that unless we make a commitment to grow ... we are managing our own demise. We are slowly watching things shrink, we’re just doing a really good job of managing how it shrinks.”

Whether proceeds from ambulances services could be shared or divided in such a way, either geographically or in services performed, that both RMH and RFD could benefit moving forward remains a question that it appears all parties are willing to keep talking about.

Approximately 80 percent of emergency runs are within the city and 20 percent are outside the city.

All sides agreed that RMH has done an excellent job to date providing emergency services and RFD also runs an excellent fire department. The question was not, it seemed, whether either entity could do a good job. The question was more what is the best way to provide emergency medical services and make it a better use of tax payer dollars than the city believes is currently happening.

City Councilman Smith summed up a portion of the city’s view saying, “RMH is a great facility. It’s never looked better. We’re fortunate to have it. Brad and his staff do a great job up there, but in this case we think and we feel like there’s a better way to utilize those dollars and we know from the city’s perspective we can do that.”

“To us it’s not winning or losing, it’s what’s best for our city residents. And in speaking with some of our county leaders, how can we incorporate the county and do the best thing for all,” added Smith.

John Byrne noted RMH had not yet had their meeting with the city on RMH moving to a sponsoring role rather than operating. Byrne spoke about the long, sometimes bumpy history of ambulances services in Rush County until RMH took it over six years ago.

“We’ve provided the best, top-notch ambulance service we could possibly provide and I’m very proud of them today. Naturally, we’re proud of that so we’re going to defend for that too at the same time. We don’t want to see it go. ... We felt as though when we were asked to be the sponsoring hospital we felt we owed it to the City Council first to sit down and meet with them and let each of those individuals have a chance to talk. It involves a roundtable discussion that needs to happen.”

Byrne agreed that this has begun recently with Karen Meyer, VP of finance and chief financial officer at RMH, meeting with city officials.

Pavey acknowledged that if the numbers come back as a minimal difference they shouldn’t do it, but if cost is a factor and there is significant impact then everyone needs to sit down and look at it seriously.

Pavey said he has confidence in RFD’s ability to run an equally effective service and save money.

RFD would hire additional employees, both civilian and firefighters, to provide these services.

Mayor Pavey said he does not want the discussion on this topic to become a behind the scenes lobbying effort instead of an open discussion.

“At that point I will push a decision. I think the lobbying of something that should be openly discussed will hurt the community more than moving in a direction,” he said.

Pavey said this would be hopefully the first of one or two more meetings before a direction is settled on. If, in two months, progress has not happened Pavey said he will push for decisions one way or the other.

Pavey did ask Brad Smith, RMH CFO, to put the city on the agenda for the next hospital board meeting to hear ALS/BLS details and to have RMH begin consideration of being a sponsoring hospital.

County officials will have to participate in the decision if they want the city to provide EMS service outside city limits, if the proposal moves forward.

Smith made sure the city heard the message of what the ambulance service has faced in the past.

“This disagreement is the cost. That’s why I think, if given the opportunity to sit down and compare the two reports, you see that what has been projected is not actual. ... We’ve got six years of data and not once has anyone asked us for that actual data,” he said.

Pavey responded saying the numbers the city used were provided to the county by RMH.

The bottom line, Pavey said, is, “Whether I have a call right now for an ambulance or whether I don’t have a call for an ambulance, I have four guys sitting at the fire station. I’m paying them. I’m already paying them. They’re already sitting there. Do I have to pay them twice? No.”

Smith also asked that future discussions focus on patient care and the mechanics of RFD delivering ambulance service. Additionally, he pointed out that in a volume business, which EMS is, that cutting the pie into too many pieces among various entities would make the numbers unworkable for everyone involved.

Pavey and Smith traded talking points numerous times on why RMH was not an invited guest to the open meeting, with Pavey saying the process had to start somewhere and it was started at the governance level and would come to RMH as the steps progress.

Sheehan asked for county leaders to add input and share information on their thoughts about this proposal in the coming meetings.

Monday night’s meeting was a start in the on-going conversation between the city, county, RMH and RFD that will determine how ambulance services are structured in the future.

The governing bodies and the mayor met originally July 5, 2012, to discuss the proposal by the city. After the initial presentation Councilman Brian Sheehan made a motion to form a committee consisting of the mayor, two appointed Council members, a Commissioner and a County Council member to meet and come up with a proposal to present to all members for their consideration. The motion passed in July. Following a series of closed door meetings this past fall no public recommendation was released by the group.

Contact: Melissa Conrad @ 765.932.2222 x107