Clock is ticking

Aspirus gives notice to county to terminate current ambulance deal

As Taylor County and Aspirus begin the process to hammer out a new ambulance service contract, members of the law enforcement and emergency services committee on Wednesday morning heard options seeking to balance coverage with cost and the availability of staffing.

Taylor County currently maintains three ambulance stations, one each in Medford, Gilman and Rib Lake. Traditionally staffing at each location was through on-call personnel who responded as needed in each area, with some full time staff members.

In line with state and national trends, the number of people willing to be oncall has been steadily declining. To make up the difference, the ambulance has had to increase the number of full time staff members covering shifts. This has lead to an explosion in labor costs. The service is operated under contract by Aspirus.

In a letter dated September 1, Aspirus gave an official 90 days notice that they would terminate the existing contract See COUNTY on page 4 but that they were open to discussing a new contract to continue to provide ambulance coverage to the county.

The letter came after the August law enforcement committee meeting where committee members rejected a contract amendment which would have had the county take on additional labor costs for the critical coverage levels to provide staffing for ambulance coverage in Gilman and Rib Lake. The county instead stuck to the contract language which caps the county’s costs.

On Wednesday, members of the county’s law enforcement committee met with Robert Kirkley, regional director EMS for Aspirus and Jason Keffeler, System Director of MedEvac to look at options for coverage models to determine where the county would like to go from here.

Kirkley presented five potential options for how coverage could look going forward. Four of them, he said he saw as being viable, but presented the fifth so that it could be at least considered.

The first option was for the county coverage to remain as it is. Ideally the system would have full time staff during the days at each station and on-call staff at night. He noted that every area wants to be covered 24 hours a day, seven days a week, but that is not always possible given the lack of on-call volunteers.

The second option presented was to switch the full time coverage from the day shifts to the night shifts and have on-call coverage during the daytime shift. He noted they have tried that model in Gilman.

Kirkley said the appeal of this option is that a lot of their staff are going to school full time during the day. However, the challenge is that people who are on-call also have full-time jobs on their own including some teachers who find it difficult to leave their classrooms during school hours.

A third option Kirkley presented was to go to an entirely full-time coverage model at all three stations. On call staff would be utilized to cover vacation or sick time or if additional ambulances needed to be called out, but otherwise the shifts would be covered by full time crews. This would involving increasing to 25.2 full time equivalents (FTE). The county currently has 13.6 FTEs on staff.

“Is there enough people who would apply for that?” asked committee member Chuck Zenner.

Kirkley said there may be, but that they haven’t tried to recruit for this because if they don’t have an opening they can’t post it for people to apply. He noted they have two more EMTs coming on board on October 1. With one being a working supervisor for the county and the other currently working as a dispatcher and will be stationed in Gilman as an FTE. This will bring Gilman up to 5.2 FTEs.

Of the options, he said this would be the one that would guarantee coverage in all the areas, but with the increase in staff would have more expense. However, he noted that being fully staffed in each area would reduce the amount of unexpected overtime that is currently being paid out.

A fourth option would be to move all the full time staff to the stations in Rib Lake and Gilman and operate them full time 24/7 with Medford 9-1-1 calls covered by the MedEvac inter-facility crew as needed during the day and with on-call personnel during the nighttime hours. He noted that Medford currently has a number of on-call personnel willing to take shifts. He said this would require 16.8 FTEs to operate. Kirkley said he believed this would reduce some of the coverage issues, noting the inter-facility crews already provide back-up for Medford.

He said it would be a matter that when the inter-facility crews were called out on a 9-1-1 call their hours would be charged to the county while otherwise their hours would be charged to Aspirus.

His final option, and the one he said he included just to be complete, was to have a single full-time base covering the county and responding from Medford. This would allow a reduction in staffing to 8.4 FTEs. Kirkley emphasized that he did not recommend this option.

Keffeler gave perspective noting the driving need for the change was because of the drop-off in volunteers and on-call personnel. “Volunteerism is basically dead,” he said, explaining that with the training and responsibility involved people want to be paid a living wage for doing the job.

He said the question is how do you get to a full time type of model. He noted that this in an issue that is nationwide, and is not unique to Taylor County.

He explained the trend is to see consolidations and centralized stations, but this greatly impacts response times.

Keffeler also said there is a revenue side that needs to be considered with most insurance providers and Medicare stagnant or attempting to reduce what they will pay at a time when labor, supplies and other costs continue to increase.

One of the major challenges is also retention. Industry-wide emergency medical services staff have a high burnout rate with about a 30% turnover. Recruitment is also a challenge because of the lack of flexibility of shift coverage and that amount of training required for it.

“EMS is not an 8 to 5 type of job,” Keffeler said.

Zenner asked for projected costs to be provided for each option so that they could factor that into the decision. Kirkley will provide that prior to the committee meeting scheduled for September 22. The full county board will discuss it on September 27.

It was noted that the county’s portion of the labor costs for the 2022 year will be $643,000 and that if the county continued going forward the way it was currently the costs would be at least $800,000.

Committee members suggested some other variations. Committee member Lorie Floyd asked about having full time crews operate on 24-hour shifts instead of 12 hour shifts with on-call supplementing them. Kirkley explained they currently have staff putting in 36-hour shifts. He said it comes down to still needing to fill the shifts.

Longer shift times also will require additional amenities for staff such as sleeping areas. Kirkley said that while Medford and Gilman have those, he said the Rib Lake base is “absolutely horrible” with one of the personnel currently sleeping in the garage stall.

Committee chairman Lynn Rosemeyer asked about additional state funding to support ambulance service efforts.

Kirkley said there are some additional funds in the budget, but they don’t come into play until 2025.

Floyd noted the county was at advanced EMT level for its rating and questioned if they are still pushing staff to get paramedic training. Kirkley said they currently have 8 advanced EMTs,14 EMTs, 1 emergency medical responder, three drivers and two paramedics on staff in the county ambulance service.

Committee members also asked about what is happening in other places. Kirkley said that in Oneida County Aspirus is running four bases for the county at a cost of $2.2 million a year and in addition Eagle River is contracting for its own base.

Keffeler said they are seeing a lot of mergers with larger coverage areas by a singly entity. He said while the number of EMTs in the state is at 21,000 compared to 20,000 10 years ago, the volume of calls has doubled in that time across the state.

In addition to the suggestions made by Kirkley, committee member Ray Soper raised the suggestion of a hybrid model. He asked about pooling the ambulances in Medford but having an EMT with a vehicle stationed full time in Rib Lake and Gilman. His idea is that these individuals would be able to immediately respond and begin stabilizing and treating patients while the ambulance is on its way. Soper said he would think this would be a way to reduce costs while still maintaining response times. He said that at a scene there is a lot of time the ambulance sits idle waiting for a patient to be stabilized enough to be transported.

“I think there are hybrids in between that have potential for saving dollars,” Soper said. He noted he would like to see some pros and cons of an idea such as that.

Kirkley said it would definitely save money. It was noted this could tie into the county-wide emergency responder organization that is currently under development. He said he supported that group’s efforts to get a responder group going.

Keffeler explained that the concern in the past for first responders is an insurance and licensing issue with if they can be part of the treatment team in the ambulance if they are not Aspirus employees. Kirkley said they have looked into mutual aid agreements and ways to work around it.

The next step will be for the committee to review the costs associated with each option before beginning formal negotiations on a new contract with Aspirus.

Robert Kirkley (left), regional director EMS for Aspirus and Jason Keffeler, System Director of MedEvac presented a number of coverage options to members of the county’s law enforcement committee during a meeting held Wednesday.Brian Wilson/The Star News