Ask and you shall receive; questions about EMS levy answered | Letters

A Journal reader recently submitted a letter asking seven specific questions of EMS about the proposed increase in the its property tax levy. Click on the headline to read the reply.

— Submitted by: J. Michael Edwards, San Juan County Public Hospital District #1, commissioner; Larry Wall, SJI EMS, director of critical care; Jim Cole, SJI EMS, chief

Dear Mr. Paulson;

We appreciate your questions and are thankful for the opportunity to shed light on your concerns.

1) If tax revenue increases due to a rebound in property values, how will (EMS) deal with the excess revenue?

It is important to note that the Revised Code of the State of Washington (RCW) allows an increase of only 1% of the previous year’s assessed rate, plus tax revenue on any property’s new construction, and will not grant anything higher, even if property values rebound. At that rate, the levy will not catch up with any rebound in property values.

2) What is the current EMS budget?

The current budget shows $3.8 million in revenues which includes the proceeds from the sale of the old EMS building. Our anticipated expenditures will equal $3.8 million which includes a potential roll over of about $400,000 into next year’s budget as beginning cash only made possible by the building sale. This was accomplished by staff pay cuts, loss of some benefits, and using some funds from the sale of the old EMS building. Each year we adjust our expenditures to meet current operational needs, and to stay within budgetary income constraints.

3) Will any of the tax revenues help subsidize a private, for profit, MedEvac flight business?

Island Air Ambulance is a service provided by San Juan Island EMS in partnership with Island Air, Inc. that contracts to provide flight operations in a fee-for-service model, not unlike other medevac services. San Juan Island EMS provides the medical operation. There is no tax subsidy for Island Air, Inc. This fee-for-service contract is similar to that of other County agencies’ contracts with outside businesses that provide a specialized service or product.

4) I know of two San Juan property owners who have been billed (approx. $16,000 each) for an Island MedEvac flight even though your policy states that there is no charge for to San Juan property owners.

San Juan Island EMS and MedEvac bills the patient’s insurance company, if any, for the services provided by our agency, and takes insurance reimbursement as payment in full. If district residents’ insurance reimbursement does not cover the entire bill, or if residents do not have insurance, they incur no out-of-pocket cost. If you know of someone who has questions on their bill for service or explanation of benefits, please have them contact the EMS agency at 360-378-5152.

5) How many calls does EMS respond to each year, and what percentage are advanced life support calls?

In 2013, San Juan Island EMS responded to 1496 calls for service requiring patient transport. According to the Medicare report mandated by the Affordable Care Act, 76% of those calls were categorized as Advanced Life Support. Given that San Juan County has the highest per capita age in the state, this high utilization of EMS services and higher level of assistance seems appropriate.

6) How does the island EMS call ratio and budget, as a percentage of population compare with areas such as Anacortes, Bellingham and Skagit Valley?

Although we have not calculated the EMS statistics in this exact fashion, we did calculate our cost per call by operations budget, minus the cost recovery through patient billing. The public’s cost is approximately $1,100 per call for service. While we have not compared this with Anacortes, Bellingham and Skagit, we did compare with Orcas Fire and EMS. Their figure is around $1,700 per call for service. Their department includes fire calls as well in that estimate. Our agency calculates MedEvac and Marine calls into our figure. These are not exact comparisons, but do give a general ball park of the cost ratios to which you refer.

The fact that we are on an island greatly increases our call costs. For instance, during non-flyable weather a patient recently was transported via ground ambulance. Because of the transport logistics involving the ferry, the total patient transport time exceeded 3 hours. On the mainland, this patient transfer take less than an hour and would require only basic life support using two EMTs. Because of the delay due to ferry transport, this patient required repeat doses of medication that could not be self-administered. This care had to be provided by a Critical Care Transport Nurse or Paramedic. With the all of the transport logistics considered, the crew and rig were out of service for a total of eight hours for a call that, on the mainland, would take less than two hours.

7) Is any of the additional revenue you are requesting needed for the new 1.8 million dollar facility you have recently moved into?

The old EMS building was sold this year, and part of those funds were used for operations. The remaining $400,000 will roll into the 2015 as available operational cash. There is a difference between a budget (which guides spending) and cash on hand (the actual amount of available funds to pay bills).Proceeds from the sale of the EMS Building and the old Medical Center were intended to pay off the existing mortgage on the new EMS Building. Because only one building sold and the other continues to be on the market, we were unable to pay off the new building’s mortgage. We budget about $100,000 per year for mortgage expense.

We appreciate this opportunity to address directly your questions. Many readers may be unaware of your service years ago as paramedic for the agency. Thank you, Mr. Paulson, for your service to the community.