TOWER– The city of Tower is willing to explore possible regionalization of the city’s ambulance service, as long as townships elsewhere in the service’s coverage area agree to take part in an analysis of how such an approach might work.
That was just one of several ambulance-related developments to come out of Monday’s regular monthly meeting of the city council here. The council appointed Councilor Kevin Norby to take part in possible discussions on alternative futures for the ambulance service, which is facing a range of financial concerns as well as demands by some in the coverage area to raise the level of care to advanced life support, or ALS. Currently, the service provides basic life support.
A possible change in the governance of the ambulance service came out of discussions, raised initially by the Eagles Nest Township representative, at the April 4 meeting of the Tower Ambulance Commission. “It was to take a look as a bigger community, at what it would take to make the Tower Ambulance Service bigger and better,” said Norby. “We need to create a group to look at this more closely.” Norby said the group would likely look at the cost of upgrading the service to ALS and possible new revenue streams, such as the creation of a taxing district, possibly overseen by a joint powers board.
Norby said rural ambulances are facing the same challenges around the country. “You can’t survive getting smaller,” he said. “So maybe you need to look at getting bigger.”
Councilor Joe Morin called the creation of an ad hoc committee “a good first step,” but acknowledged there are lots of questions that still need to be answered.
Mayor Dave Setterberg questioned whether ALS service was sustainable for Tower, even with the creation of a taxing district. “Let’s face it, right now, Ely, Virginia, they’re having a hard time keeping paramedics and ALS. So how are we going to do that better than them?”
Even so, Setterberg agreed it was worthwhile exploring options for the service.
The council also approved a pay increase of a dollar per hour for ambulance staff who respond to calls. Setterberg noted that it had been nearly seven years since the last pay increase for EMTs and EMRs who respond on a per-call, rather than on-call, basis. The council, missing Sheldon Majerle, voted 3-0-1, with Tom Suihkonen abstaining due to a conflict of interest, to approve the one dollar an hour increase.
The council also backed, again with Suihkonen abstaining, to pay EMTs and EMRs an extra $2-4 an hour for taking inter-hospital transfers. Setterberg advocated for the higher pay as part of a six-month pilot project to see if the bonus pay, which would be in addition to their base rate, would encourage more ambulance staff to take transfers.
Setterberg said increasing the number of transfers could generate more badly-needed revenue to cover the high cost of the service’s paid on-call staffing. The Tower ambulance service has been operating for the past several months with virtually no cash cushion to cover the monthly payroll and Setterberg was hopeful that increasing the number of transfers could provide revenue to help cover payroll.
Setterberg provided an analysis he had completed of the revenues and expenses generated by transfers over the past six months. He said it was clear that the longer transfers were generally net-losers for the ambulance service, particularly when the mileage charge of $1.66 assessed by the ambulance commission to help cover vehicle depreciation is included in the cost. He said since the service focused its transfers on relatively shorter distances, the numbers improved significantly. By his calculation, the service generated a net surplus of about $9,600 from 24 transfers completed in the second half of 2021, or an average of about $400 per transfer. Setterberg said if the department could double its transfers, it could generate close to $20,000 in net surplus. He said that would help to cover the cost of on-call staffing, which has jumped sharply since the Emergency Medical Services Regulatory Board highlighted the service’s past failure to maintain a 24/7 on-call roster. The service has greatly improved its staffing levels since. “We’re now up to 90-95 percent staffing,” noted Setterberg, but that improvement has come with a cost.
The EMSRB report had predicted that the cost of maintaining the required staffing level would be unsustainable given Tower’s exceptionally high on-call pay rates. The EMSRB’s financial consultant noted that Tower’s on-call rates were the highest he had encountered in the Upper Midwest and had recommended cutting the rate at least in half. Setterberg and Norby downplayed the high on-call pay rates and said that Tower was actually lower than pay rates for Ely and Virginia. Setterberg later acknowledged that the Ely and Virginia pay rates were for emergency personnel who are actually on-duty, whereas the staff in Tower is considered to be on-call, but not on-duty. “It’s not apples to apples,” he admitted.
While Morin said he was interested in trying the higher pay to see if it encouraged more transfers, he said he’d like to see measurable outcomes so the council can assess its effectiveness six months from now.
In other ambulance business, clerk-treasurer Michael Schultz provided an update on the cost savings from utilizing city workers during their regular hours to provide on-call ambulance coverage. Both the deputy clerk and the maintenance assistant are trained ambulance staff and on-call hours they cover while at work can reduce the need to pay for other on-call staff. Schultz said the deputy clerk covered 101.25 on-call hours over the past quarter, yielding a savings of $1,063. The maintenance assistant did not cover any hours.
Schultz also reported that he plans to make payments to the ambulance replacement account that the city currently owes based on the transfer mileage charge of $1.66 a mile.
“I was unaware that the funds had not been transferred,” said Schultz. The city had previously paid $6,397 for transfer mileage in 2021, out of a total of $9,791 owed. The city’s arrears, totaling $3,394, were an issue with some township representatives at the most recent ambulance commission meeting. Schultz noted that the ambulance service sometimes lacks the funds to pay larger bills, and he suggested that the council consider transferring money from the general fund to cover the cost. He said he planned to make the payment before the end of April. Norby suggested a late payment should not be a major issue. “Other townships have been a little late on their payments at times,” he said.