COOK- Since taking over as director of Cook Ambulance Service this summer, Roland Shoen has been getting a handle on what the service has and what it needs for continued vitality, and his conclusions are in line with most of the small-town rural volunteer services across the country: retain the current volunteers, recruit more EMTs, and increase revenue.
“We have 10 EMTs, 10 first responders, and we just had two new EMTs apply this week,” Shoen said on Tuesday. “We’ll get the background checks done and that will hopefully bring us up to 12. First responders do help, but you can’t move the rig without an EMT.”
With some taking on-call hours in excess of 200 to 300 hours and others covering the minimum required 24 hours, Shoen has enough staff to cover the schedule to typically provide service 24/7, although occasional gaps mean an ambulance from Tower, Orr, or Virginia has to step in to take a call.
“There are sporadic days when there’s no one available,” Shoen said. “You hope and pray that nobody needs it then. It could happen once in a month, or it could happen six times in a month.”
While Shoen has a committed group of volunteers, he’s knows that circumstances could change at the drop of a hat. Volunteerism is down in general across the country, and thousands of EMTs didn’t renew their certifications in 2020-21, Shoen said. And he cited a national survey of emergency medical services that showed the turnover rate for EMTs is a whopping 36 percent, meaning that within a four-year period a service would have to replace its entire workforce.
“If we lost over a third of our people right now, I’d be left with 11 or 12 people, and I don’t know how we’d survive with just 12 people,” Shoen said. “When I first joined (in the 1980s), people came out of the woodwork because it was a brand new idea. It was a way for them to give to their community. We had the baby boomers who were all about giving – they had the volunteer itch. You don’t find that so much anymore.”
Shoen said that the on-call hourly rate of $4 that Cook Ambulance Service pays isn’t competitive with towns such as Tower and Ely where EMTs can make almost four times that amount, and even some Cook EMTs have been splitting hours by taking shifts in Tower. The Cook service has tried to enhance its compensation by raising the rate for transfer runs to $2 per loaded mile, that translates into pay of around $160 for a transfer to Duluth, Shoen said.
Increasing the number of transfer runs is a strategy Shoen said the service is using to generate more revenue, with the intent that those patients with private insurance that pays more than Medicare/Medicaid will help overall receipts.
But transfers aren’t a sure-fire fix, either.
“You’re hoping that you’re getting a balance or at least a balance to break even, you know, get good insurance transfers, get Medicare transfers,” Shoen said. “If we take more Medicare transfers and get the low reimbursement for Medicare, you could end up losing in the game. We’re trying our best to encourage taking transfers to give our crew a little bit better pay than the $4 an hour.”
A contributing factor to the transfer game is that a temporary raise in the Medicare reimbursement that has been in place for the past five years is set to expire at the end of this year, slicing the margin for success even thinner.
And yet another consideration in increasing transfers is that the service uses its expensive full-size rigs to do the runs, increasing the miles they run and shortening the time until they have to be replaced. Full-size rigs can cost up to $250,000, but alternative smaller ambulances designed just for transfers come in at under $100,000. The city has already solicited bids for a full-size ambulance to replace its aging second rig, and Shoen hasn’t yet determined if the funds saved by getting a transfer ambulance instead could be used to increase pay. Ambulance staff have also expressed concerns about the safety of the smaller transfer ambulances, a possibly valid consideration given that emergency medical personnel are at the highest risk of being in an accident when compared to other first responders.
“Ultimately, at some point the amount of money you take in has to match the amount of money you put out,” Shoen said. “I’ve told the crew that if we’re going to keep going for these $200,000-$300,000 ambulances, they’re going to be staying at $4 an hour.
With the financial challenges already facing area ambulance services, Shoen said considering moving up to an ALS service staffed by paramedics isn’t doable.
“The going rate for a paramedic is in the mid to high $30s per hour range,” he said. “We’re paying somebody $4 an hour now and we’re barely making it.”
Shoen pulled out a calculator and ran the numbers for providing 24/7/365 service staffed with the required one paramedic making $38 an hour.
“That’s $332,880, plus benefits, he said, noting that that was more than the cost of replacing an ambulance.
The key for Cook Ambulance Service right now is recruiting more EMTs, Shoen said. With more EMTs, the service could assure 24/7 coverage. With more EMTs, the service could take more transfers, increasing the chances that strategy will increase revenue.
The city will cover the tuition cost for a Cook resident who takes the semester-long EMT certification course, Shoen said. In return, the new EMT has to commit to a minimum of 18 months with Cook Ambulance service. If he could get 12 interested people, Shoen said, that certification class could be held in Cook. He also said he would be open to working with the Orr Ambulance Service to recruit the 12 people necessary to hold the class, perhaps holding it at North Woods School.
“We need to have the community feel the urgency,” Shoen said. “Even if ten more people in the community had 24 or 48 hours that they could get out of a month for their local EMS. Those are the people we need. We need them to be EMTs because without an EMT we’re not going to roll an ambulance.”