Study group to explore SafeTech proposal

ELY- For the first time since Ely-Bloomenson Community Hospital unveiled its ambulance study, all the region’s EMS stakeholders came together to talk about next steps, if any, on Tuesday evening in Ely. An hour and a half later, very few questions had solid answers, but the Ely City Council resolved to form a study group to look in greater detail into the study’s recommendation for a regional ambulance system run by the hospital.
The meeting in Ely was officially a council study session but they invited representatives from the cities of Winton, Tower, and Babbitt, along with Morse and Fall Lake townships, the hospital, and the Ely, Tower, and Babbitt ambulance services.
Two topics came up repeatedly during the meeting. The first was about ambulance transfers from Ely to other hospitals. The other was about the fate of the ambulance services’ capital assets if the hospital took over ambulance services. Currently the facilities and ambulances affected are the property of the cities of Tower and Babbitt and the nonprofit Ely Area Ambulance Service.
The hospital’s proposal
The Ely-Bloomenson Community Hospital hired the SafeTech rural EMS consultancy last summer to study the financial and organizational viability of the area’s ambulance services. SafeTech presented its findings at a public meeting on June 13, where it recommended a merger of the EMS organizations in Babbitt, Ely, and Tower into one service operated by the hospital. SafeTech’s best-case scenario for a unified EMS provider would place two advanced life support ambulances in Ely, one in Babbitt, and one in Tower. All the rigs would be actively staffed full-time.
Under a merged ambulance structure, it appears the hospital would be eligible for 101 percent cost reimbursement under the current payment rules administered by the federal Centers for Medicare and Medicaid Services. At the study session, Patti Banks, the CEO of EBCH, pointed out that 65 percent of all regional EMS calls are eligible for federal payments.
An ambulance service run by a critical access hospital is eligible for the higher cost reimbursement if there is no other ambulance within 35 miles. Because of the distances between Tower, Babbitt, and Ely, the cost reimbursement provision is possible only if these three primary service area license holders combine as one organization under the umbrella of the hospital.
Transfers and capacity
Banks said part of the hospital’s motivation for the ambulance study was based on patient complaints and medical staff concerns over inadequate regional ambulance capacity to handle all the transports from Ely to other hospitals. Currently the wait time for transfers averages two to four hours and some requests go unfulfilled entirely. More than one in ten patients must drive themselves to more advanced care available in places like Duluth.
Several of the study session’s attendees weighed in about transfers and local rig capacity. “The problem is transfers,” agreed Chuck Novak, the chair of the board of directors of the nonprofit Ely Area Ambulance Service, although he questioned how the SafeTech recommendation would resolve the issue. “Four ambulances seem like a reduction in capability,” he said. Currently, all three services operate two rigs. Ely also has a van rigged just for transfers.
Novak noted that funding has affected Ely’s ability to respond to transfer requests, commenting, “(Because of a) lack of funding, we no longer have paid staff on-call. We have to cross our fingers that enough of our qualified staff will come in to take a transport.”
Glenn Anderson, a city council member from Babbitt, concurred with that view, noting that the four-ambulance distribution would leave Babbitt uncovered when one or more of those rigs was out on a transfer, leaving gaps in coverage.
“One ambulance (for Babbitt) is not enough,” he stated.
Dena Suihkonen of Tower’s ambulance service made a similar case, using four calls in four hours from last Monday night as an example of why Tower has two ambulances rather than one.
Banks did respond to the concern over transfers and their impact on the ability of a unified system to provide better coverage.
“(Sufficient) capacity would be the hospital’s responsibility to staff and employ. If that is the level that we are committing to, to start off with, then that is the level that we will have to achieve.” She added that because the hospital is not currently in the ambulance business, it would work with SafeTech to create “an operational model to assure that we can meet the expectation.”
Facilities and equipment
The other recurring issue that was shared by all three ambulance services was the fate of their existing facilities and rigs. Given a proposal to unify the services, all of them had questions about what would happen with those capital assets.
Given that Ely’s ambulance service just acquired a new home, Novak wanted to know:
“If the hospital takes over, what’s going to happen with our facility?”
Anderson echoed Novak’s concerns, pointing out that Babbitt’s two rigs live at Babbitt’s fire hall. He asked Banks, “Will you rent from us? Reimburse us? … If you set up in Babbitt, what about the cost of staff quarters?”
Suihkonen from Tower’s service raised similar concerns. “We don’t have a facility in Tower and Tower doesn’t have the money to build one. What will the hospital do (to maintain a rig and staff in Tower)?”
Bank’s responded, noting that those details have not been fleshed out yet, in part because the hospital wanted to hear feedback about the initial presentation before investing more time and money in developing detailed financial and logistical models of how a unified ambulance service would work: “We do not have a plan yet because we haven’t gotten that far down that path.”
Study group
Ely council member Paul Kess noted that the hospital had been hoping and waiting for feedback from other EMS stakeholders in the region before digging deeper into costs and plans to transition to a unified model. He also observed that other stakeholders certainly did have interest in seeing more details before they made any decisions regarding the SafeTech scenario.
“The devil is in the details and the details don’t exist yet,” Kess said.
Ely’s mayor and council members jumped on this, believing that digging deeper is a logical step in moving forward.
“If there are some of you who definitely want to move forward with this and want to help think these things through, then reach out to sign up right now before you leave (to be a part of the study group). Otherwise, we will send out an email and we will hound you (to sign up),” said Mayor Heidi Omerza.