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AMBULANCE COMPANY FACES FINANCE CRUNCH AS BILL PAYMENTS SLOW
Frio County commissioners have learned of the growing financial crisis that contracted emergency medical service company ShurMed is projecting should current rates and reimbursement policies continue.
ShurMed CEO David Phillips provided the court with financial and operational statistics in his monthly presentation to commissioners.
Phillips said the company responded to 191 emergency 9-1-1 calls in February. Of those, 159 resulted in transports to a medical facility. Pearsall had 123, Dilley 60 and the rest of the county’s coverage area had 45 calls for service. Phillips said the company had 70 requests from Frio Regional Hospital and completed 60 and transported seven patients via air medic flight.
“We did a couple of multi-person calls,” the CEO said. “Both were related, like the sheriff said, to immigrant pursuits.”
Phillips said the company logged 197 service calls in March, 121 medical transports and two vehicle accidents – both were related to pursuits of undocumented immigrants. Of the 197 calls, 104 were in Pearsall, 47 in Dilley, and the remaining 46 were in the unincorporated areas of the county; Frio Regional Hospital had 68 requests for transport to other medical facilities; ShurMed completed 58 along with seven helicopter transports.
Phillips told commissioners that a struggle with the ICE and Homeland Security agencies regarding payment remains ongoing.
“They were not paying us for five months,” Phillips said. “It turns out they were not paying the hospital at all. I was able to make some calls and a few days ago ICE did pay us.”
The CEO told commissioners that he believes a frank discussion needs to be had with ICE and Homeland Security administrators regarding the amount of resources their entities use in the county.
“Assuming they pay for the transports, which I mentioned they were not, my calculation is still not an equable amount for the county,” the CEO said. “The amount of unit hours that goes in far outweighs what they are paying in. Therefore, I do think at some point, we may as a group need to face that.”
According to Phillips, it costs approximately $85 an hour to run an ambulance and that in order to serve the coverage area the county should have three units, which equates to a cost of $2.25 million a year.
The county currently has two ambulances.
In order to operate, the company is funded through two sources, fees and money a government subsidy pays. Phillips said that 95 percent of payments are paid from insurance claims but payments are normally 60 percent less than the actual cost of the service.
“Those are the folks that normally pay us,” he said. “If insurance pays us $300 and we think that ambulance ride is worth $1,000 we cannot bill y’all the $700; it’s called balance billing and it is against the law.”
Phillips said there are additional concerns with insurance companies and predetermined reimbursements.
“We can bill insurance whatever we want, and we do,” the CEO said. “So if we transport to San Antonio it is going to be $2,000 they will pay us $400. That is not negotiable because insurance companies like Blue Cross, United, Medicare have already predetermined what they are going to pay us. The only reason we send a bill a little bit higher is so we let those folks know this is what it actually cost. They pay us what they pay us, period. And I can’t get the money from anyone else.”
Current healthcare insurance only pays ShurMed for transports, so requests for EMS without a transport accrues a non-reimbursable cost.
Frio County pays in $525,000 a year, leaving ShurMed approximately half a million dollars in the red a year, according to Phillips.
“Why does that matter,” he said. “In order to have stable EMS, you would have to find a way to pay. Folks who could operate those numbers you probably would not want up here; it becomes a quality issue.”
Phillips suggested two ways to overcome the deficit, namely by widening the ‘catch net’ and responding to calls in other areas adjacent to Frio County, and seeking financial resources.
“I was happy when the judge engaged the grant writer but the one disadvantage of a grant is it is episodic not perpetual,” the CEO said. “So if we get a million dollars this year, we may not get it for the next.”