BY SARAH GREGORY
Action taken by the Greene County-Greeneville Emergency Medical Services (EMS) Board on Wednesday will designate Greene County-Greeneville EMS as the only ambulance service allowed to operate in the county.
The action was taken in response to officials' mounting concerns regarding the negative impact that private ambulance services operating in the county are having on EMS revenue.
EMS Director Robert Sayne explained to the board on Wednesday that, for the EMS, transporting patients by ambulance for non-emergency reasons -- such as to and from kidney dialysis treatments -- provides a revenue stream that supports the agency's emergency operations -- such as wrecks, which do not typically generate any substantial amount of income for the agency.
He spoke during discussion with board members at the meeting, which took place at the Greene County Courthouse Annex.
COUNTY'S SOLE PROVIDER
The board voted unanimously to adopt a resolution that regulates local ambulance services, and also elected to name Greene County-Greeneville EMS as the exclusive provider for the county.
Private ambulance services wishing to operate in Greene County must be franchised, subject to the board's rules, it was agreed.
The EMS Board has not met in a number of years, Sayne said at the beginning of Wednesday's meeting.
The meeting was called, said member Lloyd "Hoot" Bowers because of recent operations by privately-owned, out-of-town ambulance services.
"In my opinion, that's eating into the inome of our local ambulance service that we've had in place for 39 years," Bowers said.
Sayne explained that not only do the private entities affect the revenue of the EMS, but also they cause confusion as it relates to 911 dispatches.
"Right now, 911 has no idea which ambulances are in the county. We don't know what other counties' ambulances are doing" at any given time, Sayne said.
"It's creating confusion with dispatchers," he stated.
EMS, HOSPITAL NEEDS
During their hour-long meeting, board members discussed a need to address the problem in such a way that meets the needs not only of EMS and 911 dispatch, but also of local healthcare providers.
Chuck Whitfield, president and CEO of Laughlin Memorial Hospital, and Daniel Wolcott, president and CEO of Takoma Regional Hospital, both serve on the board, and provided input from the hospitals' perspectives.
Both agreed that the local EMS service is their preferred provider and first call, but expressed concern about not having the flexibility to make calls to other ambulance services if an EMS unit is unavailable.
Concern was expressed about wait times for non-emergency patients -- such as those who have been treated at a local hospital and require transportation back to a nursing home.
Frustration over the amount of time it can take to discharge a patient because of having to wait for an ambulance can harm the hospital, Whitfield said, because the facilities are monitored closely as it relates to customer satisfaction.
At the present time, Sayne said, EMS will dispatch a different provider if none of their own units are available.
As discussion on the topic continued, members agreed that greater communication -- such as better coordination between the hospitals and EMS for out-of-town non-emergency transports -- will be a key element for the board moving forward.
LEGAL PRECEDENTS SET
Greene County Attorney Roger Woolsey told the board that it had "strong legs to stand on" as far as the legality of regulating local ambulance services, and suggested that the board do so.
Woolsey cited precedents, including a 1990 case based in Morristown, which determined that, because of the essential nature of the services that governmental ambulances provide, protections should be allowed to prevent other services from causing financial hardships to the degree that the governmental ambulance agencies' operations are impeded.
Woolsey recommended that the board adopt a resolution that all ambulance services in the county be franchised.
"Based on the needs of the community and public interest," Woolsey said, he recommended that only Greene County-Greeneville EMS be authorized to provide local ambulance service at the present time.
Other services wishing to franchise would have to appear before the EMS board, he said.
Woolsey said, however, that he would have to research whether the EMS board's action was sufficient, or if the board should take action on a recommendation to the Greene County Commission and the Greeneville Board of Mayor and Aldermen concerning the issue.
He suggested that the EMS board take action on it. Bowers made a motion, with a second from Greeneville Mayor W.T. Daniels, in support of the resolution.
Board members voted unanimously in favor.
After the board's action, Woolsey was asked to contact other ambulance services to notify them to cease operations; he agreed to do so.
REVENUE FROM NON-EMERGENCY
Sayne explained that the major issue is the loss of revenue from dialysis patients.
Non-emergency revenue, Sayne said, is essential for the EMS.
Dialysis patients, board members were told, are transported to dialysis treatment three times per week.
For each patient with Medicare and Medicaid there is potential revenue of $57,000 per year, Sayne said.
Each Medicare patient with a supplemental policy or Medicare Managed Care plan can generate $71,000 or more per year.
Patients with commercial insurance, Sayne said, can bring in revenue of $100,000 a year or more.
Because of this revenue, private ambulance services, he said, often choose to only transport these patients, or to otherwise "pick and choose" which services to provide.
Private ambulances, he said, rarely respond to emergency situations, which typically do not generate revenue.
Revenue from non-emergency transports, such as dialysis patients, Sayne said, support the emergency response of EMS.
"It's just about imposible to fund the emergency [cases] without the non-emergency income," he said.
QUALITY OF CARE
Greene County-Greeneville EMS has been a self-supporting entity for the last 12 years, Sayne told the board Wednesday, but he expressed concern over the loss of revenue to private ambulance services.
One reason that it is so critical that Greene County-Greeneville EMS be protected, he said, is because of the capabilities and equipment that each of its ambulances has.
Ambulance services, he said, are rated for their equipment and the services they can provide.
Greene County-Greeneville EMS is rated "A" -- which is the highest possible rating.
Responders in local EMS units have more equipment and abilities, Sayne said, than most private services.
"We want what's best for the citizens in this county," Sayne said.
"We have worked hard to make sure that we have the best-trained [emergency medical technicians] in the best-equipped ambulances we can get," he said.
TO MEET REGULARLY
The board agreed to begin meeting on a quarterly basis, beginning in October.
"It's a line of communication" between EMS and the local healthcare providers, Bowers said.
It was decided that the board will monitor the level of service EMS provides, and at future meetings, a form of a regular report will likely be discussed that takes into account response times and other performance measures.
In addition to action to make Greene County-Greeneville EMS the sole ambulance service in the county, the board also voted to name Greene County Health Department Director Shawn Street as its chairman.
The board decided to meet next on Oct. 24, at 3 p.m, in the conference room at the Greene County Courthouse Annex.
At that meeting, the board will likely discuss more organizational matters, such as adding more members -- including, possibly, emergency room doctors from each of the local hospitals, a change which both Whitfield and Wolcott advocated.