MercyOne provides update on ambulances and ‘unique relationship’ with city

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By Willis Patenaude, Times-Register


An update about the partnership between MercyOne Elkader Ambulance and the city of Elkader was a topic of discussion at a recent city council meeting. Brooke Kensinger, the chief executive officer for MercyOne Elkader Medical Center, who praised the “unique partnership, which holds each party accountable,” provided the update. 


In this partnership, which is a 28E agreement that allows funds to be collected toward sustaining the partnership, each party is responsible for certain aspects of the ambulance service. MercyOne is responsible for staffing and operating the EMS service; providing medical directorship for the service/team; purchasing equipment, supplies and medications; billing and collections; and professional liability and workers compensation coverage. The city of Elkader is responsible for purchasing, maintaining and insuring the three ambulances and Gator, providing a facility to house the ambulance and EMS equipment. 


Of course, all of this comes with a cost, not just for equipment, but also maintenance and the ambulance runs. Then there is the question of whether the ambulance service requires three rigs, rather than two, to operate at an adequate capacity. 


Regarding the latter question, Elkader City Administrator Jennifer Cowsert pointed out that the third ambulance was purchased when it became time to replace the 2005 rig, but due to the resale value of that ambulance, it was decided to keep all three.


The decision seems to have been worth it, as Kensinger added that, between December 2018 when the third ambulance was purchased and July of 2020, a third ambulance was utilized 24 times and almost exclusively in situations when the other two were out on 911 calls. 


It’s also a decision supported by Elkader Mayor Josh Pope, who said, “having the third ambulance as a backup seems to work…and if we didn’t have it, we would have to have another town or private service be back-up. The ambulance service is important to the peace of mind of the residents.” 


Concerning the issue of cost and who pays for it, that depends on what’s being paid for. According to Cowsert, basic maintenance cost has run the city between $16,200 and $21,400 over the past few years. 


As far as the hospital is concerned, Kensinger noted that, in fiscal year 2020, the EMS service ended with a net loss of about $126,000. According to the data on just ambulance runs, there was a net loss of around $147,000, all of which is absorbed by the hospital. 


As for the actual ambulance purchase, Elkader and other local townships invested $132,000 of the $246,224 total. The ambulance purchase represents the last large investment into the ambulance service made by the city. 


The hospital recently invested in lift systems, which mechanically lift patients on the cot into the ambulance, which prevents injuries for the EMS team. The cost was covered by MercyOne, Central Community Hospital Foundation (including the Michael Glesne donation) and the Upper Mississippi Gaming Corporation. 


Besides the financial aspect, Kensinger discussed the difficulties of recruiting staff for the EMS service, in large part due to the educational requirements necessary for basic entry into the occupation. An aging workforce of volunteers without replacements that has led to the hiring of full-time staff to cover the ambulance service calls, which was another large investment on the part of the hospital to continue providing quality EMS service. 


“In the past three years, with the support from the local board, MercyOne Elkader Medical Center has made a concerted effort to recruit and hire full-time paramedics for the hospital and EMS service. This initiative was a large investment for the hospital, but was worth it to take care of the community,” Kensinger said.


Elkader council member Tony Hauber was interested in patients, particularly the cost as it pertains to the uninsured and insured alike. 


Kensinger responded that the hospitals mission is to treat everyone, regardless of insurance. 


Hauber noted he asked the questions to “try to assess the burden this service, which the city partially provides, has on the constituents that utilize it [and] to make sure that the relationship is in the best interest of the citizens.” However, Hauber admitted to still not entirely understanding the cost breakdowns of ambulance trip costs and believed knowing “the calculus for the financial ability an uninsured citizen might face for utilizing the service” is essential to the relationship.


Kensinger responded to this line of inquiry in a separate interview, stating, “The gross charge of an ambulance ride varies anywhere from $795 to $2,180 plus mileage. Where the exact gross charge falls within this range is based on whether the ambulance call is emergent or non-emergent as well as if basic life support or advanced life support is provided to the patient.”


The issue is more complicated than a simple ambulance charge because, according to Kensinger, there is a distinction between two different types of charges that exist in the healthcare industry. 


The first is “gross charge” that relates to the established prices that are billed to all patients regardless of insurance coverage, she explained. The second is “negotiated charge” that relates to prices insurance companies have agreed to pay for services. All patients will receive the same “gross charge,” however, “negotiated charge” will vary based on agreements that exist with insurance companies. 


If a patient is insured, he or she will typically be responsible for a portion of the negotiated charge. The portion of the charge an uninsured or insured patient will pay a hospital for services is referred to as “out of pocket” expense. An insured patient’s out of pocket expense will be dependent on the type of coverage the patient has with the insurance company.


Hauber’s line of questioning at the council meeting prompted council member Daryl Koehn to question how the hospital knows who can’t pay versus who won’t pay and what the process is for those unpaid accounts. 


Kensinger informed the council there is a process that includes financial assistance to individuals who are uninsured, under-insured, ineligible for a government program or otherwise unable to pay. 


Koehn seemed receptive to the response, and Hauber said in a separate conversation that the current “relationship is in the best interest of the citizens, and the hospital does a great job.” 


Regardless of financial responsibilities, the “unique relationship,” in the words of Pope, is “vital to the community.” 


The hospital invests in the community, provides employment opportunities, promotes healthy living and provides numerous services to residents, and Cowsert echoed this sentiment, stating, “the hospital is a very important amenity for our community and it takes community support to keep it going.”

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