In order to keep county-wide Emergency Medical Services (EMS) intact, the Fayette County Commissioners said they have decided to place a 1.3-mill, three-year tax levy for ambulance and EMS services on the May 8 election ballot.
Given “the limitations on the amount of tax revenue and other resources which the county expects to receive from existing sources to fund necessary obligations during 2018 and beyond,” according to a recently-passed resolution, a levy which amounts to 13 cents for each $100 of valuation for a period of three years will be proposed to county voters.
“The Fayette County Auditor certifies how much money it will actually raise,” said County Commissioner Dan Dean.
The estimated property tax revenue that will be produced by the 1.3 mills is calculated to be $1,043,587, according to the certificate signed by Fayette County Auditor Aaron Coole.
“The auditor gives that certification back to us, then we do another resolution that will probably be right after the first of the year, and then it goes to the Board of Elections,” said Dean. “Then they certify everything. It has to all be done by 90 days before the election.”
Fayette County EMS was founded in the late 1970s as a volunteer organization and operated for many years with donations from the public. Periodically, the county and/or the City of Washington Court House would purchase a truck, ambulance or other necessary equipment for the EMS.
Prior to becoming a county commissioner, Dean was appointed to the EMS board around 2006, he recalled, during a time the EMS was struggling financially.
“What was happening was reimbursement rates for Medicaid and Medicare were ever-decreasing and costs were ever-increasing,” Dean said. “So the EMS was not going to be viable on its own. In about 2007 or 2008, the hospital (Fayette County Memorial Hospital) agreed to take over EMS. The commissioners at the time were nice enough to appoint me from the EMS board to the hospital board so that there would be a transition involving someone who had knowledge on the subject. I was on the hospital board for a couple of years. So the hospital took it over because they were not only going to do EMS services, they were going to do transports. That way it could make up the cost difference and make it viable again. But about a year after they started that, the rules changed on how transports would be paid by Medicaid and Medicare. Instead of paying per transport, they gave the nursing home I believe an extra dollar and 10 cents a day per patient, and then left it up to them to contract with somebody to do all the transports from there. So now the hospital was not able to make it cost-effective…they were going to lose money.”
Dean added that it actually harms the hospital to run an EMS because of cost reimbursement realities, and because the hospital is critical access, however EMS is not.
“What that means is the federal government withholds about $250,000 dollars in costs that the hospital would be reimbursed through Medicare reimbursement and now they don’t,” said Dean.
When now State Sen. Bob Peterson resigned as a commissioner, Dean was appointed by the local Republican Central Committee to fill out the remainder of Peterson’s term, beginning January of 2010.
“Once I was appointed, I could no longer serve on the hospital board. And one of the first problems that came up when I became commissioner was how to make the hospital whole,” Dean said. “The hospital had come to the City of Washington and the commissioners saying, ‘We’re going to have to give (EMS) back to you.’ So we came up with a solution of making the hospital whole in order to have one unified county system rather than see it disintegrate and have something like two townships and the city form their own EMS. It would have been a cost redundancy as far as administration, payrolls, the amount of trucks….let alone the confusion when they have to do a dispatch. It was much better to keep one county system.”
At that time, the commissioners made the decision to reimburse the hospital. The county has provided $3.3 million to fund county EMS services over the past five years.
“We started doing it with around $500,000 to $600,000 a year to make them whole. In other words, to cover any losses they had. Every year we renewed that and it’s worked fine for the last five or six years,” said Dean. “We were doing that with our sales tax money as it had been increasing every year and was providing us the revenue to be able to support the community. This year, the sales tax revenue for the county has decreased.”
According to records provided by the commissioners, sales tax revenue received by the county has steadily increased over the past five years until 2017. In 2011, the county received nearly $6.8 million; in 2012, $7.1 million; in 2013, $7.5 million; in 2014, $8.1 million; in 2015, $8.2 million; and in 2016, $9.2 million. In 2017, that number dipped from $9.2 million to just short of $8.6 million.
“One reason for this is Medicaid-managed care has kicked in, so we started losing an estimated $50,000 dollars a month beginning in September,” said Dean.
Another possible reason is what Dean described as the “Amazon effect.”
“A lot of people are buying their stuff online and are not going to brick and mortar stores,” he said. “When they do that, the sales tax isn’t collected in those instances. But everybody has to adapt to this. We are down a little more than $600,000 this year over last year. We’re estimated to lose $607,000 next year. So now you’re looking at over a million dollars. We’re going to have difficulty supporting EMS in the future….it needs a steady revenue stream to keep it going.”
The county has committed to fund EMS with $650,000 in 2018.
“This coming year, the state is making the county kind of whole with some funds that they’re replacing to make up the $600,000 deficit,” Dean said. “We went to all the townships, the city and the villages and told them how much we can make up. For the rest of it, we asked them to come up with 10 dollars per capita in their city, village or township. That way it would raise approximately $290,000 because they have about 29,000 people in Fayette County. Then the hospital would have the extra money this year to start replacing trucks again. Some of their equipment is pretty old.”
The City of Washington Court House, and the villages and townships in the county are on board with a one-year commitment.
When asked why the county’s taxpayers should vote for this levy, Dean reiterated: “In my opinion, it makes sense financially to have one unified system. You don’t have the redundancy of manpower and equipment. It is the most cost-effective to have one system for the county and it’s a good system. It’s been working well. You almost never hear anything bad about our EMS service from the community, but you do hear things like, ‘They saved my life.’ In the old days, you used to pay like 60 dollars a year if you wanted to buy a membership for EMS and then you wouldn’t have to pay anything else. Basically this is going to be about 50 dollars per $100,000 value. I hate to equate it to the old membership, but it is going to be a cost to all landowners and indirectly to anybody who rents. But we do think this is the best system.”
Reach Ryan Carter at 740-313-0352 or on Twitter @rywica