Financial solvency continued as a leading topic during Russell County EMS Board's regularly scheduled monthly meeting last Tuesday.

Discussion regarding finances and possible policy changes for non-emergency services dominated the meeting.

Russell County EMS Board Chairman James Gray was asked by Russell County Judge-Executive Gary Robertson to speak to the Russell County Fiscal Court at their monthly meeting last Monday.

Gray and RC EMS Director Terry Hancock presented the Russell County EMS 2011 - 2012 FY budget at the fiscal court meeting.

"I tried to do my best to explain to them how (EMS) gets money and I think we done a pretty good job explaining it," said Gray. "I felt like it went pretty good."

He said charging fees for ambulance service gives the appearance of accumulating a lot of money but fees charged do not represent fees collected.

"(RC EMS) may charge $500 for a run and may get $50 or $100," Gray said. "You can charge whatever you want to but that doesn't mean that's what you get."

Discussion ensued regarding abuse of non-emergency runs by patients who regularly are transported to doctors' offices for routine health assessments with little or no payment for services.

"I don't agree with having (an ambulance) tied up with somebody that abuses the system," said RC EMS Board member Mike Popplewell. "I think we're going to have to address that to some extent."

Chairman Gray shares the opinion that some non-emergency ambulance runs are a drain not only to finances but also to services.

"I'm in agreement that we need to start screening these non-emergency runs," Gray said. "I think we're going to have to…tell some of them we can't transport you."

Gray said running a business means making difficult decisions in order to continue to cover financial obligations of operation expenses.

"There are times you have to make decisions with your head and not your heart," said Gray. "The days of the good ole boy doing everything for everybody is over."

"If (EMS) is continually making runs where we're not even coming anywhere close to covering our expenses, those days are going to have to stop."

Emergency runs will always receive immediate response he said but some changes are needed regarding non-emergency runs.

Popplewell agreed to the need for assessment of non-emergency calls.

"I want anybody that needs to be carried, carried but somebody that continually abuses the system that can get a ride to the hospital to get their sugar checked or home health could come and check their sugar…I think that's where we have to draw the line," said Popplewell.

He asked staff for the number of EMS non-emergency runs for a patient who is regularly transported to routine visits for medical care.

Hancock didn't have the exact number of runs but said the patient currently owes RC EMS $27,000.

Director Hancock said he talked to the patient and the patient's family to notify them they are going to have to transport the patient because EMS has done everything they can.

"(EMS) gets tax money but we've got to realize…do you want an emergency service for emergencies or do we just carry people here and there and everywhere," said Popplewell.

Gray echoed Popplewell's concerns.

"I think we need to look at all the non-emergency runs," Gray said. "Do you keep doing something like that and let that drag the rest of your ambulance service down because it's putting (EMS) in the hole or do you cut that off and make the rest of your service stronger."

He said 70 percent of EMS revenue comes from fees for services and 30 percent comes from taxes.

A large percentage of ambulance runs are non-emergency according to Hancock.

"If we can break even, I'm all for it," said Gray. "If we can help the people out here in the community and we can just cover our expenses, that's all I ask."

Hancock said one of the problems, especially with Medicare patients, is that Medicare will only pay for patient transport to hospitals not to physicians' offices.

Medical appointments for bed ridden patients, with no other means of transportation, are regularly scheduled for EMS transport from nursing homes and private homes Hancock said.

"I feel like (RC EMS) has got to get more selective in (non-emergency runs)," said Popplewell. "I hate to say that but we've got to balance out here somehow."

Staff advised the board that some other EMS agencies have policies in place regarding coverage of non-emergency runs.

"One of the things that I know Adair County (EMS) does and there's a few more counties does is…they actually have a policy in place that they don't do any physician office runs," said Hancock. "If they can't get it worked out where the doctor can see (patients) in the emergency room or the hospital, then they don't take them."

When calls for non-emergency transport are received, Hancock said RC EMS tries to encourage an arrangement with physicians to meet at the hospital.

He said EMS staff explains to the patient that transport to a doctor's office is not covered by Medicare and the patient may be responsible for paying the bill but added that some patients have no other choice.

"We've got patients (with no other options)…we're it, they can't go (to see a physician) any other way," said Hancock.

He said some are frail, elderly patients with terminal illnesses who are bedridden with special needs to meet when moving them and no other means of transportation.

Gray suggested private ambulance companies as an alternative option for non-emergency medical transportation.

EMS staff said no private ambulance companies are authorized to transport patients in the Russell County area.

Most private ambulance companies have contracts with hospitals to handle discharge transportation in larger municipalities Hancock said.

Gray directed RC EMS staff to identify criteria for non-emergency runs to possibly discontinue from services and to outline a response fee schedule for non-emergency runs when patients are not transported.

He further directed staff to present those findings in writing at the next regularly scheduled board meeting.

"Y'all know the business better than I," Gray said. "That's why I'm asking you to put something down and then (the board) needs to decide what we're going to implement and what we're not going to implement."

In other business:

• The board voted unanimously to hire Jeremy Thomas and Brian Lawson as part-time EMT's.

• The board directed Russell County Assistant County Attorney Don Byrom to call Kentucky Retirement Systems (KRS) and set up a meeting with a KRS representative detailing sick leave and retirement policy. EMS Staff recommended contacting their KRS representative, Nadine White.

• Byrom was also instructed by the ambulance board to research litigation against a former collection agency, MGM Collection Agency, in an attempt to recover billing payments and unpaid account records from the company which has since changed ownership and possibly gone out of business.