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A third meeting involving area leaders yielded some progress on a plan that would put regional ambulance service back under the umbrella of Ely-Bloomenson Community Hospital.
Representatives of several local governments came to consensus during an Oct. 18 meeting at EBCH and agreed to seek more details, including financial models related to the plan.
“We need to start talking about real stuff,” said Joe White, a Babbitt council member and the director of Babbitt’s ambulance service. “I want to hear how are you going to staff this and how I am going to tell people what we are going to raise taxes to make this work.”
At issue is a proposal, advanced by SafeTech Solutions, that calls for EBCH to take ownership of ambulance operations in Ely, Babbitt and Tower.
Unveiled earlier in the year, the proposal calls for two fully-staffed ambulances in Ely, and one each in Babbitt and Tower.
It’s been pitched as a means to ensure full-time ambulance service in all three communities, with EBCH ownership touted as the ideal model given the hospital’s standing as a critical access hospital and its ability to capture a higher share of Medicare reimbursements.
“With (ownership) under the hospital, there’s these benefits that they get and it helps them fill the gap of some of that funding,” said Ben Wassmund of SafeTech, a firm engaged by EBCH to study the ambulance issue.
Wassmund stressed that “the hospital did not start this process looking to take over EMS” and “ultimately it’s up to the stakeholders to decide what they want to do.”
The study came in the midst of severe financial distress last year for Ely’s ambulance service, which is currently run by a non-profit board, and amid other challenges including staffing and difficulty completing many interfacility transports.
Those are issues that vex ambulance services in rural areas across the state, and Wassmund told the group that “the way you pay for EMS is either through call volume or subsidy.”
There isn’t enough volume in the area to support a full-time ambulance service and Wassmund, a consultant with more than 20 years of experience with rural ambulance issues, warned “in the future you will run out of money or require more money from the communities than is existing today.”
Over the course of 90 minutes, some questions raised by area leaders were answered or clarified, particularly a concern from Babbitt about staffing.
Current plans call for full-time staff to operate ambulances in all three communities, but Wassmund, responding to a question about what might happen to additional ambulances currently in Babbitt, noted that other ambulances could be engaged.
“If you have extra ambulances, maybe you have an on-call system for when you have all of the trucks out,” he said.
Wassmund also dismissed a concern that local first responders would not be needed with a new set up.
“If anything I would tell you to bring more on,” said Wassmund.
SafeTech envisions a system that offers some flexibility.
“When one Babbitt truck goes out, one of the trucks in Ely shifts to cover the area as best as possible,” said Wassmund. “Today that doesn’t happen.”
Attracting and retaining ambulance staff is a current challenge and the new model calls for full-time staff with higher wages and benefits.
“Right now we’ve been using staff who have not been paid a living wage,” said Wassmund. “They may not be volunteers but they’re not getting what they need to be paid. We’re at a point now where we know it’s not a long-term sustainable solution.”
But full-time service in all three communities comes with a higher cost.
And though EBCH could gain additional funding, perhaps being paid as much as 101 percent of expenses from Medicare, if it takes on ownership of the ambulance and becomes the only ambulance operation in a 35-mile area, the additional funds aren’t likely to fully fund the operation.
“The next phase is to build a pro forma with all the costs associated, what would Medicare look like and what are the true costs,” said Wassmund. “We don’t know until we do all of the math.”
While estimates weren’t advanced, there appeared to be general agreement that an additional subsidy by way of tax dollars from the area communities would be needed.
Babbitt’s White said “We’re in the game with you all but we need to be hearing and talking more specifics so we can be honest with our community.”
Babbitt council member Glenn Anderson agreed but warned that public sentiment in Babbitt is “totally against this but you have three council people who are sitting right here going ‘I think we need to look at this closer.’” Tower’s Kevin Norby said “to me it’s a no-brainer. We have to take the next step.”
Bob Berrini, a supervisor from Morse Township, noted that the financial fortunes of Ely’s non-profit service have improved i n 2 024. L ocal ambulance services were aided this year by additional funding approved by Minnesota lawmakers.
White pressed for more information and said in Babbitt “once we go forward there’s no going back.”
He also acknowledged the ongoing challenges and said “unless we go to a living wage our ambulance departments are sunk.”
Hospital officials were largely silent during the discussion although administrator Patti Banks facilitated the meeting and said EBCH’s goal “is to maintain ambulance services within our region. We as a critical access hospital partner with EMS in general.”
Wassmund recommended further study of the hospital ownership model.
“If you did this independently with a joint powers board, you don’t get the reimbursements the hospital would get,” he said. “When we look at it from our perspective. From the 30,000 foot view, this one makes the most sense, but it’s still up to you guys to decide.”
