Oklahoma`s Rural Ambulance Services Suffering Financially

Oct. 28--The financial crisis for most ambulance districts in the state is worsening and will continue to deteriorate unless an additional reliable funding source can be found for them to stay in business, a legislative panel was told Thursday.

A county property tax to raise money for rural ambulance districts authorized by a state law two years ago is insufficient to raise enough money to pay costs, several ambulance operators said.

Some suggested ambulance fees could be tacked onto electric bills, a proposal shot down quickly by two of the largest power companies in the state. And even if that idea wasn't opposed, it's unknown whether those fees would be too high to be plausible in sparsely populated areas.

Decade of decline

Ambulance operators and local officials filled a committee room and spilled out into the hallway as they pleaded with members of a House of Representatives budget committee on public health and social services to find some type of additional funding source.

About 60 ambulance services have gone out of business in the past 10 years. State Health Department records show 153 ambulance services operating in the state, excluding Oklahoma and Tulsa counties.

The plight of rural ambulance operators has been dismal for the past decade. A governor's task force studied the issue five years ago. After 16 months, it came up with findings similar to woes mentioned Thursday: low Medicare and insurance reimbursement rates, a growing number of Oklahomans without health insurance and the fact that although emergency medical service workers require extensive training, pay is far below other public safety professionals -- making recruitment and retention difficult.

"We have not done a good job of marketing ourselves," said Joe Barrett, with the Bryan County Emergency Medical Service. "People take EMS for granted. People call, and we come."

Mark Newman, director of state and federal policy for the state Health Department, said estimates indicate 16 to 19 percent of Oklahomans don't have health insurance. The uninsured reach as high as 35 percent in some parts of the state, he said.

Financial training

Rep. Paul Roan, one of three lawmakers who requested an interim legislative study on the structure and financing of emergency medical services, said some ambulance operators could do a better job if they had proper financial training. He suggested the Health Department do a better job of training operators in financial management.

"Just because a guy's a good paramedic doesn't make him a good business manager," said Roan, D-Tishomingo.

The task force recommendation to remove the constitutional cap on the taxes communities can levy on themselves to pay for ambulance service was accomplished in legislation passed in 2009. Several ambulance operators were able to get the tax increase passed, but they said the money raised in most cases is not enough to pay ever-increasing hospital bills.

Not all ambulance systems outside of Oklahoma and Tulsa counties are losing money, but they are the exception, operators told legislators.

Statewide funding?

Some operators proposed a statewide funding source for ambulance services, which come in all different varieties. Some are owned by the city or a hospital, others are ambulance districts and others are privately owned. They also are funded in different ways, such as the county property tax, donations, a city sales tax or by having their fees included on city utility bills.

"There's no easy fix," said Rep. Doug Cox, chairman of the budget subcommittee, who also requested the study. "We have to take a hard look at how much Oklahoma citizens value a rapid-response EMS, and if they're willing to pony up and make that possible.

"We have such a puzzle work of different systems, not just statewide but even within one county -- you may have one area served by millage on property tax, another area served by a sales tax, another area served by a subscription and areas in between all those with no service."

No easy solution

The different ambulance services and the variety of ways they're funded makes it complicated to come up with a simple funding solution, said Cox, R-Grove.

"In an ideal world, it would be nice to come up with one uniform system statewide," Cox said. "That would be a major undertaking because some of those hodgepodge systems are working very well, very efficiently and some of them even at a profit."

Some ambulance operators thanked lawmakers for passing the emergency medical services legislation, which also removed a state law requiring the closest ambulance to respond to an emergency. The legislation allowed for the formation of an emergency medical services district that may cross county and school district lines; ambulance operators respond to calls only within that district.

The measure also directed county governments to create a plan for countywide ambulance coverage. Only 26 of the 75 counties covered by the legislation filed plans by the April 1 deadline, Newman said.

Several electric companies oppose fee

Prague City Manager Jim Grieff said residents are charged $9 a month on their utility bills for ambulance service, which brings in about $125,000, and the city puts in $100,000 to pay the remaining costs.

Grieff said having electric companies include ambulance fees in their monthly bills would reach out to more residents and generate more revenue while reducing individual costs.

"With all residents paying a fee, all people of Oklahoma will be treated fairly and equitably, and get a quick response time of an ambulance service in their area," he said. "It is not that complicated."

But electric companies are cool to the idea.

"We are a private company not a government entity," said Bud Ground with AEP-PSO, which serves the Tulsa area and other parts of Oklahoma.

Paul Renfrow, Oklahoma Gas and Electric Co.'s vice president of public affairs, said: "OG&E ... is not interested in being a tax collector. We're a private company that would be told to be assessing this on customers. We oppose that part of it."

Copyright 2011 - The Oklahoman, Oklahoma City