Fire districts agree on revenue plan to present to Medic One Board

A majority of fire districts receiving services from Lewis County Medic One have reached consensus on how to restructure the agency's revenue policies, though official approval of such a plan is still pending.

Discussed during a workshop held Feb. 25, representatives from Lewis County Fire Districts 1, in Onalaska, 3, in Mossyrock, 8, in Salkum, 15, in Winlock, and 2, in Toledo, met to find common ground regarding plans to overcome a potential revenue deficit of $265,000 expected this year, according to current estimates, while keeping the priorities of their commissioners and taxpayers in mind.

By the end of the meeting, which lasted a little less than two hours, a plan to divide the total expenditures for Medic One based on a percentage of patient transports was agreed upon informally, but requires official approval from the Board of Directors managing Medic One, made of representatives from Districts, 2, 15 and Cowlitz-Lewis Fire District 20, in Vader and Ryderwood, who own the agency through an interlocal agreement.

"I think we got it pretty well hammered out, and I think we're going to be able to work together," said District 8 Commissioner George Kaech, who had organized the meeting. "I really appreciate everyone coming out and putting their input into it and stuff."

Under the proposed revenue structure, all six districts would pay for a percentage of Medic One's estimated $820,000 in operations costs for 2015 based on their volume of patient transports provided by the agency last year. After factoring in estimated patient revenue, the remaining costs expected to come from each district's general budget would be: $53,362 for District 1, $9,537 for District 3, $66,498 for District 8, $80,493 for District 15, $35,432 for District 2 and $19,798 for District 20, according to figures provided by Medic One staff.

While the Medic One Board had proposed a similar plan of cost sharing during a workshop held Feb. 4, officials with the contract districts (1, 3 and 8) had not been ready to discuss the proposal during the Feb. 17 regular meeting of the board, with several stating they had not received details of the proposal in enough time to review it, while others said they were concerned approval of the proposal would prevent outstanding concerns from being addressed, such as representation on the board for contract districts.

During the Feb. 25 workshop, District 1 Commissioner Duffy Scott said, as the contract districts are now being asked to contribute far more than they have in the past (they are currently charged $630 per ALS call and $25 per BLS downgrade), they ought to be considered part of the leadership of the agency rather than simply as clients.

"We're at the point now to where it's not just the north end getting billed for running calls," said Scott. "It's the north end coming together with the south end to become one, to try and keep the system afloat and sustained. So we're going from being customers to being part of the group."

Though members of the board have said recently they feel adding three more board positions would make the group unwieldy and have instead offered a single non-voting position to represent the contract districts, members of the contract district have reminded the board of a motion approved Dec. 16, 2014, directing agency leadership to develop a policy allowing contract districts each a seat on the board, though such a policy has yet to be presented for approval.

Despite a lack of resolution regarding representation issues, members of contract districts said they were prepared to go forward with presenting their cost-sharing plan to the board during its next regular meeting on March 17, with individual boards of commissioners for each district expected to discuss the matter beforehand.

It was noted, of the districts represented on the board, officials felt they will meet the greatest level of resistance from District 15 and 20, as District 15's board has submitted a list of expectations the contract districts feel they are unable to meet, while District 20's board has limited their out-of-pocket contributions to Medic One due to the small size of their overall budget.

In District 15's letter, approved by their board on Feb. 13, they said they would be opposed to a revenue plan that did not require all districts served by the agency to seek the full levied amounts available for EMS taxes, while they also felt contract districts should provide all patient revenues from their Advanced Life Support and Basic Life Support transports, similar to the policies of Districts 2, 15 and 20.

Contract district have said they need to retain their Basic Life Support revenue as these funds sustain EMT programs specific to their districts, and losing such revenue may diminish or eliminate their programs

District 15 Commissioner Stan Hankins, who chairs his board and was present at the workshop, said he was willing to put the proposed plan before his fellow commissioners, but said he would need the support of other officials as he was certain it would not be an easy sell.

Unable to attend the meeting had been representatives from District 20, though the other districts were in possession of a letter from District 20 informing them of a motion made Feb. 17 by their board that, based on the status of their overall budget (around $96,000 annually), they could not commit more than $9,645 per year on top of patient revenue, which would leave them roughly $10,000 short of their percentage of obligation in the proposal.

Officials at the workshop said they would be willing to accept other forms of compensation from District 20 to make up the difference, such as labor and equipment, and would also be willing to absorb the $10,000 into their own percentage of costs, but at that time would expect District 20 to recuse themselves from a voting position on the Medic One Board as they would no longer be contributing in the same way the other districts would be.

Officials added the proposed revenue structure would not be intended to be permanent, as they would expect Medic One to investigate changes to their billing policies to increase patient revenue, as well as seek out possible federal funding to reimburse what is not being paid for by Medicare and Medicaid. If approved, officials also said they would review the new system regularly to ensure it was sustaining the agency and would make changes as needed.

Until a new revenue policy is adopted, Medic One continues to operate according to projected deficits, which would amount to approximately $43,000 by the end of February, on top of $9,000 in added overtime expenses experienced since two paramedics resigned in January.

Officials at the workshop said, if the new policy is approved, they would expect it to be retroactive to the beginning of the year, to ensure shortfalls experienced thus far would be paid for.