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Ambulance director proposes shift to non-profit model
During a commission meeting Tuesday, Fremont County Ambulance Department director Joseph Zillmer floated the idea of converting his department to a private non-profit to resolve its financial issues. Photo by Eric Blom

Director of ambulance department proposing shift to non-profit model

Jun 12, 2014 - By Eric Blom, Staff Writer

Spinning off Fremont County's Ambulance Department into a private, non-profit organization could be the answer to its money woes, the agency's chief suggested Tuesday. In the meantime, the rising cost of benefits led the service to request a $650,000 increase to its budget for the coming fiscal year.

Overall, the requested budget was $3.5 million, up from the current $2.8 million budget, which itself was a $700,000 gain from the year before.

The proposal would drain the department's $1 million reserve and tap the general fund for $500,000 more. Revenues from services charges are only projected to be $2 million.

"That's the single largest factor that has affected our budget on the expenditures side, and that totals $800,000 as opposed to $400,000 last year," Ambulance Department director Joseph Zillmer said, referring to the cost of health insurance and pensions.

The county sets the costs of those factors, and his agency cannot control them, Zillmer said. His department is doing what it can to control the costs it oversees, such as wages. Salary expenses are projected to be $50,000 less than the $1.1 million budgeted this year, and his proposed budget keeps them flat, Zillmer said.

"Essentially, the ambulance service operates at a net loss of $1.7 million, and if we come up with a half a million this year it means we have to come up with the $1.7 million next year," Commissioner Stephanie Kessler said. "I mean, this is drastic."

Budget issues have been a concern for the ambulance for several years, and came to a head last year when the budget was increased. Commissioners hired Zillmer to head the agency in January with a mandate to control costs and increase volunteerism.

Zillmer plans to apply for a about $1 million in grants and thinks the new revenue could help the financial picture in future years. But he floated another idea to solve the financial problems.

Converting the emergency medical service into a private non-profit would help it raise more funds, decrease costs and save the county money, Zillmer told commissioners. In an interview, he explained a contract with the county would still give commissioners oversight over the organization and guarantee it provides the same service.

On the revenue side, the service would be eligible for about twice as many grants as a non-profit, Zillmer said at the

meeting. It could also save $250,000 in health insurance costs, he said.

As a separate entity, it would have fewer than 50 employees, the cutoff for some regulations in the Affordable Care Act, allowing it to offer insurance more cheaply, Zillmer said.

As EMS is part of the county government, Fremont County is liable for its actions, such as if an ambulance got into a collision while transporting a patient. Spinning off the ambulance department could lower Fremont County's insurance costs and make it not liable in the case of a tragedy, Zillmer said in an interview.

"I can't see any disadvantages, that's what makes it a win-win for everyone," he said.

If the department were to become a non-profit, a three-member board of health care experts would direct its operations, according to Zillmer's plan.

At the meeting Tuesday, commissioners questioned details of Zillmer's plan but did not indicate support for or opposition to it.

More volunteers

Another way to reduce costs would be to bring on more volunteers in Dubois. A year ago, EMS began staffing the Dubois ambulance station with one crew around-the-clock and operating two ambulances in the high country town.

The cost of that service is more than $300,000, but revenues from it total about $40,000. Roughly six former EMS volunteers have shown interest in working with the ambulance department again, Zillmer said. If they do, the full-time staffing could be reduced.

"That would cut our cost in half," Zillmer said. "The other option would be completely pull the service away, and I can't recommend that."

He also hopes to cut costs by changing the agency's policies about when to transport a patient whose primary reason for calling is an alcohol issue.

"There were over 900 where the primary (cause) was alcohol, and that cost us over $800 in cost and transport we could not collect," he said.

Commonly, the issues are public drunkenness or the caller is concerned about withdrawal symptoms, Zillmer said. He thinks callers, at times, do not really need an ambulance to take them to the emergency room, and he wants to change his department's policies to reduce transporting people unnecessarily.

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Fremont County Commission
Dubois