SALYERSVILLE – As has been the case numerous times in the county’s history, Magoffin’s ambulance services are taking another hit.
Some years back, Tran-Star, which had provided ambulance services for many years, sold to Lifeguard, which was owned by AMR. Lifeguard held a license through the Kentucky Board of Emergency Medical Services to cover Magoffin and Pike County, but after numerous instances of “level zero” situations within the first six months, the Magoffin County Judge/Executive Matthew Wireman started the lengthy process of acquiring a certificate of need so they could contract out another service. In 2021, Lifeguard pulled out of the county, and Magoffin was able to contract Net Care Ambulance Service, which then sold to Patriot EMS.
For the past couple of years, the status of the ambulance services in the county has been pretty quiet, requiring less news coverage and no “level zero” instances reported to the media, but that’s all about to change.
Patriot EMS notified Judge Wireman’s office last week, stating they are losing money and they are going to have to have $15,000 per month subsidy from the county to continue to keep two ambulances stationed in Magoffin County at all times. If the county can’t, starting this past Sunday, they will only have one ambulance stationed in the county.
“They brought some financial data and run data,” Judge Wireman said. “I have my own run data, so we could do some comparisons. Basically, what they are proposing was that, in order to keep two ambulances on the ready for Magoffin County, we were going to have to subsidize that service. This is not something that’s not normal. It happens in quite a few places, but it’s not normal for us in Magoffin County. It’s very disturbing that we’ve got to the point, in the middle of the fiscal year, end of a calendar year, and they’ve came to us with this out of the blue. Things have been relatively quiet with the ambulance service for a long time. You’re going to have complaints anytime you’re dealing with people, but it’s been a lot better than my first couple years as judge. It was quite a shock when I found out what it was they were wanting to talk about. It wasn’t totally unexpected, but it wasn’t something that was on my radar an immediate term.”
Basically, Patriot showed data to Judge Wireman showing their runs are down and the ability for the ambulance service to break even with emergency calls is not there, he said. For the past several months, they’ve reportedly ran in a deficit of approximately $15,000 per month.
“They’re attributing that to lower run calls, lower times going out and the higher number of refusals, and when they do go out on a 911 call, and they get out there and it’s refused – they refuse to go on the ambulance for whatever reason. Also, Medicaid transports, the price of those is not very much – maybe $120 to $150 to haul someone on Medicaid. So their ‘bread and butter,’ as I understand it, is transferring patients from one hospital to another, and we don’t have a hospital here for them to transfer back and forth to, so they need those trucks in those areas, and they have another station between Paintsville and Prestonsburg for that very purpose.”
Judge Wireman said he’s talked to other county judges, noting that during the pandemic there was a shortage of paramedics, so the pay rates have increased, and they have already taken advantage of every cost increase that insurances will allow, but they’re still operating at a deficit for the county ambulance services.
“I get all that,” Judge Wireman said. “If you’re in public services, this is not a profit business. Police departments, sheriff departments, fire departments – they don’t run based off of profitability. It’s a public service that’s paid for with public dollars. We have a private company in here doing 911 only and they’re not generating enough revenue off of the ones who have insurance, or the ones that have Medicare or Medicaid, to remain here. Their solution for the short term, pending us giving them a subsidy, they’re going to have one truck stationed here instead of two.”
Judge Wireman indicated that while having only one ambulance stationed in Magoffin County is very concerning, it’s not as bad as it has been.
“Before, we had zero most of the time, but it does create a lot of problems,” Judge Wireman said. “In order for us to address that issue, and I’ve spoken to all the surrounding counties, and their ambulance services and we have mutual aid, so that if something happens and we don’t have one, and Patriot can’t get an ambulance from another county here, we’ll be able to pull from one of their ambulance if they may have one available.”
He also noted that some surrounding counties are in the same situation, either with limited or no availability to cover mutual aid calls.
“Talking to their judges, one has one ambulance to cover two counties, and that is extremely frightening to me that could be a possibility 24/7,” Wireman said. “We will have one here, but when it goes out on a call, we have to make sure we have the availability from others, and Patriot for their ability, will have their units available if they can be.”
After already struggling to secure better ambulance services for the county once during his term, Judge Wireman said this “is quite the situation to be in, again.”
“We got the CON – the certificate of need we didn’t have in the county. It was an actually an emergency one that I think Lifeguard was working on from Pike County that allowed them to come in here somehow. But we have that and the county owns it, and through contractual agreements having Patriot operate on it. It may be we have to explore operating our own ambulance service, but if we do that, knowing what I know from all the other counties that are actually doing it, knowing they operate on a deficit every year, that money has to be made up, that type of money stream has to be created here. We’re not at that point, yet, but that’s something we might be talking about in the future.”
As far as the $15,000 subsidy for the second ambulance to be stationed in the county, Judge Wireman said the county’s budget doesn’t have the money to cover that at this time.
“There’s nothing in my budget, and there’s no revenue stream in my budget, to take on the additional cost,” Wireman said. “The only way we could do it is if I shut down some service that we offer, or we curb everything back, and I don’t know if that could generate that kind of money.”
Judge Wireman said it would be impossible to make that kind of change in the middle of the fiscal year and after tax revenue comes in. He said they get grants, but they’re all reimbursement grants, so they have to have money in the bank to get that funding. He also noted that counties in other areas of the state may have the ability to generate more revenue, Magoffin County doesn’t have as many options.
He said he’s also looking into the possibility contracting with another company for those services just to see what the best options are.
“There’s a lot of unknowns, and we did look into this pre-pandemic, but everything has increased significantly since then,” Judge Wireman said. “It’s pretty tough.”
