Ambulance chief: Budget must double to keep pace

May 20, 2013 By Eric Blom, Staff Writer

The Fremont County Ambulance Department's budget will need to nearly double in future years for it to deliver adequate emergency medical services, said its director. At a May 14 budget hearing, Lauri Wempen brought a proposal to the Fremont County Commission which called for $4.1 million for the ambulance service next year.

The ambulance service received $2.1 million this year.

The county board had sharp questions for Wempen but will not make budget decisions for several more weeks.

A major part of the hike would pay to bring 25 part-time employees working 36 hours per week to full time with benefits.

The total cost of that part would be $1.2 million compared to the $506,000 they cost now as part timer workers, Wempen stated in her written budget request.

The current full-time staff has seven EMTs, two bookkeepers, two division supervisors. The ambulance department also has two part-time medical directors and 45 to 50 part-time EMTs, the proposal stated.

Part of bringing on more full time staff would allow the Dubois station to have five regular EMTs rather than the one it has now.

Hiring a consultant to make staffing and scheduling recommendations added $25,000 to $90,000 to the increase, Wempen said at the meeting.

The money

Draining the ambulance service's $1.3 million reserves and an $833,000 infusion from the general fund would pay for the $2 million budget increase, Wempen said.

The emergency medical service charges for services. That income has made up the vast majority of its revenues in the past.

For example, this fiscal year, it expects $2.07 million from payments for ambulance services and $2.26 million in revenue overall, according to the budget request. Total expenditures are projected to by $2.05 million.

The $1.3 million in reserves has accumulated over many years and could only be used once.

"We have a plan in place to sustain this program without coming back to the general fund," Wempen said. "I'm looking for seed money so we can get kicked off and take this to the next level."

Possibilities for future revenue streams include an additional sales tax, a special district, a subsidy from municipalities and grants, Wempen said.

Grants seem a remote chance as the ones the ambulance service already receives only cover capital expenses and amounted to $189,000 last year, according to the written request. At the meeting, Wempen said she has been unsuccessful finding grants for operations expenses

Other options will at some level bring higher taxes to Fremont County.

Important issues

The question of funding the ambulance service at a higher level has major implications according to Wempen.

"Do we still want to try to maintain the same level of care, or do we tell the community we can't send an ambulance for you?" she asked.

Commissioner Keja Whiteman questioned why the line item for overtime jumped from $109,000 this year to $688,000 in Wempen's proposed budget.

"I get that you'll have more employees, but I think if you have more employees you'd reduce overtime," Whiteman said.

Wempen explained her planned schedule would have employees routinely work 12 to 30 hours of overtime per week.

"If I reduce that overtime, that takes twice as many people," she said.

The consultant hired as a part of the proposed budget would study the ambulance service and recommend scheduling and staffing changes to become more efficient, Wempen said.

Full-time staff needed

Scheduling her employees now is difficult because they are part time and have other obligations, Wempen said. Bringing more staff to full-time would lead them to commit to the ambulance service and Wempen could have more structure in scheduling, she said.

Even without raising the 25 employees to full time, they would qualify for health benefits because of the Affordable Care Act passed by Congress in 2010, Wempen said.

Under the law, employees working more than 29 hours per week would be eligible for benefits starting July 2014, she said. Those employees currently work 36 hours a week.

"I would have to double or triple my staff to get people under that limit," Wempen said.

Under the proposed budget, the health benefits jump from $132,000 this year to $761,000 next.

Dwindling numbers of volunteers and difficulty retaining part time staff has also lead Wempen to recommend augmenting personnel.

She said some EMTs decide they cannot get by with a part time job without benefits and leave Fremont County's ambulance service for better paying jobs elsewhere. Increased training and paperwork requirements have also led to fewer people volunteering with the emergency service, Wempen said.

The county board was skeptical all the requested were needed.

"It kind of seems to me you're asking us several things at once," Commissioner Travis Becker said. "wouldn't it be beneficial to do a study first."

Commissioner Stephanie Kessler thought the current staffing level could work better.

"If we're hiring people at 36 hours a week, how can we not tell them when they need to work?" she queried.

Commissioner Larry Allen thought potential volunteers will think the increased staff means there the ambulance service has less need for unpaid help, and will be dissuaded from contributing.

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