BENTONVILLE — Benton County’s debate over rural ambulance service will not end before 2013, county officials agreed.
The county remains in talks with eight ambulance providers on how to pay for ambulance service to rural areas. The debate has lasted two years so far. Cities have kept up service but Bentonville and others insist the county should cover costs fully.
The county proposes ambulance providers share a $300,000 county subsidy for 2013 — double the 2012 subsidy — while seeking a lasting solution. Some providers, however, said they need that much individually.
Rob Taylor, chief of the NorthEast Benton County Fire Department, told county officials NEBCO would need about $324,000 a year from the county if a new system eliminated the department’s current $40 per-household fee.
Rogers Fire Chief Tom Jenkins said Rogers alone needs a yearly county subsidy of $317,125. This would cover six firefighter/emergency medical technicians to staff an ambulance and provide $25,000 a year toward an ambulance replacement fund.
The Issue
Seven cities in Benton County still provide ambulance service to areas outside their boundaries. Garfield-based NEBCO also operates an ambulance service. Bentonville Mayor Bob McCaslin said two years ago Bentonville should not pay to provide ambulance service beyond its borders forever. He pointed to a provision of state law that requires the individuals or governmental entities receiving the service to pay the costs.
“It’s Arkansas state law that mandates that municipalities be reimbursed for the service,” McCaslin said. “I didn’t write that law. It’s not my law.”
The statute cited by McCaslin states: “All direct and indirect costs of extending those services shall be borne entirely by patient user fees or subsidies provided by the patient, municipalities or county to whom those services are rendered. In no event shall the city extending ambulance service beyond its boundaries be required in any manner to subsidize or otherwise extend financial support to render those services.”
Ambulance Costs
Bentonville has asked the county to agree to pay $400 for each ambulance call that results in a patient being transported, with an exception for Bentonville residents. A county estimate of the cost of doing business with Bentonville at that rate puts the county’s bill at $114,720 by 2015. Countywide, a $400 flat fee for each ambulance call resulting in a patient transport is estimated to cost $794,880 by 2015.
In Washington County, Central Emergency Medical Service, provides ambulance service for Fayetteville and those parts of the county south of the U.S. 412 corridor served by Springdale. Payment to CEMS is based on population, with cities and the county contributing $3 per person, based on U.S. Census figures, Capt. Becky Stewart of CEMS said.
The ambulance service in Springdale, a function of the city fire department, handles medical calls for several small towns in both counties, as well as some parts of rural Washington County along U.S. 412, and the cities of Lowell and Bethel Heights in Benton County. Springdale charges for rural and small-town service in a variety of ways.
Springdale calculates what percentage of their calls come from the cities of Tontitown and Elm Springs and rural north-central and northeast Washington County, and submits an annual budget request to the Washington County government to cover those calls, said Kevin McDonald, assistant fire chief. “This year, it was right in the ballpark of $2.2 million,” McDonald said. “As far as I know, the county has always covered those costs both for the rural areas and the small towns.”
Lowell and Bethel Heights pay a flat $400 per call rate. They switched from a percentage-of-call system to the flat rate about a decade ago.
“We’re up there simply because, right now, we’re the closest in terms of response time,” McDonald said of the calls in Benton County. “We’ve been running outside the city since 1968, because there was nobody else out there to do it.”
Bentonville remains committed to its $400 charge for each ambulance call that results in a patient being transported. Centerton, Highfill, Cave Springs and the Northwest Arkansas Regional Airport have all signed agreements with Bentonville for service at that rate.
Jenkins said Rogers chose to use a different model to arrive at the cost.
“That’s not what we believe is appropriate,” Jenkins said of the per-run charge. “There are two finite costs. One is the cost of the service itself. The other one is what we bill the patients, bill their insurance or bill Medicaid for. That cost varies according to the run and what is involved.”
“The bigger question is ‘What do we need to cover this area?’” Jenkins said.
Justice of the Peace Dan Douglas doubts there is enough public support for rural ambulance service to approve a sales tax or millage increase. He said the county’s $300,000 subsidy for 2013 provides no real benefit and doesn’t promote a real solution.
“No matter what we do, it’s going to cost money,” Douglas said. “The first thing we need to do is make sure we’ve got every inch of the county covered. We’ve got to decide who’s going to do it and at what cost.”
Options
A 100-page study by The Ludwig Group consulting firm of Memphis, Tenn., came up with seven options. These range from doing nothing to establishing an ambulance service as a department of county government, a partnership with Central Emergency Medical Services in Fayetteville, contracting out all services to a single private ambulance provider, contracting with fire departments, forming a public utility, or utilizing a combination of private providers and fire departments.
Most options involve a single provider for all rural areas. A consultant’s study’s gives a hypothetical budget for a county department that would cover the expense of providing rural ambulance service. That figure amounts to a startup cost of about $1 million and an annual budget of about $2 million. The report suggests a millage increase to pay for such a system.
Ambulance service in Washington County looked much like Benton County’s current situation through the mid-1980s, with several providers covering various areas of the county. Some companies were private, for-profit concerns, while others were organized as nonprofit groups. As various providers quit the business, Central Emergency Medical Services took over the majority of rural and small-town service along with Fayetteville.
Central EMS was reorganized in 2006, converting from a nonprofit company to a modified version of a public utility. Converting allowed Central an exclusive contract for both emergency and nonemergency service throughout most of Washington County.
A public utility model similar to CEMS is “highly unlikely” to be Benton County’s final choice, said Bob Clinard, Benton County judge. For such a system to work, the major cities would have to agree to cooperate with the county in a single system, essentially shutting down their municipal service, he said.
Central EMS isn’t planning to expand into far northern Washington County, or into Benton County, Stewart said.
A private ambulance service remains an option of interest to some justices of the peace, who have asked Clinard to have county staff gather information on private systems in use in other areas. Marshal Watson, the county’s public safety administrator, said two private systems expressed some interest in the county, However, they would only be interested where one of them would become the exclusive provider of ambulance service.
Contracting with individual fire departments has generated mixed responses from fire chiefs.
Gravette Mayor Byron Warren calls the ambulance service his city provides to unincorporated areas a moral necessity, though not a legal requirement.
“Absolutely, we’re happy with whatever we can get,” Warren said of the subsidy. “Two years ago we didn’t get a dime from them. Then we got $22,000 and this year it’s up to about $32,000. To me, it’s unexpected.”
Gravette’s ambulance service operates on a different model than most city services. Warren said the city staffs its primary ambulance daily with part-time emergency medical technicians chosen from a pool of volunteers who mostly work for other, larger departments and are willing to work part-time for Gravette. This spares the city training and benefits costs. He also said the revenue from the ambulance runs outside the city are keeping the service in operation.
“If we didn’t have the county runs, we couldn’t support our ambulance service,” Warren said.
Other departments see calls from outside their primary service areas as a drain on their finances and a diversion of resources from their primary responsibility. Siloam Springs Fire Chief Greg Neely said his department might have to reconsider offering ambulance service outside the city.
“If we cannot provide for our citizens in a manner consistent with our mission and our budget, we would have to do one of two things: pull back on county responses or request and direct additional subsidies to augment our staffing levels,” Neely told the county.
All eight ambulance providers told county officials they’re willing continue serving the areas outside their primary region, but said some subsidy from the county is needed.
Springdale indicated that the city would prefer to limit its coverage to the city, but has no plans to immediately cut service.
Some combination of private companies and fire departments might also combine to cover all rural areas, according to the Ludwig Group report.
Uncertain Future
Several justices of the peace have said they want some kind of public input on the issue before they make a final decision and are disappointed in the lack of interest so far. Justice of the Peace Patrick Carr said he hasn’t received any calls or email on the subject.
“It amazes me that nobody seems to have a dog in this hunt,” Carr said.
At a recent County Hall meeting in Siloam Springs the issue was put to the audience, with little response. Bill Dark, who lives east of Rogers and would be affected by any change in rural ambulance service, said he thinks the cost should be borne by those who use the service. Another comment, from Karl Mounger of Siloam Springs, asked the county avoid contracting with a private ambulance company.
“Please work out something with these cities,” Mounger said. “Don’t get a private ambulance service for the county.”
Bentonville leaders, meanwhile, just want to see some sort of resolution.
McCaslin said Bentonville is “trying to remain optimistic” about reaching a settlement, but said Bentonville’s offer is unchanged. He said the city has already discussed the details of the cost — and even removed several elements that were questioned. He said the county has to make the final decision as to how it chooses to proceed.
“We don’t seek out that business outside the city,” McCaslin said. “If the county wants to provide ambulance service, that’s fine with us. But, as long as we’re going to provide it, it’s not going to be a free service.”
Dan Craft contributed to this report.