Auditors from Fitch & Associates, hired last year by the Anderson County Commission to conduct an operational audit of the county’s Emergency Medical Services, or EMS, delivered a rather dire picture of the current state of the ambulance service.
Here is a broad overview of the problems identified by the auditors and their recommendations as to how to address the serious and long-running problems with EMS.
EMS was designated a self-funding enterprise fund by the county about ten years ago and expected to be able to generate enough revenue to sustain itself going forward. Auditors pointed out what many people have long ago figured out, and that is that: “Anderson County EMS is fighting a valiant, but likely unwinnable battle to remain financially and operationally viable as a self-funding entity, in both the emergency and non-emergency spheres.”
Auditors say that for an ambulance service to be able to operate as a self-funding entity, a set of very unique circumstances need to be in place, namely it needs to be in a densely populated area, with lots of people covered by commercial health insurance and a low number of Medicare and Medicaid patients. None of those factors are in place in Anderson, as georgraphically the county is very spread out; only 11% of the population has commercial insurance–which generates more regular revenue; and the number of Medicare and Medicaid recipients is high, and the federal government places a hard cap on what services they will pay for.
Many of those same factors also mean that Anderson County is a poor candidate for privately contracting EMS services out at an acceptable rate.
The main issues facing EMS center around a serious need for new ambulances and new equipment. Auditors say that most of the ambulances in the fleet are “well beyond” their acceptable service windows and that critical vehicle failures–those failures that occur from the time a call is dispatched to the time an ambulance is supposed to arrive on the scene–are three times the accepted national standard. Auditor Skip Kirkwood said that in his lengthy career he had never seen “an ambulance fleet this broken down and worn out.”
The biomedical equipment inside the ambulances is also aging rapidly and is hard to repair and not always 100% reliable.
Another issue is that of “chasing revenue,” the practice of running convalescent calls–taking homebound patients to the hospital and the like–which many times leaves large swaths of Anderson County uncovered for emergency services and force mutual aid agreements to be called into play.
Auditors also pointed out that the ambulances in Anderson County are not strategically-placed to provide maximum coverage and the lowest response times, criticizing officials for using donated and often, inconveniently placed buildings as ambulance stations.
Speaking of response times, Anderson County’s average response time is 19 minutes, well above the acceptable national standard of roughly 12 minutes.
Auditors stated “no one person or decision is responsible for ACEMS’s current financial situation and no one person or decision can resolve all of the issues noted in this report. It will take a concerted and long-term effort involving the commitment of county leadership and the community, to develop and agree upon goals and strategies in order to improve Anderson County’s EMS system. An overarching recommendation is that the Mayor and EMS Director develop an immediate and long-range strategic plan that can be brought to the County Commission for review, approval, and funding.”
Auditors recommended that before anything else occurs, there needs to be a policy-level discussion on what kind of EMS the county wants to have, with two primary choices facing County Commissioners and other stakeholders: namely, does the county want to continue to provide both emergency and convalescent services, or do they want to provide only emergency services and leave convalescent and other calls to other entities.
Once that decision is made, auditors say that the Commission needs to communicate their desires to the management of EMS so that Director Nathan Sweet and County Mayor Terry Frank can let them know exactly how much money it will require to accomplish that goal. Describing EMS as underfunded for years, it will then be up to the Commission to provide the necessary funding. Currently, the Anderson County government provides only about 3.5% of the EMS budget, which is well below the national average of some 32% that comes from local governments to its emergency services.
Another priority will be to replace the Computer Aided Dispatch (CAD) system currently being used by the EMS, which does not smoothly communicate with the 911 Dispatch Center’s equipment, which in turn negatively affects response times.
Auditors also addressed morale issues in the department and said that a large part of employees’ criticism of EMS leadership is for things that are out of management’s control, like providing enough funding for new ambulances, equipment and pay increases. Auditors were extremely complimentary of the quality of the EMS employees and their “outstanding” participation in the survey and numerous on-site interviews conducted by the audit team.
Auditors recommended getting as much community input as possible, all with the aim of andswering two key questions: What kind of EMS service do you want? And, how much are you willing to pay for it?
Commissioners seemed eager to start working to get that community feedback, with suggestions including town hall meetings, surveys and other forms of outreach to help the community make its voice heard on this issue that affects just about everyone living in Anderson County.