The Washington County Emergency Medical Services Authority, known as Downeast EMS, startled employees in early May when Director Steven Welsch notified them of belt‑tightening measures. While no one has been laid off or lost hours, DEEMS will be lowering its payment share of health insurance coverage to 50%. In addition, those employees who are on "call pay" during the night shift will see a reduction in hourly rate.
Call pay, Welsch explains, is for those employees who are stationed at a base at night but not out on a call. Call pay is not required to meet minimum wage. The wage of $7.5 per hour is being reduced to $5 per hour. Welsch stresses that if a call comes in and the night shift goes out in the truck, their regular pay is not affected. Neither will day pay be affected. DEEMS has 15 member communities plus a portion of the unorganized territories, with bases in Baileyville, Eastport, Lubec and Machiasport.
Isaac Stephenson, a DEEMS paramedic and supervisor of the Lubec and Machiasport bases, says, "No employee was consulted prior to them sending this out. It came without warning; nobody knew." He has been with the organization for three years, and he fears that the cuts may make recruiting employees more difficult. "We all understand that this is a field not to go into to make top dollar." Employees make anywhere from $8 to $18 an hour depending on their skill level.
Navigating healthcare in the county
“We're in significantly better shape this year than this time last year,” Welsch says of the organization. A 10‑month refinancing process has allowed for smaller monthly payments, he says. However, while the DEEMS budget took into account a 3% decrease in Medicare payments, the organization did not anticipate the rate of payment denial that has been taking place. "You have to fight to get your money," and part of that fight is having the right software, which Welsch says has been changed in what he considers a deliberate fashion to facilitate denials. The billing company that DEEMS uses is out of Bangor, and in the many years that they have operated Welsch says that they have never seen the kinds of denials that are coming through. The billing company has gotten savvy with the software, and Welsch expects that they now will see fewer denials of payment.
However, the challenges of operating in the healthcare field in Washington County are not just being felt by the hospitals. Welsch explains, "Washington County has the worst payer mix in the state right now." Those with private insurance are between 6‑9% of the population, as opposed to 25‑30% in southern Maine. A high percentage of the population uses MaineCare, which reimburses at 34%, and Medicare, which reimburses at 42%. And then there is a "very, very high no‑pay rate. We see in the 10‑13% range."
Per diem paramedic Walter Plaut of Trescott says, "Washington County has a lot of people who can't pay for what they receive. There are people in this community who have had claims denied because of over‑use of the ambulance service."
The "constant change" in reimbursement policies "has probably gotten worse," with claims denials and policy shifts making it difficult "to make ends meet" and to plan for the future, says Plaut. However, while he understands the difficulties that any healthcare service faces, he is frustrated that employees were not consulted for input about financial issues. Stephenson expresses the same frustration.
Welsch comments, "It's that payer mix that's put the strapping on the county C-- and the low population numbers." The service has on average 1,900 ambulance runs per year.
"Frankly, I don't think people care whose name is on the side of the truck," Plaut says. He questions the business model and suggests that management should visit with other ambulance services to see how they do it. He also suggests that possibly having a county or multi‑county service would make more sense than the current multi‑town setup. "Maybe Aroostook needs to be part of it."
The proposed fiscal year 2015 Calais ambulance budget is for a little over $875,000. In comparison, the annual budget for Downeast EMS, with its 15 communities plus the UT, is about $1.45 million, of which $1.1 million is payroll.
And contrary to Plaut's contention that people do not care where their ambulance service comes from, Baileyville residents voted in favor of retaining their membership in Downeast EMS, despite receiving an offer from the Calais ambulance service. However, Robbinston has left for Calais, and Baring is leaving in June.
Eastport businessman Gilbert Murphy wears three hats with DEEMS, as a part‑time per diem employee, a board member and a city councillor. "We are working to streamline operations," he explains. "For what Eastport, Lubec and the UT pay, if we [Eastport] were to do it on our own it would cost more than what we pay now. We get 24 hours, seven days per week coverage. That's a lot of coverage for what we pay for." He adds, "I feel strongly about this." He explains that larger ambulance service companies are happy to do transfers but are not interested in providing emergency services in the area because of the lack of population. "It's not a money maker." Downeast EMS has "a lot of trained personnel, and while there are no paramedics here, we do have advanced EMTs." Having such staff on hand allows for a variety of treatment that keeps patients from having to go to the hospital. "We have several diabetic patients in town that we can treat on the scene." The same goes for someone suffering from anaphylactic shock. "It's a really good service," he says with pride.
Paying for the service
While all Downeast EMS communities pay to be members, in 2013 Eastport, Lubec and the UT agreed to provide a loan guarantee of up to $540,000, with each being responsible for a third, or up to $180,000. When presenting information to the Eastport City Council, Welsch said the loan would be at about 2.5% interest for the duration of 10 or fewer years. The First issued the previous loan of $600,000 in 2009 when Calais withdrew its membership from Downeast EMS, leaving the service with an annual loss of $100,000 in membership revenue. The 2006 loan "is down to $229,000, and we've never missed a payment," Welch said in 2013.
The loan of up to $540,000 encompassed the remaining $229,000 of the 2006 loan, a $14,000 loan taken out to purchase a trailer, a $100,000 line of credit and the funds to purchase replacement trucks for a fleet purchased in 2006. The loan restructuring will reduce the monthly payment by about $2,000 from the amount of $7,500.
"The service is alive and well. We aren't going anywhere," says Welsch. He anticipates that within six months they will have a much better idea of how reimbursements will be coming in.
DEEMS board meetings are open to the public and are held on the last Tuesday of the month, usually at 4:30 or 5:30 p.m. at the Meddybemps Community Building. Call Downeast EMS at 427‑6100 for more information.