This article originally appeared in the Teton Valley News.
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WHO ‘YA GONNA CALL?
County discusses who should provide ambulance services
Scott Stuntz TVN Staff
When someone in Teton County dials 911, the ambulance that responds to that emergency could be staffed by either the Teton County Fire District or Teton Valley Health Care (the hospital).
However, that could soon change. Last week the Board of County Commissioners heard a proposal from the fire district on ways to restructure how emergency services are provided.
That proposal was in response to a request made by BOCC chairman Bill Leake last July. According to the minutes of the July 13 meeting, he asked the fire district to “analyze their staffing and budget needs and provide a detailed proposal within the next few months.” Leake stressed that no major changes would take place soon and said all aspects would be reviewed carefully before a decision is made to disband the Ambulance Service District (ASD) and transfer all assets to the Fire District.
The hospital asked for $200,000 more than the Ambulance Service District had in funds for the year. Leake said he asked for the proposal from the fire district after he asked those at the table for a solution and was met with silence.
“When there’s a funding problem I have to do something to address it,” Leake said.
The fire district presented its proposal at a meeting of the Ambulance Service District on Jan. 25. Teton Valley Heath Care responded to the proposal by taking out ads in a recent edition of the Teton Valley News. One featured a letter from doctors endorsing hospital involvement in emergency services and the other was an ad rebutting the financial claims made in the fire district’s proposal.
The two sides vary widely in their views on how much the different options would cost, with fire saying the savings would be in the hundreds of thousands and the hospital saying they would be far smaller, less than $10,000.
Leake said that it is much too early to be batting around those huge overall numbers.
“Arguing about the numbers right now won’t get anyone anywhere,” he said.
He said the county first needs to sit down and lay out what services they are legally obligated to provide and what other services they can afford.
Hospital CEO Keith Gnagey said the hospital would probably be able to shoulder some of the extra costs this year, as it was forced to last year, in order to pay for ambulance service.
Gnagey said the main issue is quality and that in order to ensure a high level of care, the hospital needs oversight over ambulance services. He said quality links directly to the financial sustainability of the system; how hospitals are paid for the care they provide is changing rapidly.
Under traditional payments, providers were paid for the services they provided, such as for the casts they put on or the cuts they stitched up. Gnagey said the industry is shifting to paying for “outcomes,” meaning preventative care and in-home treatment, the kind provided by ambulances, is key. He said to thrive in this new philosophy, the hospital needs to be able to manage all types of clinical care, including emergency services.
“It’s not about the money, it’s not about who [the fire district is] is, it’s about the hospital’s mission of providing the best health care we can, all the other issues are secondary,” he said.
Gnagey said of course the financial picture is important, but the value the county gets for the money it’s spending is vital as well. He said the hospital doesn’t want to take over the operation of the ambulances in the county, but to maintain the current joint operation that he said is working quite well.
“Now, how can we make it better?” he said.
The ambulance service district will take up the matter again at a county meeting this Monday, Feb. 8.