Funding, staffing continue to present major challenges for local ambulances

West Concord Ambulance Director Peter Moen was faced with a crisis, and it wasn’t a call.
For decades the department had two loyal volunteers in town, who were able to cover daytime shifts.
Then in December after a combined 63 years they retired. By the first of the year the city was looking for two full-time day shift EMTS.
In over five months not a single applicant has come forward.
For now, and potentially at least until the end of the year, West Concord has relied on its ambulances to come from Dodge Center Ambulance, for 12 hours a day, five days a week.
“They are providing service for us during the day,” Moen said.
It’s a reality rural ambulances across the State and country are facing. Issues finding staff, volunteerism at an all-time low, and then the biggest issue facing Dodge Center Ambulance right now, a lack of appropriate reimbursement rates for insurance, have caused headaches for ambulance directors.
‘Suspended Service’
Dodge Center Ambulance Director AJ Gengler and Moen sat next to each other at a recent regional ambulance directors meeting, when Moen asked Gengler if he should talk about West Concord being on the hunt for full-time EMTS.
Gengler said he could but they’d laugh. Everyone was facing similar issues, he said.
Moen asked and the others in the room laughed; it was a reality for rural communities in general.
With no contenders for a $17 an hour plus benefits job with West Concord it led to the decision to be made to “suspend” its service from 5 a.m. to 5 p.m. on weekdays.
The agreement currently runs through June, and, Moen said the hope is to extend it. In exchange for providing service to West Concord, any of the calls Dodge Center Ambulance does they are allowed to keep all the revenue for.
Under state law the maximum amount of hours a week an ambulance can suspend its service is 108.
“There was a hit to our civic pride when we had to give up our day time service to Dodge Center,” Moen said.
Gengler didn’t disagree, with EMTs being at a premium right now in Minnesota.
“It’s a crisis throughout Minnesota with staffing,” he said.
Gengler has three full-time EMTs including himself, and three part-time employees, paid at a rate between $21 to $25 an hour.
The rest of the service hours are being supplemented by volunteers who get paid $3 an hour to be on call, and then an additional hourly wage “in the teens” for any call they go on, Gengler said.
“These professionals, who are supposed to be lifesaving professionals, we’re paying $3 an hour to prepare them to come help you,” Gengler said.
Gengler, however, said at the moment, while things could certainly change abruptly, staffing isn’t their biggest concern right now for Dodge Center Ambulance.
Instead the biggest concern Gengler pointed to is funding.
Long Term Solutions
Two years ago Gengler said the department billed roughly $1.7 million but only received $650,000 in cash.
While there are a variety of reasons he said the biggest issue is insurance companies, particularly for Medicare and Medicaid patients not paying their fair share.
“You can send a $2,000 bill and you maybe will get $400 or $500 if you’re lucky from that bill,” Gengler said.
With 60 to 70% of rural EMS calls being those patients, Gengler knows there needs to be other ways to generate revenue.
“We need the government to pay the true cost of a bill and ambulance ride,” Gengler said.
Some ambulance providers like West Concord for example are part of the Fire Department, and receive support from the city financially through it.
Dodge Center Ambulance on the other hand receives $5,000 from Kasson, $7,500 from Dodge Center, but still provides services to smaller communities like Mantorville, Claremont and surrounding townships.
It’s why Gengler has been making the rounds to different township boards and city council meetings having preliminary dialogues about the potential of going with a Tax District for the ambulance’s Primary Service Area.
Gengler said if they were to go in that direction, it would require a number of steps including various public hearings and approval from all the different communities.
The idea of a taxing district is that the board, made up of representatives from each community’s governing bodies, would decide on what the tax levy would need to be each year.
But Gengler said even if they were to create one he hopes it wouldn’t have to be used.
“We hope we will never have to use it if we do get it formed,” he said.
Moen recognized the fact that if a Tax District was to be formed, and West Concord wasn’t part of it, then residents in the communities paying taxes may have concerns about allowing the department to be subsidized by Dodge Center Ambulance.
He said preliminary conversations have taken place by leaders in West Concord, also noting other options could be something like a countywide model.
In West Concord, Moen said it’s their hope to be able to keep what they are doing with the help of Dodge Center Ambulance for as long as possible.
“I would say at this point the best case scenario,” Moen said.
Big Savings
One of the biggest reasons, for now, as to why Dodge Center Ambulance is in need of revenue, is because of the equipment that needed to be replaced.
Without any kind of levy dollars going toward capital equipment, it leads to some equipment outpacing its expected life expectancy, compared to when it was originally purchased.
A potential short-term solution rural ambulance providers are hoping for is a $120 million bill being debated in St. Paul which will provide one time funding for different equipment and other needs.
But Moen and Gengler know it’s only one time funding. There needs to be a long-term plan to increase revenues.
Then it’s back to the issue of staffing. Gengler explained state model projections say it costs between $800,000 and a million dollars a year to staff a full-time 24/7 ambulance.
Dodge Center Ambulance saved taxpayers around a half million dollars last year, based on their current pay for volunteers and staff compared to the cost of having a full-time staff, according to Gengler. He knows if more staff, particularly paid part-time and full-time staff is needed then it would require more revenue.
But as long term conversations are taking place, the reality is everyone is struggling to find people.
For example, last Friday, when Gengler and Moen sat down for an interview with the DCI, Gengler was scrambling to find some people who may be available to hop on the second ambulance with him if needed.
Dodge Center Ambulance was covering the daytime shift for the entire county. Hayfield wasn’t able to field a crew either.
“Right now every service is just stealing the other service’s employees,” Gengler said.