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August 15th and this is our meeting of the. 00:00:00
Boyd County EMS Task Force if we could all stand for Glitch. 00:00:03
I pledge allegiance to the flag of the United States of America. 00:00:09
And to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all. 00:00:14
All right. Thank you everyone for being here. I'm pretty excited about today. The last task force meeting that we had, we had 00:00:24
discussed reaching out to our friends up in Putnam County and asking them to come down and see if they would be willing to give us 00:00:32
just a presentation on how they operate their model up there. And graciously, Deputy Chief Taylor is here with us today and. 00:00:40
Today is going to be all about listening to their model, asking them some questions and and seeing how they run things up there. 00:00:48
And so I'm looking forward to hearing anything, everything so. 00:00:53
If nobody has any objection, I'd like to go ahead and see if we can get this potato started. 00:00:59
All right, Miss Taylor, thank you. 00:01:04
Good afternoon. 00:01:08
Like Commissioner Sharp said, my name is Anthony Taylor, the technically the chief of operations now. We had a title redo here 00:01:09
recently in months, but my job is the same. 00:01:14
I am going to talk about how our service works. If you're not familiar with Putnam County is it's. 00:01:21
North. It's actually the southwestern part, halfway between Indianapolis and Terre Haute. We service quite a large area. It was 00:01:26
Googling last night. Looks at Urias County is about 180 or 190 square miles were almost 500. 00:01:35
Bigger population is much more dense here. So our agency is what we would call a municipal third party or third service EMS 00:01:45
system. We are county base, county operated and we only engage in 911 transports, so 911 responses. We do not do any inner 00:01:50
facility. 00:01:56
Of snow hospital hospital we only service our. 00:02:03
County as a whole, unless we're requested for mutual aid. 00:02:08
So easiest way to explain how our agency became a thing because it was basically born in 2020. 00:02:11
Was prior to that it was a not-for-profit called Putnam County Operation Life which started in 1974 and that went all the way 00:02:18
through until December 31st of 2019. 00:02:24
The model sounds very similar to what was just described to me. So basically a private service that was being supported by Putnam 00:02:30
County for quite some time. Despite multiple bankruptcies. Their last two year contract they were getting $400,000 a year support. 00:02:38
And then we basically became an agency. 00:02:47
I did not start, neither did our current chief, Chief Kelly Russ until March 23rd of 2020. 00:02:53
The original administration to the chief and at the time the assistant chief had vacated their positions by February 14th. So 00:02:59
there was about a five or six week period of time where the agency was without any leadership. 00:03:05
Which was an adventure because 20/20 was a pretty. 00:03:13
Remember memorable year with code. 00:03:16
So we walked into what I would call pirate ship. 00:03:20
Of a lot of change and. 00:03:25
A budget that once I figured it out in April, that did not cover payroll. 00:03:27
So the original. 00:03:33
Budget that was approved would not have covered our full time employees. 00:03:35
We've since moved to a model where. 00:03:40
We now have a local income tax. It is maxed at the 0.2%. 00:03:43
And that plus our revenue where we only obtain revenue from our insurance companies. We are now able to project self-sustaining 00:03:48
with a capital replacement plan with no support that was approved in 2023 with our lit starting to be collected January 1st of 00:03:56
this year. So we'll walk through some information and I have a knack for when I use PowerPoint. 00:04:05
Speaking ahead of the slide, so I do apologize, but one of the biggest accomplishments of. 00:04:15
My almost 10 year career has been able or being able to make an agency that no longer puts financial burden on the residents or 00:04:20
the taxpayers. So if you call 911 in our county and you live in our county, we will bill your insurance company and then you will 00:04:26
no longer ever receive a bill after that. 00:04:33
So we just call that no balance billing. If you don't have insurance, then we just write it off. We don't consider. 00:04:40
Having to think about money, we see improved patient care out of that. We don't have people who are concerned about the financial 00:04:51
implications of using emergency services because who here, if you needed to call the police, would expect to get a bill from law 00:04:55
enforcement. 00:05:00
Nobody EMS should be the same way. We are a public. 00:05:06
Service. We are here for the public and we're typically called on people's worst days for the lights. 00:05:10
So our coverage area is 483 square miles. We have 13 townships, 10 fire departments, only one of which is career being in 00:05:17
Greencastle. Our population is around 37,000 ish and then during the school year we add about 2100 students at DuPont, so bringing 00:05:25
us to about 29295 to bring about the year. I-70 we have a massive stretch of it and it is one of the most fatal stretches of I-70. 00:05:32
So we do have to really consider southern. 00:05:39
Coverage. 00:05:47
Our staffing model IS3ALS ambulances. 00:05:49
Then I should I pursued since this NEOS task force, but everybody to wear a difference between ALS and Beatles, right. So we staff 00:05:53
our ambulances with one paramedic, one ENT. If we have people who are EMT's and then ultimately promotes being a paramedic, we 00:05:59
could end up with AA, LS, O2, paramedic staff to ambulances and then our administrative staff. So myself and Chief Ross are 00:06:05
obviously both paramedics and we were both chase. 00:06:11
Vehicle capable so we both have ALS equipment which comes in handy when we have our one BLS volunteer ambulance. It's not a PCEMS 00:06:18
ambulance, comes from a Volunteer Fire Department up north in Rochdale. 00:06:25
They provide us with mutual aid if they need ALS then we hop on their truck and. 00:06:32
It basically gives us an extra ambulance. 00:06:38
We do transport to 10 different facilities, so Putnam County Hospital, which is in Greencastle, so the Center River County is a 00:06:41
critical access hospital. 00:06:46
Our nearest Cath lab at all is Hendricks Regional and Danville. So it's going to be about a 40 minute transport time and it's only 00:06:51
Monday through Fridays, 8:00 to 5:00, no holidays, no weekends. So bankers hours. So then we have IU W, which is an Avon. We're 00:06:58
looking at about 50 minutes transport time to your nearest cat lab. So if somebody's having a heart attack. 00:07:05
They need a catalog that's our nearest one and then we will only go to Indianapolis for specialty resource centers. So whether 00:07:13
that be we need a pediatric capable hospital. So if we're going right ground, Riley Hospital for Children, our burn centers at 00:07:19
Eskenazi or any of the Level 1 trauma centers. 00:07:25
That's important because we also have to think about how the number of ambulances and where we will go by ground will actually 00:07:32
play a factor into your staffing and coverage model. So if we were to be allowing people to go to basically any hospital if they 00:07:38
want in the state of Indiana. So if we were to say they could go to the Heart Center in Carmel by ground, that's a three to four 00:07:44
hour round trip that that ambulance is going to be out of service when we are bypassing multiple hospitals that have the same 00:07:50
capabilities. 00:07:56
So looking towards how you would want to shape this, you would. 00:08:02
You would have to consider what hospitals you would be allowing people to go to. 00:08:06
So, Mr. Taylor, so can you go back on that slide? 00:08:10
So you're saying that these are not? 00:08:14
The transfers from the hospital going to another hospital, these are. 00:08:18
911 calls, correct? These are 911 calls. We do not do any inter hospital, OK, because I heard you say that earlier. I just wanted 00:08:24
to make sure. So we do strive to get patients to the right hospital. 00:08:30
The first time. So if Putnam County Hospital is a critical house access hospital is the most appropriate place and that's where 00:08:37
the patient wants to go, then absolutely. But from a clinical perspective, we don't want our providers transporting somebody with 00:08:43
chest pain to Putnam County Hospital because they don't have cardiology on site because then they end up being transferred waiting 00:08:48
for an ambulance for. 00:08:53
Hours to days when we could have just taken them to the right hospital to begin with. 00:09:00
Thank you for your clarification. So our staffing model, we have 26 full time employees, 24 of which are operational. 00:09:05
On our Greencastle truck which would be medic one, we have our Lieutenant paramedic which is our shift supervisor and we have 4 00:09:14
shifts. So our employees work a 24 hours on 72 hour off rotation into rotation. I've never gotten to work. 00:09:22
They love it, so they work 91 days a year, assuming they don't take any days off. 00:09:30
And they make. 00:09:35
Pretty decent salary in my opinion and they got a 21% raise this at the start of this year. Our medics are making about $59,000 a 00:09:37
year and our EMT's are making about 48. Our supervisors making about 61,000. 00:09:44
Working a 2472 hour rotation, then we have 14 part time employees, one of which is our administrative assistant Kenzie who's 00:09:52
amazing. She works 19 hours a week. It's a flexible schedule. And then we have 13 operational EMT's and paramedics just depending 00:09:58
upon the blend of that to help backfill into any vacancies that we may have with time off for people out for maternity leave or 00:10:03
other medical problems. 00:10:09
Or run volume. 00:10:16
Just to give you guys some sort of idea as to what we work with, this year will probably be just over 4000 runs with about 2600 of 00:10:19
those being transports. 00:10:25
Refusals. 00:10:32
If you are an EMS, refusals of transports are like awful because of the number one reason to be sued and but we do have quite a 00:10:33
few, especially with car accidents and then we utilize air transport a lot. Where is your guys''s nearest level 1 trauma center? 00:10:40
So we have University who is in Louisville and we also have Cosared Children's in Louisville. We also have three different flight 00:10:46
companies in this area. 00:10:52
Air Methods, Air Evac and Phi, is that correct? So we have three and we have a Phi base in the middle of our county, which is 00:10:59
great. And we have area back next door and then Lifeline and IU Health Lifeline and I think two of the counties nearby. So we use 00:11:05
air quite a bit just because of how long it would take for us to get to a trauma center. 00:11:12
But we also fly our medical patients as well, not just people who are traumatically injured. Chief reference to the last slide, do 00:11:20
you know how many of those transports would be as you classified long like the hour away or so 58% of our runs year to date have 00:11:28
gone to Putnam County Hospital and the remainder would then be outside of that with Hendrix Meaner second. 00:11:36
Most frequented, I think that percentage is like 20 something to maybe a low 30% transport there, so. 00:11:45
The rest of those would then be going to Avon or Indianapolis, which would be hitting that hour mark. So about 40% of your runs 00:11:53
are out of pocket for several hours. 00:11:58
Thank you. 00:12:04
And during the week, that's what actually gets me out of the office quite a bit is that if we do have 3 simultaneous transports 00:12:06
happening and another call comes out, I mean. 00:12:10
Management, administration and teaching and all these other things is my primary job, but my top priority is to serve the 00:12:15
community. So how we acquired our agency is the county basically absorbed Putnam County Operation Life and with that they absorbed 00:12:21
all of their assets, which was a blessing. 00:12:27
And a curse at the same time. So the three stations that we have were. 00:12:34
In desperate need of repair. And the fleet that we were handed over was also less than ideal. It got the. 00:12:41
Basics done, but it costs a lot in maintenance. They gave us 3/20/17 Type 1 Dodge 4500 ambulances, which we are slowly replacing. 00:12:48
We've gotten two of them out of our frontline. We do have a 2013 Type 3 ambulance that came from them and then those two vehicles 00:12:55
that are. 00:13:01
Crossed out are no longer even within our department. We've since added two Chevy Tahoes and we've purchased two Type 3 ambulances 00:13:08
with our third and 4th already on order. As you guys consider this, we started looking at projections for our capital replacement 00:13:18
plan about 2031 ambulances. So what we would have paid about $240,000 in 2021-2022, we'll be looking at about half a million. 00:13:27
In 2031, so just keeping that in mind, is the budget SO11 quick question. 00:13:37
What brand of ambulances do you go with and what how long does it take you to get those? 00:13:43
So. 00:13:50
We. 00:13:52
Our bids thus far have been won by Fire Service Inc, so the Reveal coached ambulances built down in Orlando, FL and then shipped 00:13:53
up here. 00:13:58
We've gotten them in a spouse just 12 months, but our current one we ordered shortly before the UAW strike, so it's going to look 00:14:04
at about two years. So which is why we went ahead and just put that 4th one on order with a replacement plan of replacing these 00:14:09
ambulances every three years. 00:14:14
And you are currently running 3 units, how many vehicles do you actually then own? 00:14:22
So we have 6 ambulances. 00:14:27
And what would be 3 chase vehicles? So we have a 2017 Explorer, 2 Tahoes and then our three frontline ambulances and their three 00:14:32
reserve ambulances. 00:14:36
Focusing on the ambulance, it's not the chase vehicles. What do you see long range as your need for spares? Do you need just one 00:14:42
sitting in the shop in case one breaks or do you need more than one so. 00:14:48
Ideally one for every truck, which is why we've not traded anything in and we've actually kept one as a reserve. And the reason 00:14:54
we've done that is in 20/21, it was the summer of 2021, we went through not one, but two reserves and we ended up having to borrow 00:15:01
an ambulance from the fire department outside of our county assembly to be able to continue operation. So keeping if you can have 00:15:07
one for one, it does at least give you some extra. 00:15:14
Sorry to get into the details and. 00:15:21
Thinking of our capital needs, do you then rotate those spares or do you run a primary and when it goes down then you go to the 00:15:25
backup? It would be exactly that. So we have our three frontline Greencastle truck is our busiest with Cloverdale, which is Medic 00:15:31
5 in the South being our second busiest and then Medic 3 at North. So when we replace an ambulance where we get a new one, it goes 00:15:37
into service in Greencastle and then we just rotate it through as they get replaced. 00:15:43
But we do keep the reserves as reserves because they're they've been used. 00:15:50
Quite a bit so. 00:15:56
So. 00:15:58
One of the reasons I think. 00:16:00
I think things get overlooked sometimes. Why it's important to have almost a one to one ratio is that, you know, we think about 00:16:02
covering, you know, our community and everything, but just your typical amount on one call isn't all your community. I mean, 00:16:06
people are sometimes worried about the bullers. 00:16:11
Baseball games, basketball games, football games that happened at the schools and stuff, community events, festivals, so on, so 00:16:17
forth, which you're also going to be responsible for coming. I don't think people really want to take the coverage trucks off to 00:16:22
cover those when you could have, you know? 00:16:27
A separate shift or a detail set up for that. And that's exactly what we do. So like to call, for example, we do cover depository 00:16:33
football games, We bring in a crew for that. We actually make two-part timers. That's all they want to do. One of them then with 00:16:39
Putnam County for 50 years and we use one of our reserve ambulances for that because we will not take a frontline truck out of 00:16:46
service for a special detail. 00:16:52
When we also consider the capital expenses on the front end. 00:17:00
We were transferred these assets, so we had Phillips MRX monitors that were transferred over, manual cots, super outdated cots and 00:17:03
stair chairs that have since been replaced. And a lot of that we were able to fortunately do with CARES Act money. So we were able 00:17:09
to get. 00:17:15
Brand new monitors because the Phillips MRX was recalled by the FDA, so that had to be replaced. That was a very large purchase of 00:17:21
I believe our First Capital purchase in April of 2020. We then were able to get mechanical CPR devices. We are very dependent on 00:17:27
Volunteer Fire responses and sometimes that can be prolonged. 00:17:34
Or non existent just depending upon availability. 00:17:42
We've tried to design our service to decrease injuries and improve patient care as much as possible by taking out a lot of 00:17:45
workload. So we have power cost power loads which will be coming in industry standard new striker stair chairs. That way we have 00:17:53
decreased back injuries. And then in 2020 we also knew state statute was going to be changing as to how EMS and controlled 00:18:00
substances or narcotics we're going to be regulated. So we went ahead and went with a commercial system that. 00:18:08
And tracks this for us and then we had to upgrade computers. So we've spent a lot of money, but ideally. 00:18:15
These devices and stuff should last. 00:18:23
About seven years on the monitors, seven years on Lucas devices, about five years on the power constant power loads. So I know 00:18:26
that there was a study done, I'm not sure if it was the Lucas or the auto point. I think what is the that there's actually more of 00:18:32
a positive outcome chance when those devices are used so. 00:18:39
So we've had. 00:18:46
Have the exact statistics, but we've definitely had quite a few cardiac arrest survivals to discharge where they are now living at 00:18:48
their back at home. 00:18:52
And anecdotally, I would say those were rare prior to the Lucas. It could just be, I mean, a lot of factors could fall into that 00:18:58
which would be improved dispatching earlier recognition by bystanders and just sheer luck, but. 00:19:05
We love our Lucas devices and the auto pulse which is by Zoll will accomplish a very similar. 00:19:13
It accomplishes the same thing. The literature though is kind of up in the air on the benefit of it. It definitely is beneficial 00:19:18
in a setting where we have decreased amount of manpower, so decreased hands that can do fresh CPR and then during transport, so in 00:19:24
a highly or densely populated area with a bunch of responders. 00:19:31
The literature is going to say the Lucas device or any other mechanical CPR is not going to do anything that your hands can't do. 00:19:37
It's just people do get tired. If you've never done CPR, it's exhausting and humans are statistically really bad at doing it. 00:19:44
So our buildings, we have three stations, Bainbridge N Greencastle in the center, which also houses or houses our administrative 00:19:54
side and training facility and then Cloverdale being in the South. All three of these have been remodeled. The administrative side 00:20:00
of our Greencastle station and the whole training was again through a grant courtesy of COVID funding through the state of 00:20:05
Indiana. 00:20:11
The rest of it was done basically through the expense of the county over. 00:20:18
Span about a year and a half, with labor done primarily by the trustees of the county jail, which saved a lot of money. 00:20:25
I mean, there was a lot of talent, the showers and stuff that they put in. They do construction full time when they're not 00:20:33
incarcerated and they're beautiful. So our crews have great stations to be able to. 00:20:38
Stay at and call home for 24 hours at a time. 00:20:44
So money the the business side of what we have to do is looking at billing. So even though I said we don't balance bill patients 00:20:49
anymore, we used to and we do still bill insurance. So in 2020. 00:20:56
We had some of the lowest billable rates that I think I've ever seen. So 2020 through 2022, our rates were quite low with our BLS 00:21:04
emergent. So our BLS transports were the 8 hundreds. We then see that in 2023, we increased those rates up and then in 2024, so in 00:21:12
February this year, we went ahead and just maxed it. What Medicare will allow us to build, that is what we're building. 00:21:20
So we've learned that you might as well just maximize that on the front end because we do see increases in revenue and you're able 00:21:29
to build for it. Just because you can build lower doesn't mean that that's going to be sustainable. We're not out here trying to 00:21:36
price down to people, but we do have to be able to sustain. Sure. So. 00:21:43
Have you? 00:21:52
I know you just raised it last year, but have you seen a noticeable difference since you've? 00:21:53
Done this where you've raised the rates up, is it making your return any bit better or? Yes, yeah, yes, we definitely have seen an 00:21:59
increase in. 00:22:03
Revenue and yeah and and and and just this is just what you build insurance, whatever is left over never reaches correct. The only 00:22:10
patients that do get billed are people who would be non residents so they don't contribute to the lit. 00:22:17
So anybody who may be involved in a collision on I-70, if they're from out of town, out of state, they will receive a bill. Now, 00:22:26
whether or not they pay it is a totally different question. 00:22:32
Or if we were even able to identify the patient. So we do have to write off if we call somebody John Doe, Jane Doe, because we 00:22:39
can't, can't bill you if we don't. Yeah. It seems like so many people spend so much money and so much time trying to to to chase 00:22:45
the leftover that sometimes it's. 00:22:50
With what you get back, it's easier just to move on. So up until we're would have been the first quarter of last year we were. 00:22:56
Collecting money from people so we would put them into trucks in order to ****** the tax return to try to collect or even out that 00:23:05
lost income or the bad debt. 00:23:11
In 2020 they were still using an actual collections company and. 00:23:17
I'm glad we don't have to deal with that anymore because Trex was a pain because every single. 00:23:23
Person had to be added into that in the spreadsheet every month and now we just don't have to worry about it, which is great. I 00:23:29
did click ahead so you could see revenue and you'll see, yes, our run volume was increasing and it still has increased. But even 00:23:36
when we stopped balance billing in February of 2023, we saw a increase of about 280 ish $1000 in billable revenue or I should say 00:23:44
collected revenue alone. 00:23:51
The projections for this year slightly drop off a little bit, but that's also just based off data at the end of July. So we'll 00:23:59
see. Typically December brings in quite a bit of revenue, just bills that haven't been paid yet by insurance companies. So January 00:24:06
1st of this year under Indiana code, we implemented a EMS lit tax that actually started its collection process with our tax 00:24:13
revenue. 00:24:20
Projected for the year 1.87 million. 00:24:27
And the cost to the taxpayers? About $37 per person. 00:24:30
So some people think of it as they're paying for a subscription or they're paying for a service that they may not use. 00:24:34
We're not talking hundreds to thousands of dollars. 00:24:41
Yes, 37 dollars is $37.00 but at least I know that if somebody calls 911 and needs their kid transport to the hospital. 00:24:44
They basically already prepaid for it. 00:24:54
And they don't ever have to worry about not calling simply because they don't think they can afford it. 00:24:57
So, our billable encounters. 00:25:03
My type in years. So this is where you have to start thinking about the call volumes and the level of service that's being 00:25:05
provided to patients with BLS calls being some of actually they are our lowest billable with the exception of non transports and 00:25:12
then our ALS ones and ALS twos using Medicare's billing criteria. Our service, our call volume is quite a less heavy and that this 00:25:20
chart shows you that and the trend continues that we do transport more patients a less than BLS that. 00:25:27
Bring in more revenue, but that also uses more money in supplies. 00:25:35
So having to balance that because you cannot build for consumables or items that are used one by one to patients in the statement. 00:25:40
DMF for EMS transport. So it doesn't matter if I use a $150.00 IO needle or I just start an IV and give you some pain meds. 00:25:49
The billable amount is going to be about the same that you can do. 00:26:00
All right. Expenses. 00:26:06
This is something that I will be very blunt. 00:26:09
When our county went forward with. 00:26:14
Taking on this entire project, they did not do enough homework. 00:26:18
The prior director sold the idea of municipal EMS to them at a budget that was like 1.2 or $1.3 million a year. 00:26:23
That I don't know where those numbers came from. 00:26:31
I appreciate that they got the agency created before my time, but it was not truthful. So truly making sure that you do the work 00:26:35
on the front end to find out what it's going to cost will make your life much easier. Because in 2020, which isn't even included 00:26:41
up here for a reason, because there's not enough data that's readily available even to our county auditor who would have paid all 00:26:48
the bills. 00:26:54
As to what expenses were our departments because we were pulling money from so many different funds. 00:27:02
That I don't know. 00:27:07
I truly can't tell you. 00:27:11
Which is crazy and it. 00:27:12
I don't know, but our expenses do go up each year. Some things are controllable, some things aren't. And a lot of those expenses 00:27:16
increased or have increased or payroll costs because as people get raises that cost more. We have also seen market increases in 00:27:23
supplies. So when medications go on shortage or we have a resin shortage due to a storm in the Caribbean, that skyrockets prices 00:27:29
for IV fluids and flushes that we do still have to have. 00:27:36
And then in 2023-2024, we also saw an increase just with. 00:27:44
Should say 2022-2023 an increase due to construction costs because there were larger projects happening. So you include your 00:27:49
capital expenditures in this. We do. 00:27:53
How's it going now? So starting, we just submitted our 2025 budgets and we have our hearings for that next week and even our 2025 00:27:59
numbers include some capital replacements, so like vehicles and stuff. But we will ideally now that we'll have this lit coming or? 00:28:07
The LIT established for Year 2 next year, our goal is to just have a capital cumulative fund and start moving that separately. 00:28:15
That way we're not just blending all of it together so it's a little bit clearer. 00:28:21
Our revenue and expenses. 00:28:30
We see that the start of 2024, I should say 2024 in general, is the only year. 00:28:33
That our agency is. 00:28:39
In the green we between billable revenue and taxable revenue. 00:28:41
Our income is actually going to supersede the expenses projected for this year. 00:28:48
Which is not the case for 2020-2021, 2022 or 2023 where I mean. 00:28:53
We were getting. 00:29:00
Close to $1,000,000 of support each year from the county general fund, which had it doesn't even consider the need for capital 00:29:01
replacement. So looking at it, we are able to basically plan out to 10 years from now and say that as long as we are able to 00:29:08
continue these trends. 00:29:14
We'll be able to do our capital replacement projects. We'll be able to continue moving forward and considering inflation and all 00:29:22
of those things without needing to tap into any other funding sources. 00:29:27
So this is the big 1/20/24 this. 00:29:34
Chart is a little skewed because of the way that the Y axis for the monetary amount actually scaled itself. But we definitely see 00:29:39
a more positive balance this year. Looking at 2025. Some of those budget items might get slashed, which would then drop the 00:29:47
expenditure site. And we also don't truly know what the raises, if any, that will be granted by the county will be. So this is. 00:29:55
A over projection of expenses rather than. 00:30:04
Our largest budgeted items payroll, maintenance and support and operating supply. 00:30:10
It's really that I don't know what your county does for perf matching or perf contribution or your fringe benefits cost, but that 00:30:17
does cost us quite a bit of money. That and liability insurance. 00:30:23
Maintenance and support services, that's going to include all of our vehicle maintenance, building maintenance. 00:30:30
And that is one of the biggest headaches is making sure that all of those things continue to work. Do you guys have your own like 00:30:34
vehicle maintenance department, like your highway department do any vehicle maintenance? Yeah, they have their own and so does the 00:30:42
Sheriff's Department. But I'm jealous. I don't know if some of the other departments, if they use a lot of a lot of the sheriff's 00:30:49
does maintenance on other vehicles as well. County, that would save a lot of money. 00:30:56
And then also having a building maintenance person that can do your routine HVAC, electrical work would save a lot of money. We're 00:31:04
hoping to see that with next year if the county will go that route where we just have one person that overseas all of these areas 00:31:10
and does that maintenance for a building rather than us having to call in contractors all the time because it never fails. The air 00:31:15
conditioning stops working on a Sunday. 00:31:20
So in the middle of the summer, so then we have to pay for an emergency call. 00:31:26
One quick question real quick, SO. 00:31:30
You all have have stations, yes, that are yours that you have. They're your own buildings. Is there a reason you didn't use any of 00:31:33
the fire departments that were there? Is it because they were volunteering, They're not staffed or they're not really set up for 00:31:39
that or? So the assets were already there. So those were transferred from Operation Life. They had already built them. As we look 00:31:45
to expand, so looking multiple years out, we already know that just geographically and where people are living, we're going to 00:31:51
need to add another ambulance. 00:31:57
And where we'll put that will be the interesting part, but it will most likely be at one of our Volunteer Fire departments if they 00:32:04
are willing to accommodate that because that does at least decrease the assets and for that portion of the community, they then 00:32:10
have an ambulance much closer to any emergency. 00:32:15
Yes, of all your expenses, I know you acquired the buildings. How much of that was the housing? 00:32:22
Versus the operation of the buildings, you know how much are you other. 00:32:29
$3,000,000 expenses whoever was there. How much of that is your? 00:32:33
Office Your crew houses your maintenance of your buildings. 00:32:37
Versus ambulances. 00:32:42
Without having a report like directly in front of me, I would roughly ball parking, but I would say probably about 40% of our 00:32:45
operating expenses are in buildings. 00:32:50
And then the rest of it, almost all of it would be. 00:32:56
And if I were you, do not go with a diesel. 00:33:01
Unless you guys have a bunch of diesel mechanics because that's what we've ran into is we don't have. 00:33:05
Mechanics in our county that are. 00:33:10
Equipped to be able to lift the weight of our ambulances despite how rural we are. So if we have heavy diesel work that needs to 00:33:12
be done, we do have to go out of county with it and that is not cheap and very time consuming. 00:33:17
So unlike it has saved us a lot of money and fuel, we don't get deaf. So it's. 00:33:23
I would recommend that. 00:33:29
Yeah, I think Allstate Board is the only place around here that has a lift capable of lifting an AV. 00:33:31
Smyrna Stadium. 00:33:37
Bus. Bus transportation maybe? Yeah, I guess so. 00:33:39
All right. So really with your older vehicles, you're not doing much? 00:33:43
Service work with them then. 00:33:47
Knock on wood, Knock on wood. 00:33:50
Things do break on them, so when we do have to get them work done. 00:33:56
These we need the vehicles facility operational, it is a lot less. 00:34:00
Now, in 2020-2021, I mean we were. 00:34:04
Constantly putting our ambulances into the garage. I mean, they could be. 00:34:08
I mean we had one out of service for like 6 1/2 months. 00:34:13
The garage because it needed its entire engine replaced. 00:34:16
When there's a call that comes in. 00:34:22
Is the fire department responding as well? Because likely they're going to get there first if there's ten of them and three of you 00:34:25
guys, I would guess just geographically depends upon the call type. So we use tiered dispatching. So when our 901's in there 00:34:31
answers the phone based on their emergency medical dispatching algorithm, it's going to have them ask a bunch of questions and 00:34:37
it's going to determine the call type if that. 00:34:43
Determines it to be a non life threatening emergency. 00:34:50
Fire's not going to be dispatched on it. There are a couple departments that you request to be put on every run. So that is their 00:34:54
department's choice. So they're more than welcome to do that. We don't send fire to nursing homes. That was their request. Unless 00:35:00
it's a cardiac arrest or something that we know is going to require additional hands, they don't get sent on that. Anything life 00:35:06
threatening, yes. 00:35:11
Based on that algorithm, fire would be dispatched and then we will also start fire. 00:35:18
For distance, so let's say Cloverdale, which is about 30 minutes, 20 to 25 to 30 minutes South of Bainbridge, which is our 00:35:22
northernmost truck if. 00:35:27
Both of our southern trucks are out and that Bainbridge truck is getting sent and they have not been centralized for coverage yet. 00:35:33
The fire department's going on. 00:35:39
If that answers your question. So you guys don't utilize the fire department for everything then? 00:35:42
Just. 00:35:49
You know we do. 00:35:51
If they wish to go on every call. 00:35:53
If their department one side, we welcome that, but we don't. 00:35:56
Have them dispatched. 00:36:01
Because we also have to recognize that. 00:36:03
We need those resources available for other things and then the volunteer aspect of it as well. I mean, they could be very 00:36:06
welcoming from work. Or we have one Fire Chief who I swear he makes it to almost every run somehow with works night shift I don't 00:36:11
think. 00:36:16
He ever sleeps. 00:36:22
But he does not need to be woken up in the middle of the day for what will eventually just be a BLS transport. And if we do end up 00:36:24
needing them, we can always request them to be dispatched. 00:36:29
And saves taxpayer money. 00:36:35
So looking towards the future. 00:36:41
Currently in the process and waiting to see if we are or awarded any federal grant money to start mobile integrated health 00:36:43
program. So community paramedicine and our three target areas will be adult and substance abuse or substance use disorder are post 00:36:51
Natal care because we have no OB capabilities within our county. So we don't have any prenatal or post Natal care and then aging 00:36:58
in place. We have quite a population that is getting older and a lot of people don't want to or cannot. 00:37:05
Afford to go into assisted living or skilled nursing. So if they are able to stay in in their home, we would like to have a 00:37:13
program that can help facilitate that and that is a billable service to Medicare. Medicaid will reimburse for MIHRI removal 00:37:21
integrated health, but we have to recognize that that's also going to increase the number of employees that we have and then 00:37:28
operating expenses as well because the vehicle is in everything that goes into just expanding. Are there any other counties? 00:37:35
That are moving in with this mobile integrated health as well, because that seems to be the answer for a lot of people. I mean 00:37:43
that it's kind of one of those programs that seems to take care of some of the trouble calls before they become overly 00:37:49
problematic. And you're right, I mean, I think everybody seeing an increase in lift assists calls and falls, you know, not 00:37:55
necessarily injured, but they fallen and they can't get back up on themselves. They don't have anybody. 00:38:01
Seems like mostly Great health is helping a lot with that. Even a lot of law enforcement, whether they're doing a lot of these 00:38:07
psyche vows and stuff like that, they're using the mental, the mobile integrated health programs to kind of do those. So 00:38:14
Crawfordsville Fire, which is in Montgomery County just north of us, they cover the EMS for the entire county. Even in their city 00:38:21
fire department, they have a mobile integrated health program that would be considered a model for the entire state of Indiana. 00:38:28
They definitely do it and use it. I know Bloomington also has had great success with it as well. 00:38:36
Our goal is to basically make it or try to decrease people's needs portfolio. So my background is in public health and trying to 00:38:43
focus on the prevention side of things. So if we can prevent you needing any ambulance, not only are we going to see an improved 00:38:49
quality of life for the resident, we also have. 00:38:55
Increased expenditure on the financial side of things, so really trying to balance the use of resources more into the prevention 00:39:01
side and not on the reactive side and using fault as an example, a lift assist only in our county to go back to that. Ambulances 00:39:07
don't consent on this. So that's a fire department call. Now. Multiple fire departments aren't available then yes, we will certain 00:39:13
ambulance to it, but we have way less ambulances than we have fire departments. And if somebody's fallen and not injured, it makes 00:39:19
more sense to keep. 00:39:25
That medic unit service rather than take them out for 20-30 minutes. 00:39:31
And somebody else could have a lifeguard, an emergency at the same time down the street. 00:39:37
So we also want to move our supervisors off the ambulance. So it's going to require us to hire an additional 4 paramedics full 00:39:43
time. And the idea being that that then increases our ALS chase capabilities. So we would then have a chase medic 24 hours a day 00:39:51
that can then supplement on this high acuity calls. They can take on more of a management and supervisory role. 00:39:58
And hopefully take on. 00:40:07
A lot of the day-to-day that is currently being done and has been for the last several years. Maybe because only one person I can 00:40:09
only do it all for so long, but having them on an ambulance where they are taking calls does make it very difficult. 00:40:17
For them to actually be able to do things beyond gestation here. 00:40:26
We'd also like to see our administrative assistant get moved to full time and then vehicles previously were being replaced on a 00:40:30
need and condition rather than offensive replacement plan. So we're hoping to move towards that as our capital fund gets 00:40:37
established. And then within 10 years, we do want to have that 4th truck putting our northern truck currently moving it closer to 00:40:44
the center of the county, but still north and then getting one put in on the northwestern corner. 00:40:52
Northeastern corner of our county, closer to Hendricks County because we know Danville is expanding a lot and we do provide mutual 00:40:59
aid. We have a standing policy that if another county calls for a resource, we send. It doesn't matter his last one. 00:41:06
Because we can't predict a 911 call, we can't predict an emergency. But if somebody needs it right now? 00:41:14
And we have it. We'll send it. We'll deal with that next call when it comes in. 00:41:19
Hard lessons that we have learned. 00:41:27
Make sure your assets are good and start with that. Make sure you have a solid understanding of what you're getting into it 00:41:32
looking at the study that. 00:41:35
Commissioner Sharp sent me yesterday from Baker Tilly. It looks like you guys have already done a lot of homework and looking at 00:41:40
all of the numbers and looks like you're already seeking a sentence from your DLGF because that's the step, the most important 00:41:45
step to go the lit route. And then don't let the place take from a pirate ship. So hire the right people on the front end in order 00:41:51
to run it. 00:41:57
And it'll make your life a lot easier and it. 00:42:05
Dedicated my entire life it seems, for the last 4 1/2 years to make our agency try to be the best that it can be for the community 00:42:08
and. 00:42:12
And we are fully staffed. 00:42:18
Retention rate is very high and when we do have people separate, they usually separate to go into the fire service full time when 00:42:20
law enforcement full time where they've gone back to school. 00:42:25
So we don't see the turnover even though for several years we repel pain well under the market. 00:42:30
So the schedule itself is a massive recruiting. 00:42:37
Tactic and retention tactic as well. 00:42:40
Can I ask a question about that? 00:42:46
Do you know what the career fire department schedule? 00:42:48
Is in Greencastle. A greenhouse is 2448 Hollywood County. 00:42:52
OK, how does that mesh then that you're not In Sync? 00:42:56
Isn't an issue at all or it is not an issue? 00:43:02
And it hasn't been. We previously were rotating crews from station to station. When I first started in my position, they were 00:43:06
rotating every shift. And then with COVID, we were able to knock that down to rotate every month. And eventually the crews were 00:43:12
surveyed, they showed they voted to have permanent stations. So that is what then ended up happening. So now we do at least have 00:43:18
the same crew members working at the same station, covering the same area, working with the same fire departments on a regular 00:43:24
basis. We we don't see an issue with it. 00:43:30
Now on the training side, because I do the training for both our department and Greencastle fires, having to keep the two 00:43:36
rotations is a little bit more complicated, but it does not operationally affect anything. 00:43:42
You do off shift training or is it only when they're on their shift? Our employees if it is required training, we do it on shift 00:43:48
unless it's something that truly can't be. We do try to minimize excessive overtime. 00:43:55
But if it is not required required, we will offer it to them at no cost. They do have to come off shift to do it, but we will not 00:44:02
pay them for that. Let's just continue education for interest. So are you a training institution? 00:44:08
We will be OK. 00:44:15
We are an AHA training site and we do offer EMR classes. Currently we have 4 primary instructors on our roster so. 00:44:16
I'll eventually get the training institution application and my goal is to go up to the a ENT or the advanced EMT level. I will 00:44:29
not take on a parameter program. 00:44:33
Circling back to billing, how much do you write off a year? 00:44:40
So this year alone. 00:45:03
Months to the individual or start of the year to the end of July $81,435 were considered bad debt we had. 00:45:07
2.056 million that had to be considered adjustments just based off of insurance contracts. So effectively we're writing off two 00:45:16
point. 00:45:20
1,000,000 thus far. 00:45:27
If you consider adjustments as write offs. 00:45:30
The write off figure that you mentioned is that somebody from outside the county that you build that did not pay. 00:45:33
The bad debt portion would be. 00:45:40
The outside of the counties, because those are going to be and those have not technically been written off, they're still just 00:45:44
pending, but they're currently negative balanced I. 00:45:48
They may end up being written off because the collection site of it's honestly. 00:45:53
It's not worth it. 00:45:58
Then the adjustment side, looking at the large figure of a couple, $1,000,000, that's gonna just be your insurance write offs that 00:46:01
we have to discount down and that's just where insurance you bill them for 2000, they say we'll pay you 1200. 00:46:07
Or whatever it may be, Right, right, right. So the difference is that in what you're quoting there? 00:46:15
Yes, I was pretty far off on that, Yeah. 00:46:24
Yeah, we'll build about 3500 and get a $300.00 reimbursement, I think the national average at this point. 00:46:27
Is $450. 00:46:35
Return for your billing from insurance so and there's always. 00:46:37
Leftover, whether it be. 00:46:43
1000 up to 1002 thousand dollars. 00:46:45
That is the money that you are writing off because you put the revenue stream in place and that is what take care takes care of 00:46:48
it. It was the argument that we made when we were attempting to get the lead pass was the the taxpayers are paying for it and they 00:46:54
should not be billed for it. 00:47:00
I've said this on several occasions where I can't tell you how many times people have struggled to pick up the phone and call 911 00:47:07
just simply because they were unsure whether or not calling for an ambulance. But they've been such a financial hardship that it 00:47:13
could send them into bankruptcy. So they. 00:47:19
Essentially waited and waited until a time came. Well, you just couldn't wait anymore and it resulted in a negative outcome. 00:47:26
Have you guys seen a change in? 00:47:34
That. 00:47:36
Where people have less of that hesitation. 00:47:39
So whether or not they have hesitation to call on the front end, it's hard to assess. So I don't have a definitive answer on that. 00:47:42
But I can tell you that when I've been on scene, especially shortly after we rolled out this whole, we're not going to send you a 00:47:47
bill at the end of the day. 00:47:53
We would have people that would call us and they didn't want to go and obviously we don't want you to sign our reviews or. 00:48:00
They shouldn't want people to be signing refusals from a clinical and operational standpoint, but. 00:48:08
We can now tell them you won't get a bill, and I absolutely have that change people's mind. 00:48:16
That we will not bill you for this. And instead of them going to the wrong hospital by car when they're having chest pain and they 00:48:21
go to Puffin County Hospital, who they're going to follow in Tala, they'll do their jobs, they'll stabilize them. But if they need 00:48:27
transferred, let's say they are having a massive heart attack, they're going to be sitting there until somebody is able to 00:48:33
transfer them, whether it be by ground or air or really dangerously private vehicle. 00:48:38
Which is a whole different thing because now you're talking about bringing a service that does not offer. 00:48:45
What you're providing, correct, So now we have the ability of getting people to the right place. 00:48:50
Based off of our knowledge, training and experience, the first time, the first time I'm going to ask a question. I'm not near as 00:48:56
intelligent as these guys because I'm not in this field. 00:49:01
The HSA health insurance. 00:49:07
Program is by far growing at a pace larger than the PPO. 00:49:10
The first X amount is your responsibility. 00:49:16
So if you're not going to say, you're not going to send me a bill. 00:49:19
I'm responsible for the first X amount anyway, even if you build my insurance company. 00:49:24
Explain. 00:49:29
You're something for your pay. 00:49:31
You're gonna build my insurance company, and my insurance company's gonna tell me you owe this. So you would get an EOB that would 00:49:33
tell you that you will owe that amount, and you will still not owe the county any money. You just don't pay the bill. 00:49:39
OK. Just curious. Yeah, that's what it is. And. 00:49:47
They're indirectly already paying for it, right? 00:49:54
So there's no sending to collections out of county accounts Somebody wrecks on I-70. 00:49:57
No, I mean we could put them into trucks, but especially out of state. 00:50:05
People, they're not going to file an Indian or tax return, so we'll never see that money back. So that's just more clerical work 00:50:09
and paying people to manage that with very little chance of a return. I have one other question. The volunteer ambulance that 00:50:16
still is in existence, how many runs do they make a year? 00:50:22
I want to say a couple 100. 00:50:29
I don't know off the top of my head. I will say that when they are dispatched, they have a great response. I mean they do have 00:50:32
volunteers that show up and take the call and I mean they have. 00:50:37
Been my saving grace a few times, quite actually quite a few times that they're, they're the closest ambulance and I'm sitting in 00:50:43
the middle of an intersection in the rain waiting for somebody to be able to take us to the hospital so. 00:50:49
We don't have a mutual aid contract with them per se when it comes down to the billing site. So a lot of places would say, oh, 00:50:57
it's a flat rate that we're paying you. So to say it's like 350, We would bill, collect whatever we got and then just pay them 00:51:05
$350.00 for the transport. We just skipped them the funding that we get paid so because it's not our vehicle. 00:51:12
And it's typically me that's going to be on board for ALS. It's not truly costing our agency any more money. 00:51:21
While we're on that subject, what is your average response time? 00:51:28
9 minutes and like 48 seconds last month. 00:51:32
Wow. And you got, I'm sorry, what's the square mileage? 83 square miles, you said right underneath 5 minutes. 00:51:36
If I. 00:51:46
Question, you mentioned DePaul University, yes? 00:51:47
How are you the primary response for the students in the university or do they have their own medical system? We are their only 00:51:50
responsibility. I know that they have student health, but when it comes to emergencies, we are there only response that they would 00:51:57
get. And how do you treat the students if they're like out of state? Do you treat them like they're county residents? 00:52:03
Because they are not tax paying in the county. 00:52:10
So we also have a Correctional Facility in our county as well. So remember or any offender that is. 00:52:12
Incarcerated the Putt and Bill Correctional Facility. 00:52:21
They are actually going to be billed. 00:52:24
The total amount and then Wexford or whoever IDFC is contracted with will then make that payment. 00:52:27
On their behalf. 00:52:33
One more question. 00:52:35
This hasn't been a big issue, but I've heard some people mention that the LIT funding is a very good way to get this going. 00:52:38
But no matter what kind of tax revenue you're going to do, you're going to segregate your society a little bit whether you do 00:52:44
property tax people that don't own property. So if you have retired people that aren't earning income, that aren't paying into the 00:52:49
lid. 00:52:54
Might be your. 00:52:59
Larger population of users of your services? Have you gotten any feedback or pushback in the county in that regard? 00:53:01
I mean, there were definitely people that had negative thoughts on it, especially in the comments on the local newspaper online. 00:53:08
But the biggest fear seems to always be that people will then just call all the time, they'll misuse it. And we don't really see 00:53:17
that we, I mean, yes, we have patients that use the 911 system frequently, but they are also in the same proportion as to 00:53:23
beforehand. 00:53:28
I do know that. 00:53:36
Slit can only be in effect as of right now for 25 years. So eventually the only option most likely moving forward is once you hit 00:53:38
that mark, it's going to have to be some other form of tax income, which would then be proper taxes most likely. We did have a 00:53:44
massive push back against that. So that did not that was not approved. 00:53:51
You know what I started when I started researching this topic? 00:54:01
And I reached out to Putnam because they were one of the first, I guess, that really kind of implemented this. 00:54:06
EMS Slit. 00:54:12
Had some information available and. 00:54:13
And you know, the more I kind of studied it more kind of fit what we. 00:54:15
Looking at for us, you know where you have. 00:54:20
37,000 people totaling your. 00:54:23
County we, we have more than that, but we're kind of divided by the city of New Albany and Floyd County where that kind of matched 00:54:25
up. Another thing that matched up with our uninsured rate as well as our call volume so putting. 00:54:32
Putnam County side to side with where Floyd County was matched up pretty closely overall. 00:54:40
Outside of the obvious geographical science, so. 00:54:46
Yeah, it was. 00:54:51
Very impressed. So I have worked. I guess a little bit about my background. 00:54:54
I started a 911 working for a private service that's contracted to do 911 in Martinsville. After that I then went to Indianapolis 00:54:58
EMS which is technically a hospital based. 00:55:04
EMS agency if you really get down to it, this thing contracted by the city of Indianapolis, the one in Martinsville closest 00:55:11
source. I mean carry ambulance shut down. I had already left by that point, but they just all of a sudden stopped providing 00:55:16
service at the top end in multiple counties across the state of Indiana where. 00:55:22
Non county. 00:55:28
Ran or non municipal ran entity just one day stops. 00:55:30
Giving you an ambulance. 00:55:36
I think that's one of the things that we've discussed that, you know, throughout this whole process is, is that we've realized 00:55:37
just how vulnerable we are at the whim of of. 00:55:42
You know some of these companies and I think we have great companies in the area that are wanting to be great community partners. 00:55:47
But at the end of the day, I mean, you know. 00:55:54
They need to make money. 00:55:57
To exist and if they feel like an area is no longer. 00:55:59
Profitable for them than. 00:56:02
They're going to move their operations and. 00:56:04
All too often we see communities and chaos when that happens. 00:56:07
And I think. 00:56:10
Several of the incidents that's happened in this area over the last. 00:56:13
Several years, especially in the last couple years, I think everybody's ready for some stability. 00:56:17
Don't get me wrong, this is a very expensive venture that is very time consuming in labor. 00:56:23
Filled way to go. 00:56:29
But once it's established, I, I, I personally believe that 1/3. 00:56:32
Party or not third party, but a third service. 00:56:40
Municipal EMS agency that covers the entire county is the best EMS model that we can provide to any county in the state of India, 00:56:43
if not across the nation because it brings them, it brings that public safety department into the same realm as fire, law 00:56:50
enforcement and dispatch so that the county or the municipality that has direct oversight. 00:56:56
And is directly responsible for everything that's being done and delivered to the community. 00:57:03
If I could, I just realized I had another question. Sorry. It's about staffing. You made a very affirmative statement that you 00:57:09
don't have a problem with retention and recruitment. 00:57:13
That's unusual. 00:57:18
How much of your staffing are people that live in your community? That's why it works really well, or you have people traveling to 00:57:21
work. I'm just wondering what's that special recipe that you guys have figured out because everybody else is having trouble with 00:57:25
that. 00:57:29
So I have employees that drive from out of state. 00:57:34
We have employees from Illinois. I have some that are local to the community. It's where they've lived their whole lives. So 00:57:36
there's giving back. I have people that live in Indianapolis, Hendricks County's. 00:57:41
That recipe that you? 00:57:48
Asked about. 00:57:51
That's good management. 00:57:54
I mean it really is a simple being supportive. 00:57:56
And non punitive except for when it's needed in actually being there for your employees goes a long way. I mean at one point in 00:58:00
time we paid terribly. I mean in 2020 our EMT's were. 00:58:05
Paid, in my opinion, a horrible wage. I had no control over it. 00:58:11
But making less than $15.00 an hour and we're expecting you to go out making life saving decisions. I started as an EMT at $9 an 00:58:17
hour. It was terrible to try to pay bills but. 00:58:23
We treated them well. 00:58:30
It really is that. 00:58:33
What percentage of your employees work somewhere else? 00:58:35
Person, we're full. 00:58:39
Part time. 00:58:40
Part time, somewhere else, full time for Putin. 00:58:44
At the most forever 24 operational employees to one sixth of them. 00:58:52
You think retention is a lot because of the schedule? 00:58:59
I think the schedule is one of the biggest factors into it. 00:59:02
And. 00:59:06
It was in place before I was there, so I can take no credit for that. I. 00:59:08
But I can also tell you that that. 00:59:13
Schedule is in place. 00:59:16
For several years before I was there and they did have a massive turnover rate before Putnam County actually took one. The 00:59:18
organization, they were constantly putting a truck in service and changing how they were staffing and trying to make it work with 00:59:25
the budget that they had and the management. It just kind of just a little more chaotic before now. 00:59:31
So. 00:59:42
Do you, I guess you guys have it a bargaining unit for when it comes to raises and stuff like that, Is that correct? 00:59:46
Your benefits? 00:59:53
Technically, no. The County Council just decides. The commissioners decide. 00:59:55
The benefits package that the County Council then decides what raise they're willing to approve budget wise and we just kind of 01:00:02
get told that so we don't really have bargaining. So yes I we want you to get paid more. The county did a salary study last year 01:00:07
I. 01:00:13
And that's how our EMT's and paramedics and supervisors were able to get a 21% raise just because they were paid so far under the 01:00:19
market previously and now they're actually paid probably in the upper order order. 01:00:25
What what is what is the market for paramedics up in your area? Right about 24 ish an hour base we pay I think it's like 2535 an 01:00:32
hour for them to. 01:00:38
And who do you guys report? Who's your chief report to the commissioners directly? 01:00:48
It is an appointed position. 01:00:54
Anyone else have any more questions for? 01:01:02
Deputy Chief Taylor. 01:01:04
Yeah, go ahead. 01:01:08
Hey, yeah, yeah. 01:01:10
Medville Inc, it's a billing company out of Indianapolis. They do all of our billing and all of our compliance and medical records 01:01:15
requests. That way we don't have to deal with the Medicare and Medicaid. 01:01:21
Compliance site. 01:01:27
So when you look at your projections. 01:01:32
2024 they have. 01:01:34
So currently the way that it is. 01:01:44
Place right now, so we have two different funds. We have our revenue based from billable revenue and then we have our lit and that 01:01:47
just becomes part of the operating balance. But the goal is that next year since it will be year two, we will actually start 01:01:53
shifting transferring funds from those two funds that are excess and putting them into. 01:01:59
Cumulative funds, that way it's just completely separate. But any money that our department collects, whether it be taxed or 01:02:07
billable, that can only be used by EMS, so that cannot be reappropriated to another corner. 01:02:12
Correct, it does not go into the general fund. 01:02:25
19. 01:02:31
13 lbs off the top of my head. 01:02:32
So we have 10. 01:02:44
10 fire departments, only one career the rest are all non paid so we have 9 Volunteer Fire departments. 01:02:46
Cloverdale is technically. 01:02:55
Or they would be a district technically. Even on the Township, real school is also technically a district. 01:02:58
7.7 in Bainbridge because those would still be fire production districts within. 01:03:06
The two townships would be part of the fire production, so yeah. 01:03:12
We have the Albany Township, Franklin, Georgetown, Lafayette, Greenville, so there's five townships. 01:03:20
Fire based EMS the transporting site. 01:03:36
Like if they have ambulances. 01:03:40
So I have worked as a fire medic. 01:03:42
I've worked in many settings that involve Firebase DMS. I think it has a place. I think it can be done well as long as its 01:03:46
priority is put. 01:03:50
And the emphasis is put on patient care. We're on staffing ambulances with somebody because they're being forced to be on it. 01:03:54
That's what often times happens. Patient care does unfortunately suffer. And then what we also what I've. 01:04:01
Experience and observed is that billable revenue that. 01:04:08
Does happen from those transports never gets put back into the EMS site. It gets used on the fire suppression side and EMS is kind 01:04:12
of just there as a money making scheme. 01:04:16
It will get the jump. 01:04:23
So. 01:04:29
So single role departments. 01:04:32
First, single role EMS providers. It can be done as long as the culture is right. 01:04:35
Deputy Chief, thank you so much for being here with us today. I appreciate it. 01:04:47
I know you took what to take about two hours to get here to turn out. It was a great drive though. Well, we greatly appreciate it. 01:04:52
We're we were excited to hear. 01:04:56
She had this present today. If you guys have any questions that do come up, I was going to say you could maybe hang out for a few 01:05:01
minutes after the end of the meeting just in case anybody might have some more questions for you. I'm sure some people might 01:05:05
appreciate that. Thank you. Thank you. 01:05:09
Does any of the board have any comments? 01:05:16
Does any of the public have any comments? 01:05:23
That being said, I'll take a motion to adjourn. Motion to adjourn. Thank you. 01:05:29
Everybody have a great day. 01:05:34
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August 15th and this is our meeting of the. 00:00:00
Boyd County EMS Task Force if we could all stand for Glitch. 00:00:03
I pledge allegiance to the flag of the United States of America. 00:00:09
And to the Republic for which it stands, one nation under God, indivisible, with liberty and justice for all. 00:00:14
All right. Thank you everyone for being here. I'm pretty excited about today. The last task force meeting that we had, we had 00:00:24
discussed reaching out to our friends up in Putnam County and asking them to come down and see if they would be willing to give us 00:00:32
just a presentation on how they operate their model up there. And graciously, Deputy Chief Taylor is here with us today and. 00:00:40
Today is going to be all about listening to their model, asking them some questions and and seeing how they run things up there. 00:00:48
And so I'm looking forward to hearing anything, everything so. 00:00:53
If nobody has any objection, I'd like to go ahead and see if we can get this potato started. 00:00:59
All right, Miss Taylor, thank you. 00:01:04
Good afternoon. 00:01:08
Like Commissioner Sharp said, my name is Anthony Taylor, the technically the chief of operations now. We had a title redo here 00:01:09
recently in months, but my job is the same. 00:01:14
I am going to talk about how our service works. If you're not familiar with Putnam County is it's. 00:01:21
North. It's actually the southwestern part, halfway between Indianapolis and Terre Haute. We service quite a large area. It was 00:01:26
Googling last night. Looks at Urias County is about 180 or 190 square miles were almost 500. 00:01:35
Bigger population is much more dense here. So our agency is what we would call a municipal third party or third service EMS 00:01:45
system. We are county base, county operated and we only engage in 911 transports, so 911 responses. We do not do any inner 00:01:50
facility. 00:01:56
Of snow hospital hospital we only service our. 00:02:03
County as a whole, unless we're requested for mutual aid. 00:02:08
So easiest way to explain how our agency became a thing because it was basically born in 2020. 00:02:11
Was prior to that it was a not-for-profit called Putnam County Operation Life which started in 1974 and that went all the way 00:02:18
through until December 31st of 2019. 00:02:24
The model sounds very similar to what was just described to me. So basically a private service that was being supported by Putnam 00:02:30
County for quite some time. Despite multiple bankruptcies. Their last two year contract they were getting $400,000 a year support. 00:02:38
And then we basically became an agency. 00:02:47
I did not start, neither did our current chief, Chief Kelly Russ until March 23rd of 2020. 00:02:53
The original administration to the chief and at the time the assistant chief had vacated their positions by February 14th. So 00:02:59
there was about a five or six week period of time where the agency was without any leadership. 00:03:05
Which was an adventure because 20/20 was a pretty. 00:03:13
Remember memorable year with code. 00:03:16
So we walked into what I would call pirate ship. 00:03:20
Of a lot of change and. 00:03:25
A budget that once I figured it out in April, that did not cover payroll. 00:03:27
So the original. 00:03:33
Budget that was approved would not have covered our full time employees. 00:03:35
We've since moved to a model where. 00:03:40
We now have a local income tax. It is maxed at the 0.2%. 00:03:43
And that plus our revenue where we only obtain revenue from our insurance companies. We are now able to project self-sustaining 00:03:48
with a capital replacement plan with no support that was approved in 2023 with our lit starting to be collected January 1st of 00:03:56
this year. So we'll walk through some information and I have a knack for when I use PowerPoint. 00:04:05
Speaking ahead of the slide, so I do apologize, but one of the biggest accomplishments of. 00:04:15
My almost 10 year career has been able or being able to make an agency that no longer puts financial burden on the residents or 00:04:20
the taxpayers. So if you call 911 in our county and you live in our county, we will bill your insurance company and then you will 00:04:26
no longer ever receive a bill after that. 00:04:33
So we just call that no balance billing. If you don't have insurance, then we just write it off. We don't consider. 00:04:40
Having to think about money, we see improved patient care out of that. We don't have people who are concerned about the financial 00:04:51
implications of using emergency services because who here, if you needed to call the police, would expect to get a bill from law 00:04:55
enforcement. 00:05:00
Nobody EMS should be the same way. We are a public. 00:05:06
Service. We are here for the public and we're typically called on people's worst days for the lights. 00:05:10
So our coverage area is 483 square miles. We have 13 townships, 10 fire departments, only one of which is career being in 00:05:17
Greencastle. Our population is around 37,000 ish and then during the school year we add about 2100 students at DuPont, so bringing 00:05:25
us to about 29295 to bring about the year. I-70 we have a massive stretch of it and it is one of the most fatal stretches of I-70. 00:05:32
So we do have to really consider southern. 00:05:39
Coverage. 00:05:47
Our staffing model IS3ALS ambulances. 00:05:49
Then I should I pursued since this NEOS task force, but everybody to wear a difference between ALS and Beatles, right. So we staff 00:05:53
our ambulances with one paramedic, one ENT. If we have people who are EMT's and then ultimately promotes being a paramedic, we 00:05:59
could end up with AA, LS, O2, paramedic staff to ambulances and then our administrative staff. So myself and Chief Ross are 00:06:05
obviously both paramedics and we were both chase. 00:06:11
Vehicle capable so we both have ALS equipment which comes in handy when we have our one BLS volunteer ambulance. It's not a PCEMS 00:06:18
ambulance, comes from a Volunteer Fire Department up north in Rochdale. 00:06:25
They provide us with mutual aid if they need ALS then we hop on their truck and. 00:06:32
It basically gives us an extra ambulance. 00:06:38
We do transport to 10 different facilities, so Putnam County Hospital, which is in Greencastle, so the Center River County is a 00:06:41
critical access hospital. 00:06:46
Our nearest Cath lab at all is Hendricks Regional and Danville. So it's going to be about a 40 minute transport time and it's only 00:06:51
Monday through Fridays, 8:00 to 5:00, no holidays, no weekends. So bankers hours. So then we have IU W, which is an Avon. We're 00:06:58
looking at about 50 minutes transport time to your nearest cat lab. So if somebody's having a heart attack. 00:07:05
They need a catalog that's our nearest one and then we will only go to Indianapolis for specialty resource centers. So whether 00:07:13
that be we need a pediatric capable hospital. So if we're going right ground, Riley Hospital for Children, our burn centers at 00:07:19
Eskenazi or any of the Level 1 trauma centers. 00:07:25
That's important because we also have to think about how the number of ambulances and where we will go by ground will actually 00:07:32
play a factor into your staffing and coverage model. So if we were to be allowing people to go to basically any hospital if they 00:07:38
want in the state of Indiana. So if we were to say they could go to the Heart Center in Carmel by ground, that's a three to four 00:07:44
hour round trip that that ambulance is going to be out of service when we are bypassing multiple hospitals that have the same 00:07:50
capabilities. 00:07:56
So looking towards how you would want to shape this, you would. 00:08:02
You would have to consider what hospitals you would be allowing people to go to. 00:08:06
So, Mr. Taylor, so can you go back on that slide? 00:08:10
So you're saying that these are not? 00:08:14
The transfers from the hospital going to another hospital, these are. 00:08:18
911 calls, correct? These are 911 calls. We do not do any inter hospital, OK, because I heard you say that earlier. I just wanted 00:08:24
to make sure. So we do strive to get patients to the right hospital. 00:08:30
The first time. So if Putnam County Hospital is a critical house access hospital is the most appropriate place and that's where 00:08:37
the patient wants to go, then absolutely. But from a clinical perspective, we don't want our providers transporting somebody with 00:08:43
chest pain to Putnam County Hospital because they don't have cardiology on site because then they end up being transferred waiting 00:08:48
for an ambulance for. 00:08:53
Hours to days when we could have just taken them to the right hospital to begin with. 00:09:00
Thank you for your clarification. So our staffing model, we have 26 full time employees, 24 of which are operational. 00:09:05
On our Greencastle truck which would be medic one, we have our Lieutenant paramedic which is our shift supervisor and we have 4 00:09:14
shifts. So our employees work a 24 hours on 72 hour off rotation into rotation. I've never gotten to work. 00:09:22
They love it, so they work 91 days a year, assuming they don't take any days off. 00:09:30
And they make. 00:09:35
Pretty decent salary in my opinion and they got a 21% raise this at the start of this year. Our medics are making about $59,000 a 00:09:37
year and our EMT's are making about 48. Our supervisors making about 61,000. 00:09:44
Working a 2472 hour rotation, then we have 14 part time employees, one of which is our administrative assistant Kenzie who's 00:09:52
amazing. She works 19 hours a week. It's a flexible schedule. And then we have 13 operational EMT's and paramedics just depending 00:09:58
upon the blend of that to help backfill into any vacancies that we may have with time off for people out for maternity leave or 00:10:03
other medical problems. 00:10:09
Or run volume. 00:10:16
Just to give you guys some sort of idea as to what we work with, this year will probably be just over 4000 runs with about 2600 of 00:10:19
those being transports. 00:10:25
Refusals. 00:10:32
If you are an EMS, refusals of transports are like awful because of the number one reason to be sued and but we do have quite a 00:10:33
few, especially with car accidents and then we utilize air transport a lot. Where is your guys''s nearest level 1 trauma center? 00:10:40
So we have University who is in Louisville and we also have Cosared Children's in Louisville. We also have three different flight 00:10:46
companies in this area. 00:10:52
Air Methods, Air Evac and Phi, is that correct? So we have three and we have a Phi base in the middle of our county, which is 00:10:59
great. And we have area back next door and then Lifeline and IU Health Lifeline and I think two of the counties nearby. So we use 00:11:05
air quite a bit just because of how long it would take for us to get to a trauma center. 00:11:12
But we also fly our medical patients as well, not just people who are traumatically injured. Chief reference to the last slide, do 00:11:20
you know how many of those transports would be as you classified long like the hour away or so 58% of our runs year to date have 00:11:28
gone to Putnam County Hospital and the remainder would then be outside of that with Hendrix Meaner second. 00:11:36
Most frequented, I think that percentage is like 20 something to maybe a low 30% transport there, so. 00:11:45
The rest of those would then be going to Avon or Indianapolis, which would be hitting that hour mark. So about 40% of your runs 00:11:53
are out of pocket for several hours. 00:11:58
Thank you. 00:12:04
And during the week, that's what actually gets me out of the office quite a bit is that if we do have 3 simultaneous transports 00:12:06
happening and another call comes out, I mean. 00:12:10
Management, administration and teaching and all these other things is my primary job, but my top priority is to serve the 00:12:15
community. So how we acquired our agency is the county basically absorbed Putnam County Operation Life and with that they absorbed 00:12:21
all of their assets, which was a blessing. 00:12:27
And a curse at the same time. So the three stations that we have were. 00:12:34
In desperate need of repair. And the fleet that we were handed over was also less than ideal. It got the. 00:12:41
Basics done, but it costs a lot in maintenance. They gave us 3/20/17 Type 1 Dodge 4500 ambulances, which we are slowly replacing. 00:12:48
We've gotten two of them out of our frontline. We do have a 2013 Type 3 ambulance that came from them and then those two vehicles 00:12:55
that are. 00:13:01
Crossed out are no longer even within our department. We've since added two Chevy Tahoes and we've purchased two Type 3 ambulances 00:13:08
with our third and 4th already on order. As you guys consider this, we started looking at projections for our capital replacement 00:13:18
plan about 2031 ambulances. So what we would have paid about $240,000 in 2021-2022, we'll be looking at about half a million. 00:13:27
In 2031, so just keeping that in mind, is the budget SO11 quick question. 00:13:37
What brand of ambulances do you go with and what how long does it take you to get those? 00:13:43
So. 00:13:50
We. 00:13:52
Our bids thus far have been won by Fire Service Inc, so the Reveal coached ambulances built down in Orlando, FL and then shipped 00:13:53
up here. 00:13:58
We've gotten them in a spouse just 12 months, but our current one we ordered shortly before the UAW strike, so it's going to look 00:14:04
at about two years. So which is why we went ahead and just put that 4th one on order with a replacement plan of replacing these 00:14:09
ambulances every three years. 00:14:14
And you are currently running 3 units, how many vehicles do you actually then own? 00:14:22
So we have 6 ambulances. 00:14:27
And what would be 3 chase vehicles? So we have a 2017 Explorer, 2 Tahoes and then our three frontline ambulances and their three 00:14:32
reserve ambulances. 00:14:36
Focusing on the ambulance, it's not the chase vehicles. What do you see long range as your need for spares? Do you need just one 00:14:42
sitting in the shop in case one breaks or do you need more than one so. 00:14:48
Ideally one for every truck, which is why we've not traded anything in and we've actually kept one as a reserve. And the reason 00:14:54
we've done that is in 20/21, it was the summer of 2021, we went through not one, but two reserves and we ended up having to borrow 00:15:01
an ambulance from the fire department outside of our county assembly to be able to continue operation. So keeping if you can have 00:15:07
one for one, it does at least give you some extra. 00:15:14
Sorry to get into the details and. 00:15:21
Thinking of our capital needs, do you then rotate those spares or do you run a primary and when it goes down then you go to the 00:15:25
backup? It would be exactly that. So we have our three frontline Greencastle truck is our busiest with Cloverdale, which is Medic 00:15:31
5 in the South being our second busiest and then Medic 3 at North. So when we replace an ambulance where we get a new one, it goes 00:15:37
into service in Greencastle and then we just rotate it through as they get replaced. 00:15:43
But we do keep the reserves as reserves because they're they've been used. 00:15:50
Quite a bit so. 00:15:56
So. 00:15:58
One of the reasons I think. 00:16:00
I think things get overlooked sometimes. Why it's important to have almost a one to one ratio is that, you know, we think about 00:16:02
covering, you know, our community and everything, but just your typical amount on one call isn't all your community. I mean, 00:16:06
people are sometimes worried about the bullers. 00:16:11
Baseball games, basketball games, football games that happened at the schools and stuff, community events, festivals, so on, so 00:16:17
forth, which you're also going to be responsible for coming. I don't think people really want to take the coverage trucks off to 00:16:22
cover those when you could have, you know? 00:16:27
A separate shift or a detail set up for that. And that's exactly what we do. So like to call, for example, we do cover depository 00:16:33
football games, We bring in a crew for that. We actually make two-part timers. That's all they want to do. One of them then with 00:16:39
Putnam County for 50 years and we use one of our reserve ambulances for that because we will not take a frontline truck out of 00:16:46
service for a special detail. 00:16:52
When we also consider the capital expenses on the front end. 00:17:00
We were transferred these assets, so we had Phillips MRX monitors that were transferred over, manual cots, super outdated cots and 00:17:03
stair chairs that have since been replaced. And a lot of that we were able to fortunately do with CARES Act money. So we were able 00:17:09
to get. 00:17:15
Brand new monitors because the Phillips MRX was recalled by the FDA, so that had to be replaced. That was a very large purchase of 00:17:21
I believe our First Capital purchase in April of 2020. We then were able to get mechanical CPR devices. We are very dependent on 00:17:27
Volunteer Fire responses and sometimes that can be prolonged. 00:17:34
Or non existent just depending upon availability. 00:17:42
We've tried to design our service to decrease injuries and improve patient care as much as possible by taking out a lot of 00:17:45
workload. So we have power cost power loads which will be coming in industry standard new striker stair chairs. That way we have 00:17:53
decreased back injuries. And then in 2020 we also knew state statute was going to be changing as to how EMS and controlled 00:18:00
substances or narcotics we're going to be regulated. So we went ahead and went with a commercial system that. 00:18:08
And tracks this for us and then we had to upgrade computers. So we've spent a lot of money, but ideally. 00:18:15
These devices and stuff should last. 00:18:23
About seven years on the monitors, seven years on Lucas devices, about five years on the power constant power loads. So I know 00:18:26
that there was a study done, I'm not sure if it was the Lucas or the auto point. I think what is the that there's actually more of 00:18:32
a positive outcome chance when those devices are used so. 00:18:39
So we've had. 00:18:46
Have the exact statistics, but we've definitely had quite a few cardiac arrest survivals to discharge where they are now living at 00:18:48
their back at home. 00:18:52
And anecdotally, I would say those were rare prior to the Lucas. It could just be, I mean, a lot of factors could fall into that 00:18:58
which would be improved dispatching earlier recognition by bystanders and just sheer luck, but. 00:19:05
We love our Lucas devices and the auto pulse which is by Zoll will accomplish a very similar. 00:19:13
It accomplishes the same thing. The literature though is kind of up in the air on the benefit of it. It definitely is beneficial 00:19:18
in a setting where we have decreased amount of manpower, so decreased hands that can do fresh CPR and then during transport, so in 00:19:24
a highly or densely populated area with a bunch of responders. 00:19:31
The literature is going to say the Lucas device or any other mechanical CPR is not going to do anything that your hands can't do. 00:19:37
It's just people do get tired. If you've never done CPR, it's exhausting and humans are statistically really bad at doing it. 00:19:44
So our buildings, we have three stations, Bainbridge N Greencastle in the center, which also houses or houses our administrative 00:19:54
side and training facility and then Cloverdale being in the South. All three of these have been remodeled. The administrative side 00:20:00
of our Greencastle station and the whole training was again through a grant courtesy of COVID funding through the state of 00:20:05
Indiana. 00:20:11
The rest of it was done basically through the expense of the county over. 00:20:18
Span about a year and a half, with labor done primarily by the trustees of the county jail, which saved a lot of money. 00:20:25
I mean, there was a lot of talent, the showers and stuff that they put in. They do construction full time when they're not 00:20:33
incarcerated and they're beautiful. So our crews have great stations to be able to. 00:20:38
Stay at and call home for 24 hours at a time. 00:20:44
So money the the business side of what we have to do is looking at billing. So even though I said we don't balance bill patients 00:20:49
anymore, we used to and we do still bill insurance. So in 2020. 00:20:56
We had some of the lowest billable rates that I think I've ever seen. So 2020 through 2022, our rates were quite low with our BLS 00:21:04
emergent. So our BLS transports were the 8 hundreds. We then see that in 2023, we increased those rates up and then in 2024, so in 00:21:12
February this year, we went ahead and just maxed it. What Medicare will allow us to build, that is what we're building. 00:21:20
So we've learned that you might as well just maximize that on the front end because we do see increases in revenue and you're able 00:21:29
to build for it. Just because you can build lower doesn't mean that that's going to be sustainable. We're not out here trying to 00:21:36
price down to people, but we do have to be able to sustain. Sure. So. 00:21:43
Have you? 00:21:52
I know you just raised it last year, but have you seen a noticeable difference since you've? 00:21:53
Done this where you've raised the rates up, is it making your return any bit better or? Yes, yeah, yes, we definitely have seen an 00:21:59
increase in. 00:22:03
Revenue and yeah and and and and just this is just what you build insurance, whatever is left over never reaches correct. The only 00:22:10
patients that do get billed are people who would be non residents so they don't contribute to the lit. 00:22:17
So anybody who may be involved in a collision on I-70, if they're from out of town, out of state, they will receive a bill. Now, 00:22:26
whether or not they pay it is a totally different question. 00:22:32
Or if we were even able to identify the patient. So we do have to write off if we call somebody John Doe, Jane Doe, because we 00:22:39
can't, can't bill you if we don't. Yeah. It seems like so many people spend so much money and so much time trying to to to chase 00:22:45
the leftover that sometimes it's. 00:22:50
With what you get back, it's easier just to move on. So up until we're would have been the first quarter of last year we were. 00:22:56
Collecting money from people so we would put them into trucks in order to ****** the tax return to try to collect or even out that 00:23:05
lost income or the bad debt. 00:23:11
In 2020 they were still using an actual collections company and. 00:23:17
I'm glad we don't have to deal with that anymore because Trex was a pain because every single. 00:23:23
Person had to be added into that in the spreadsheet every month and now we just don't have to worry about it, which is great. I 00:23:29
did click ahead so you could see revenue and you'll see, yes, our run volume was increasing and it still has increased. But even 00:23:36
when we stopped balance billing in February of 2023, we saw a increase of about 280 ish $1000 in billable revenue or I should say 00:23:44
collected revenue alone. 00:23:51
The projections for this year slightly drop off a little bit, but that's also just based off data at the end of July. So we'll 00:23:59
see. Typically December brings in quite a bit of revenue, just bills that haven't been paid yet by insurance companies. So January 00:24:06
1st of this year under Indiana code, we implemented a EMS lit tax that actually started its collection process with our tax 00:24:13
revenue. 00:24:20
Projected for the year 1.87 million. 00:24:27
And the cost to the taxpayers? About $37 per person. 00:24:30
So some people think of it as they're paying for a subscription or they're paying for a service that they may not use. 00:24:34
We're not talking hundreds to thousands of dollars. 00:24:41
Yes, 37 dollars is $37.00 but at least I know that if somebody calls 911 and needs their kid transport to the hospital. 00:24:44
They basically already prepaid for it. 00:24:54
And they don't ever have to worry about not calling simply because they don't think they can afford it. 00:24:57
So, our billable encounters. 00:25:03
My type in years. So this is where you have to start thinking about the call volumes and the level of service that's being 00:25:05
provided to patients with BLS calls being some of actually they are our lowest billable with the exception of non transports and 00:25:12
then our ALS ones and ALS twos using Medicare's billing criteria. Our service, our call volume is quite a less heavy and that this 00:25:20
chart shows you that and the trend continues that we do transport more patients a less than BLS that. 00:25:27
Bring in more revenue, but that also uses more money in supplies. 00:25:35
So having to balance that because you cannot build for consumables or items that are used one by one to patients in the statement. 00:25:40
DMF for EMS transport. So it doesn't matter if I use a $150.00 IO needle or I just start an IV and give you some pain meds. 00:25:49
The billable amount is going to be about the same that you can do. 00:26:00
All right. Expenses. 00:26:06
This is something that I will be very blunt. 00:26:09
When our county went forward with. 00:26:14
Taking on this entire project, they did not do enough homework. 00:26:18
The prior director sold the idea of municipal EMS to them at a budget that was like 1.2 or $1.3 million a year. 00:26:23
That I don't know where those numbers came from. 00:26:31
I appreciate that they got the agency created before my time, but it was not truthful. So truly making sure that you do the work 00:26:35
on the front end to find out what it's going to cost will make your life much easier. Because in 2020, which isn't even included 00:26:41
up here for a reason, because there's not enough data that's readily available even to our county auditor who would have paid all 00:26:48
the bills. 00:26:54
As to what expenses were our departments because we were pulling money from so many different funds. 00:27:02
That I don't know. 00:27:07
I truly can't tell you. 00:27:11
Which is crazy and it. 00:27:12
I don't know, but our expenses do go up each year. Some things are controllable, some things aren't. And a lot of those expenses 00:27:16
increased or have increased or payroll costs because as people get raises that cost more. We have also seen market increases in 00:27:23
supplies. So when medications go on shortage or we have a resin shortage due to a storm in the Caribbean, that skyrockets prices 00:27:29
for IV fluids and flushes that we do still have to have. 00:27:36
And then in 2023-2024, we also saw an increase just with. 00:27:44
Should say 2022-2023 an increase due to construction costs because there were larger projects happening. So you include your 00:27:49
capital expenditures in this. We do. 00:27:53
How's it going now? So starting, we just submitted our 2025 budgets and we have our hearings for that next week and even our 2025 00:27:59
numbers include some capital replacements, so like vehicles and stuff. But we will ideally now that we'll have this lit coming or? 00:28:07
The LIT established for Year 2 next year, our goal is to just have a capital cumulative fund and start moving that separately. 00:28:15
That way we're not just blending all of it together so it's a little bit clearer. 00:28:21
Our revenue and expenses. 00:28:30
We see that the start of 2024, I should say 2024 in general, is the only year. 00:28:33
That our agency is. 00:28:39
In the green we between billable revenue and taxable revenue. 00:28:41
Our income is actually going to supersede the expenses projected for this year. 00:28:48
Which is not the case for 2020-2021, 2022 or 2023 where I mean. 00:28:53
We were getting. 00:29:00
Close to $1,000,000 of support each year from the county general fund, which had it doesn't even consider the need for capital 00:29:01
replacement. So looking at it, we are able to basically plan out to 10 years from now and say that as long as we are able to 00:29:08
continue these trends. 00:29:14
We'll be able to do our capital replacement projects. We'll be able to continue moving forward and considering inflation and all 00:29:22
of those things without needing to tap into any other funding sources. 00:29:27
So this is the big 1/20/24 this. 00:29:34
Chart is a little skewed because of the way that the Y axis for the monetary amount actually scaled itself. But we definitely see 00:29:39
a more positive balance this year. Looking at 2025. Some of those budget items might get slashed, which would then drop the 00:29:47
expenditure site. And we also don't truly know what the raises, if any, that will be granted by the county will be. So this is. 00:29:55
A over projection of expenses rather than. 00:30:04
Our largest budgeted items payroll, maintenance and support and operating supply. 00:30:10
It's really that I don't know what your county does for perf matching or perf contribution or your fringe benefits cost, but that 00:30:17
does cost us quite a bit of money. That and liability insurance. 00:30:23
Maintenance and support services, that's going to include all of our vehicle maintenance, building maintenance. 00:30:30
And that is one of the biggest headaches is making sure that all of those things continue to work. Do you guys have your own like 00:30:34
vehicle maintenance department, like your highway department do any vehicle maintenance? Yeah, they have their own and so does the 00:30:42
Sheriff's Department. But I'm jealous. I don't know if some of the other departments, if they use a lot of a lot of the sheriff's 00:30:49
does maintenance on other vehicles as well. County, that would save a lot of money. 00:30:56
And then also having a building maintenance person that can do your routine HVAC, electrical work would save a lot of money. We're 00:31:04
hoping to see that with next year if the county will go that route where we just have one person that overseas all of these areas 00:31:10
and does that maintenance for a building rather than us having to call in contractors all the time because it never fails. The air 00:31:15
conditioning stops working on a Sunday. 00:31:20
So in the middle of the summer, so then we have to pay for an emergency call. 00:31:26
One quick question real quick, SO. 00:31:30
You all have have stations, yes, that are yours that you have. They're your own buildings. Is there a reason you didn't use any of 00:31:33
the fire departments that were there? Is it because they were volunteering, They're not staffed or they're not really set up for 00:31:39
that or? So the assets were already there. So those were transferred from Operation Life. They had already built them. As we look 00:31:45
to expand, so looking multiple years out, we already know that just geographically and where people are living, we're going to 00:31:51
need to add another ambulance. 00:31:57
And where we'll put that will be the interesting part, but it will most likely be at one of our Volunteer Fire departments if they 00:32:04
are willing to accommodate that because that does at least decrease the assets and for that portion of the community, they then 00:32:10
have an ambulance much closer to any emergency. 00:32:15
Yes, of all your expenses, I know you acquired the buildings. How much of that was the housing? 00:32:22
Versus the operation of the buildings, you know how much are you other. 00:32:29
$3,000,000 expenses whoever was there. How much of that is your? 00:32:33
Office Your crew houses your maintenance of your buildings. 00:32:37
Versus ambulances. 00:32:42
Without having a report like directly in front of me, I would roughly ball parking, but I would say probably about 40% of our 00:32:45
operating expenses are in buildings. 00:32:50
And then the rest of it, almost all of it would be. 00:32:56
And if I were you, do not go with a diesel. 00:33:01
Unless you guys have a bunch of diesel mechanics because that's what we've ran into is we don't have. 00:33:05
Mechanics in our county that are. 00:33:10
Equipped to be able to lift the weight of our ambulances despite how rural we are. So if we have heavy diesel work that needs to 00:33:12
be done, we do have to go out of county with it and that is not cheap and very time consuming. 00:33:17
So unlike it has saved us a lot of money and fuel, we don't get deaf. So it's. 00:33:23
I would recommend that. 00:33:29
Yeah, I think Allstate Board is the only place around here that has a lift capable of lifting an AV. 00:33:31
Smyrna Stadium. 00:33:37
Bus. Bus transportation maybe? Yeah, I guess so. 00:33:39
All right. So really with your older vehicles, you're not doing much? 00:33:43
Service work with them then. 00:33:47
Knock on wood, Knock on wood. 00:33:50
Things do break on them, so when we do have to get them work done. 00:33:56
These we need the vehicles facility operational, it is a lot less. 00:34:00
Now, in 2020-2021, I mean we were. 00:34:04
Constantly putting our ambulances into the garage. I mean, they could be. 00:34:08
I mean we had one out of service for like 6 1/2 months. 00:34:13
The garage because it needed its entire engine replaced. 00:34:16
When there's a call that comes in. 00:34:22
Is the fire department responding as well? Because likely they're going to get there first if there's ten of them and three of you 00:34:25
guys, I would guess just geographically depends upon the call type. So we use tiered dispatching. So when our 901's in there 00:34:31
answers the phone based on their emergency medical dispatching algorithm, it's going to have them ask a bunch of questions and 00:34:37
it's going to determine the call type if that. 00:34:43
Determines it to be a non life threatening emergency. 00:34:50
Fire's not going to be dispatched on it. There are a couple departments that you request to be put on every run. So that is their 00:34:54
department's choice. So they're more than welcome to do that. We don't send fire to nursing homes. That was their request. Unless 00:35:00
it's a cardiac arrest or something that we know is going to require additional hands, they don't get sent on that. Anything life 00:35:06
threatening, yes. 00:35:11
Based on that algorithm, fire would be dispatched and then we will also start fire. 00:35:18
For distance, so let's say Cloverdale, which is about 30 minutes, 20 to 25 to 30 minutes South of Bainbridge, which is our 00:35:22
northernmost truck if. 00:35:27
Both of our southern trucks are out and that Bainbridge truck is getting sent and they have not been centralized for coverage yet. 00:35:33
The fire department's going on. 00:35:39
If that answers your question. So you guys don't utilize the fire department for everything then? 00:35:42
Just. 00:35:49
You know we do. 00:35:51
If they wish to go on every call. 00:35:53
If their department one side, we welcome that, but we don't. 00:35:56
Have them dispatched. 00:36:01
Because we also have to recognize that. 00:36:03
We need those resources available for other things and then the volunteer aspect of it as well. I mean, they could be very 00:36:06
welcoming from work. Or we have one Fire Chief who I swear he makes it to almost every run somehow with works night shift I don't 00:36:11
think. 00:36:16
He ever sleeps. 00:36:22
But he does not need to be woken up in the middle of the day for what will eventually just be a BLS transport. And if we do end up 00:36:24
needing them, we can always request them to be dispatched. 00:36:29
And saves taxpayer money. 00:36:35
So looking towards the future. 00:36:41
Currently in the process and waiting to see if we are or awarded any federal grant money to start mobile integrated health 00:36:43
program. So community paramedicine and our three target areas will be adult and substance abuse or substance use disorder are post 00:36:51
Natal care because we have no OB capabilities within our county. So we don't have any prenatal or post Natal care and then aging 00:36:58
in place. We have quite a population that is getting older and a lot of people don't want to or cannot. 00:37:05
Afford to go into assisted living or skilled nursing. So if they are able to stay in in their home, we would like to have a 00:37:13
program that can help facilitate that and that is a billable service to Medicare. Medicaid will reimburse for MIHRI removal 00:37:21
integrated health, but we have to recognize that that's also going to increase the number of employees that we have and then 00:37:28
operating expenses as well because the vehicle is in everything that goes into just expanding. Are there any other counties? 00:37:35
That are moving in with this mobile integrated health as well, because that seems to be the answer for a lot of people. I mean 00:37:43
that it's kind of one of those programs that seems to take care of some of the trouble calls before they become overly 00:37:49
problematic. And you're right, I mean, I think everybody seeing an increase in lift assists calls and falls, you know, not 00:37:55
necessarily injured, but they fallen and they can't get back up on themselves. They don't have anybody. 00:38:01
Seems like mostly Great health is helping a lot with that. Even a lot of law enforcement, whether they're doing a lot of these 00:38:07
psyche vows and stuff like that, they're using the mental, the mobile integrated health programs to kind of do those. So 00:38:14
Crawfordsville Fire, which is in Montgomery County just north of us, they cover the EMS for the entire county. Even in their city 00:38:21
fire department, they have a mobile integrated health program that would be considered a model for the entire state of Indiana. 00:38:28
They definitely do it and use it. I know Bloomington also has had great success with it as well. 00:38:36
Our goal is to basically make it or try to decrease people's needs portfolio. So my background is in public health and trying to 00:38:43
focus on the prevention side of things. So if we can prevent you needing any ambulance, not only are we going to see an improved 00:38:49
quality of life for the resident, we also have. 00:38:55
Increased expenditure on the financial side of things, so really trying to balance the use of resources more into the prevention 00:39:01
side and not on the reactive side and using fault as an example, a lift assist only in our county to go back to that. Ambulances 00:39:07
don't consent on this. So that's a fire department call. Now. Multiple fire departments aren't available then yes, we will certain 00:39:13
ambulance to it, but we have way less ambulances than we have fire departments. And if somebody's fallen and not injured, it makes 00:39:19
more sense to keep. 00:39:25
That medic unit service rather than take them out for 20-30 minutes. 00:39:31
And somebody else could have a lifeguard, an emergency at the same time down the street. 00:39:37
So we also want to move our supervisors off the ambulance. So it's going to require us to hire an additional 4 paramedics full 00:39:43
time. And the idea being that that then increases our ALS chase capabilities. So we would then have a chase medic 24 hours a day 00:39:51
that can then supplement on this high acuity calls. They can take on more of a management and supervisory role. 00:39:58
And hopefully take on. 00:40:07
A lot of the day-to-day that is currently being done and has been for the last several years. Maybe because only one person I can 00:40:09
only do it all for so long, but having them on an ambulance where they are taking calls does make it very difficult. 00:40:17
For them to actually be able to do things beyond gestation here. 00:40:26
We'd also like to see our administrative assistant get moved to full time and then vehicles previously were being replaced on a 00:40:30
need and condition rather than offensive replacement plan. So we're hoping to move towards that as our capital fund gets 00:40:37
established. And then within 10 years, we do want to have that 4th truck putting our northern truck currently moving it closer to 00:40:44
the center of the county, but still north and then getting one put in on the northwestern corner. 00:40:52
Northeastern corner of our county, closer to Hendricks County because we know Danville is expanding a lot and we do provide mutual 00:40:59
aid. We have a standing policy that if another county calls for a resource, we send. It doesn't matter his last one. 00:41:06
Because we can't predict a 911 call, we can't predict an emergency. But if somebody needs it right now? 00:41:14
And we have it. We'll send it. We'll deal with that next call when it comes in. 00:41:19
Hard lessons that we have learned. 00:41:27
Make sure your assets are good and start with that. Make sure you have a solid understanding of what you're getting into it 00:41:32
looking at the study that. 00:41:35
Commissioner Sharp sent me yesterday from Baker Tilly. It looks like you guys have already done a lot of homework and looking at 00:41:40
all of the numbers and looks like you're already seeking a sentence from your DLGF because that's the step, the most important 00:41:45
step to go the lit route. And then don't let the place take from a pirate ship. So hire the right people on the front end in order 00:41:51
to run it. 00:41:57
And it'll make your life a lot easier and it. 00:42:05
Dedicated my entire life it seems, for the last 4 1/2 years to make our agency try to be the best that it can be for the community 00:42:08
and. 00:42:12
And we are fully staffed. 00:42:18
Retention rate is very high and when we do have people separate, they usually separate to go into the fire service full time when 00:42:20
law enforcement full time where they've gone back to school. 00:42:25
So we don't see the turnover even though for several years we repel pain well under the market. 00:42:30
So the schedule itself is a massive recruiting. 00:42:37
Tactic and retention tactic as well. 00:42:40
Can I ask a question about that? 00:42:46
Do you know what the career fire department schedule? 00:42:48
Is in Greencastle. A greenhouse is 2448 Hollywood County. 00:42:52
OK, how does that mesh then that you're not In Sync? 00:42:56
Isn't an issue at all or it is not an issue? 00:43:02
And it hasn't been. We previously were rotating crews from station to station. When I first started in my position, they were 00:43:06
rotating every shift. And then with COVID, we were able to knock that down to rotate every month. And eventually the crews were 00:43:12
surveyed, they showed they voted to have permanent stations. So that is what then ended up happening. So now we do at least have 00:43:18
the same crew members working at the same station, covering the same area, working with the same fire departments on a regular 00:43:24
basis. We we don't see an issue with it. 00:43:30
Now on the training side, because I do the training for both our department and Greencastle fires, having to keep the two 00:43:36
rotations is a little bit more complicated, but it does not operationally affect anything. 00:43:42
You do off shift training or is it only when they're on their shift? Our employees if it is required training, we do it on shift 00:43:48
unless it's something that truly can't be. We do try to minimize excessive overtime. 00:43:55
But if it is not required required, we will offer it to them at no cost. They do have to come off shift to do it, but we will not 00:44:02
pay them for that. Let's just continue education for interest. So are you a training institution? 00:44:08
We will be OK. 00:44:15
We are an AHA training site and we do offer EMR classes. Currently we have 4 primary instructors on our roster so. 00:44:16
I'll eventually get the training institution application and my goal is to go up to the a ENT or the advanced EMT level. I will 00:44:29
not take on a parameter program. 00:44:33
Circling back to billing, how much do you write off a year? 00:44:40
So this year alone. 00:45:03
Months to the individual or start of the year to the end of July $81,435 were considered bad debt we had. 00:45:07
2.056 million that had to be considered adjustments just based off of insurance contracts. So effectively we're writing off two 00:45:16
point. 00:45:20
1,000,000 thus far. 00:45:27
If you consider adjustments as write offs. 00:45:30
The write off figure that you mentioned is that somebody from outside the county that you build that did not pay. 00:45:33
The bad debt portion would be. 00:45:40
The outside of the counties, because those are going to be and those have not technically been written off, they're still just 00:45:44
pending, but they're currently negative balanced I. 00:45:48
They may end up being written off because the collection site of it's honestly. 00:45:53
It's not worth it. 00:45:58
Then the adjustment side, looking at the large figure of a couple, $1,000,000, that's gonna just be your insurance write offs that 00:46:01
we have to discount down and that's just where insurance you bill them for 2000, they say we'll pay you 1200. 00:46:07
Or whatever it may be, Right, right, right. So the difference is that in what you're quoting there? 00:46:15
Yes, I was pretty far off on that, Yeah. 00:46:24
Yeah, we'll build about 3500 and get a $300.00 reimbursement, I think the national average at this point. 00:46:27
Is $450. 00:46:35
Return for your billing from insurance so and there's always. 00:46:37
Leftover, whether it be. 00:46:43
1000 up to 1002 thousand dollars. 00:46:45
That is the money that you are writing off because you put the revenue stream in place and that is what take care takes care of 00:46:48
it. It was the argument that we made when we were attempting to get the lead pass was the the taxpayers are paying for it and they 00:46:54
should not be billed for it. 00:47:00
I've said this on several occasions where I can't tell you how many times people have struggled to pick up the phone and call 911 00:47:07
just simply because they were unsure whether or not calling for an ambulance. But they've been such a financial hardship that it 00:47:13
could send them into bankruptcy. So they. 00:47:19
Essentially waited and waited until a time came. Well, you just couldn't wait anymore and it resulted in a negative outcome. 00:47:26
Have you guys seen a change in? 00:47:34
That. 00:47:36
Where people have less of that hesitation. 00:47:39
So whether or not they have hesitation to call on the front end, it's hard to assess. So I don't have a definitive answer on that. 00:47:42
But I can tell you that when I've been on scene, especially shortly after we rolled out this whole, we're not going to send you a 00:47:47
bill at the end of the day. 00:47:53
We would have people that would call us and they didn't want to go and obviously we don't want you to sign our reviews or. 00:48:00
They shouldn't want people to be signing refusals from a clinical and operational standpoint, but. 00:48:08
We can now tell them you won't get a bill, and I absolutely have that change people's mind. 00:48:16
That we will not bill you for this. And instead of them going to the wrong hospital by car when they're having chest pain and they 00:48:21
go to Puffin County Hospital, who they're going to follow in Tala, they'll do their jobs, they'll stabilize them. But if they need 00:48:27
transferred, let's say they are having a massive heart attack, they're going to be sitting there until somebody is able to 00:48:33
transfer them, whether it be by ground or air or really dangerously private vehicle. 00:48:38
Which is a whole different thing because now you're talking about bringing a service that does not offer. 00:48:45
What you're providing, correct, So now we have the ability of getting people to the right place. 00:48:50
Based off of our knowledge, training and experience, the first time, the first time I'm going to ask a question. I'm not near as 00:48:56
intelligent as these guys because I'm not in this field. 00:49:01
The HSA health insurance. 00:49:07
Program is by far growing at a pace larger than the PPO. 00:49:10
The first X amount is your responsibility. 00:49:16
So if you're not going to say, you're not going to send me a bill. 00:49:19
I'm responsible for the first X amount anyway, even if you build my insurance company. 00:49:24
Explain. 00:49:29
You're something for your pay. 00:49:31
You're gonna build my insurance company, and my insurance company's gonna tell me you owe this. So you would get an EOB that would 00:49:33
tell you that you will owe that amount, and you will still not owe the county any money. You just don't pay the bill. 00:49:39
OK. Just curious. Yeah, that's what it is. And. 00:49:47
They're indirectly already paying for it, right? 00:49:54
So there's no sending to collections out of county accounts Somebody wrecks on I-70. 00:49:57
No, I mean we could put them into trucks, but especially out of state. 00:50:05
People, they're not going to file an Indian or tax return, so we'll never see that money back. So that's just more clerical work 00:50:09
and paying people to manage that with very little chance of a return. I have one other question. The volunteer ambulance that 00:50:16
still is in existence, how many runs do they make a year? 00:50:22
I want to say a couple 100. 00:50:29
I don't know off the top of my head. I will say that when they are dispatched, they have a great response. I mean they do have 00:50:32
volunteers that show up and take the call and I mean they have. 00:50:37
Been my saving grace a few times, quite actually quite a few times that they're, they're the closest ambulance and I'm sitting in 00:50:43
the middle of an intersection in the rain waiting for somebody to be able to take us to the hospital so. 00:50:49
We don't have a mutual aid contract with them per se when it comes down to the billing site. So a lot of places would say, oh, 00:50:57
it's a flat rate that we're paying you. So to say it's like 350, We would bill, collect whatever we got and then just pay them 00:51:05
$350.00 for the transport. We just skipped them the funding that we get paid so because it's not our vehicle. 00:51:12
And it's typically me that's going to be on board for ALS. It's not truly costing our agency any more money. 00:51:21
While we're on that subject, what is your average response time? 00:51:28
9 minutes and like 48 seconds last month. 00:51:32
Wow. And you got, I'm sorry, what's the square mileage? 83 square miles, you said right underneath 5 minutes. 00:51:36
If I. 00:51:46
Question, you mentioned DePaul University, yes? 00:51:47
How are you the primary response for the students in the university or do they have their own medical system? We are their only 00:51:50
responsibility. I know that they have student health, but when it comes to emergencies, we are there only response that they would 00:51:57
get. And how do you treat the students if they're like out of state? Do you treat them like they're county residents? 00:52:03
Because they are not tax paying in the county. 00:52:10
So we also have a Correctional Facility in our county as well. So remember or any offender that is. 00:52:12
Incarcerated the Putt and Bill Correctional Facility. 00:52:21
They are actually going to be billed. 00:52:24
The total amount and then Wexford or whoever IDFC is contracted with will then make that payment. 00:52:27
On their behalf. 00:52:33
One more question. 00:52:35
This hasn't been a big issue, but I've heard some people mention that the LIT funding is a very good way to get this going. 00:52:38
But no matter what kind of tax revenue you're going to do, you're going to segregate your society a little bit whether you do 00:52:44
property tax people that don't own property. So if you have retired people that aren't earning income, that aren't paying into the 00:52:49
lid. 00:52:54
Might be your. 00:52:59
Larger population of users of your services? Have you gotten any feedback or pushback in the county in that regard? 00:53:01
I mean, there were definitely people that had negative thoughts on it, especially in the comments on the local newspaper online. 00:53:08
But the biggest fear seems to always be that people will then just call all the time, they'll misuse it. And we don't really see 00:53:17
that we, I mean, yes, we have patients that use the 911 system frequently, but they are also in the same proportion as to 00:53:23
beforehand. 00:53:28
I do know that. 00:53:36
Slit can only be in effect as of right now for 25 years. So eventually the only option most likely moving forward is once you hit 00:53:38
that mark, it's going to have to be some other form of tax income, which would then be proper taxes most likely. We did have a 00:53:44
massive push back against that. So that did not that was not approved. 00:53:51
You know what I started when I started researching this topic? 00:54:01
And I reached out to Putnam because they were one of the first, I guess, that really kind of implemented this. 00:54:06
EMS Slit. 00:54:12
Had some information available and. 00:54:13
And you know, the more I kind of studied it more kind of fit what we. 00:54:15
Looking at for us, you know where you have. 00:54:20
37,000 people totaling your. 00:54:23
County we, we have more than that, but we're kind of divided by the city of New Albany and Floyd County where that kind of matched 00:54:25
up. Another thing that matched up with our uninsured rate as well as our call volume so putting. 00:54:32
Putnam County side to side with where Floyd County was matched up pretty closely overall. 00:54:40
Outside of the obvious geographical science, so. 00:54:46
Yeah, it was. 00:54:51
Very impressed. So I have worked. I guess a little bit about my background. 00:54:54
I started a 911 working for a private service that's contracted to do 911 in Martinsville. After that I then went to Indianapolis 00:54:58
EMS which is technically a hospital based. 00:55:04
EMS agency if you really get down to it, this thing contracted by the city of Indianapolis, the one in Martinsville closest 00:55:11
source. I mean carry ambulance shut down. I had already left by that point, but they just all of a sudden stopped providing 00:55:16
service at the top end in multiple counties across the state of Indiana where. 00:55:22
Non county. 00:55:28
Ran or non municipal ran entity just one day stops. 00:55:30
Giving you an ambulance. 00:55:36
I think that's one of the things that we've discussed that, you know, throughout this whole process is, is that we've realized 00:55:37
just how vulnerable we are at the whim of of. 00:55:42
You know some of these companies and I think we have great companies in the area that are wanting to be great community partners. 00:55:47
But at the end of the day, I mean, you know. 00:55:54
They need to make money. 00:55:57
To exist and if they feel like an area is no longer. 00:55:59
Profitable for them than. 00:56:02
They're going to move their operations and. 00:56:04
All too often we see communities and chaos when that happens. 00:56:07
And I think. 00:56:10
Several of the incidents that's happened in this area over the last. 00:56:13
Several years, especially in the last couple years, I think everybody's ready for some stability. 00:56:17
Don't get me wrong, this is a very expensive venture that is very time consuming in labor. 00:56:23
Filled way to go. 00:56:29
But once it's established, I, I, I personally believe that 1/3. 00:56:32
Party or not third party, but a third service. 00:56:40
Municipal EMS agency that covers the entire county is the best EMS model that we can provide to any county in the state of India, 00:56:43
if not across the nation because it brings them, it brings that public safety department into the same realm as fire, law 00:56:50
enforcement and dispatch so that the county or the municipality that has direct oversight. 00:56:56
And is directly responsible for everything that's being done and delivered to the community. 00:57:03
If I could, I just realized I had another question. Sorry. It's about staffing. You made a very affirmative statement that you 00:57:09
don't have a problem with retention and recruitment. 00:57:13
That's unusual. 00:57:18
How much of your staffing are people that live in your community? That's why it works really well, or you have people traveling to 00:57:21
work. I'm just wondering what's that special recipe that you guys have figured out because everybody else is having trouble with 00:57:25
that. 00:57:29
So I have employees that drive from out of state. 00:57:34
We have employees from Illinois. I have some that are local to the community. It's where they've lived their whole lives. So 00:57:36
there's giving back. I have people that live in Indianapolis, Hendricks County's. 00:57:41
That recipe that you? 00:57:48
Asked about. 00:57:51
That's good management. 00:57:54
I mean it really is a simple being supportive. 00:57:56
And non punitive except for when it's needed in actually being there for your employees goes a long way. I mean at one point in 00:58:00
time we paid terribly. I mean in 2020 our EMT's were. 00:58:05
Paid, in my opinion, a horrible wage. I had no control over it. 00:58:11
But making less than $15.00 an hour and we're expecting you to go out making life saving decisions. I started as an EMT at $9 an 00:58:17
hour. It was terrible to try to pay bills but. 00:58:23
We treated them well. 00:58:30
It really is that. 00:58:33
What percentage of your employees work somewhere else? 00:58:35
Person, we're full. 00:58:39
Part time. 00:58:40
Part time, somewhere else, full time for Putin. 00:58:44
At the most forever 24 operational employees to one sixth of them. 00:58:52
You think retention is a lot because of the schedule? 00:58:59
I think the schedule is one of the biggest factors into it. 00:59:02
And. 00:59:06
It was in place before I was there, so I can take no credit for that. I. 00:59:08
But I can also tell you that that. 00:59:13
Schedule is in place. 00:59:16
For several years before I was there and they did have a massive turnover rate before Putnam County actually took one. The 00:59:18
organization, they were constantly putting a truck in service and changing how they were staffing and trying to make it work with 00:59:25
the budget that they had and the management. It just kind of just a little more chaotic before now. 00:59:31
So. 00:59:42
Do you, I guess you guys have it a bargaining unit for when it comes to raises and stuff like that, Is that correct? 00:59:46
Your benefits? 00:59:53
Technically, no. The County Council just decides. The commissioners decide. 00:59:55
The benefits package that the County Council then decides what raise they're willing to approve budget wise and we just kind of 01:00:02
get told that so we don't really have bargaining. So yes I we want you to get paid more. The county did a salary study last year 01:00:07
I. 01:00:13
And that's how our EMT's and paramedics and supervisors were able to get a 21% raise just because they were paid so far under the 01:00:19
market previously and now they're actually paid probably in the upper order order. 01:00:25
What what is what is the market for paramedics up in your area? Right about 24 ish an hour base we pay I think it's like 2535 an 01:00:32
hour for them to. 01:00:38
And who do you guys report? Who's your chief report to the commissioners directly? 01:00:48
It is an appointed position. 01:00:54
Anyone else have any more questions for? 01:01:02
Deputy Chief Taylor. 01:01:04
Yeah, go ahead. 01:01:08
Hey, yeah, yeah. 01:01:10
Medville Inc, it's a billing company out of Indianapolis. They do all of our billing and all of our compliance and medical records 01:01:15
requests. That way we don't have to deal with the Medicare and Medicaid. 01:01:21
Compliance site. 01:01:27
So when you look at your projections. 01:01:32
2024 they have. 01:01:34
So currently the way that it is. 01:01:44
Place right now, so we have two different funds. We have our revenue based from billable revenue and then we have our lit and that 01:01:47
just becomes part of the operating balance. But the goal is that next year since it will be year two, we will actually start 01:01:53
shifting transferring funds from those two funds that are excess and putting them into. 01:01:59
Cumulative funds, that way it's just completely separate. But any money that our department collects, whether it be taxed or 01:02:07
billable, that can only be used by EMS, so that cannot be reappropriated to another corner. 01:02:12
Correct, it does not go into the general fund. 01:02:25
19. 01:02:31
13 lbs off the top of my head. 01:02:32
So we have 10. 01:02:44
10 fire departments, only one career the rest are all non paid so we have 9 Volunteer Fire departments. 01:02:46
Cloverdale is technically. 01:02:55
Or they would be a district technically. Even on the Township, real school is also technically a district. 01:02:58
7.7 in Bainbridge because those would still be fire production districts within. 01:03:06
The two townships would be part of the fire production, so yeah. 01:03:12
We have the Albany Township, Franklin, Georgetown, Lafayette, Greenville, so there's five townships. 01:03:20
Fire based EMS the transporting site. 01:03:36
Like if they have ambulances. 01:03:40
So I have worked as a fire medic. 01:03:42
I've worked in many settings that involve Firebase DMS. I think it has a place. I think it can be done well as long as its 01:03:46
priority is put. 01:03:50
And the emphasis is put on patient care. We're on staffing ambulances with somebody because they're being forced to be on it. 01:03:54
That's what often times happens. Patient care does unfortunately suffer. And then what we also what I've. 01:04:01
Experience and observed is that billable revenue that. 01:04:08
Does happen from those transports never gets put back into the EMS site. It gets used on the fire suppression side and EMS is kind 01:04:12
of just there as a money making scheme. 01:04:16
It will get the jump. 01:04:23
So. 01:04:29
So single role departments. 01:04:32
First, single role EMS providers. It can be done as long as the culture is right. 01:04:35
Deputy Chief, thank you so much for being here with us today. I appreciate it. 01:04:47
I know you took what to take about two hours to get here to turn out. It was a great drive though. Well, we greatly appreciate it. 01:04:52
We're we were excited to hear. 01:04:56
She had this present today. If you guys have any questions that do come up, I was going to say you could maybe hang out for a few 01:05:01
minutes after the end of the meeting just in case anybody might have some more questions for you. I'm sure some people might 01:05:05
appreciate that. Thank you. Thank you. 01:05:09
Does any of the board have any comments? 01:05:16
Does any of the public have any comments? 01:05:23
That being said, I'll take a motion to adjourn. Motion to adjourn. Thank you. 01:05:29
Everybody have a great day. 01:05:34
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