At the task force meeting on Feb 3rd, we were joined by two commissioners and the EMS director from Morgan County. As many of you may have read in the paper, Morgan County Ambulance is going through some difficult financial times right now for many of the same reasons as we’re seeing here in our own county.
The concept of a multi-county EMS authority was discussed briefly and met with a good deal of interest from both counties (Washington County may also be interested) as well as from the task force. Because of the flexibility that can be built into the creation and design of an authority under state statute, it is plausible that Logan County could partner with one or more other counties to create a regionalized EMS system.
The are many, many details which would need to be thought through before this option could float up as a viable solution. However, just off the top there could be the potential to save money just through the economy of scale – combining efforts, resources and costs across two or three counties rather than each bearing the full burden on their own.
Of course, each participating county would still have ambulances and staff stationed there, they would simply all be managed under one budget through the multi-county authority. Ambulances and crews could be rotated from point to point in order to fill in during busy times or during shortages caused by vacations or illness, or to cover inter-facility transports.
By streamlining the billing process, human resources, management, supply ordering, training, maintenance, etc., and merging those savings along with the income from the call volume of each of the counties combined, it ‘may’ be possible to operate this type of system without seeking as much support from the taxpayers.
Obviously the task force still has some work to do in terms of determining what is best for our particular situation, but because this multi-county concept is new and fresh we wanted to solicit your thoughts and ideas.
You can read more about this meeting on the Journal-Advocate website at:
http://www.journal-advocate.com/ci_17294415?IADID=Search-www.journal-advocate.com-www.journal-advocate.com (but come back here to comment, please!).
Before posting, please take a moment to look at the “Posting Tips” and “Comment Policy” sections. Lets try to keep the conversation in this thread focused solely on this concept.
Thanks and we look forward to hearing from you!
Kudos to all on the task force for trying to find the best solution for sustaining a quality ambulance service in Logan County. A multicounty arrangement should at least be explored so all options are considered. The counties already collaborate on several other services so why should the ambulance be any different?
ReplyDeleteI actually like this idea better than any of the others. In these hard economic times it seems like a great idea to help each other out.
ReplyDeleteI agree. This is a great idea. Let's explore the options.
ReplyDeleteFort Morgan has nice ambulances so Logan County taxpayers won't have to buy Doug's outdated equipment. They have enough personnel to run calls in all 3 counties. Morgan County runs about 100k short a year so it would be an easy fix to pay them 120k a year to take care of EMS in our county. The only questions would be about dispatch. Where would the central dispatching be located? How would the calls be routed? For example, if I have a medical emergency in Sterling and I dial 911, will I have to talk to the Sterling dispatcher and then have to be transferred to Fort Morgan?
ReplyDeleteGreat questions!
ReplyDeleteWhile nobody yet knows exactly how a multi-county EMS system would look, it is probably premature (and very unlikely) to think that we would take equipment and staff from one existing service and spread them across more than one county. Each would need to have its own.
As for dispatching, with the way our 9-1-1 dispatch centers are already connected, it would also be pretty unlikely that calls for help would be routed any differently than they are today. A 9-1-1 call would still be answered by the same dispatch center that it is now, and they would still dispatch an ambulance out of the closest station. If there wasnt an ambulance available (rare!), then they would make a request through another dispatch center just like they would do today -- all it takes for them to talk is the push of a button. There would probably be very little (if any) change.
Just a reminder, dont forget to take a look at the "Posting Tips" link above before commenting.
Thanks everybody! Keep the thoughts coming.
right on! now this is the type of plan i think a lot of people might like.
ReplyDeleteHow would central dispatching work if there are 3 dispatch centers?
ReplyDeleteGood question, and hopefully we can provide a little clarification...
ReplyDeleteIt is unlikely that there would need to be any change in the way 911 calls are received or dispatched from how it is done today. There would still be EMS staff and ambulances stationed in each county that participates, just like there is now.
For example: A call from Wiggins would still be answered at the Fort Morgan dispatch center, and an ambulance would be sent from a station in Morgan County. Same thing here -- if a call comes in from Fleming, it would go to the Sterling dispatch center and an ambulance would be sent from Sterling.
EMS calls are not the only things that go to 911 dispatch centers -- law enforcement and fire calls also go there, so re-routing or reconfiguring how the current system works is just not an option.
If there are internal arrangements that might need to be made (e.g., repositioning of ambulances or staff, handling inter-facility transports, etc.) then those could be handled by simple phone calls or radio traffic between the various EMS stations.
Hopefully that helps clear up the dispatch issue.
Are all the Logan County commissioners on board with this? If not, they need to be. This seems like the way to go. What are the next steps?
ReplyDeleteWe havent taken any sort of poll or vote within the task force yet, so its difficult to know exactly who might be in favor of a multi-county system.
ReplyDeleteThe commissioners were the ones who invited the kind folks from Morgan County to come and speak with the task force, which I think shows they are willing to explore different options.
As for next steps: We still have a lot of details to work through regarding each of the options on the table (including this one) before we can decide which would fill our needs the best. Conversation regarding this type of multi-county EMS system is just in the very beginning stages.
I don't possibly see how a combined county system would work. All three systems are struggling with severe budget shortcomings and two of them have ongoing management issues.
ReplyDeleteHow can anyone expect to solve a problem by combining three problems?
In this system you would be dealing with nine county commissioners, three county financial departments and three county legal departments. How many bosses would the poor EMS Coordinator answer to? If there was a central Board put in place to oversee the system what would the equitable make up of the Board be since one county has much less population and call volume? The Board members would still ultimately answer to their respective County Commissioners and the Board meetings would become a political football. At least one of the counties would always feel like they're paying too much or not getting enough. It would be a recipe for disaster.
Can you imagine combining all three Sheriff’s Departments or having one central Fire Department? It would be constant bickering over budgets and service.
Let's fix Logan County’s problem and assure Logan County residents that they have a safe and efficient system (whatever that might be) that works best for them.
Those are legitimate concerns. The money issue was discussed above -- you save through operational efficiencies and economy of scale.
ReplyDeleteThere are several multi-county agencies in this area that function well. Centennial Mental Health and the Northeast Colorado Health Department are two good examples.
The health department functions as a district with six participating counties. Its board is made up of representatives from each county, it receives funding from each county, it provides equal services in each county and its employees travel as necessary to provide those services out of its six respective office locations. It has its own accounting systems and pays its own bills. It contracts with the Morgan county attorney to represent its legal interests across all six counties.
All of the counties get along very well in regard to their expectations and funding of the department and there just arent any political battles being fought between them.
The simple fact of the matter is that it would be impossible for any of the six counties to have the range of programs, staff and services if they hadnt combined forces (and money) to create and fund one health department. It has worked well for over 60 years.
There is no reason to think that a multi-county EMS service couldnt run just a smoothly.
There can be as many or as few details written into the agreement that would create the multi-county authority as necessary to limit or eliminate opportunities for friction between the counties.
In fact, at the meeting where this idea was presented, both sets of commissioners commented on how well they actually do work together on these types of things.
It is very unfortunate that the Logan County Commissioners and the Sterling City Council can't work together as well.
ReplyDeleteThis system already works today, The Northeast Health Dept. oversee's activities in 6 counties and it appears to run just fine.
ReplyDeleteThere are multiple examples of multi county coops, maybe not for EMS in Colo. but in other areas sure.
The cost per call drops when you have more volume of calls.
Positives of this plan include economies of scale, one billing office, moving ambulances from one area to another based on need. Integration of protocols, policies. There are 3 designated trauma centers in the two counties. and Currently Washington county transports patients to one or the other of the two counties.
Issues could be what Anonymous said... but the management would be centralized... one problem in the past doesn't necessarily mean that problem has to be transferred. we see all the time.. "Under New Management" and the management would be selected qualifications could be closely scrutinized.
Right now everyone is "Stuck with what they have", It may not be as complicated as you think.
It may be time to think unconventionally.. certainly business as usual with the given economic climate, isn't acceptable, like depending on the voters to fund. This may be something that may actually be self sustainable without voter support.
i didnt know there were other departmetns that were in more than one county. if it works for them then i dont see why it couldnt be made towork with ambulances too. anything you can do wihtout more taxes will make people happy. how would you get all of the ambulances thouh?
ReplyDeleteAmbulances... well, thats a great question. There are probably several ways that ambulances can be brought into a multi-county EMS authority. We cant speak for Morgan or Washington counties, but here in Logan County there has already been discussion between the commissioners and Life Care for the county to potentially purchase some of the ambulances -- if they did that, the county could either lease or sell them to the authority for a nominal fee.
ReplyDeleteSince this type of authority is technically a government agency, it will have access to funding streams and grants that privately owned businesses typically cant apply for, so that is another possibility.
They could be purchased outright by the new authority if the cash were available, but that is unlikely.
Its another one of those topics where there is a lot of flexibility in how it can be accomplished.
You have far more confidence in intergovernmental cooperation that I.
ReplyDeleteI’ve read about all the issues we have with our Commissioners dealing with our own City Council.
Again, how do you combine three problems to solve one problem? None of the systems being considered for this co-op is healthy. They’re all underfunded and face internal strife. If this tri-county service needs to ask taxpayers for additional funding, which is a certainty, you’d have to pass a tax increase in all three counties. Good luck with that.
There will certainly be future conflict regarding budgets, equipment,staffing and service. Do you have any idea how many square miles this service would cover?
Nine Commissioners working together is a pipe dream. What if future Commissioners feel this system is bad for their county and want to opt out? One county or another will always feel that they’re paying too much and not getting enough. In a few short years we’d be right back where we are now.
We need to do what’s right for our county and build a system that we control. Let’s focus our attention on our problem and not take on the whole regions problems. Three wrongs don’t make a right.
Confidence comes from witnessing things you can believe in. The agencies that the various counties already collaborate in are successful, and some of them have been that way for decades.
ReplyDeleteThe health department was mentioned earlier -- it is made up of six counties, and there just arent those sorts of issues with conflict between counties. I've personally been to nearly every monthly health department board meeting for over seven years, and I have never seen commissioners bicker over what they're putting into or getting out of the department. It just doesnt happen. And the amount of money each puts in is vastly different from one to the next - yet they all get served equally. All six counties seem to be well aware of the fact that they wouldnt have what they do in terms of programs and services if it werent for the contributions of each of them combined.
Its not utopia by any stretch, but if it didnt work well it wouldnt have lasted for over 60 years as the largest district health department in the entire state. In fact, the multi-county concept has proven to have so many benefits that the state actually restructured public health statutes recently to further encourage this type of collaboration.
As for funding, 'nothing' is certain at this point.
The task force isnt necessarily saying this type of system will be the way we go... this thread is just an opportunity to toss out pros and cons... so keep them coming!
I think it's kind of funny that people are so accepting of breaking new ground with a multi-county ems system and hate the idea of fire-based ems. Look around, there are more fire-based ems systems than multi-county systems but no one on here is saying that fire-based is working already. I'm not necessarily in favor of one over the other but I am smart enough to know that a fire-based system would work just as well as a tri-county system. With better management, even a private system would work. Having the ems system be government run will improve the service. Background checks, physical standards and moral turpitude should all be part of a government system.
ReplyDeleteThere is actually quite a bit of support out there for each of the models that has been discussed... what the task force has to struggle with now is which one makes the most sense for Logan County.
ReplyDeleteWhat we are hoping to hear in this thread is what ideas or questions people have about the multi-county concept.
As we move farther along in the decision, there will be opportunities to discuss the other options in detail.
Either combining services across 3 counties or combining EMS with the fire department would make each entity involved more efficient. Merging services means less administrative and personnel costs, etc. The city and county work together to provide many services now but there is contention because each thinks the other should pay more. I've read in these posts about services that span several counties and they appear to run smoothly. Are these services funded similarly to how EMS would be funded- line item in each county's budget or special tax? If so, how do they determine what is equitable? If the counties currently do not comingle funds, then they don't really know how well they work together.
ReplyDeletethe multi agency type of program works it works for fire dist. as in west metro fire north metro fire south metro fire these are all multi agencys working together under one board so lets give it a try
ReplyDeleteThe minutes from the last meeting havent been posted yet so correct me if I'm wrong. Didn't Commissioner Dave Donaldson vote to NOT talk to the city council? Was he representing his constituents when he made that vote? I am in his district and I WANT the city and county to communicate as much as possible. I'd like to see our services stay in our own county but I understand if that's not possible. It really makes me mad that he would vote against communicating with the city council under any circumstances. All the elected officials work for the citizens, please don't forget that.
ReplyDeleteThe city and the county could form the same type of authority. The city could contribute based on the population of the fire district and the county could contribute based on the county's population.
ReplyDeleteThe minutes from the Feb 10th meeting have not been posted because they have not be voted and accepted by the task force yet.
ReplyDeleteAs for the vote that occurred, it ended up being a six-to-six vote. The issue on the table was whether or not to form a sub-committee to draft an MOU (written agreement) and come up with a new preliminary budget for a fire-based EMS system involving the City of Sterling.
Commissioner Donaldson was not alone in his vote to hold off on doing those things for right now. There was a sense from several members that this move was premature given that the task force had not yet decided that fire-based EMS was indeed the best solution.
The city manager and city council have both been represented on the task force from the very beginning because they are important partners in this process. There is no reason to think they wont continue to participate in the future.
Personally I like the multi-county idea. As a life long resident of Logan County, and now a new resident of Morgan County I think this model would work well. In fact, I could really see this blossoming into more than just the three counties. I think anytime you can combine resources, it makes things much more economical.
ReplyDeleteLogan County is not unique in facing these issues, the following url is from a recent article published in an EMS Journal.
ReplyDeletehttp://www.jems.com/article/administration-and-leadership/where-ems-headed
The health care industry is headed into unknown ground. Hospitals are concerned with the new health care laws, corporately owned health care organizations are restructuring agreements to save money. We will all have to adapt and EMS will have to adapt as well. I believe that EMS will become more of a safety net for care than what it is used for currently. It may be more of a cooperative safety net with other providers of health care not traditionally seen as the 911/Inter-facility transport system it is today.
The most expensive aspect of health care starts after the response, what happens if intervention prevents the expense? Many people today do not call 911 or wait until the later stages of illness to ask for help. We buckle up to prevent serious injury, think of wellness and early intervention as buckling up.
Whatever the model, adapting to a changing health care model will be key to long term survival.
That's interesting. Fire departments devote resources to fire prevention. Maybe EMS can become an educational resource for accident/illness prevention.
ReplyDelete**Reposting from Feb 21 with corrected info**
ReplyDeletePart of the benefit of forming an 'authority' is that there is a great deal of flexibility in how the financial side can be structured.
The health department, for example, is funded on a per-capita basis. Each county pays in a set amount according to their population. All of that money goes into the same account and is expended as approved by the various commissioners in its annual budget. This money helps fund salaries, benefits, equipment, building maintenance, travel expenses, etc., etc., for all six counties. Again, there is just no struggle over what is "equitable" -- each county is benefiting from far more collectively than just the dollars they put in individually.
Lets say one individual county is putting $100,000 into the health dept. What they're getting out of that is the benefit of almost $700,000 that goes in collectively from all six of them. Thats not even counting what is collected in fee's and grant dollars that also benefit all six counties. So for the $100,000 that "county A" puts in, they're basically getting an agency with a $2.7m budget that is providing them with over 40 staff and resources. Not a single one of them could hope to come anywhere close to that on their own.
All of this is not to say that a multi-county EMS authority would necessarily run like the health department, but its just an easy example to help people understand that these types of organizations do exist, and they do run without friction between counties.
If this option does surface as a viable one, there is no reason to think the same level of cooperation between the various commissioners wouldnt continue to be the rule rather than an exception.
The commissioners from Logan, Morgan and Washington counties have met this week to discuss this possibility in more detail and have plans to meet again in the future. You can take a look at the article in today's South Platte Sentinel at:
ReplyDeletehttp://www.southplattesentinel.com/ (02-23-2011 issue)
Or in the Journal-Advocate at:
http://www.journal-advocate.com/ci_17462140
If you have comments or questions, please come back here to post them since the task force will not be directly responding on the J-A blog.
Thanks!
The multiple-county service is a sound idea. The Northeast BOCES is another great example(as are other BOCES) of multiple entities uniting resources for the common good.
ReplyDeleteWhich EMS program this committee decides on hopefully will not tax property owners but instead do a sales type tax. There are many more people serviced by the ambulance than property owners and I am tired of paying for everyone else is property taxes!
ReplyDeleteThe commissioners are working to develop a system that will not need additional tax support at least in the short term. Thats not set in stone yet, because a lot of factors need to be figured into the budget -- but if it does need support from the voters it is highly unlikely that it would be sought in the form of a property tax.
ReplyDelete