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Viewpoint: What does St. Croix EMS cost?

By Bill Campbell, EMS Ad-hoc Committee member

What does the St. Croix Emergency Medical Service cost? And who pays for it? I had no idea until I joined the EMS ad hoc Advisory Committee — five Hudson residents who volunteered to search for a way to make the SCEMS sustainable. You may recall the controversy last summer, when the City Council considered a proposal to sell the SCEMS to Hudson/Lakeview Hospital.

Many objected, including me, but few knew the details of how the service is currently supported.

The SCEMS 2018 budget for operations, maintenance, and capital outlay is $1,510,933. The predicted revenue for 2018 is $1,509,976. Most of that revenue comes from patients who are transported: $1,035,582, or 68.58 percent. Less than a third—$474,394, or 31.42 percent—comes from the property taxes of the residents in the SCEMS service area (City of Hudson, Town of Hudson, Village of North Hudson, and parts of the Towns of Troy and Warren) at the rate of $17 per resident. Budget numbers provided by Hudson Finance Director Brenda Malinowski.

Whenever the ambulance transports an individual, he or she is charged an average of $1,300 for the service. Medical supplies and mileage can increase the charge to more than $2,000. Patients with health insurance pass the bill along. Most private insurance companies will pay the bulk of that charge. Medicare pays only $420, Medicaid even less. Individuals who have no insurance owe the full amount.

The difference between the rate SCEMS charges and the Medicare/Medicaid rates lead to one of the fiscal difficulties the service has wrestled with in recent years. This problem will only get worse as our population ages and the number of Medicare/Medicaid recipients inevitably rises.

The long-term remedy for this problem rests with the US Congress, which severely restricts

Medicare rates and has reduced Medicaid payments to ambulance services. In the short term, the State of Wisconsin could provide relief. The federal Medicaid program offers states supplemental reimbursement for ground emergency medical transportation costs—but the state has to apply for them. Many states have done so, and their ambulance services have doubled their receipts for Medicaid patients. Wisconsin has refused to apply for those reimbursements, even though it would cost the state nothing.

Increasing Medicaid payments would certainly make SCEMS more sustainable, but it would not address the more fundamental issue: Should SCEMS continue to be a public service supported and operated by the city, like our fire and police services? Should it be outsourced to a corporate entity? Is there another model we might adopt? When we call the ambulance, how much should we have to pay as individuals? How much should taxpayers support? Should the entire cost of the ambulance service be borne by the individuals it transports, on a per-trip basis? Should at least some of those costs be supported by taxpayers? What's the appropriate balance?

Future viewpoints will address these issues, and more.