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Voyageur's Best Features of 2003

Ambulance crew

Among the first in Minnesota
Local ambulance district saves valuable services
by Lynne Gilfus  | March 18, 2003

A few months ago in Cromwell, an elderly man fell and broke his hip. The Cromwell Fire and Ambulance Service responded, transporting him to Moose Lake Hospital. There, the attending physician decided that the man would require treatment at St. Luke's Hospital in Duluth. Cromwell's ambulance then transported him to St. Luke's, and returned home to get ready for the next run. When the bills were finally being settled by Medicare, they decided that Cromwell would only be paid for the initial trip to Moose Lake. The ambulance service would have to take the loss for the rest. Unfortunately, this case has not been the exception to the rule since the Balanced Budget Act of 1997 was passed.

"It impacted 25% of our budget," said Mike Peterson, who saw the handwriting on the wall several years ago.

He began to piece together information about the budget cuts, and took a serious look at the finances of Cromwell's ambulance service. His discoveries were grim. Medicare and some health insurance companies no longer cover the total cost of the ambulance service. Also, Medicare does not reimburse for any medications used during a run. Mike's records showed that more and more of his operating budget was being consumed by replacement of the medications and expendable medical supplies that insurance was no longer covering. The final call to action came in the realization that the number of runs every year was increasing between 7 and 12 percent.

The bottom line? "This year, we don't have financial problems. In five years, yes we would have," said Mike. Cromwell Fire and Ambulance Service would need increased financial support to offset the reduction in insurance and Medicare coverage.

Mike then assembled a presentation about the Cromwell Fire and Ambulance Service, past, present and future, and requested a short time slot at monthly council meetings in the cities and townships that the ambulance service attends. The total service area is 261 square miles, including the City of Cromwell, the City of Wright, and the organized townships of Beseman, Eagle, Lakeview, part of Automba, Kalevala, Skelton, Haugen (Aitkin County), and the unorganized townships of Corona, Progress and Red Clover.

After holding about six meetings and sharing his dismal financial predictions, the cities and townships all agreed that something had to be done.

"We could sit and do nothing and watch it all go away," said Paul Johnson, Chairman of Beseman Township, "or we could take action."

Representatives of each city and township began a series of meetings to determine the best course of action to take, and the extent of financial contribution needed. This was not the average task force, either. The members of the committee were dedicated to solving the problem as quickly as possible with the least financial impact to the communities served. Mike Peterson was pleased with the immediate response, and continued to be instrumental to the process. Their persistence and dedication caught the eyes of the Minnesota Department of Health Office of Rural Health and Primary Care.

"I heard about the meetings going on up here," said Linda Grohoski, Senior Research Analysis Specialist for the Office of Rural Health. "I came up for a visit and found a fabulous ambulance service here. They are dedicated and professional."

As a result, Ms. Grohoski used Cromwell Fire and Ambulance Service case studies in the Department of Health's recent study titled "A Quiet Crisis: Minnesota's Rural Ambulance Services at Risk" which was released in December 2002. The financial crisis of rural ambulance services is spreading nationwide, and the State study was one of the first done, and by far the most complete.

"We started with an initial survey of rural ambulance services," said Ms. Grohoski. "We had a 98% response, which is unheard of!" The average response is generally around 20%.

As a result of the thorough coverage, the study has now been given national attention, with Senator Dayton requesting copies for presentation to a Congressional committee in Washington.

As Ms. Grohoski's study was being completed, Cromwell Fire and Ambulance Service was getting closer to a resolution for the projected financial woes. Using extensive data compiled from past years of service and projections based on visible trends, Mike Peterson presented a figure to the committee of $12,000 for the first year (2003) to balance his budget and cover emergency medical service operating costs. The cities and townships agreed with the figures, and work proceeded to the next step.

The Northwest Carlton County Ambulance District was formed, a Board elected, and legislation started to create the tax levee required to fund the District. Based on the number of households in the area, the levee will amount to approximately $15 per household this year, which will appear as a new line item on property tax bills.
Board Chairman Doug Suhonnen said, "This guarantees everyone in the district will have ambulance service no matter what their income."

Mike Peterson expressed his concern that people would stop using the service over concerns for the cost. 

"We want to make certain that people will call us no matter what. Even if you just think you need an ambulance, CALL US", Mike stressed. "Your job is to call early and call often. Our job is to respond and treat you. If you wait too long to do your job, we can't do our job."

Now that there is a method to solve the financial problems of the ambulance service, the members feel that there will be some changes.

"I think we'll see a drastic rise in the number of calls this year," said Mike McNulty, a member of the service.

There is also a very strong feeling of responsibility to solve the problem and keep the ambulance available.

"We have an obligation to our townspeople to keep this service alive," said Paul Johnson. "It's not just roads that keep a township together."

The agreement to enact the tax levee is nearing final signatures, and the Cromwell Fire and Ambulance Service is enjoying a little more breathing room these days. As always, Mike Peterson is looking to the future.

"Everything is working well now," he said. "We just want to make sure it's working well for the next team coming in."

This article first appeared in the March 18, 2003 issue of the Voyageur Press.