The financial status of the Clinton County Ambulance Service, which is subsidized monthly by the county through its occupational tax revenue, has been the subject of discussion in recent months and even years. However, the local ambulance service is basically no different from any other county operated EMS, which has to subsidize the service to keep it operational.

At last week’s meeting of Clinton Fiscal Court, Phyllis Amonett of Ampyss Financial Solutions, the local company employed by the court to handle ambulance service billing, addressed the court on the billing process…as well as reasons why the local ambulance service, and many others of its comparable size, are not a profit maker, and can’t break even on an annual basis.

Amonett, Director of Emergency Services Lonnie Scott and Crystal Pillar, who handles the EMS billing at Ampyss, discussed the reasons why the local ambulance service can’t break even and the billing process itself.

The bottom line reason is the “run volume” for an area this size, that doesn’t produce enough revenue to cover the operating costs of keeping an ambulance service at full staff. That is coupled with the lower base rates paid by Medicaid and Medicare, as well as some people who use the service simply not paying at all, or not picking up their cost of an ambulance bill after the insurance has paid its part.

“Due to low run volume, it costs as much to operate in a county this size as it would an area with a 25,000 population,” Scott said during an interview last week.

Total runs last year made by the ambulance service were 2,593 and through the first nine months of this year, only 1,780 runs had been made.

The costs for ALS (Advanced Life Support) runs are $550; non-emergency, $450; BLS (Basic Life Support) $300 and non-emergency, $200, plus $13.50 per mile for each run. However, the actual revenues received from the aforementioned rates come up short. For example, Amonett noted to fiscal court last Wednesday that a $550 bill, if charged to Medicare or Medicaid, would only see $312.29 of that amount paid, as that is the set rates by the federal program.

The collection rate is relatively high, with numbers of people who actually pay on their ambulance bills–at 87 percent–however, because of write-offs and set fees that an insurance company can be charged (no more than the base cost of the run), that percentage of revenue collected by the ambulance service isn’t anywhere near reached.

Amonett told the court that as far as an ambulance service this size with the low number of runs, there was no chance of breaking even, much less seeing the service operate in the black.

County Treasurer Dallas Sidwell said that for the ambulance service to break even, it would have to average taking in about $70,000 per month. The current revenues taken in by the service, on average over the past year, was about $49,500 per month.

Scott noted that a lot of smaller county ambulance services, which don’t have a specific ambulance tax such as nearby Adair and now Russell counties have, are struggling and have to be subsidized by local governments in some form.

When the local occupational tax was implemented back in the 1990s, there was public perception it (tax) was needed to make sure the ambulance service remained solvent and in operation. Currently, the lack in funding to the tune of around a quarter million per year, is subsidized in part with occupational tax funds–as is other services offered by the county subsidized with use of the occupational tax revenue.

Amonett noted that in cases where people have insurance, the insurance company tells how much they will pay on a claim, how much is written off, as well as what amount the insured person themselves owe above the amount the insurance company pays. She continued that in most cases, getting people to pay the amount above the insurance settlement is difficult.

Scott also noted that 96 percent of the counties in Kentucky operate their own ambulance services, many of them smaller counties such as Clinton.

Non-insured individuals are billed the same amount as those insured and those on Medicaid and Medicare and over one-half of what is still out in debt and being billed by Ampyss is that owed by individuals.

The fact that the majority of people who use the ambulance service are either Medicare or Medicaid patients, also adds into the mix of coming up short on actual revenues, considering the amount by those groups is about $200 less than the actual cost of an ambulance run.

Pillar also noted that the situation with the ambulance service not being able to fully break even “was not fixable, but the situation could be better.” She agreed with Amonett that people who owe ambulance run bills should take responsibility and if those bills were paid, the service would be in much better financial condition.

Amonett also said she understood that most people couldn’t pay an entire amount of an ambulance bill at once, but that Ampyss “would gladly set up payments” for anyone owing for a ambulance run.

All three also noted that at least the ambulance service is able to generate over two-thirds of the revenues it costs to operate, pay staff and keep a local ambulance service in the county.

In the meantime, Ampyss will continue to try and collect as much as possible on bills owed to the service and county officials, as well as ambulance personnel themselves, will continue to explore ways of increasing revenues and decreasing operating costs.

County officials and others have indicated in the past that the vast majority of Clinton County citizens want a locally run and operated ambulance service.