Ambulance district to change emergency service provider

Wednesday, November 18, 2015

South Barry County district to move to Mercy amidst 
transparency issue

Beginning in March 2016, and for the first time in 27 years, the South Barry County Ambulance District will not have CoxHealth providing emergency medical technician services on its ambulances.

On Nov. 10, the district's board accepted a proposal from Mercy Emergency Medical Services to provide EMTs and paramedics at a cost of $0 to the district.

The district submitted requests for proposals for contract deals in mid-September, and Ken Cieslinski, board member, said the board met with Mercy representatives and CoxHealth representatives before making their decision.

"This was not an easy decision, as Cox brought EMS to this part of the the state, and we owe a lot to them for helping to put EMS services in southern Barry County where it is today," Cieslinski said. "We have paid $95,400 per year to Cox for EMS services, and a lot of our constituents would ask, 'Why Cox?'

"We discussed requesting for proposals before the last time we got a rate increase from Cox in 2011, and I voted no on that increase. We requested the proposals this time just to make sure everyone is on the same page and we are all kept honest, and because our constituents requested it. There has absolutely never been an issue with service provided by Cox."

Cieslinski said unlike the past, both proposals came in requesting $0 for the subsidy, instead of the $95,400 previously payed to CoxHealth. Instead of requesting the subsidy, the CoxHealth proposal on page 3 said because of changes in the payor mix of south Barry County in the last 18 months, as well as additional federal reimbursement allowance (FRA) money released by the state of Missouri, CoxHealth would be able to run the service independent of a subsidy from the district.

The Mercy proposal, on its last page, said in light of the district maintaing equipment and facilities, it would not request any subsidy for contract services.

The contract awarded by the district is a five-year contract, which is renewed each year.

According to the Missouri Hospital Association, the FRA program began in 1991 and has evolved to maximize federal matching dollars and reduce the burden of MO HealthNet on state general revenue.

"Our first thought was, how do you go from almost $95,000 per year to $0 per year?" Cieslinski said. "There seemed to be a lack of transparency regarding the contract fee. That begs the question, 'How did we get to $0?'"

Cieslinski said Mercy representatives said the provider has, in some other districts, eliminated subsidies as many as four years ago.

"We renewed the contract with Cox without knowing anything about FRA money," Cieslinski said. "There was a lot of emotion at the meeting [on Nov. 10], and rightfully so, and we did not throw caution to the wind regarding our employees. That weighed very heavily on us, but at the end of the day, they are constituents just like anyone else, and we have to do what's best for all our constituents."

According to Cieslinski, all 18 of the EMTs and paramedics may be hired by Mercy, provided they meet Mercy standards. He said he hopes to keep each one of the 18, and does not anticipate any not meeting standards.

According to Bob Patterson, Mercy EMS executive director, Mercy will also honor the employees' pay and benefits, including honoring each employee's hire date for seniority, paid time off, sick leave, vesting and benefits.

"Mercy is offering the same 18 people jobs with Mercy, and the pay scales are very comparable," Cieslinski said. "That kept resounding to me, that what are the odds of a company respecting seniority and benefits -- it's very unlikely. That Mercy would do that seemed more than fair.

"I am optimistic everyone will stay on, because the board is happy with the services they provide."

Cieslinski said the switch comes with a couple other benefits, such as Mercy having three helicopters at its disposal, compared to Cox's one. The district has the advantage of being located near the center between Branson West, Joplin and Rogers, Ark., cutting flight time almost in half compared to flights from Springfield. In addition, Mercy helicopters can fly instrument-only in weather that other providers cannot.

Patterson said he's excited to begin service the residents of southern Barry County.

"We're very excited to be able to serve the people of this community, and with resources like Mercy Hospital Cassville, as well as three Life Line helicopters and three other ground ambulance services in close proximity, we'll be able to get patients the help they need quickly," he said.

The board met with Mercy and CoxHealth representatives after receiving proposals by Nov. 2. On Nov. 9, the board met in closed session to review the proposals ahead of the Nov. 10 regular board meeting.

Jean Maneke, legal counsel for the Missouri Press Association, said because the proposals were to negotiate a contract for services, the district was not obligated to release the proposals until a contract was signed.

"The proposals become open after a contract is signed because they may have been negotiating back and forth for the best deal," she said. "Sealed proposals related to contracts may remain closed until the contract is signed."

The change in services comes on the heels of the implementation of a half-percent sales tax for the district, which was passed by voters in April by a 66-34 margin.

According to 2013 tax revenues from the ambulance district, the proposal will generate about $570,000. Using 2014 figures listed at, municipalities and un-incorporated areas in the district reported $122,989,620 in total taxable sales. If a half-percent tax was applied to that amount, it would generate about $614,948.

As of Nov. 10, the district had $64,510 in its checking account and $144,477.01 in its capital equipment account for a total balance of $208,987.46.

Ricky Savage, Cox EMS western regional manager, did not return a message left for comment.

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