BCEMS director defends board, agency's late collections

Bedford County Emergency Medical Services director Chad Graham briefed his board members on Monday night about the presentations he will make to two county committees later this month -- one in defense of having a board, the other to explain the status of BCEMS's collections.

The BCEMS board began Monday night's meeting by presenting a plaque to former board member Joe McCurry, who resigned last year after 12 years on the board.

"Whatever we needed, you were there for it," said board chair Larry Hasty.

"I hated to see you go," said board member Doyle Wilhoite. "I would really like to have seen you stay a little longer."

When the issue of choosing a replacement for McCurry was presented to the county commission's rules and legislative committee, commissioner Joe Tillett raised a question about whether an EMS board was needed at all. Now that many of the county's financial operations have been centralized, commissioners said the ambulance service could be put under the jurisdiction of the commission's law enforcement committee rather than having its own separate board. Graham is scheduled to appear before the rules committee next week to discuss the issue.

Graham said the board provides for community involvement and noted that its members aren't compensated. He said the board is able to focus its entire attention on the needs of EMS in the county and supervises non-financial department matters. He also responded to complaints that commissioners don't know what's going on with the agency by noting that board members are appointed by the commission, that board meeting minutes are provided to the county mayor's office, and that he makes a quarterly report to the commission. He said he is available to attend other meetings upon request.

Meanwhile, at last month's meeting of the financial management committee, questions were raised about why BCEMS had been behind in its collections. Of the $659,440 in receivables as of last Thursday, $264,100 of the bills are less than 30 days old, and $171,755 are more than 150 days old. Graham said the situation is mostly due to Medicare billing, including increasing regulations which the county must meet to obtain payment. He said the service has reviewed its current billing process to ensure efficiency and enrolled in an insurance verification program to improve the accuracy of its billing information.

When considering only private pay customers -- those who pay their own BCEMS bills -- there are $75,613 worth of accounts older than 150 days, but in the vast majority of those cases the ambulance service is continuing to collect something from the customer, and that's why those accounts haven't been turned over to a collection agency.

Graham said he has two full-time people on staff to handle billing, and briefly had one part-time employee as well. One of those full-time employees was out on maternity leave for a while. Meanwhile, a county spending freeze has prevented him from hiring any new staff.

Graham said Marshall County EMS, which makes a smaller number of calls each month, has had three people in its billing department for the past seven years, so Graham defended his staff's efficiency and work ethic, and board members agreed.

"Our department works more efficiently with fewer people," said board member Whitney Neeley.

The overall BCEMS budget is on track for the year, said Graham. At the end of December, halfway through the fiscal year, both revenue and expenses should be at 50 percent; in fact, spending was just under budget, at 49.8 percent, while revenue was ahead of budget, at 60.87 percent.

One troublesome budget item is the maintenance costs for ambulances. Because of the county's tight budgets, the ambulance service has not put a new ambulance or chassis into service for several years, abandoning what had been a rotation schedule for replacing the ambulance units. The county did buy an ambulance chassis last year, because it was a model which was about to be discontinued, but hasn't had the money to mount one of the existing ambulance boxes to the new chassis. As the existing fleet ages, said Graham, it costs more to maintain, and the vehicle maintenance line item was at 60.26 percent at the end of December.

Graham told board members he expects that all county departments will be asked to remain at their current budget levels for the 2010-2011 fiscal year. He plans to submit a budget of that sort to the board next month, but will also include a prioritized list of alternatives showing how much it would cost to buy a new ambulance unit, increase staffing, and so on.