South Barry County Ambulance District makes final push for sales tax

April 1, 2015
Charlea Mills
    In a final push for the passage of a 1/2-cent sales tax for the South Barry County Ambulance District (SBCAD), the Board has hosted numerous open houses and forums to answer community questions. Board members visited the Cassville Area Chamber of Commerce’s Ballot Issues luncheon, the Cassville Library for a community Q and A, the Cassville Senior Center and the Central Crossing Senior Center to explain their position on the sales tax.
Main questions that have come up in the community have been regarding why the current funding is insufficient for the service, what does the district pay for, and how much money will be generated with the tax money if the sales tax passes.
    On April 7, voters will determine the fate of the proposed rollback, which would eliminate the current real estate and personal property tax levy in place, which generates around $220,000 annually, and replace it was a 1/2-cent sales tax that would apply to sales within the District. Monett and Purdy would remain unaffected by the tax if it passes because they are both part of the Barry-Lawrence Ambulance District.
    Recent estimates provided by the SBCAD would have the 1/2-cent bringing in between $560,000 to $615,000 annually. For 2013, the tax would have generated $569,421 and in 2014, the tax would have generated $614,650. Earlier estimates had the number lower because tax estimates were not yet available for 2014.
    Some confusion in the community led to questions about what the ambulance district pays for and what Cox Health, the current ambulance contract holders, provides. The ambulance district owns the six ambulances that are split between the Cassville ambulance barn and the Shell Knob ambulance barn. The district owns the facility in Cassville, but the other facility in Shell Knob is owned by Central Crossing Fire Department. The district is responsible for the ambulances, the upkeep of the facilities, and most of the equipment within the ambulances, such as the cots and other life-saving equipment, like Cardiac Monitors.
    Aging equipment is an on-going concern for the district because of the high cost of replacement. Cardiac Monitors run around $35,000 each and ambulance refits are around $130,000. Out of six ambulances, two have over 200,000 miles on their odometers and two others are nearing 300,000 miles. The district says that an increased call volume is primarily responsible for the need for additional funding. Last year, the service travelled 315,417 miles between the six ambulances.
    Of the approximate 3,000 calls each year, nearly one-third are for nonresidents. Ken Cieslinski, chairman of the board, said, “One of the biggest issues is that the residents are paying for the service, but those visiting the lake and other places are using the service. This is a more fair way to provide funding and ensure we have the life-saving equipment we need to get people where they need to go.”
    Without funding to replace equipment, the board says that services will definitely decrease. Currently, the ambulance service transports  22.1 percent of people to the local Mercy Hospital in Cassville. Other transports are based on the level of emergency or the preference of the injured party based on their insurance coverage. For example, if the ambulance service transports someone to Springfield, currently Cox receives around 7.9 percent of the transfers and Mercy Health receives 16.7 percent of the total transports.
    For the SBCAD, CoxHealth EMS provides the consumable supplies within the ambulance as well as fuel and maintenance to run the ambulances and utilities at the two facilities. Cox also provides the personnel for the ambulances, including salaries and benefits for 16 full-time EMTs and Paramedics, two PRN EMTs and one PRN Paramedic.
    The SBCAD pays CoxHealth an annual $95,400 to help mitigate the costs to provide the staff and supplies to keep the ambulance service running, however, the service runs at a deficit for Cox. So when questions arise regarding why residents still receive a bill for an ambulance ride when their property tax funds the district, the answer comes down to money. CoxHealth is presently running at a $77,600 deficit for first five months of the 2015 Fiscal Year, a trend that is on-going due to a fairly low percentage of collections on billing (around 33 percent)  and the high cost of running emergency medical services. The deficit provided doesn’t include administrative, education or billing staff that also runs the ambulances.
    Ricky Savage, regional manager for CoxHealth EMS, stated, “If you run ambulances to be profitable, you wouldn’t have any ambulances.” Even so, the service maintains a high-level of accountability for their staff. Savage said, “Each zone of the county has a different time limit for when we need to arrive. For the suburban area, we have 12 minutes, 25 minutes for the zone outside of that, and 45 minutes for the outlying zone. We are the only ambulance service in Missouri that does that.” On top of that, the staff has one minute to leave the station once a call comes in.
    Once the ambulances leave the stations, they are updated with notes from Cox dispatch on a tablet so they are prepared once they get to the scene. To ensure coverage, the ambulance service makes sure that there is one ambulance at each station with staff ready to go while the other ambulance is out on a call. However, increasing call volumes are making that harder to accommodate. Savage said, “We’re needing to add another ambulance if the Board sees fit to do so. We really need more coverage based on the services we’re providing.”
    Cox uses previous call history to determine how many staff are on site at all times. Savage said, “We know we’re more busy during vacation season when people are all down around the lake, so we plan for that.” However, without the equipment and the staff, the board and Cox say that services will suffer.
    CoxHealth, which is a non-profit entity, issued a statement regarding the tax initiative. They said, “CoxHealth absolutely supports the SBCAD’s sales tax initiative. We have seen the positive results with the Dade County Ambulance District and Douglas County Ambulance District. Douglas County (Ava) passed their sales tax in the early 2000’s and, as a result, was able to double their ambulance coverage. Douglas County is now able to provide their ambulances with top of the line equipment and upgrades which ensures their citizens are receiving the absolute best care possible. We are very excited and ready to show the people of South Barry County Ambulance District those same positive results.”
    Savage said, “We have identified that at times we do not have enough ambulances on duty to respond to all the emergencies. Our call volume has continued to climb as so have Mercy Cassville’s patient census for the Emergency Department. They are seeing more people than ever, and some are very sick. This means more people need to go to a higher level of care such as hospitals in Rogers, Joplin or Springfield. Mercy understands we have a limited amount of ambulances, and we work together as a team very well. We meet on a regular basis and progressively work out kinks in the system to provide the best service we can with limited resources. Without the good relationship and teamwork that wouldn’t be possible. The South Barry County Ambulance District also does a fantastic job at making sure the needs and the safety of the citizens stays our first priority.”
    If the tax passes, the funds would begin to be collected this year, probably in October, and the property tax levy would rollback once the tax is in full-effect.

CoxHealth EMS staff Ricky Savage (left) and John Ray (right), respond to a call and take a patient into one of the South Barry County Ambulance District’s ambulances.

CoxHealth EMS Regional Manager Ricky Savage places an IV in a patient during a transport.