I wrote this letter to the editor over a year ago, when the scandle with our local rescue squad came to a head. My letter did not get published, as several other folks wrote letters covering some of the same themes with more intense expressions. Given the recent bankruptcy and bank foreclosure on the rescue squad, I thought that the letter was still pertinent to my readers, whether you live in an urban, suburban, or rural community. We all face the issues here regarding social expectations, budgets, and sense of community. If you come visit, this is not a good time to have a heart attack or chain saw accident in your area. After the letter, I will fill you in on the chronology of events.
You have written a couple of times, questioning where the volunteers have gone. Diane Hype’s profile of Lynn Lyon (1/4/12) points out that paid care providers are filling the role of family and neighbors who are not presents because of work or living elsewhere. The Mathis-Baker Rescue Squad has requested that the County Commission help fund their immediate operations budget during a hard time. I think that we, family members, voters and tax payers, need to consider whether we should be funding stop-gap measures or accept that we want to pay someone else to provide us with services.
For me this is not some set of abstract concepts. My parents are nearing their 8th decade but live on the west coast. My work responsibilities take me out of the county for 10 to 12 hours on work days. I support the Rescue Squad by attending their monthly dinners and sending additional donations during the year. But, a few hundred dollars in contributions does not make up for their budget shortfall.
These trends have not just fallen upon us, but have been developing over several decades. First, when the Rescue Squad began operations as a voluntary organization 40 years ago, cardiac and vascular surgeries, cancer treatments, and dialysis were experimental procedures. Now they are routine. But, someone in the midst of a heart attack or stroke needs to get to the medical facilities in Winchester, Harrisonburg, Morgantown, or Charlottesville quickly to reduce the debilitating effects of these emergencies. Other treatments might require going to a facility two or three times per week. Forty years ago, brave volunteers were providing basic first aid, now they are counting the minutes to get someone to have a CT scan or making multiple transport runs twenty to sixty miles to keep someone alive.
A second trend is the reduction in the number of people volunteering. As you have noted this is a combination of those already volunteering aging and being committed to several organizations, workers holding jobs too far away to respond, and young folks being more interested in entertainment during their free time. When we join the community meals at the firehall in Baker, we notice that we are often among the younerg people there, at age 50. Other than some children or grandchildren with families, we see few people who are less than middle aged or older.
A final trend I see for Hardy County is the increase in Weekenders and Retiries. We are among that group. We come without family networks to care for us. We come at a time when health issues will start to affect us. We come without knowledge, and sometimes judgment, about the risks of country life. We come from cities where local governments cleared our roads, provided water and took our sewage, and policed our neighborhoods and took us to the hospital. We come with a lot of expectations, regardless of how much we might idealize rugged individualism. But, behind every rugged individual is a government agency paying the way.
The volunteer fire squad was formed in the 1970’s when several folks donated some property and built a three-bay garage in which to park a few fire trucks. They were dedicated neighbors who helped to limit fire damage and provide first aid. The rescue squad came along a couple of decades later, with the fire and rescue squad building separate, larger structures to house equipment and volunteers that accumulated over the years. Most of this was funded by chicken dinners, holiday fill-the-boot donation drives, and state and federal grants. Every few years, the technology, equipment, and training needed to run the squads increased in complexity. Firetrucks or ambulances may cost in excess of $250k these days. Mortgages increased in kind.
About ten years ago, the rescue squad faced a crisis. Volunteers went through months/years and thousands of dollars to become EMT or paramedics. The squads could not keep them on as volunteers, when they could travel to adjoining suburban areas and be hired to stay up all night, etc. The rescue squad came up with a scheme to develop a paid staff to do transport runs for patients to dialysis, MD appointments, etc. The rationale was that the squad could bill insurance for transportation to medical appointments through medicaid and medicare. This allowed them to retain the volunteers whom they had helped to fund in their training.
This plan seemed to be working, with paid staff covering days, and volunteers being on call at night. The payments were rolling in, to the extent that the rescue squad purchased a building and opened a satelite location in the next county, which had a hospital and nursing home which needed to transport people to and from places.
The scandle came to light at a County Commission meeting, in which the director of the recue squad made a last minute plea for funding to cover the mortgage. If the funds were not committed by the next day, they would have to close their doors. The commissioners were caught off guard, and came up with the funds.
What had occured was that someone, who was not hired to do the transport runs, took photos of patients walking from the ambulance into the local dialysis clinic. These photos were sent to the Center for Medicare and Medicaid services. CMMS investigated and found that they rescue squad negelected to have MD orders to establish medical necessity for payment for the transport services. The squad argued that, while the patients could walk into dialysis, they could not walk out of dialysis, of which no photos were included. Regardless, they still did not meet the CMMS requirement of having the proper documentation. CMMS handed out a fraudent claims verdict and a $1.5m fine. You have to sell a lot of chicken dinners to cover $1.5m.
Also, under the Stark Act, any organization found to submitting fraudient claims to the federal government is barred forever from participating in medicare billing. That is forever. Most health care organization are deathly afraid of the Stark Act because it would mean closing their doors if they could not participate in medicare reimbursement.
The rescue squad could no longer bill for their transport runs. The paid staff were let go. They could not meet their mortgage payments. They eventually disbanded as a corporation and reformed as a volunteer squad again, but still could not make payments to the bank. Meanwhile, every other local fire squad (administratively different) lined up at the County Commission meeting asking for funds to cover Worker’s Comp insurance, new equipment, etc.
A few months ago, the rescue squad filed for bankruptcy, and the bank foreclosed on the property and equipment. The County Commissions, required by the state to provide ambulance services, formed an Ambulance Authority, which is trying to set up a means of providing EMT services. They worked out a deal with the bank to pick up a couple of ambulances (the bank is local and trying to work with the various parties) to be housed at a couple of local firehalls, until a fuller solution can be put into place. That puts those vehicles 20 minutes further away from us, staffed by dedicated volunteers, who probably live 20 minutes from the firehall, or work out of the area.
We do have two helicoper transport options to the medical centers 1 to 2 hours drive away. The helicopers can you have there in 20 to 30 minutes. A co-worker’s father was heli-vacuated out some years ago after getting bit by a rattle snake. She told me that the bill for transport was $60k.
Watch your step, when walking around health care these days.