Muskogee County Emergency Medical Service had to dip into its reserves to pay its bills for the fiscal year that ended June 30, said Terri Mortensen, director.

The ambulance service operated $442,000 in the red last year, she said.

Still, it’s not time for CPR for the service. The money came from its reserves, which now total about $3.8 million.

However, the service lost $130,000 in the fiscal year that ended June 30, 2007.

Muskogee EMS’ financial situation isn’t nearly as bad as that of many of other services around the state, said Shawn Rogers, director of the Oklahoma Department of Health’s Emergency Services division.

“It’s just terrifying how many ambulance services are teetering on the (financial) brink at any one time,” Rogers said. “Any of them that are under 1,000 runs a year are probably virtually month-to-month in terms of whether they are going to have the manpower and the money to continue to operate.”

To break even with one 24-hour ambulance requires about 2,000 runs a year without going to taxes, he said.

Muskogee County EMS made approximately 18,000 runs last year, said Rebecca Smith, EMS spokeswoman.

The service was established in 1982 to serve only rural Muskogee County and made 1,242 calls that year.

Today, it covers the entire county, with three stations in Muskogee and satellite locations in Warner, Webbers Falls, Fort Gibson and Haskell.

“Agencies like Muskogee are really rare,” Rogers said. “The only two that are bigger (in Oklahoma) are the two EMSAs, in Tulsa and Oklahoma City. They run about 44,000 a year each. Fully half of our agencies run on fewer than one call a day. They make it on volunteerism, public subsidy and luck. And their luck is running out.”

Muskogee County EMS isn’t sitting around waiting for luck to improve their financial picture.

About 16 percent — $1.3 million — of its funding comes from ad valorem (property) taxes. The rest comes from private pay and billing insurance, Medicare and Medicaid, Mortensen said.

About 60 percent of that money comes from Medicare and Medicaid reimbursement, which increased about 2 percent last year, Mortensen said.

Rogers said Medicare reimbursements are about 30 percent below the actual cost of services.

In addition, higher fuel prices are driving ambulance operation costs as well as the cost of medical supplies up, Mortensen said. She listed specifics:

• Fuel costs increased about 60 percent last year, going from $169,000 to $244,000.

• Medical supplies increased 43 percent: from $179,000 to $255,000.

The service isn’t just sitting around hoping for some miracle solution to its financial woes. Mortensen said the agency has been tightening its belts for several months:

• They hope to reduce overtime by filling those shifts with employees paid at regular time.

• Instead of purchasing totally new ambulances, they are remounting the box part of a unit on a new chassis, at a savings of about $40,000 per unit.

• Employees are assigned housekeeping duties instead of using a janitorial service.

• Dispatchers are reducing mileage. For example, if an EMS team already is at the hospital from an emergency call and there’s a patient who needs to be transported to a nursing home, that unit is making the transfer instead of calling out an additional unit.

• Cutting back on non-essential driving. Employees are reducing mileage by picking up lunch on the way back from a call instead of driving an ambulance to lunch or meal break.

• Using employee teams already on duty to make appearances at special events rather than calling in extra staff.

Smith said raising property taxes to make up the deficit is not an alternative. The 3 mills now assessed are at the state maximum. The state House passed legislation last session to remove the cap, but the bill did not make it out of the Senate.

Mortensen said EMS is constantly looking for ways to trim expenses without diminishing service. The service frequently gets suggestions and questions from the public, like why an ambulance is left running while its crew is out of the vehicle, she said.

While it might appear more efficient to turn off the key, it really is not, Mortensen said. The ambulances are equipped with a lot of electrical equipment and medications that cannot withstand extreme temperatures.

Rogers said the state Legislature has taken its first steps toward finding answers to this crisis, with an appropriation of $2.5 million from tobacco taxes to the establishment of an EMS development fund.

The program’s goal is to work out a mechanism to prop up rural ambulance services, Rogers said.

That could mean some big changes in number of services in the state to improve the economy of scale, he said.

For example, Dewey County has had four ambulance services since the 1960s, he said. Between them, they run less than 150 calls per year.

“We are hoping we can encourage them (Oklahoma ambulance services) to look at ways to cooperate instead of having their own services.”





By the numbers

Here’s a look at the number of ambulance runs and total calls for area emergency medical services in 2007:

Service Total runs Transported

Muskogee 16,597 12,884

Checotah 1,025 460

Eufaula Served by McAlester

Tahlequah 2,615 2,031

Stilwell 1,181 932

Wagoner 2,423 1,662

Source: Oklahoma State Department of Health ambulance registry, 2007.