As the Johnson County Rural Health Care District board worked on its budget this spring, it was hoping to find cost savings. Like all special districts in Johnson County, the rural health care district’s mill levy has shrunk dramatically, and the district was hoping to balance its budget without having to dip into reserves.
As the board crunched the numbers, it eliminated the purchase of a powerlifting device for the Kaycee Ambulance Service for a one-time savings of $34,000.
It also reduced the payroll request from Buffalo EMS, the board’s contractor, from $550,000 to just under $500,000. The proposed increase, Buffalo EMS Director Dave Harness told board members, was to pay for extra labor for ambulance transfers requiring a nurse. The board voted to maintain the existing payroll line item.
The issue has never been about the quality of the care provided by Buffalo EMS and its employees. But as the board looks around for cost savings, it lacks critical information that would guide its decision-making. Because the board lacks complete access to detailed financial information regarding staff payroll, hours and duties, it makes it impossible to control costs.
In 2017 as the board looked for cost savings, it looked at the health insurance plan Buffalo EMS employees receive. The package was described by a board member as a “Cadillac policy” that was more generous than the policy that county, school, hospital or city employees receive. At that time, the rural health district paid 100% of employee premiums. But the board did not know how many employees it was insuring or whether those employees were full-time employees of Buffalo EMS or even providing services to the rural health district.
The board tried to cap its expenses for health insurance by putting a dollar limit on the budget line item. Harness told board members to set a budget number for health insurance and then he, as the contractor, would be responsible for choosing a policy and a way to pay for that policy – irrespective of how many employees Buffalo EMS employed and whether those employees were full time or not. That came to a bad end when, midway through the year, the board learned that it was likely to finish the year $22,000 – or 16% – over the $139,000 it had budgeted.
For the first time in nearly 20 years, the rural health board will rework its contract for ambulance services.
There are three possible remedies the board could pursue to ensure that it has some budgetary control over how taxpayer dollars are spent.
One, the board could competitively bid the contract with a private contractor responsible for services and equipment for a lump sum payment plus a percentage of collections, as is the case with many ambulance services, including Sheridan County. It would be up to the contractor to build the cost of operations into their bid.
Two, the board makes the northern portion of the county’s ambulance services public – as the Kaycee Ambulance Service is. The board would employ an ambulance director and EMTs or paramedics.
Or finally, it could write into the contract that whomever provides the ambulance service operations must provide complete, detailed financial transparency so that the board and the taxpayers have a thorough understanding of exactly how tax dollars are being spent.