The Hyde County commissioners voted Monday night, Oct. 18, to retain paramedic-level emergency services in Hyde County.

In a 4-to-1 vote, the commissioners approved Interim County Manager David M. Smitherman’s recommendation to hire two additional full-time paramedics, which will reduce overtime and the over-reliance on part-time staffers.

On staff currently are five paramedics with one vacant position for a total of six available positions. Monday’s action authorized Smitherman to advertise for three paramedics.  That will bring the total number of paramedics to eight and retain the current staff of basic and intermediate EMTs.

Smitherman’s plan, devised with the help of paramedics Brian Carter and Jeff Hibbard, also includes changing staff scheduling, eliminating the chase vehicle on the mainland, and exploring the cost of outsourcing billing or enhancing the in-house collections to achieve better revenues.

Board chairman Tom Davis voted no, saying the plan will cost too much.

Earlier in the day, the commissioners held another special meeting specifically to discuss the EMS budget, which was approved in June for $1,578,141.

At issue was whether this would be a true number by the end of next June and if the commissioners would receive a request for more money late in the fiscal year as happened this year.

The fiscal year runs from July 1 through June 30. The budget is online at www.hydecounty.org.

Commissioner Sharon Spencer, in her successful motion, insisted that no one on the current staff of basic and intermediate EMTs be let go. Several in the Swan Quarter audience applauded.

Since it will take some time before the new paramedics are on board and the savings are realized, the commissioners will review in January how this plan is working.

Overtime pay is inevitable for a service that requires 24-hour coverage. Smitherman’s plan builds a known quantity of overtime pay into the expenses, while also allowing for unplanned contingencies.

“If properly staffed, overtime will be considerably less,” Smitherman said. “If we get the right staff on the ground, we’ll be fine.”

This year’s budget includes $190,000 in overtime pay. Salary figures are $705,000 for full-time staff and $90,000 for part-time.

Moreover, the county wants to grow the EMS service from within—giving opportunities for current EMTs to become paramedics and stay in the county, Smitherman said. Beaufort County Community College only recently improved its paramedic program. So it will take some time for more local people to become trained.   In the meantime, the hiring of three fulltime paramedics now will result in overtime savings.

As for billing, Smitherman said he thinks the collection revenues of $390,000 are too low and that he is exploring the costs of outsourcing billing, which might yield a better collection rate than the current 42 percent. Requests for proposals are being sent Oct. 19 to eight firms across the nation who do this work, including the Ocracoke Health Center. Billing had been outsourced but was brought back in-house in 2009.
 
Robert Swain, the EMS director in Tyrell County, commented at Monday night’s meeting that Tyrell has a 61 percent collection rate with an outsourcing billing company called EMS Management Consultant Services.

Smitherman explained that part of the reason the collection rate is so low is that Medicare and Medicaid pay only a fraction of what each emergency run actually costs, which is $859.
 
Medicare and Medicaid reimbursement rates change quarterly, he said, and these agencies will only pay up to 80 percent of what is billed, never 100 percent.
However, Spencer noted that private insurance is supposed to pick up that 20 percent.
Moreover, no one reimburses the county for the 400-plus responses that don’t result in transport to a medical facility.

David Daye, a paramedic on the mainland, asked the commissioners to hire a department head to manage the EMS service. Hyde County is currently without an EMS director and has seen several come and go in the last few years.

“We don’t have a boss man except for Mr. Smitherman,” Day said.

Paramedic-level service was put into effect countywide in 2009.  Before that, only Ocracoke Island had paramedics, while the rest of Hyde County had basic- and intermediate-level EMTs.

Before 2009, the entire EMS expense budget was $928,672.  The estimated total EMS expense for 2010, as of April 30, was $1,430,916, according to the most recent budget online.

In other action: Smitherman will be gone at the end of January and the county has received several applications for county manager. The current plan is for these applicants to be reviewed and an offer of employment be made sometime in December, so that a new person can start in January for some overlap with Smitherman.

Jay Etheridge, chairman of the ABC board, reported that while there was a low inventory of liquor in July, it is getting back on track. Hurricane Earl’s arrival during Labor Day weekend caused a $6,000 to $9,000 loss in sales revenues.

After questioning by Anson Byrd asking for an income, cash flow, and balance sheet, Etheridge said the ABC checking account has a balance of $38,119. Liquor bills total $40,532.

He also said as to inventory, there is $55,441.06 worth in the Mattamuskeet warehouse and $23,768 worth on Ocracoke.

Commissioner Darlene Styron asked Etheridge for a breakdown between the sales on Ocracoke and the mainland.


(Connie Leinbach is also a reporter for The Observer in Ocracoke)

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