County EMS Service to Be Impacted by St. Mark’s Shake-Up

The closure of many services at St. Mark’s Medical Center could cost Fayette County EMS upwards of $1 million a year.

“I think it’s going to have a significant fiscal impact on our department,” said Fayette County EMS (FCEMS) Director Josh Vandever.

He estimated the total impact of increased labor and equipment costs at about $1.15 million annually. This year’s budget for FCEMS stood at just over $4 million. That amounts to a 28 percent increase.

“This isn’t a worse-case scenario,” Vandever said. “It could be worse. It could be $2 million or $2.5 million. But this is what I feel like is a reasonable conservative estimate of what could be our impact.”

Even though the emergency room at St. Mark’s will remain open, Vandever said EMS crews will have to transport many more patients farther away to hospitals in Columbus, Brenham, Bryan or Austin due to the limited services at St. Mark’s. In addition, Vandever said he anticipates an increase in ambulance calls from patients who would have driven or gotten a ride to the St. Mark’s ER in the past.

“What’s going to happen to all the people who used to (drive) to the ER with an emergency?” he said. “Are they going to go to another ER or are they going to continue going here? Or will they just call 911? Is there going to be a percentage of the population hesitant to use St. Mark’s due to this? I think it’s realistic to say ‘Maybe.’ Whether that is fair or not to the hospital is another conversation altogether.”

Accordingly, Vandever said the increase in calls could necessitate an increase in staffing and equipment.

“We’re going to have to look strongly at the possibility of adding another crew because of the increased turnaround time that our ambulances are going to be looking at,” Vandever said. “With the added mileage we’re looking at, I think we’re going to have to increase the pace at which we replace ambulances.”

In recent years FCEMS has replaced roughly one ambulance every year. Vandever said the County may need to increase the pace to three replacements every two years.

“And the price of ambulances is shooting through the roof,” he said.

The last ambulance the County priced was $330,000.

“We replace them when they get to about 250,000 to 300,000 miles,” Vandever said. “That’s a dually truck with a fully loaded bed being run like a sports car for seven years.”

Right now, FCEMS keeps four ambulance crews on call around the County 24 hours a day, seven days a week. The County was already working to establish a new station in Round Top to be staffed by an additional ambulance and crew.

“This doesn’t change the need for that Round Top unit,” Vandever said. “The citizens in Round Top and Carmine and the influx of population we get during the antique fairs – that’s what we budgeted for this year and that’s still the plan. We were planning to slowly phase it in, but this is forcing us to be a little more intentional. “

Vandever said he believes FCEMS will need to add an additional full-time ambulance crew on top of the Round Top expansion.

“Medic One (the ambulance based in La Grange) might run seven calls in a day,” he said. “When seven calls take 30 minutes each, that’s not a big deal. But when seven calls are three hours a piece, that’s a very big deal. That becomes 21 hours in a day spent actively providing emergency care.”

Fayette County ambulance crews work 48 hour shifts.

Other impact include an estimated $560,000 annually in lost revenue from transfers. FCEMS earns a lot of revenue each year by transporting patients from St. Mark’s to other medical facilities. Vandever expected transfers to drop by two-thirds after St. Mark’s cuts its services. He estimated another $75,000 a year in fuel and equipment depreciation costs from the projected increase in mileage.

“Our current plan is, if we feel like (St. Mark’s) can handle an emergency, stabilize and send them home, then we will still deliver patients here,” Vandever said. “In turn, that supports us and allows us to keep ambulances in service. But if we start taking these people to (St. Mark’s), and left and right they are being transferred to bigger centers, and that causes double-billing and all this other stuff, then we’ll have to really take a look at that and make a decision. What’s this doing to our ambulance availability and what’s it doing to the patients? In the end we’ll have to make a decision – what’s best for the patients and the County. That’s who we have to be responsible to.”

Vandever said he did not believe healthcare outcomes for EMS patients will suffer because of the changes.

“I don’t think there will be a big shift in outcomes as long as we sustain the service that we need to provide and get the assets we need to meet an increased volume or the increase in (call) time,” Vandever said.

However, Vandever said the changes at St. Mark’s could affect patients in other ways.

“The real inconvenience and trouble is going to be when an 80-year-old husband or wife breaks their hip, and now their spouse may not be comfortable driving to Austin,” he said. “If we give them a ride in the ambulance, they’re going to have to find a way to get back. They’re going to have to rely on friends and family to get them there. It’s going to be an inconvenience.”