The issue: Nature Coast EMS
Our Opinion: You only get what you pay for
Public safety is undeniably a core responsibility of county government.
Nonetheless, the Citrus County Board of County Commissioners (BOCC) has been guided for decades by a budget philosophy of cheaper is better, engendering a propensity for commissioners to inadequately fund essential public safety services.
This budget philosophy resulted in county fire services being severely underfunded to the point that its deterioration saw county commissioners desperately vote to turn over its responsibility for fire services to then-Sheriff Jeff Dawsy in 2011.
The first rescue step taken under Sheriff Dawsy’s leadership was pressing the BOCC to adopt a fire services Municipal Services Benefit Unit (MSBU) to provide the requisite revenue to rebuild the department.
With fire services sufficiently resourced to provide the professional response that every resident deserves, the BOCC once again assumed its responsibility for this essential public safety service in 2017.
Although the object lesson of fire services’ rescue was that cheaper is not better, the BOCC did not fully grasp it as evidenced by the recent tribulations of Nature Coast Emergency Services (NCEMS).
From the time the county contracted with NCEMS in 2000 until early this year, the nonprofit ambulance provider had a recognized track record of quality responsive service.
In 2012, NCEMS achieved national accreditation from the commission on Accreditation of Ambulance Services — an honor held at the time — by just 10 services in Florida and 206 nationwide. In 2016, it was named the Florida Emergency Medical Service Provider of the Year.
This begs the question as to how NCEMS went from a recognized success to one on life support this past January.
While internal leadership and management problems were contributors, the central reason was the funding arrangement rooted in the original contract between NCEMS and county government. In the hope that NCEMS revenues would attain self-sufficiency, the contract stipulates that the first year subsidy of $1 million be reduced 5% each subsequent year.
While a hopeful arrangement in theory, changing circumstances made it impractical.
Having one of the oldest populations in the state, 64 percent of our county’s EMS calls are paid by Medicare compared to 40 percent for a typical county. As such, the census-based reclassification of Citrus County from rural to urban has resulted in a Medicare reimbursement hit of about $500,000 annually. Additionally, NCEMS must pay the county for dispatch services, which exceeds the county subsidy by about $300,000 annually.
The welcome news that NCEMS has rebounded under its new leadership is encouraging. However, its rebound would not have been possible without the BOCC boosting NCEMS’ shoestring subsidy by $415,000, adding $200,000 in capital improvements, and assuming its mortgage debt.
With the EMS subsidies of our four neighboring counties ranging from $1 million to over 19 million annually, the BOCC, at long last, appears to have learned the object lesson that you only get what you pay for.
Hopefully, county government’s core responsibility of providing life saving services, henceforth, will be guided by a budget philosophy that no reasonable cost is too much.