Published Jan. 30 in the Nicholas Countian

Nicholas and Robertson County officials meet to address growing concerns about ambulance service in two communities

The Nicholas Countian

CARLISLE — The Nicholas County and Robertson County fiscal courts held a joint meeting Thursday night, January 23, to discuss the emergency ambulance service being provided by AER, Inc. (American Emergency Resources). The service, based in northern Kentucky, has requested additional funding to support its operations in the two counties during the remainder of its current contract and the current fiscal year, both ending on June 30, 2003.

Dr. Tony Albano, Chief Executive Officer and Medical Director of AER, opened the three-hour meeting with a visually-supported presentation to the two groups of officials, which included the judge executives, the magistrates, the county attorneys, the county clerks, and the county treasurers. An audience of approximately 50 other interested individuals, including current and former ambulance service employees, Nicholas County Fire & Rescue Squad members and City of Carlisle officials, also were present to hear the presentation and the discussion that followed.

Dr. Albano stated that the purpose of his presentation was to offer a look at the need for a cooperative effort to solve problems on how to maintain emergency medical service coverage for what was called “the Nicholas County - Robertson County joint ambulance district.” The problem revolves around alleged financial difficulties encountered by AER in reimbursement from Medicare, Medicaid and other sources for the emergency services billed. He said his company had estimated a reimbursement rate of 68-72 percent, but the reality after the first six months of operation is that reimbursement has been at the rate of 36 percent. 

Robertson County Magistrate Diana Poe asked, “Why do you think you are collecting only 36 percent, when the national average is about 65 percent?”

Dr. Albano replied that it has to do with demographics, the percent of clients in each group such as private pay, Medicare or Medicaid pay, etc. AER is using the same billing service as did the previous contract provider in Nicholas County, who had a higher rate of reimbursement.

Dr. Albano said AER is willing to maintain the current system of emergency service to the two communities as long as the operation is not at a loss to the company. He said his company has made an effort, since being awarded the contract by the Nicholas County Fiscal Court last year, to increase the volume of vehicle runs, with no emergency refused. He also noted that AER had expended significant dollars in upgrading both facilities and equipment of the Nicholas County Ambulance service since taking over the operation on July 1, 2002. He said the total dollars expended, including dollars from the company’s reserve funds, were about $138,000.

Dr. Albano said the company needs an additional subsidy from the fiscal courts in order to continueservice through the end date (June 30) of the current contract. He suggested that there are two options the fiscal courts might consider - (1) a one-time allocation of $60,000 or (2) an ‘open-book’ allocation equal to $10,000 per month, but in which the fiscal courts would be responsible only for the difference between that amount and the amount received in reimbursements below the $10,000.

Dr. Albano said the second vehicle was ‘the killer,’ resulting in a huge drain on AER’s resources. He said the payroll to operate two vehicles in Nicholas and Robertson counties exceeds the company's payroll in the company’s home base in Florence. 

The contract signed with the Nicholas County Fiscal Court last year calls for three vehicles, two primary and one backup, to provide ALS (Advanced Life Support) service 24 hours per day seven days per week in Nicholas County. Although those exact words appear in one paragraph of the contract, Dr. Albano cited another, conflicting paragraph in an effort to justify the lesser degree of service being provided now.

Robertson County was facing a loss of emergency service for its citizens after several attempts to maintain it had failed and the beleaguered service was disbanded in September 2002. In an effort to assist, the state EMS withdrew the Certificate of Need for Robertson County and negotiated with AER and the Bracken County EMS taxing district to allow the services to ‘grow’ into Robertson County. According to state EMS official Brian Bishop, who was present at the meeting, Robertson County became non-existent from the EMS standpoint following the withdrawal of the certificate. 

AER agreed to provide ambulance service in the southern portion of Robertson County, between Mt. Olivet and the geographic boundary with Nicholas County, with Bracken County EMS covering the northern portion of the county.

Nicholas County Fiscal Court magistrates apparently were surprised to learn that they, as the certificate holder and contract holder for the emergency ambulance service, had not been involved in the negotiations or in any ‘agreement’ that was reached regarding the state’s unilateral ‘growth’ of Nicholas County as far as Mt. Olivet. The Robertson County Fiscal Court contribution to the expanded service was a $5,000 subsidy and the transfer of an ambulance title to the Nicholas County Fiscal Court.

Magistrate Daryl Stacy his concern several times that the ‘agreement’ adding Robertson County to the AER service area was potentially dangerous to Nicholas County residents in need of emergency care. He said he also feels that the ‘agreement’ caused AER to be out of compliance with its original contract with the Nicholas County Fiscal Court.. 

As the Thursday night meeting was nearing conclusion, after three hours of presentation and discussion, Nicholas County Magistrate Billy Dixon asked, “If there are no more dollars for an additional subsidy, what then?”

Dr. Albano replied, “We (he and COO RN-EMT-P Andy Wartman) would report back to the company’s directors.” He added that he didn’t know what the outcome might be, but said it ‘probably would be drastic.’ (Dr. Albano and Wartman are two of the five directors of AER. The other three are two physicians and a lawyer, unidentified by Albano.)

Dr. Albano acknowledged, however, that he would expect AER to honor its current contract until June 30, even though the anticipated loss by June 30 would be in the neighborhood of $67,000. He said his goal is to remain in Nicholas County and Robertson County and to extend the stay after June 30, providing a needed service to the citizens of the communities without seeking a profit.

Both the Nicholas County Fiscal Court and the Robertson County Fiscal Court tabled any action on the request by AER for the additional subsidy until the courts meet in regular session in February. Judge Executive Tincher said an answer would be given following the Nicholas County Fiscal Court’s next meeting, scheduled for Tuesday afternoon, February 11, at 4:00. 

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