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Edmonson Co. EMS ‘urban’ classification negatively impacting agency, taxpayers

Edmonson County EMS cites barriers that are making them lose money.
Edmonson County EMS cites barriers that are making them lose money.(WBKO)
Published: Oct. 26, 2021 at 5:19 PM EDT
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EDMONSON COUNTY, Ky. (WBKO) - In the latest installment of Bridging the Great Health Divide, WBKO News Reporter Kelly Dean is looking into Edmonson County EMS as the agency cites barriers.

RELATED: Edmonson County EMS facing critical staffing shortages

Over the intercom at the Edmonson County EMS bay, 911 operators call out the number ‘24.9.’ That’s the miles for the current EMS patient’s transport.

“We’re as rural about it as it gets. There’s not even-there’s not a traffic light in Edmonson County. We do not have a hospital,” said Keith Sanders, Edmonson County EMS Director/Paramedic.

Despite this reality, Edmonson County is still classified as ‘Urban’ by the federal government.

“It affects our Ambulance Service negatively because on the Medicare runs that they make, they’re not able to charge Medicare the $3.50 a mile for the first 17 miles like all the other ambulances surrounding Warren County do,” explained Edmonson County Judge-Executive Wil Cannon.

The county is classified as ‘urban’ because it shares a zip code with Bowling Green which is a metropolitan statistical area. Medicare makes its reimbursements determination based on the zip code for whether the areas are considered urban or rural.

“We lose this reimbursement on the Medicare side, (and) it hinders us from grant money. The only other source of revenue we have is tax revenue, so it increases the tax burden on our citizens because that money has to be made up somewhere,” said Sanders.

Sanders has been with the ambulance service for almost 30 years and contributed to a study back in 2011 that showed the burden that the urban classification places on the service, including the amount of money they are losing.

“It costs our Ambulance Service about 30 to $40,000 a year, which is a lot of money for them. It would help them a lot to be able to bill that Medicare,” said Cannon.

“Right now we’re looking at over 10 years, that’s $300,000 in revenue. And it’s probably closer to 450 to 500,” said Sanders. “When we lose $80,000 out of revenue, we need $80,000 out of tax money so we manage our budget-- we run pretty much on a zero balance. We run a break-even service.”

All this doesn’t include the money they’re missing out on by not being able to apply for rural grant money. The only way to change this classification is on the federal level.

“It’s such a unique problem. There are not very many places that fall into this classification. It’s not one of those things, that’s on the front burner to fix,” said Sanders.

Meanwhile, Sanders is calling on local lawmakers, solely for support.

“Support from the General Assembly would help. If our General Assembly would go on record saying hey, this needs to be fixed. I feel that would carry weight with our congressional delegation.”

While the classification is a simple title, it has a complex meaning that has impacts that are creating a snowball effect on a community’s health and wealth.

“A lot of times nobody thinks about EMS until they actually are needed. And when they pick up a phone call 911 they expect an ambulance to be there. And the problem that we’re starting to face is that when they pick up their phone and dial 911, there might not be anybody show up for a while,” expressed Sanders.

Kelly Dean reached out to McConnell, Paul and Guthrie’s Office to ask what each is doing to help resolve this issue. Guthrie’s office was the only one that responded with the following:

“Rural health care is vital for Kentuckians, especially for constituents I serve in the Second District. I’m currently working on ways to modernize and improve rural health care as the co-leader of the House Republicans’ Healthy Future Task Force. I am actively working with Edmonson County to explore ways to solve this issue to ensure the county is being reimbursed fairly by Medicare. The county’s issue stems from a restrictive reimbursement formula that classifies the county as falling under an urban area, instead of a rural area, and there is currently no appeals process to bring their case forward as a rural jurisdiction. I look forward to digging into this issue further and exploring solutions that will help Edmonson County and other parts of Kentucky. This is yet another reason why I am fighting against Democrats trying to get government bureaucrats more involved in our health care.” – Rep. Brett Guthrie (R-KY) 2nd Congressional District.

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