Dennis Morlan, a Jefferson native who returned home three decades ago to operate Greene County EMS, is nearing retirement. Someone who buys the business will face considerable obstacles. HERALD FILE PHOTOOwners of Greene County EMS, Marcia and Dennis Morlan have seen call volume over the past 30 years increase 400 percent. However, their rate of pay has stayed the same. HERALD FILE PHOTO

Condition critical for EMS in county

Medicaid ‘fiasco’ wreaking havoc on ambulance business

For The Jefferson Herald

A series of problems — financial, health and availability of personnel, to name a few — have combined to challenge the continued operation of Greene County Emergency Medical Services Inc., company proprietor Dennis Morlan told the Greene County board of supervisors Monday.

The company’s financial problems come from several sources. Morlan sharply criticized the state of Iowa’s decision to privatize Medicaid services.

“The Medicaid change is a total disaster,” he said.

Morlan said the company will need about $200,000 a year, plus building costs, to keep the doors open. If what he called “the Medicaid mess” weren’t there, that figure would be about $100,000.

But Medicaid privatization cost Greene County EMS $100,000 last year, he said, through reduced and delayed reimbursement payments for ambulance-related services.

The “Medicaid fiasco,” as Morlan called it, forced his company to take a 25 percent decrease in income last year.

Other third-party payers, including Medicare and insurance companies, also significantly reduce what they pay relative to billed costs, Morlan said. He estimated the number of emergency medical calls for which the full billed amount is paid is less than five percent.


Medicare and insurance companies pay maybe 50 percent of what is billed, he said, and Medicaid further cuts another two-thirds of the level of Medicare payments. For Medicaid calls, Morlan estimates his company loses money for patients it transfers to other locations out of town.

Morlan said he and his wife Marcia, who together operate Greene County EMS, came here 32 years ago, and are working for the same amount of money from the Greene County board of supervisors at which they started: $3,200 a month, or $38,400 a year.

The county’s entire budget for ambulance service is $50,000 a year. The county owns the ambulances used by Greene County EMS.

Greene County EMS can’t afford to pay its staff enough to compete with other companies, Morlan said, particularly with benefits that people want today. He has lost employees to other similar organizations because of the salary.

“We train people, and then they head for the big city,” he said.

In short, Morlan said, “We need more money. We won’t walk out the door, but we have to do something.”

Greene County EMS answers about 900 calls a year, about average for a population base of its size, Morlan said. But well over 100 of those are “dry runs,” for calls made in error. Such dry run calls are not reimbursed, although the cost to respond to them is similar to valid calls.

The company has to retain two staffs at all times, in case two or more calls come in at the same time, Morlan explained.

He also criticized the local organization (Grow Greene County Gaming Corp.) that awards funds from Wild Rose Casino to area nonprofit groups.

He contrasted the distribution of casino grants by Grow Greene County to the way the local organization at Emmetsburg — another Wild Rose Casino community — handles the distribution there. The Emmetsburg group, Morlan said, has a regular public safety category of grants.

Criticizing the local group’s priorities, Morlan specifically mentioned the $20,000 that Grow Greene recently earmarked for a band that will perform at the overnight RAGBRAI stop in Jefferson on July 23.

In addition to his company’s financial health, Morlan also noted his personal health problems. He is a cancer survivor, and his treatments have weakened him to the point that he can’t easily lift 40 pounds anymore.

“Physically I should not be working as hard as I have to,” he said.

He didn’t plan to retire this year, but his health is pushing his timetable up.

A few people have expressed interest in acquiring Greene County Emergency Medical Services, he said, but the low reimbursement rates and resulting staff shortages make that difficult for them to do financially.

Morlan told the board he plans to do “serious research” to see how other communities handle their emergency services. There are many different models around Iowa, he said. Some are operated by hospitals, some by counties and some by other methods. A few operate like his company, but “they have the same problems we have.”

Supervisor John Muir, chairman of the board, responded that the county will do similar research.

“Ambulance service is not a direct obligation of the county,” Muir said, “but it’s a concern that the county needs to address.”    

Morlan said that younger people today don’t seem to step up to help with fire and emergency medical services. And we can’t rely on other counties to do it for us, he added, as they’re also short-staffed and too far away for immediate help.

“Quality patient care is the name of the game,” Morlan concluded. “That’s what we deliver.”

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