EMS needs to keep better records

Forgive us if we don’t have a lot of sympathy for the Surry County EMS department at present.

Nor the board of commissioners, for that matter.

The county Board of Commissioners on Thursday approved a payment of $281,646 to the N.C. Division of Medical Assistance as reimbursement for money the county received from state coffers, money to which the county was not entitled.

Surry County is paid by the Division of Medical Assistance for every medical transport its EMS workers give to Medicaid patients. The rate at which the county is paid involves, no doubt, some convoluted formulas set forth by the Medicaid program which makes it difficult to determine what is and is not a transport which qualifies for reimbursement. However, the chief factor in determining the rate is simple: the county determines how much it costs, on average, to transport any patient to a hospital or other medical facility, and that’s the figure North Carolina pays to the county.

That per-transport cost is also relatively simple: county EMS officials tally how many such trips they make in a year, and divide that number into the department’s total cost.

What Surry County did wrong, however, was use incorrect figures in these calculations. EMS said it transported 4,963, when it actually made 8,934 such transports. The lower, erroneous figure generated a higher per-transport cost. Thus, Surry County was paid based on false data for fiscal year 2011, data that was 44 percent off.

Finance Office Sarah Bowen told the board the county is likely on the hook for another $815,000 or so because of incorrect figures used in successive years.

Surry County EMS performs a vital function in the county, with some of the best, most qualified people in the state working there.

We don’t believe this was intentional, but to have been so far off in keeping track for something as basic as the number of transport calls EMS makes in a given year calls into question virtually everything that department does, particularly when it comes to bookkeeping and administering the budget.

EMS Director John Shelton seemed to indicate part of the problem lies with the fact no one could get a straight answer from the Division of Medical Assistance when determining what is and is not a qualifying transport. We have no doubt this is true — many operations, particularly those that involve federal money, are just one giant bureaucracy. Its employees seemed to be trained in the art of saying “I don’t know” or “That’s not my job” or, even when giving an answer, adding something along the lines of “But if that’s wrong, that’s your problem, not mine.”

Still, determining the total number of transports in a given year should be pretty simple. Surry County underreported by 44 percent — that averages incorrectly counting about 11 EMS patient transports a day. It seems like someone, somewhere, should have been able to figure out the county was underreporting that many transports on a daily basis.

We hope the commissioners will take a deep, hard look at the department, to figure out how the budget is being administered, and to determine what oversight there is to catch errors like this before taxpayers end up on the hook, again, paying for such mistakes.

No, we don’t feel particularly sorry for EMS or the board over this issue, but we do feel badly for the residents and taxpayers of Surry County. They fork over tax dollars to pay for basic services such as law enforcement and EMS services, then they are socked with extra charges any time they need the very EMS workers they’re paying tax dollars for, and now we learn taxpayers are footing the bill for EMS overcharging the state.

Surry County residents deserve better.

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