Dollars and documents

The South Central Wyoming Emergency Medical Services (SCWEMS) board met at 6 p.m. Wednesday, April 9 at the Riverside Town Hall.

All members of the board were present with the exception of Ralph Brokaw.

Chaiman John Rutherford opened the meeting and had guests to the meeting introduce themselves. Kyle Warren with the Hanna EMR station introduced himself first while members of the media, Saratoga Mayor John Zieger, Carbon County Commissioner Sue Jones, Saratoga Care Center Administrator Mark Pesognelli and Health Management Services (HMS) President Karl Rude were among others to make themselves known at the meeting.

After approving minutes from the last SCWEMS meeting, the board quickly turned their attention to matters of finance.

Financial Failures

During the meeting, several financial statements failed to pass the committee. Encampment representative Karran Bedwell noted that previous reports were incorrect in showing beginning and ending balances from month to month. Suggestions were made to correct what were seen as errors in reporting and SCWEMS bookkeeper Tiffany Herring and consulting accountant Jan Young agreed to make those changes for upcoming reports.

Bedwell reported that payments from municipalities were currently at 25 percent from the towns of Hanna, Medicine Bow and Riverside. It was decided to bill the municipalities quarterly instead of waiting for the towns to pay on their own.

Bedwell also reported that collections for monthly invoices were up to 20.4 percent. Rutherford joked with the board, “I’ll never get over that,” and continued to board chuckles that, “Between the payment percentage and the adjustments it is difficult to comprehend how much, between the billing and what Medicare/Medicaid, the Veterans affairs actually pay versus what they are billed—and then that debt is just staggering to me. I will never get over the fact that it is just such a difference between. In most worlds, what you are billed is what you pay. Not in this world.”

It was noted that the service writes off 43 percent due to the order in which insurance companies get the bills and that those entities often pay the first bills that get up to a certain amount. It was then added that SCWEMS was now billing more quickly with those bills being generated straight from trip tickets.

The bills were then approved with the exception of the CNA Surety bonding bill.

Payroll in the amount of $12,067.20 was also approved during the financial portion of the meeting.

The budget was also discussed during the meeting, but since Young said she had just received the amended budget and that Brokaw was currently busy with calving, the budget still needed work. Rutherford said he would like to see profits and loss versus the budget in future. Herring said that previous months reconciliations were right on. The board then voted to fail the balance statement pending suggested changes.

Ambulance Director

Report

Ambulance Director Melissa Sikes reported that she had several radios to be reprogrammed and that there were five students currently in EMT classes and that those students seemed to be progressing well. Sikes also reported that she had paid a trainer to come out to teach because he had volunteered and the board decided that the instructor needed to invoice the board for that payment.

The board then accepted the director’s report.

Guest speaker

Kyle Warren with the Hanna EMR said he had information on a personnel issue. That was remanded to executive session.

Old Business/Clinic

Contract

The first item under old business was adding authorized signatures, including the bookkeeper, to the WYO-STAR account. It was noted that absent member Ralph Brokaw needed to take care of that and the item was tabled.

Purchase of old bills was the second item and it was expressed that a contract was expected soon.

The board heard from Herring that credit and debit card collection methods were waiting on information from audited financials from 2015, 2016 and 2017 to complete this report.

When a report on the Saratoga Station expansion was called for, Saratoga Mayor Zieger stated that since Saratoga had not bonded for this project, the town was awaiting funding. This funding was expected around October.

When the subject of retirement for the ambulance director came up, it was explained that since running this amount through the State of Wyoming was not possible, the board should pay 8.3 percent of the director’s salary to the director to be invested in a retirement fund as the director saw fit. This motion carried.

Clinic Contract

When the agenda turned to the SCWEMS contract with the Platte Valley Clinic, HMS President Rude addressed the board saying, “Since beginning our operation as a new standing clinic in town, we operated under the auspices that we would continue to furnish nurses to the benefit of the ambulance service until what time we could come to an agreement on a contract. I received an email last week that frustrated me a little bit that made the terms we negotiated under were not what I had understood them to be—or had even brought false pretenses to. HMS is still committed to providing nurses—even though we haven’t been paid yet,” Rude continued, “We will continue to provide nurses until we can find a contractual arrangement.”

Rude then added, “When we started the negotiations, my understanding of that was that we would be paid an ‘on call’ rate and when we received the contract it was a ‘call-out’ rate—but the dollars figures didn’t change. So as I had made my commitment, my understanding of it was that we would be receiving an on call $4 an hour that when we were in operations and our staff was present in the clinic the clinic would be paid $4 an hour to the availability of that staff to be on the ambulance. When I received a contract it said that we would be paid $4 an hour when that person was called out to the service of the ambulance.”

Bedwell immediately replied, “We never negotiated a contract with you. The only contract that we talked about was when Mark (Pesognelli) came to our meeting in Elk Mountain and told us he didn’t have enough staff to negotiate a contract. We haven’t done anything since.”

Rude Replied, “Correct. That was the second thing I learned as recently as today. That negotiation was not happening with the people that should be negotiating that. Any understanding that we had, and any strain or frustration that Mark had brought to you guys, clearly those negotiations were not happening with the right people. So I came down here today to be able to saw we’re glad to continue fresh. We do want to be able to support you guys. We want to be able to come to an understanding of what that contract can and should look like.”

Rude went on to explain what he was paying for staff to be out of the building. The board was receptive to the comments and asked Rude to send in a rough contract of what he needed. Rude agreed and said he would amend what was done in the past get them a contract shortly.

Rude also said that there are solutions within the funding model that exist at a critical access hospital to help bring Federal funds on board to help ambulances have professional drivers and EMTs that are paid full time. Rutherford then thanked Rude for his expertise and cooperative spirit.

As the last item of old business, it was noted that the Local Government Liability Pool contract had come through with a $500 deducible.

New Business

Under new business the billing from Wakefield-Ariel Scott was discussed. Wakefield is the company that generates billing directly from electronic trip tickets generated on ambulance calls. Bedwell said Wakefield bills the service $20 per bill generated and that further conversation was needed to clarify the situation.

Employee pay stubs was the next item up and while it was noted that some employees had not been receiving stubs, Herring said that she had taken care of those.

Boswell Springs/

Classic Air

Boswell Spring and Classic Air Medical were the next items on the agenda. It was noted that the Boswell Springs impact funds had been halted at least temporarily. Though there was a question about whether there was a possibility of having to repay the funds already paid, Commissioner Jones said there was no mechanism in place to recoup those funds. Since those funds were sponsoring the contract between SCWEMS and the Classic Air Medical life flight service, the board was concerned with making sure that contract was paid out. The contract had been paid up for the first three quarters of the year, but Rutherford said the board should keep an eye on making sure this stayed paid in the future. Jim Coleman, SCWEMS secretary, noted that the board had set aside two years funds for this contract without counting the Boswell Springs funds.

Jones said that, in the future, it would be a good idea to keep track for how much was asked for (for impact assistance funds), what was being asked for and where that money actually goes.

Budget

Rutherford said he had been working on the 2019-2020 budget and had been working on the Department of Audit proposed budget. Rutherford added he needed to get with Herring to get different numbers to finish those budgets. He said he would get the proposal to the board when completed and that he had solicited information from Sikes about future needs.

To solve budget issues the board decided to hold a special budget meeting and scheduled that meeting for 6 p.m. on May 2 to be held at the Hanna Fire Station.

Bonding

The question then arose about who had been bonded in the past. It was determined that the entire board had been bonded because previously any member of the board could sign checks.

It was decided that going forward the group should bond only check signers, the treasurer and bookkeeper going forward in the amount of $25,000 each.

Executive Session

The board then adjourned to executive session to discuss personnel, litigation or other confidential matters.

The agenda said there would be a motion to exit the executive session with no action taken.

Next Meeting

The next regular meeting of the SCWEMS board will be at 6 p.m. May 14 at the Hanna Fire Hall. As was noted earlier, there will be a special budget meeting at 6 p.m. May 2 also in the Hanna Fire Hall.