By Kathryn Reed

El Dorado County is looking at redefining how medical care is provided to those who call 911 for an ambulance.

Paramedicine is a growing service throughout the United States, and is a model being looked at locally. Potentially nurses could be riding in an ambulance. They would have the ultimate say over whether someone goes to the hospital. But at the same time they could provide a higher level of care to the patient compared to what the paramedic or emergency medical technician who currently rides in the ambulance can do.

This is also designed to cut down on the “frequent fliers” using the ambulance to get to the hospital – often times for prescription meds.

The Affordable Care Act has created a conundrum – more people have medical insurance, but the reimbursements don’t cover the cost of doing business.

“Seventy percent of El Dorado County ambulance drives are Medi-Cal or Medicare. They don’t cover all of it. The feds pay a flat amount, which is far less than what an ambulance trip costs,” El Dorado CAO Don Ashton told Lake Tahoe News.

Ambulance service in El Dorado County is likely to change in the coming years. Photo/LTN file

California law mandates counties provide ambulance service. El Dorado has joint power authorities on both sides of the Sierra to handle the respective service. The West Slope contract expires in 2018, the Tahoe one in 2019. It’s possible the West Slope contract could be extended one year to be aligned with the Cal-Tahoe JPA.

“We are trying to get a structure in place that is more sustainable in the long term,” Ashton said. “Once contracts expire, we have several options regarding ambulances.”

One idea is to privatize them. While that is on the table for the team to investigate, it is not the option Ashton favors. (It didn’t work well in Tahoe in the 1980s.) He envisions ambulance service in the county being more coordinated. This could help with inter-facility transfers and coverage. It’s possible the current JPA structures would no longer exist or they could be redefined or even combined into one.

Barton Memorial Hospital in South Lake Tahoe and Marshall Hospital in Placerville could be partners in the JPA. Both medical facilities have expressed interest. For this to happen state law would need to be changed. The county is working on that, with reps from the hospitals having written letters to state lawmakers in support of changing legislation to allow their entities to be included in the ambulance JPA model.

“Barton Health values care team coordination and supports endeavors where we can collaborate with other community partners to deliver consistently exceptional care,” Mindi Befu, spokeswoman for Barton Health, told Lake Tahoe News. “Barton Health is exploring options to have a representative on the JPA board of directors to provide a hospital perspective and assist with oversight in the delivery of emergency medical services. Barton does not plan to operate ambulance services; however, we will continue to work with El Dorado County, the city of South Lake Tahoe, and their partners and contractors to deliver comprehensive, high-quality patient care.”

She said this is not being looked at as a revenue stream. But their involvement has the potential to save everyone money.

Finances are driving the desire to come up with a new model for providing ambulance service. Call volumes are increasing, reimbursements are decreasing and overall expenses are more each year. A team is meeting about once a month to come up with a plan that provides care to residents in a timely, cost-efficient manner. The goal is to be able to roll out whatever the new plan is as soon as the JPA contracts expire.

Others who are part of the reconfiguration discussions said it is possible the hospitals could save money by being in the JPA if they provide the higher level of medical care in field. This is because that would be less expensive than having a patient arrive in the emergency room who doesn’t need to be there and then the government or private insurance company not fully reimbursing the facility for the care given.

Corey McLeod, doctor and director of emergency medical services for Barton, has been instrumental in working with the county as it rejiggers ambulance service.

The Tahoe JPA has already changed, with North Tahoe Fire Protection District joining it this fall. That department folded into Meeks Bay a couple years ago, so it’s boundaries are from the West Shore to Kings Beach. This is the department where Tim Alameda came from. He is the newly hired fire chief of Lake Valley Fire Protection District. The other JPA member is South Lake Tahoe Fire Department. Lake Valley and South Lake each have two members, with North Tahoe having one.

Having an uneven board for the past couple years has made progress for the Cal-Tahoe JPA difficult. Whatever the future configuration is, many who are involved want to keep an odd number on the board.

Having Barton involved is met with differing opinions from the local fire chiefs. Alameda, while he admits to still getting up to speed on things, sees Barton as a welcome addition.

South Tahoe Fire Chief Jeff Meston wasn’t so warm to the idea.

“It seems like it isn’t a good idea on the surface; it would perhaps give them too much control on how we do business with taxpayer funds, compared to how they do business. It just doesn’t seem like a prudent move to me,” Meston told Lake Tahoe News.