Henry County Medical Center’s Emergency Medical Services is in such dire financial straits that HCMC is asking the county for some help, preferably by paying for the purchase of an ambulance every year.

EMS is the ambulance service that is part of the medical center’s conglomerate of agencies. It’s the most problematic one financially, seeing as how it loses hundreds of thousands of dollars most years.

Lisa Casteel, CEO of the medical center, attended Monday’s meeting of the Henry County Budget Committee and made a presentation about the EMS program, saying she wanted to work to “put things on the table and see what we can come up with.”

EMS lost $467,051 in the 2017-18 fiscal year, and it’s projected to lose $850,963 in the current 2018-19 fiscal year.

In the last 10 years, the medical center has seen an average loss from EMS of about $320,000 — money that the medical center just pays for out of its overall budget.

“EMS has always operated at a loss, and the medical center subsidizes it,” Casteel said.

Only once in recent years — the 2014-15 fiscal year — did EMS actually make a profit. It finished in the black by $118,729 that year, which Casteel called an anomaly.

Bad debts are a big part of the problem, and it appears to be getting bigger. In the 2017-18 fiscal year, EMS had to write off $701,061 in bad debts. For the current 2018-19 fiscal year, it’s projected that number will more than double — to $1,426,039.

Henry County Mayor Brent Greer asked why there would be such a huge increase in one year, and Casteel said that, while some of the dollars are carried over from year to year, “it’s mostly just more people not paying their bills.”

EMS has been a part of the medical center for nearly 30 years, but it just became incorporated as its own entity in 2005. Since that year, it has lost nearly $381,000 a year on average.

Casteel’s decision to go to the county for help was in an effort to find out what the possibilities are for financial assistance for EMS.


She said her first choice for aid would be to ask the county to buy a new ambulance for EMS on an annual basis. EMS keeps a fleet of six ambulances at any given time, with one new ambulance rotated in every year. EMS pays for that new one now, and the current cost is about $180,000.

The oldest ambulance currently being used was bought in 2011 and has nearly 380,000 miles on it. Another unit, bought the next year, already has more than 386,000 miles on it.

The number of runs made by ambulances has risen from about 5,600 in both the 2016 and 2017 fiscal years to 5,800 in the 2018 fiscal year to a projected 6,100 this year.

That raises the expenses of the ambulance service, but with fewer collection of debts, it makes the bottom line even worse.

Another option Casteel presented to the committee included adding an assessment fee on residential utility meters to help make up for the non-payment of ambulance bills. The fee could be either $1, $2 or $3 a month on Paris Board of Public Utilities customer bills, which, with about 15,300 residential meters in the county, would raise hundreds of thousands of dollars for EMS.

Greer and Casteel stressed that plan has only been discussed in general terms with BPU General Manager Terry Wimberley, and that many more talks would have to be had in order to move forward on that kind of plan.

A third option mentioned by Casteel was an increase in county property taxes, with the revenue from that increase going toward EMS.

“This is not going to be a one-year problem,” Greer said of the EMS’ financial woes. “We need to really delve into this thing.”

Casteel was clear her first choice would be for the county to pay for a new ambulance every year.

“That’s what we’re seeing in other counties,” she said.

Hardin County, for example, provides an ambulance every year for its EMS, and Benton County provides a $650,000 subsidy to the hospital there annually.

There are some areas where ambulance service has been turned over to private companies. Greer mentioned Loudon County in East Tennessee as an example of that method.

“Seeing the kind of losses that the EMS is having and how they’re getting worse each year, $180,000 is not going to solve that,” Greer said. “There is a problem here that we need to address, and we need to continue these discussions later on.”

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