Cheboygan Life Support Systems, CLSS, Director Dallas Hyde spoke with the County Board of Commissioners Tuesday morning about the ambulance service and how millage money allocated to them is used. The county levies a millage of up to .3 mills to help fund the ambulance service, to aid in better operation of the service, stabilize declining revenue reimbursements and to help cover increased cost of wages to allow CLSS to be competitive with other communities while still offering well trained and well qualified medical personnel to respond to calls. Some of the millage is also used to help purchase equipment needed by the crews. “I'll give you a little bit of background on the millage and why the millage happened,” said Hyde. In the past, CLSS was able to bill governmental insurance providers, Medicare or Medicaid, for patients they would pick up. If the ambulance ride was $900, CLSS would bill the insurance company. However much the insurance company paid would be accepted and then they were able to bill the patient for the remaining balance." When the Balanced Budget Act went into effect, that all changed and CLSS was no longer able to bill patients for the remaining amount if they had Medicare. These type of patients make up around 60 percent of all calls taken by CLSS. “So that took about $300,000 out of our billing, just like that,” said Hyde. “It's not like it was a bad thing we needed to find other funding if we were going to keep our ambulance service going. So, we went for a millage.” The first four years of the millage, CLSS asked for .25 mills and the next four years was zero up to .3 mills. Now, every year, they ask the county board to set the rate of the millage between the zero and .25 mills. “We have kept it at .25 every single year, we haven't gone up to .3 yet to date anyway,” said Hyde. “The way the millage works, right now we have three ambulance providers in Cheboygan County.” Emmet County EMS, formerly Allied EMS, took over Mackinaw City, Mackinaw Township and part of Hebron Township. Onaway Area Ambulance covers all of Forest and Waverly Townships. The way the millage is set up, whatever ambulance company covers a township, the millage funds go to that service. For example, those who live in Forest Township, their millage money goes to Onaway Area Ambulance. This is the same for Mackinaw City and Mackinaw Township. In Hebron Township, the money is not split between Emmet County EMS and CLSS, all millage money goes to Emmet County EMS. “We're not really fighting over that half of a township money wise,” said Hyde. “That money goes to help pay for equipment purchases and it also helps for wages.” One issue identified by the ambulance board several years ago was CLSS was starting to be a training center for other ambulance services. The rates of pay were much lower at CLSS and they were not competitive anymore. “So we would hire new people, train them and then other agencies would come in at a whim whenever they needed a full time person and they could take our good employees,” said Hyde. “Now we are a little bit more competitive.” There are still come ambulance services around the region with larger millages, so CLSS cannot be as competitive with them, but they are close. Because of this, CLSS is not losing as many employees as they used to. Without the millage, they could not be able to stay competitive. “So what this millage does, it helps us buy equipment and it helps us with the stop gap of wages,” said Hyde. Hyde also outlined the service's capital improvement plan, outlining the major purchases they have to make each year. One of the largest impacts on the ambulance service in the recent past was the closing of Cheboygan Memorial Hospital. When the hospital closed, they went up to about 500 more transfers per year. When the hospital was open, around 90 percent of all calls responded to from the Cheboygan Ambulance Station were taken to the hospital in Cheboygan. 500 of the people who were taken to the hospital ended up staying in Cheboygan, rather than needing to be transferred to Petoskey or another hospital. “Right now we are down to about 46 percent of our patients go to Cheboygan Hospital from this station,” said Hyde. “The rest of them now are going directly to Petoskey.” For a priority three patient, someone not extremely sick, if they request to go to Cheboygan, according to the Medical Control matrix, they are taken to Cheboygan. However, if they are a priority one patient, meaning they are having a heart attack or in a bad car accident, they are taken directly to Petoskey. “Occasionally we will go to Cheboygan for stabilization,” said Hyde. “You have to remember, most of the time, there's one person in the back of that ambulance. So, if you have a really, really bad injured or sick patient, it's a 41.6 mile drive from downtown.” There are two on duty staffed crews in the Cheboygan station 24 hours a day, seven days a week, with one staffed crew in the Indian River station. There are times when CLSS can have up to six trucks on the road at one time because of the number of calls to which they need to respond. Last month, CLSS made 285 transports, either taking a patient to the hospital, or transferring them from one hospital to another. “So we are very busy,” said Hyde. “One of our biggest expenses, if you look on the ambulance replacement program, we're actually going to be bringing an ambulance bid in to my board meeting tomorrow.” CLSS's current ambulance replacement plan is replacing an ambulance every year and a half. However, with six ambulances in the fleet, they are pretty old when they reach the end of their life with the service. From the Cheboygan Station, each ambulance gets around 70,000 miles put on it each year. By the time it gets cycled through and is done at the station, there is around 300,000 miles on the trucks. Because of this, the ambulance board is talking about possibly going to replacing the ambulances one every year until they are able to catch up a little bit. Once the ambulances get that old with that many miles on them, they become a maintenance nightmare and they are not the safest to have on the road. Without the millage, CLSS would be forced to decrease services, going from the three crews they have now down to two, which would not allow them to meet demand. “So it's definitely something that is needed to keep us going like we are,” said Hyde. The ambulance service is also looking at the feasibility of switching their radios from the 100 watt radios to the newer 800 mHz radios. This will be due to the upcoming narrow banding and to get rid of the dead spots in the county where the trucks cannot talk on the radio. This switch can get very expensive, so Hyde hopes there will be some sort of grant that can help cut down the cost. He also outlined how CLSS took over the management of Rogers City, Mackinac Island and St. Ignace ambulance services and the subscription program the service has, which for $60 a year for a family makes use of the ambulance affordable for most. These subscriptions also work with the partnerships with Emmet County EMS and Onaway Area Ambulance, so if a patient is picked up in any of the extended areas, they are covered by the subscription. Commissioner Chris Brown complimented Hyde on the first class operation he has with his ambulance service, commenting how clean the rigs were and how professional and courteous the medics were. Commissioner Chair Pete Redmond echoed the praises for CLSS. “I know that I, myself, along with the board, appreciate all the hard work that Dallas and his staff does,” said Redmond. “We appreciate the board of directors, our Commissioner Wallace is a part of that. It's an entity that's out there every day but you don't hear a lot about it, so that tells me things are running smoothly.” Redmond said he feels it is critical the millage on the ballot in November passes so that operations can continue to run smoothly.