Dean Cole, Program Administrator with the Nebraska Department of Health and Human Services Emergency Medical Services and Trauma Program, presented an hour long consultation with the Kimball County Board of Commissioners on its decision two weeks ago to take over the ambulance service.

Kimball County has held a private contract with Jim O’Brien, the current ambulance service director, for over 40 years. His most recent contract expires at the end of October. Cole, along with Panhandle Medical Services Coordinator Larry Wallace, advised the commissioners how to transit from a private contract-based ambulance service system to one that will be county operated.

The first suggestion to the commissioners is to have the state EMS and trauma program team conduct a thorough EMS Assessment of the Kimball Ambulance Service. Cole recommended that two outside individuals come to Kimball to conduct the assessment. He suggested that Gary Windgrove, who helps run the Mayo Clinic Ambulance Service in Minnesota, be brought in along with Jim Murray, retired EMS Director for the State of Wyoming who now resides in Nebraska. Cole also added that Windgrove is an expert in rural ambulance services. These outside personnel would look at Kimball’s current ambulance service, what it needs now and in the future from billing to management.

A report would be compiled after the assessment is completed at no cost to the county for it is financed through critical access hospital money as part of a federal rural health program. “The board has no obligation whatsoever to do the recommendations,” Cole told the commissioners. The assessment would take approximately two to three months to complete.

In addition to the assessment, Cole suggested that an audit would be conducted and have the new county-run ambulance service join the Rural Nebraska Regional Ambulance Network in which Kimball Health Services hospital is a member of, but the current privately contracted ambulance service Kimball has is not.

Ambulance services get reimbursed by Medicare and Medicaid money in which O’Brien has been handling solely up to this point. “It is very important that the transition become smooth for your Medicare and Medicaid reimbursements,” Cole said.

He added that the county should consider hiring a medical billing service under an initial one-year contract during this transitional period. “Going with a vendor would probably be money saving in the long run,” Cole said, due to the medical coding and other technicalities that are involved. Also, a electronic patient data collection system will be required by 2014 and must be compatible with the state billing system.

Attorney Robert Brenner, independent Kimball County legal council, asked if area hospitals the ambulance service works with operate under written contracts with the county. Cole suggested that the County have a written contract with the physician medical director of these hospitals and reimburse this person for their services.

Commissioner Larry Engstrom questioned Cole as to whether or not a ambulance board needs to be created to oversee the operation. There was also a question on whether to form a special Ambulance Service District which would provide the county a taxing tool to offset the costs of running its new program.

How smoothly the transition goes depends to some extent on how well O’Brien works with the county during this time. O’Brien asked Cole if his office has ever experienced problems with the service he has ran over the years. Cole said that he has had issues with O’Brien on the use of the electronic patient data collection system.

The commissioners plan to hold a special meeting September 27 to review applications and conduct interviews for its Ambulance Service Director with the hopes of having this new person on board the beginning of October. Audience members present during the commissioners meeting Tuesday morning questioned if the county will have time to review and possibly follow through Cole’s recommendations.

Kimball Hospital Director Ken Hunter asked if it is realistic to have an employed ambulance director by October 3.

“I can see hiring the person, but to try to transition in 30 days with a volunteer ambulance service, do you think that is realistic?”

Audience member Jerry Williams had concerns about service during the transition time. Commission Chair David Bashaw explained to the audience that no disruption of ambulance service will take place during the change.