Residents of Eureka Springs who are not covered by any health insurance may see their rates for using the city’s ambulance service increase.

That’s what would happen if a new rate structure is approved by city council.

Eureka Springs Fire Chief Gary Inman told city council members at the council’s regular meeting on Monday, July 28, that his department participated in the nationally required Ground Ambulance Cost Data Collection Initiative aimed to show how much it costs fire departments across the country to make an ambulance call versus how much they’re reimbursed by insurance companies.

“… The overall cost per transport is $2,673 with the average reimbursement being $1,147,” Inman said. “We’ve always known that there was a pretty big disparity between how much it costs versus how much we collect. You could kind of read some of the advocacy efforts and what they have planned next, but Medicare and Medicaid both pay very poorly compared to private insurance.”

Current federal laws require ambulance services to accept the payment they receive from insurance companies, regardless of whether it covers all expenses, Inman said.

The Arkansas state legislature recently adopted Act 867, Inman said, which allows ambulance services to be reimbursed for up to 325 percent of the Medicare rural rate.

While covered individuals would still be responsible for copayments and deductibles, the new regulations wouldn’t affect their out-of-pocket cost, Inman said.

“This does hurt one demographic of people and that is people that do not have insurance at all,” he said. “If a person has insurance, they still pay their copayments, their deductibles like they always have. But, then the remainder of their bill past what the insurance pays is considered payment in full.”

Inman said he expects most ambulance services in the state will enact rate increases in order to receive higher reimbursements.

“We’re by no means obligated to raise our rates; we don’t have to,” he told council members.. “It’s my recommendation that we do. But, ultimately, it’s your decision.”

Council member Terry McClung wanted clarification how the rate increase would affect those on Medicare.

“We have a lot of retirees in our area here, of course, and so just so we can understand in actual dollars and cents, a retiree on Medicare with the Advantage Plan, what’s he going to pay for an ambulance?” McClung asked.

“He’ll pay the same thing that he has always paid,” Inman answered. “He’ll be responsible for any copayments or deductible or other fees that are pre-agreed upon between him and Medicare or Medicaid.

“ … We accept what Medicare pays as payment in full.”

The benefit for ambulance services who raise their rates would be higher payments from private insurance companies, Inman said.

“There’s a big difference between what Medicare pays and what private insurance pays, everybody knows that,” he said. “They are lobbying right now. I mean that’s the purpose of that study that they did over the past four years, is so that they do have information that they can go to Congress and try to increase the Medicare and Medicaid amounts that they pay for ambulance transport. But, right now, that’s what we have to live with, and the state of Arkansas recognizes that as a problem, and they have adjusted the private insurance rates, what they felt was significant enough to make up for the difference.”

Council member Rachael Moyer asked Inman if he knew how much his department loses by providing service at the current rates.

“I can’t say what the number is, but we do operate in a deficit every year, and it’s a significant deficit,” Inman said.

Council member Susane Gruning asked Inman if neighboring cities such as Berryville or Green Forest have increased their rates.

“This is so new that not everybody has made their changes yet,” Inman said. “Everybody is in the process of doing the same thing that we’re doing.”

Inman later added that while it is early in the process, Eureka Springs wouldn’t be the first city in the state to take advantage of what the law now allows.

“… That’s what everybody will go to eventually because that’s what the state says we can collect from private insurance,” he said. “No, there probably hasn’t been a whole lot of people do it yet because it’s so new, but that’s the direction it’s headed. …” McClung ended up making a motion to table the subject until the council’s next meeting to give Inman an opportunity to research items the council requested.

PAYING FOR WATER/SEWER SYSTEM

While the city has received money on a loan from the state to help pay for the reconstruction of the city’s water and sewer system, Moyer presented a new idea for the city to help fund the project and future projects.

“Rather than rely on the rate increases to fund the needed water and sewer updates that we know we need, I feel it would be more equitable to spread the cost of updates over all of those who come to Eureka Springs and enjoy the amenities here,” Moyer said. “I’m interested in pursuing a municipal bond for water, sewer and street repair and an accompanying sales tax to retire that bond.

“My understanding is that our financial standing would support this. And I know that conceptually, at least, this would spread the cost not just to 2,000 households in Eureka, but to everyone who visits here. So, I just wanted to open up the discussion to see if that was something that the council thought was worth pursuing, or if we wanted to have any further discussion on that.”

The future, even beyond a new treatment plan, is the focus, Moyer said.

“So, we have a crumbling water sewer infrastructure, right?” she said. “We know we’ve got several million dollars worth of repairs and updates that need to be made. That’s just right now. That’s not with the effect of time, as we know we are all experiencing. So, I’m sure that there’s more things down the road. I don’t know, Simon (Wiley, the city’s public works director) might have a different idea, but if he does, he can please share it.

“I’m guessing that there are other repairs and updates that we don’t know of yet that are just down the line. So, this is an ongoing issue that not just we experience, but cities all over the state. In fact, the governor is trying to address this now. So the way that we’re currently dealing with it is we’ve done a rate study, we’ve proposed an increase in rates to try to cover the expense of that. But, what that does is it just puts the burden on the people who live here, own property here. We’re not a big community, so it’s a big burden on a few people. And my thought is that if we could look for a bond issue and create a sales tax that would be dedicated to retire that bond, then everyone who comes to town and participates in all the things there is to do here would pay that tax. And that money would then be used to pay for those infrastructure improvements. …” Wiley reminded council members that rates adopted were a result of state-mandated Act 605, a law making sure water departments in the state were being fiscally responsible.

“Now, if you guys want to go above and beyond that by creating another sales tax bond issue you’re more than free to do that,” Wiley said. “I think the people have to vote on it, and the last time that we had a vote, they voted it down just to keep it in perspective.”

Mayor Butch Berry reminded council members of that vote as well.

“I think it was four or five years ago we tried to do the 1-cent sales tax dedicated to water and sewer,” Berry said. “Actually, it was three-quarters water and sewer and one-quarter for The Auditorium.

“It overwhelmingly failed.”

McClung responded: “There was a very strong opposition that was misguided.”

Gruning questioned whether residents would be now more inclined to vote for a tax.

“I remember that vote because we had just moved here full-time,” Gruning said. “And it seemed like the focus was more on The Auditorium and less on for supporting the water increase by the 1 percent that tourism would help pay for. I think now that water rates have gone up, that they may rethink that: Why should we, the citizens, pay for the big problem?

“I would hate to say because it didn’t work four or five years ago that it wouldn’t work today.”

Berry agreed. “I think it’s a great idea,” the mayor said. “When we tried to do it in the past, the same premise was the citizens aren’t paying this tax, that 90 percent of the tax is going to be generated by the visitors. …” McClung said the council could discuss the issue “until the cows come home without resolving nothing,” before suggesting an idea that was discussed in the past.

“I would encourage the mayor, once again, to put together an ad hoc committee to discuss things like the sales tax increase for bond issues … or any and all other avenues of raising money like we talked about doing before,” McClung said.

After a bit more discussion the council voted to have Berry proceed with the committee.

OTHER ITEMS

During his regular update to council on all things water and sewer, Wiley told council members that his department currently has four openings.

“I want to let the public know that we do have four openings in public works right now,” Wiley said. “So, if you are looking for a job, please reach out.”

The council also approved Susan Harman’s reappointment for another term on the city’s planning commission.

PUBLIC COMMENTS

Three people spoke during public comments, all continuing to bring up the ongoing hospital controversies.

Ferguson Stewart, chair of the city planning commission, indicated he was against any large hike in water and sewer rates, comparing a $40 bill he paid in 2012 to a current bill that is “over $110.”

“That’s just two people that’s both on Social Security,” Stewart said. “… So, 4,000 gallons of water and it’s $110, so I want you to think about that, OK? Think about that.”

Stewart then turned his attention to the hospital, voicing support for the commission and current staff.

“I am in sync 100 percent with what I think the mayor’s into that says commissioners are hard to find,” Stewart said. “These commissioners on the hospital commission, I know them and I’ve met the CEO at the hospital and I think that these people will get the job done. …. Commissioners are volunteers and I’m afraid if you do anything to impact those commissioners by threats or innuendos that I’m afraid you’re going to lose those commissioners, qualified hospital experienced commissioners, which I am not one of those.”

There has been talk in recent meetings of removing members of the hospital commission, with Berry often reminding council members how difficult it is to find interested individuals to fill vacant roles.

Then-chair Kent Turner was removed by the council in late January and former chair Barbara Dicks resigned in late November at the urging of Berry during the early weeks of the hospital controversy.

Those seats were filled by Vivian Smith and Willie Daniels. Smith joined the commission earlier this year while Daniels recently was approved.

Former hospital medical records clerk Samantha Webb continued to voice her displeasure with Berry for not doing more for the former employees she has said were done wrong by hospital administration.

“If this were taking place in any other town, heads would have rolled and justice served long ago, but not Eureka Springs,” Webb said. “All of us put our hearts into what we did for the hospital until they chose to yank it all away, cut us loose, and wash their hands of the whole thing, and they’re getting away with it.

“… Almost nine months of newspaper articles, meetings, and the question so many of us have: Why? Why are members of the hospital administration and commission determined to avoid accountability and transparency, not just when it comes to finances, but the treatment of their current and former employees? Why are they still being protected? Why are Jodi Edmondson and Cynthia Asbury still employed? Why was an anonymous letter allowed to be read? Why are we never on the agenda, again, the employees?

“Why is it that the mayor has no idea what you’re talking about, yet the moment any of you start to delve into something, he’s only too quick and too willing to defend the administration and commission? Will the mayor and hospital commission prove David Avanzino wrong and allow us to see that they are not, in fact, ignoring the human side in all of this? And why would former chair Barbara Dicks be concerned about a toxic workplace lawsuit?

“When someone shows you who they are the first time, believe them. I’m pretty sure they’ve done just that since the very beginning. It’s just that it only came to light through the articles released by The Independent and Times-Echo. Even more so in recent months and weeks.”

Heather Wilson, a member of the city advertising and promotion commission suggested hiring a “forensic accountant” to look at hospital finances, then recommended that the city should think about utilizing a city manager.

“… In my doctoral work … I study and design curricula on systems thinking, a concept that seems simple on the surface,” Wilson said. “When one part of the system fails, it strains the entire structure. You ignore it and then you’ve got problems. Proactive systems stay healthier. You schedule checkups before your body breaks down. You change the oil in your car before the engine runs dry. When breakdowns become catastrophic, whether a car, whether a medical situation or your business, you bring in the right expert, a mechanic, a doctor, a systems leader.

“Our town is well past this point. It’s time to bring in a city manager who truly understands how every part of this community fits together and who has the professional skill to rebuild the structures that are failing us. If this hasn’t yet been fully considered, I urge you to do so. If it has, I ask you to reconsider it with fresh perspective. A quick review of Arkansas code shows that the responsibility for this decision lie squarely on the city council.

“While it may not be possible to immediately address every failing aspect of city leadership, it is within your reach to make meaningful action happen. This means removing those who are not serving the community effectively and placing capable leaders where they are needed most, even when it’s uncomfortable or opposed to personal alliance. There has been talk that making these types of changes to leadership would cause failure, particularly where the hospital is concerned. That is not how resilient systems operate. Healthy systems, they withstand change. In fact, it’s often required to grow stronger. We’ve seen this in other parts of city government. We’ve adapted, we’ve improved when we’ve changed and embraced those implementations. Despite statements and innuendos, to the contrary, you do have the authority to repair and rebuild this system. Use it, please.”

A LOOK AHEAD

In agenda setting for the council’s next meeting set for Monday, Aug. 11, council member Avanzino requested an item to “discuss recent conduct concerns involving a council member and any potential actions that the council may consider in response.”

Council member Harry Meyer — who was absent from the July 28 meting — has been involved in an array of accusations in recent weeks, including allegations of assaulting a neighbor with a vehicle.