Rich Leipfert: Costs swelling, dollars shrinking at Mac Fire

But forces beyond our agency’s control are limiting the resources needed to continue heeding its creed, and they have to be addressed on both a short- and long-term basis to put us on a sustainable footing in the future.

The organization started as an all-volunteer firefighting force that also responded to emergency medical calls. It transported patients to the hospital in a van, providing nothing more than basic life support services.

Through innovation, creativity and the desire to serve, we have expanded into a one-stop, all-hazards emergency response system, capable of handling everything from structure fires to vehicle extrications.

On the fire side, we maintain a force of highly trained personnel prepared to respond at a moment’s notice. In addition, we have established a code enforcement division dedicated to preventing fires in the first place.

On the EMS side, we now provide advanced life support services, enabling us to effectively treat everything from an allergic reaction to a bee sting to advanced cardiac care. This is carried out by highly trained and committed professionals deployed in state-of-the-art ambulances equipped much like a hospital emergency room.

But this system and these abilities come at a cost. Many citizens are not aware of the level of services these systems provide to the community, or the costs associated with such advanced degree of services.

As with all public service agencies, staffing is our largest expense.

Over the years, the availability of volunteers has been reduced, due to legislation that requires increased training hours for volunteer participation as well as the fact that most businesses restrict or prohibit their employees from responding during work hours. This reduces our response capabilities.

For departments relying more heavily on volunteers, if not entirely, the impact is even more dramatic.

Hiring full-time staff is required to offset the loss of volunteers and maintain a sustainable work force for both fire and emergency medical responses. And each firefighter/paramedic position costs us about $140,000 a year, when you consider salary and benefits consistent with state law, union contracts and city policies.

Equipment and supplies are also big expenses.

A basic fire engine can run $400,000 in today’s market. Meanwhile, costs associated with medical equipment and pharmaceuticals are skyrocketing.

An example of the latter is naloxone, an opiate overdose reversal drug best known under the brand name Narcan. A dose that cost 85 cents 10 years ago now costs $42.

We have two sources of revenue, general fund tax dollars and fees charged for EMS service.

Medicare and Medicaid patents account for 82 percent of our EMS calls, and those calls are only reimbursed at 30 percent of their actual cost. We have to take this into consideration as we seek ways to make our service sustainable in the future.

As we move forward, we must find new ways to fund the system if we are to maintain our service capability without bankrupting taxpayers. And we have to accomplish that in the face of both a growing population and an aging demographic, both serious challenges in their own right.

As our population grows, so does the demand for services and the cost of providing those services. Our call demand has risen 137 percent over the last 20 years, and that is stressing the system.

What’s more, an increasing number of long term care providers have established facilities in McMinnville in response to our growing and aging population.

This increases demand for services to an even greater degree, mostly on the Medicare/Medicaid side. And we’ve found that a significant percentage of the calls we are getting from this quarter are actually non-emergency in nature.

Recently, the city took several steps to address some of the financial challenges our organization is facing in this regard. A key element is a new care facility specialty business license, designed to reimburse the city for costs associated with the growing burdens of non-emergency use of the city’s EMS system and additional code enforcement required for care centers.

There are a variety of other ideas on the table, some involving new fees or taxes. But these are more stopgap solutions than guarantors of long-term sustainability.

Throughout the country, fire departments are struggling with the same challenges as ours here in McMinnville. The most success seems to be coming through  partnerships, consolidations or mergers among local fire and EMS systems to centralize overhead, streamline management and economy of scale into play.

Yamhill County is currently home to nine fire departments, seven of which employ chiefs being paid on either a part-time or full-time basis. They all work together at fire scenes and respond to each other’s districts routinely in response to significant incidents.

One example of this type of collaboration is the contract the city recently reached with the Amity Fire District. Through this partnership, we have improved EMS response times, increased availability of Amity fire apparatus and laid the groundwork for future cooperation on a larger scale.

Joining forces in a collaborative way can reduce duplication of efforts, thus freeing up existing funding to help assist with shortfalls. However, that is not, in itself, a viable long-term answer either.

Creating a larger fire district with a self-supporting tax base is likely the best way to address the long-term viability of our organizations. That would allow us the privilege of continuing to provide the high levels of service our citizens have come to expect and deserve.