BY MARK J. CRAWFORD
Telegraph Editor
STARKE — Bradford County’s second budget workshop covered the singular topic of Bradford County Fire Rescue and gave commissioners a lot to think about.
Director Allen Parrish laid out the proposed operational plan for 2022-23 and what it will cost to carry out that plan.
Parrish has cut $562,000 from the budget by not filling six positions due to a hiring freeze. As previously reported, this triggered the loss of one ambulance, which Parrish said would also result in a 20% reduction in ambulance response to the public and increased response times. In the first week without the ambulance, he said they had already experienced delays.
In addition to not filling those positions, personnel training hours will be cut, as will the number of on-call contingency personnel and personal leave coverage hours.
With a 9% cut from the current budget, the request for next year is $5.8 million. Projected revenue from fees for service and interfacility transfers is $3.26 million, a conservative number, according to Parrish. That means the board will need to find an additional $2.56 million to fund the fire rescue budget as proposed.
Personnel wages, salaries and benefits account for 80% of the budget. Around $310,000 is requested for executive salaries, which includes the director, two division chiefs, a training captain and the fire marshal/inspector. Wages and salaries for the 50 full-time fire rescue employees and 15 part-timers total $2.6 million. Benefits, including taxes, retirement, insurance and worker’s compensation adds another $1.7 million. All compensation is set by the commission. Union-bargained pay increases resulting from class changes as well as department departures will impact the final numbers.
The remaining budget request includes $1.03 million for operations, a $75,000 grant match for a new ambulance and/or remount, and $70,000 in contingency funds.
The operations plan provides for four advance life support ambulances — one each in Starke, Sampson City, Lawtey and Theressa. It provides for an Advance life support fire engine with a paramedic/fighter and a EMT/firefighter at Sampson City. A basic life support engine with two EMT/firefighters will be stationed in Lawtey and Theressa. The paramedic lieutenant will be stationed at fire rescue headquarters and the fire lieutenant will be stationed at the courthouse annex.
Missing from the budget request is $789,000 the sheriff received to refurbish the station in Heilbronn Springs prior to Parrish becoming responsible for fire services. Parrish said if the board decides to proceed with that project, the money will need to be put back into his budget.
Parrish said this is a first draft of his budget which will undoubtedly change as budget workshops continue. The next was scheduled for Tuesday, April 12, at 6 p.m.
Billing and collections
Because Bradford County Fire Rescue has been in the spotlight as commissioners consider how to cover public safety costs, Parrish also tried to clear up misconceptions about how the department operates. One criticism has been billing for services and the thousands of dollars in uncollected debt written off each month.
Both billing and debt collection services are outsourced, with Alachua County Fire Rescue currently contracted for billing. More than $4 million was collected in 2020-21, for which Bradford paid Alachua nearly $169,000. That was 4% of net revenue, which is normal for the industry, Parrish said. National Recovery Agency handles unpaid debt, keeping 15% of whatever it collects.
Bradford County Fire Rescue has a single administrative assistant, and when Parrish was hired in 2008, that individual was taking work home on weeknights and weekends to try to stay caught up. There was still a three- to four-month backlog and $3 million in uncollected debt — none of which was being reported to credit bureaus. That’s why shortly after joining, Parrish recommended outsourcing billing.
Around 5,000 accounts were turned over to the first billing vendor, and within months they were caught up — evidenced by the citizens who would line up at the EMS office to complain they were being billed for past services rendered.
Parrish said bringing billing in house would require three full-time employees (the number Alachua has assigned to Bradford billing) making a $15 an hour minimum wage plus benefits, several thousand dollars in software, plus the unknown cost of ongoing employee certification.
While the perception might be that the county would do a better job billing for its own services, it would come at a cost and some additional problems, like employee turnover and retention.
Not that outsourcing has been without problems. Whenever Parrish sensed a vendor was underperforming, he would quickly find another. The service changed hands many times,
“I was told at that point in time by the then county manager that we were going to make one more move to a billing company and that was going to be it, and that I was going to have to live with whatever we got. … Each time you transition the billing company, it takes a long time to do that because they have all the records and it’s very confusing,” he said.
Parrish said creating a billing department might pay off for Bradford County in the long run, but the decision needs to be based on information, not perception.
“I mean, we’re hurting for revenue, and for us to spend that money that we’re not going to get a return on for many years down the road, I think we need to look at that,” he said.
Outsourcing debt collection allowed credit bureaus to be notified with patients did not pay. Prior to that, EMS could only seek a county judgment, which Parrish said never recouped any money. There was no uniform policy. The policy in place now is auditor recommended and commission approved.
Now when fire rescue requests and the commission approves monthly write-offs, those are the bills that get referred to the collections agency after 180 days of nonpayment. This is not debt that is being forgiven, as some seem to believe, Parrish said.
“There’s been a lot said about write-offs, a lot of conversation about EMS writing off accounts, throwing away money, not collecting enough money. I’ve heard it all over the last couple of months,” he said.
Even the threat of ruined credit doesn’t ensure fire rescue will be paid for its services. Unlike a business that could refuse service for nonpayment, fire rescue must respond, Parrish said, even when patients are uninsured and have no other means of payment.
“Out of all the collection agencies that we’ve been with since I’ve been here, NRA has been the most productive, and with saying that, they still aren’t very productive. One way we look at that is if the collection agency is not able to collect a lot of money, it must mean that our billing company is doing a fairly good job. … The other way to look at that is simply, industrywide, people just don’t pay their medical bills,” he said.
Parrish also talked about how they are hurt by Medicaid and Medicare, which adjusts medical bills by hundreds of dollars — money which the county is never paid. He showed examples, including a $945 charge reduced to $190 after the Medicaid adjustment.
Parrish hasn’t given up on increasing revenue through billing. He would like to negotiate a performance-based contract with Alachua County Fire Rescue to incentivize their work for Bradford by allowing Alachua to keep a percentage of what it collects instead of a flat fee.
A flat fee is how they have been paid since 2015, with an annual 2% increase.
Other misconceptions
Parrish addressed what some have said about the ambulance service being too big or the number of calls being inflated. He showed how the number of calls for service has increased since 2020. He also made a case for something else they have been criticized for, and that is transporting emergency room patients to the hospital. He said giving up that contract would be “foolish” considering it netted more than $1 million in 2020-21. Unlike some patients, the hospital pays its bills.
Parrish said it is not true that he kept a private ambulance service from operating in the county. In fact, in 2017 he issued a certificate to operate in Bradford to a company who was assisting with interfacility transfers at his request. The next year, Bradford EMS ceased most transfers, focusing instead on emergency response. He and the medical director even helped the company find a local facility from which to operate.
Then the hospital in Starke was purchased by HCA and turned into a standalone emergency room. According to Parrish, HCA preferred working with the county instead of the private vendor, so fire rescue — with the board’s approval — began making those transfers and profiting from the arrangement. The private company’s certificate to operate was not renewed.
“The reason we went with the transfers to start with is we knew we had to add another truck to take care of the 911 calls. But, we knew we couldn’t afford it. That’s why we went and got the transfers. It’s sitting there for us. It’s a million dollars. The county’s starving for revenue, and we were willing to go work for it. So, anybody that says we shouldn’t be doing transfers is not looking at it economically,” he said.
