The ambulance company recently chosen for Augusta, Central EMS, charges Forsyth County, Ga., its primary existing market, significantly less than Augusta patients are now billed by other providers.
But the two counties – and their EMS agreements – are significantly different.
Augusta-Richmond County leaders remain divided in the choice of an EMS provider, with some backing Central, the provider in Forsyth County picked to serve Augusta by a regional state council.
Others want to stick with Gold Cross EMS, the Martinez company that abandoned its Augusta license during efforts to secure a new contract but now wants the business back.
Forsyth is a wealthy county of 260,000 north of Atlanta with a median household income of $121,000, according to census data. The median income in Forsyth far exceeds Augusta’s $46,237 and even neighboring Columbia County’s median of $85,928.
Central EMS has been the provider in Forsyth since 2016, when the county commission replaced a local firm that continued to raise its rates.
Under Central’s current contract with Forsyth, the county pays an annual EMS subsidy that goes up 3% each year and is currently around $1.03 million. The subsidy is in addition to what Central can bill and collect from patients.
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‘Like one department’
Forsyth County enjoys a tight working relationship with Central, dispatching its ambulances from the 911 center in the county public safety building, said Ron Fagan, division chief for Forsyth County Fire Department.
Fire and EMS equipment use the same radio channel, and personnel can track vehicles headed off to emergencies simultaneously, he said.
“I can look at my computer right now and see all of them,” Fagan said. “We are almost like one department living together.”
Under the contract, Central must maintain 10 ambulances dedicated to Forsyth 911 medical emergencies during daytime hours, and eight overnight, Fagan said.
The number of ambulances is determined by call volume, and Central must add a new vehicle if calls increase by 90 per month over four months, according to the contract, obtained through an open records request.
Eight of 14 Forsyth fire stations host an ambulance and crew, and there’s little lag in response times, he said.
“Typically the fire apparatus or EMS arrive relatively close together, or EMS gets there first,” Fagan said.
The department sees some overlap in staff, but firefighters must be off for 12 hours prior to a firefighting shift, Fagan said.
Monitoring the contract
Reports of late or never-responding ambulances are a chief of complaint by Augusta commissioners who oppose renewing relations with Gold Cross.
Rick Hamilton, EMS coordinator for the Forsyth fire department, helped create the request for proposals that’s now part of Central’s contract, which he manages.
“The big points are how many med units they have to have in service and what their response times are in calls,” Hamilton said.
Central has to send a report every time a response time is greater than eight minutes that documents the reason for the delay, he said. By the 15th of each month, Central sends a report on the number and types of calls, their destinations, the number of cancelations and other data.
“It gives you a good picture of how they did for that month,” Hamilton said.
For instance, during December, Central responded to 1,470 calls and transported patients from 1,049 or 71% of them, he said.
Fewer people, more calls
Subtracting Fort Gordon, Augusta-Richmond and Forsyth are about the same geographic size, but Augusta has more fire stations, with 19.
And despite the smaller population of 206,000, Augusta had 50% more EMS calls, averaging 2,200 per month, last year, with 65% resulting in transports.
That’s according to data included in the state’s request for EMS proposals won by Central.
Other data in the request was lacking. While Augusta had 26,628 EMS calls last year, the method of payment – such as private insurance, Medicaid or Medicare – for 22,518 of them was not reported.
Central President Gary Coker hasn’t said what he wants Augusta to pay, only that its private equity owners deserve a 10% profit. The amount would be determined during contract negotiations.
Augusta is currently paying Gold Cross a month-to-month contract subsidy that would total $1.9 million annually.
Gold Cross Vice President Steven Vincent has suggested a charge of $99 per call, which would amount to around $2.6 million annually.
He’s also stated Gold Cross could provide eight ambulances for $2 million or 10 for $2.75 million.
Columbia County contract
In Columbia County, where Gold Cross is the licensed provider, the EMS contract includes a $850,000 annual subsidy “to provide care for needy inhabitants” and to “help offset contractor expenses.”
The county can request from Gold Cross a quarterly summary of its collections versus written-off bad debt.
The contract, obtained through an open records request, requires seven dedicated ambulances and three quick-response vehicles available at all times.
Columbia County’s contract requires an ambulance to be en route within five minutes of the call. Gold Cross is supposed to email a report to the county manager for all calls that have a response time greater than 30 minutes, it states.
Higher rates
Gold Cross unveiled rate increases in Augusta and Columbia two years ago that are higher than Forsyth’s. The rates are $1,750 per transport plus $28 per mile.
Central’s contract in Forsyth specifies what it can bill for and how much it can charge, Hamilton said.
Subject to annual 3% increases, Central can bill Forsyth patients approximately $1,200 per transport plus close to $20 per mile.
Hamilton said the size of Central’s parent company allows them to make smaller profits from 911.
“Generally, a 911 ambulance service is not a moneymaking thing, but they’ve got a huge non-emergency transport side throughout Georgia,” he said.
Parent company Priority EMS has over 800 ambulances at locations across the country. Its Georgia subsidiaries are the main providers in Cobb, Rockdale, Morgan, Catoosa, Clarke, Oconee and Newton counties.
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More contract provisions
Central’s contract with Forsyth includes a bond it could be forced to repay for reasons such as breaking the law, falsifying data, excessive downsizing or inadequately certified staff.
It prohibits Central from paying gratuities or doing favors for any government official to win their support.
It includes penalties. If Central doesn’t make response times 90% of the time in a month, it must pay $1,000 for each percentage point under 90%.
Failing to report the times ambulances arrive on scene is a $250 penalty unless mitigating circumstances are shown.
Susan McCord is a staff writer with The Augusta Press. Reach her at susan@theaugustapress.com
