ACA, sequestration hits Sidney's emergency response budget

The emergency response care program in Sidney faces a shaky budgeting future due to federal cuts and uncertainty resulting from upcoming changes in federal healthcare laws.

Randy Meininger, the program manager for emergency response care, which is a department of Regional West Medical Center, spoke with the Sidney city council last night about his troublesome budget.

In 2002 a partnership for emergency response care was formed with the city, the county Regional West Medical Center and Sidney Regional Medical Center to be able to provide advanced medical and life support services in Cheyenne county and the city of Sidney.

"Since that time, we've been able to add some paramedics on the roster," Meininger said. "Which is a good thing for the community, and like everything else, we're up against tight budgets."

The program took a 2 percent loss from sequestration.

"We're directly hit by that," Meininger said. "That'll pose us some issues going into our 2013-14 year."

Some parts of the program are seeing negative numbers pop up in the budget.

"What that does mean is that we have to put off some replacement of equipment," Meininger said. "Everything is in excellent working order and meets all requirements of the state and federal government. However, we aren't able to replace some of the equipment quite as fast as we'd like."

One of the biggest projects the emergency services program did this year was increasing the reach of the emergency communications system in the region. All public safety frequencies had to be placed on a narrow bandwidth as of January 1, 2013 to allow for more space for other frequencies. The system now has a 16 county span and reaches Ogallala and well into Colorado. The medical radio system now has a wide enough range to communicate with downtown Denver.

Meininger's contract calls for two ambulances, one of which can be used for transports in or out of the Sidney area, the other of which has to remain in the vicinity for 911 calls. Meininger thinks that ambulance services will soon have to change to keep up with the evolving nature of health care.

"Ambulance services are going to have to be more proficient and get involved on the pre side," Meininger said. "Of keeping people healthy and help keeping them out of the hospital."

Sidney will have to consider updating its emergency services practices, just like many other communities have already done, Meininger added.

"I think we're gonna have to re-title emergency medical services to essential medical services," Meininger said. "You're seeing across the state different projects, and across the nation, ambulance service where the paramedics are actually working on the pre-side to actually help keep patients out of the hospital. That will go hand in hand with the Affordable Care Act and with medical models that will become more popular in the years to come."

The council seemed concerned about the emergency services budget, but understood that it is a vital service to the community, involving many complicated facets.

"In the meantime, we operate in the red until we figure it out," Sidney Mayor Wendall Gaston said.

City Council member Chris Gay wondered if Meininger had a solution in mind for resolving his budget woes.

"I don't see a solution in the near future," Meininger said. "There's some changes at the federal level that may allow us to do some things, but right now the healthcare industry is just in limbo, not knowing which way to shift and we're no different. Right now, healthcare is in a struggle."

Although the current contract calls for two ambulances the company has always provided three.

"We may need to pull back and just provide for what the contract is," Meininger said.

First, he would make sure no one would be put in jeopardy by cutting back ambulance services.

"So far, we've been able to meet the needs of the community and I'd be lying if I said that 100 percent of the time we could meet 100 percent of the needs of the community. That's just not realistic. But we're pretty close," he explained.

The company started seeing negative numbers in its budget about two years ago. In 2011, Meininger emergency services received a federal cut of 2.3 percent and then got hit with a two percent cut this year.

"It just keeps snowballing," Meininger said.

The governor agreed that healthcare is getting more complicated.

"And care requirements are going up," Gaston said.

Medical equipment is also being taxed right now that wasn't taxed in the past, Meininger added.

Sidney's city manager Gary Person defended the emergency management system to the council.

"Just to put it in a historic perspective, we had a real mess on our hands in regards to the service that was being provided to the community prior to the time that Randy stepped in with a proposal," Gary Person said. "I can tell you that it was an absolute crisis at the time."

Person understands why the council might balk at the red numbers in the budget.

"Its far better than the situation we had a decade ago," Person said.

The mayor agreed with Person.

"I think we're getting a good service at this point," Gaston said. "A better service."

The service is looking into ways to cut down on expenses, but hasn't made any decisions at this point.

"We're looking at how you keep competencies but put more part time people on, instead of full time people," Meininger said. "We're just like any other corporation out there right now with the healthcare changes. We're looking at those same things."