In rural Columbia County, ambulance crews hold the line on emergencies
Health care in Columbia County mirrors the health care landscape for many rural communities. Through a comparison of statistics compiled by the Oregon Office of Rural Health, Columbia County doesnt have the worst access to health care and emergency services. But it doesnt have the best, either.
And also like many rural communities, the first line of emergency care falls to ambulance crews paramedics and emergency response technicians who work 24-hour shifts and respond to emergencies ranging from heart attacks to earaches. For south Columbia County, emergency response duty falls to the firefighter-paramedics with Columbia River Fire & Rescue and Scappoose Rural Fire District.
Collapse of a proposed hospital project in St. Helens in 2011 due to federal rule changes, a veto of the project from the Oregon Department of Human Services and a referendum from local taxpayers that gutted its financial base solidified ambulance response as the top and only emergency health care service in Columbia County. Factor in fast-moving, sweeping changes many restrictive in the national and state health care programs, and its a scenario unlikely to change anytime soon, though mandates could alter the current billing structure.
When it comes to emergency response, for the most part residents in south Columbia County have it as good as most.
Its about the same as the first hour they would receive in an emergency department, said Columbia River Fire and Rescue Division Chief Brian Burright.
Its not entirely the same, he admits. For one, the environment for care is always shifting administering emergency procedures to a person who has collapsed in a small bathroom is considerably different than working under well-lit conditions with a staff of trained caregivers and the latest in medical equipment at a state-of-the-art emergency room.
And then theres the drive. In critical cases, it can mean a high-speed run into Northwest Portlands Legacy Good Samaritan Medical Center for most south Columbia County residents, with each call resulting in a two-hour commitment from the emergency response crew.
Unmet need with rising
St. Helens along with Clatskanie and Vernonia qualifies on the state statistical spectrum as an area of unmet need based on a complex formula that considers five variables, including the percentage of primary care visits met, travel time to the nearest hospital, mortality ratio, low birth weight and ambulatory care sensitive conditions, the latter also known as preventable hospitalizations.
Of the 4,000 calls CRF&R fields annually, nearly 75 percent 2,900 are requests for emergency medical services, Burright said.
Tom Moung, 33, is a seven-year veteran with CRF&R who said one variable almost certain to increase is the number of calls the agency has to manage.
From an operational standpoint with this department, we will likely run more calls, Moung said, adding that he has seen the call volume increase by 100 annually since he started.
Most 65 percent of the transport calls, in light of Columbia Countys aging population, are reimbursed through Medicare, which pays 80 percent of allowed charges. Burright said there is much that is not recovered, however. Even with the agencys permanent tax rate that equates to $594 annually for a house assessed at $200,000, he said demand is reaching a point that is putting stress on available resources.
Were right on the bubble right now of needing more resources, he said, adding that the budget has stabilized in comparison to recent years.
During a 1.5-hour visit at CRF&Rs stationhouse on Columbia Boulevard in St. Helens, as many as five response requests blared over the stations loudspeakers. Most, on that given day, responded out of CRF&Rs Rainier station.
Each incoming call is prioritized at Columbia 911 dispatch to assess response level. For each call requiring a response, a staff of at least two cross-trained firefighter-paramedics makes the trip.
Typically an ambulance and a fire engine both respond, a practice sometimes criticized for the added expense but one Burright said is needed to safeguard against lost time should multiple calls demand parallel response. Its not an unusually occurrence, he said.
Each trip to an emergency room is also part of the funding equation for the service. Medicare and Medicaid, as Burright explained, dont provide reimbursement for emergency summons that dont result in an emergency room trip.
The only time we bill is if we close the back of the ambulance doors and take you to a hospital, he said. At the high end, an ambulance trip to a hospital costs $1,000, with lower-level emergencies billed at $600, he said.
The billing formula could change, however, as part of Gov. Kitzhabers broader statewide health care reform initiatives spearheaded under the title of Coordinated Care Organizations, Burright said.
Under the current system, emergency response for actions such as administration of a glucose shot or for a diabetic is free. Burright said possible state changes could result in a fee attached to that treatment. Exactly how much, and other possible effects from the changes such as greater cooperation between all local health care providers, isnt clear.
Its kind of an unknown, he said. Hopefully its going to allow us to have better collaborative partnerships.
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