By Richard Sullins | richard@rantnc.com

For the second time in five years, Lee County residents could have a new provider of emergency medical services when the next fiscal year begins on July 1.

After a second public hearing and questions from the commissioners on Monday night, the county’s staff was directed after a 4-3 vote to prepare a first reading of an EMS franchise ordinance with MedEx, a privately-owned ambulance service based in Hertford County.

This first draft of the ordinance will serve as the basis for negotiations that will govern who will provide emergency medical services for Lee County, as well as the expectations of the county under which they will be provided.

An earlier public hearing, held on October 6, was sparsely attended. This second public hearing on Monday saw attendance of a little more than 100 persons in the audience.

FirstHealth of the Carolinas has held the county’s EMS contract since October 2021, but that agreement ends on June 30. FirstHealth and MedEx both made submissions for the next contract which will cover EMS service locally until 2031.

Monday’s vote to move into a negotiation phase with MedEx came along party lines, with Republicans Andre Knecht, Taylor Vorbeck, Samantha Martin, and Chairman Kirk Smith voting to in MedEx’s favor. The board’s Democrats, Cameron Sharpe, Robert Reives Sr. and Mark Lovick, cast their ballots in favor of moving to the next step in the process with FirstHealth.

The selection of MedEx as the company with which to negotiate surprised many in Lee County. County staff had recommended to the commissioners earlier this year that selecting a vendor a full year ahead of the FirstHealth contract’s expiration in June would be advantageous to the board, given the commissioners have a plateful of issues that need to be handled before the terms of four among their membership (Republicans Smith, Knecht, and Vorbeck, and Democrat Reives) are put before the voters 13 months from now.

The justification was that clearing the table of as many of these issues as possible before the election would help to prevent them from becoming campaign issues. The financing of a new elementary school, an unresolved dispute with the school board over locally funded positions, and a decision on the refurbishment or replacement of a new county jail and justice center are items already at the top of that list.

While the commissioners have been collecting cost estimates on those big-ticket items for the past several months, the estimated costs of a new five-year deal for EMS were still on the horizon. It was an amount that had been in the calculus as an item the commissioners were believed to have been planning for, but not believed to be so large as becoming a budget buster. Those who keep watch on Lee County politics was generally expecting to see an increase in the overall price of the EMS contract.

However, almost no one anticipated the extent of surprise when the county’s Emergency Medical Services Advisory Committee was presented with a proposal from FirstHealth of the Carolinas, the current franchise holder, which proposed increasing the contract’s value by millions of dollars per year. The original contract with FirstHealth was agreed upon in 2021 after it wrestled the county’s business away from the service that had provided since 1997, Central Carolina Hospital.

FirstHealth assumed control of Lee County’s emergency medical service functions on October 1, 2021. FirstHealth quickly hired some of the former CCH employees and occupied some of the spaces CCH had made use of before.

FirstHealth experienced some expected issues with the start-up of its own operations, and many of these were brought to resolution over time. As FirstHealth continued to make regular reports to the commissioners, the company appeared to be hitting its performance metrics most of the time and the commissioners appeared to be generally happy with the way things were going.

But an undercurrent of concern began to make itself felt more with each passing year, much of it centering around the ways the increasing costs of providing the service were being passed along to the county. This circumstance came as rising inflation returned as a contributing factor to the escalating costs of healthcare in the United States, and there was little that seemed to slow it down. FirstHealth was not immune from those changes in the industry and its leadership discussed them with the commissioners at several points during the life of the contract.

Still, having the incumbency of an existing agreement gave FirstHealth an advantage. The company seemed to have a good relationship with the county and it was meeting the performance measures within the contract. So when the county’s EMS Advisory Committee issued a Request for Proposals in late spring, few were surprised when it recommended a renewal of the contract for another five-year term.

That feeling among the county’s own professional staff could be seen among the items in the packet of materials sent to the commissioners before Monday, in a draft of a franchise agreement between the county and FirstHealth that spelled out how the partnership would function between the two until the summer of 2031.

Instead, Monday’s vote directed county staff to prepare a second EMS franchise agreement, this time with MedEx. That draft item is expected to be on the agenda for the next scheduled meeting of the commissioners on November 3.

Many of the questions posed by the commissioners to MedEx CEO Dillon Lowe centered around the ability of his company to meet the performance metrics contained within the RFP that all applicants were asked to respond to.

The company makes use of more than 400 employees outfitted in upwards of 90 vehicles in its present footprint of 13 North Carolina counties, making more than 75,000 annual transports. MedEx projected it will make 7,386 emergency calls in Lee County during the first year, along with an additional 6,000 non-emergency transports during the same period, just over 13,000 calls in all.

By way of comparison, FirstHealth projected receiving 5,229 emergency calls, along with another 4,639 that would be classified as non-emergency calls in 2026, for a total of 9,868 calls received. That’s a difference of 3,500 more calls projected to be received by MedEX than FirstHealth during the first year of the contract and making its projected costs $3.3 million less than FirstHealth.

The disparity leaves anyone who sees the numbers at a loss to explain it. How could MedEx provide more care for fewer dollars? And how could FirstHealth’s costs have skyrocketed in such a short time? It was this stark difference between FirstHealth’s numbers and the “more calls, less price” proposal from MedEx that drew the greatest number of questions.

The final piece of putting all this together and helping it to make sense is a brief explanation of how contracted companies like FirstHealth and MedEx get paid. The largest portion of an ambulance call is usually paid by Medicare or a private insurer. The remaining amount gets paid by the county to the provider to settle the claim, and it is the sum total of these amounts, called subsidies, that gets presented to the county for payment.

As the discussion between executives and commissioners went back and forth, the level of incredulity among board members just seemed to increase, leading Democratic Commissioner Mark Lovick to seek on-the-record assurances that the addition of 13,000 more calls to the 85,000 the company is already receiving would not cause the company’s systems to crash, placing the lives of patients in Lee County on the line, and that the increased calls would not exceed the company’s ability to give each the attention that patients and their families expect.

Matt Prestwood, president of FirstHealth Moore Regional Hospital, said the cost for his company to provide emergency response capabilities this year in Lee County was $6 million. Compare that figure with the amount contracted by the county in the first agreement between Lee County and FirstHealth for EMS services in fiscal year 2022-23 – that was $795,000. The proposal submitted by FirstHealth would have increased those subsidies by $5.2 million over three years. Prestwood couldn’t provide a specific explanation for the differences between the two, other than that it resulted from increases in the cost of doing business.

What happens next?

Monday’s 4-3 vote sends the matter back to county staff for revisions to the franchise ordinance, an action that would amend the proposed franchise ordinance to remove the name of FirstHealth and put MedEx in its place.

Then the hard work of agreeing on terms and conditions gets done through the back and forth of negotiations. The county and MedEx will work toward an agreement on the amount the company gets compensated for per call, along with any other details.

Meanwhile, MedEX chief executive officer Dillon Lowe has told The Rant his team is ready to come to Lee County once the remaining processes are finished, and that they plan to hit the ground running.

“MedEx is confident that, once approved, we can bring immediate enhancements to Lee County’s EMS system – not only through exceptional emergency medical services, but also by becoming a strong local employer and community partner,” he said. “Our commitment is to deliver dependable, compassionate care while investing in the people, infrastructure, and future of Lee County. We are optimistic about the opportunity to serve Lee County and confident that our team can provide both the exceptional medical care and community-focused values that residents deserve.”