Buncombe County grants franchise to private EMS service

Fundamentally, Medical Emergency Ambulance president Kermit Tolley says his company’s new franchise with Buncombe County won’t result in much visible change to how his business operates.

“It’s all about the paperwork,” he says.

Although some commissioners remain concerned the agreement could cut into revenue generated by local volunteer fire departments, the Buncombe County Board of Commissioners decided in a 4-3 vote on March 5 to grant an expanded franchise to Tolley’s private EMS service, also known as Medic. Commissioners Brownie Newman, Jasmine Beach-Ferrara and Amanda Edwards voted in the minority.

The text of the franchise agreement will come back to the board for final approval in the coming weeks.

If approved, the new agreement will allow Medic to respond to emergency calls in the county, which the company is already called on to do when county- or fire department-operated EMS services don’t have ambulances to spare.

Former interim County Manager George Wood noted in a January memo to commissioners that the provision of back-up emergency services technically falls outside the bounds of Medic’s current franchise with the county, which is limited to non-emergency medical transport.

Newman said he’s concerned that granting a franchise to a for-profit agency like Medic will “undermine” the county’s system of emergency response agencies, many of which are volunteer fire departments. Only a certain number of calls happen every year, he said.

“The only way these agencies have money is from the revenues they generate from providing services and the tax money that we invest,” Newman said. “If their revenues are cut into from the for-profit entity, that means they have less money to operate their agencies.”

A study of Buncombe County’s EMS service conducted by Management Solutions for Emergency Services, of which commissioners heard the results last April, concludes that it is “hesitant” to recommend commissioners allow an external company to operate in the county system.

“The data clearly shows that you do not have a need for them at this time and, should you see an increase in call volume, we would recommend you allow your current system to expand to its fullest extent first,” the study says.

Like other EMS services in North Carolina, the study says, Buncombe County EMS agencies manage to collect only a portion of the funds they bill people. The average collection rate in the state, the study says, is 70 percent.

Taking a specific look at the Fairview Fire Department, the study says that if an external company responded to half the calls that Fairview billed for in 2017, the department would lose about half of the approximately $262,000 they collected that year.

Tolley, however, says Medic would only respond to an area covered by a volunteer fire department if the fire department’s ambulances were already engaged on other calls. The placement of Medic’s ambulances, he says, is “100-percent driven” by the county’s 911 center. “I can’t just take an ambulance and post it out in Weaverville and have them wait for calls,” he said. “I can’t do that.”

Including calls from the city of Asheville, Tolley says his company responds to about 200 calls in an average month, the majority of which come from inside city limits. That number includes routine calls, emergency calls and convalescent transport. He doesn’t anticipate that the number of emergency calls to which Medic responds will increase as a result of the new franchise.

Tolley estimated that Medic responded in February to about 11 emergency calls from the county.

The proposed franchise will have a one-year term, which commissioners can decide to extend. County attorney Michael Frue says the franchise will require Medic to station its ambulances in locations assigned by the county 911 center.

“We’re not going out here trying to make money and those types of things,” Tolley says. “Obviously we have to to stay in business, but we’re here for our community.”