Ambulance and hospital achieve preliminary agreement

The City of Nome and Norton Sound Health Corp. have moved closer to an agreement over services of Nome Volunteer Ambulance Dept.
NVAD, staffed by about 20 volunteers, provides in-city emergency ground ambulance services.
The City budgets the NVAD operational and capital expenses. NSHC provides health services to the Bering Strait region of Alaska. The services comprise emergency room in-patient and out-patient care, long-term care and emergency evacuation services.
The two entities have been trying to achieve a memorandum of understanding for almost two years. A major hurdle has been fees the ambulance administrators say they need to keep the first response operation in the black on supplies, training, vehicle maintenance and other expenses. NSHC has wanted to pay the amounts allowed by Medicaid, Medicare and Indian Health Service with no billing to patients for the unpaid charges left over. Ambulance finances have fallen into the red ink.
Following a confab between Angela Gorn, CEO of NSHC, and Tom Moran, city manager, Gorn signed an MOA on April 7. On the evening of April 11, the Public Safety Building parking lot filled with cars of ambulance volunteers who met to fine-tooth comb the document. They found the agreement needed some torquing and tinkering.
It’s a start, said Tom Vaden, long associated with the ambulance service, and for over 20 years a provider of training for health aides and first responders.
“I think this will benefit the region, which is what everyone got up and asked for two meetings ago. There are lots of regionally sustainable items in there.  We smoothed out some of the kinks last night.  Essentially, NSHC is giving Nome what they want, except for IHS /Medicaid billing and we can live with that,” Vaden said.
According to the document, NSHC has loosened the purse strings to compensate payment shortages by remitting a “volunteer appreciation stipend” of $25 per each ambulance transport to Norton Sound Regional Hospital; however NVAD would accept payment of a Medicare-Like-Rate for Indian Health Service beneficiaries and refrain from balance billing.
NSHC offered other in-kind and financial support—including NSHC-paid employees to assist with ambulance services.
Further, NSHC would provide a complete physical exam include drug screening and necessary vaccinations required by State of Alaska for volunteers starting service with service as necessary according to the ambulance chief and the NVAD medical director at no cost to the City or NVAD. NSHC would also provide a sponsoring physician as medical director for NVAD and also assist with training, including one Emergency Medical Technician class per year for maintaining volunteers’ certification.
NSHC under the proposed agreement also offered a full-time employee to work as a volunteer during his shift. NSHC would provide billing services for the ambulance based on NVAD providing documentation as basis.
NSHC agreed to a lump sum of $10,000 annually for upkeep of the NVAD ambulance fleet. According to the document, NSHC also agreed to ask NVAD for a list of equipment needs for inclusion in Alaska Code Blue Project and other grant funding opportunities. The Code Blue Project was started in 1999 in an effort to identify, prioritize and seek funding for essential equipment for rural emergency medical services in Alaska. NSHC and other medical services have representation on the steering committee.
NSHC would provide Advance Life Support ambulance service with supplies as oxygen, IV supplies, consumable medicine, and other equipment.
NVAD would continue to provide 24-hour, seven-days emergency ground ambulance transport services to Nome’s citizens. NVAD would maintain a separate inventory for consumable medical supplies. The ambulance service would comply with the Indian Child Welfare Act and maintain patient confidentiality according to the Health Insurance Portability and Accountability Act on private protected health information.
NVAD would provide vehicle storage for its own ground ambulance fleet as part of the agreement.
In conversation at the April 10 Nome Common Council meeting volunteers for the ambulance took exception to a clause in the MOA stating that hospital employees while working the ambulance would be under supervision of the hospital. Not good, ambulance personnel said, as all risk during ambulance transports affect responders’ certifications.
This and other details are being worked out to prepare a more final MOA between NVAD and NSHC to land on the Nome Common Council worktable at the April 24 regular meeting.
Vickie Erickson, 24-year veteran of the Nome Volunteer Ambulance Dept. resigned the ambulance chief’s position April 4. Nome Volunteer Fire Department Chief Jim West Jr. has taken over as interim ambulance chief.