May 17, 2023 849 PM
BIG BEND — Discussions among local government and healthcare leaders regarding the possible creation of a regional emergency medical services entity are ramping up, with the creation of a task force devoted to the issue and the movement of a Senate bill that would allow the hospital district to oversee the operation.
The exploration of a regional EMS concept comes at a time when EMS providers — which are scattered across the tri-county area and operate in a variety of ways — are grappling with staffing and funding shortages. Proponents argue streamlining the Big Bend region’s EMS operations would help cut costs, increase efficiency and better serve constituents located across a vast region.
J.D. Newsom, executive director of the Big Bend Regional Hospital District (BBRHD), who is heading up regional EMS solution efforts, said after an initial meeting last August, and a more recent meeting this month, enthusiasm for the idea remained and involved parties — around 30 local officials — were ready to accelerate the planning process.
“We want to move, hopefully, a little bit faster than we’ve been moving because it’s such an important conversation for us,” said Newsom.
The district aims to host another meeting next month, and will soon develop a smaller, more nimble task force consisting of EMS directors and political leaders that will make recommendations to cities and counties.
The hospital district has been collecting data on 911 call volumes throughout the area and assessing a variety of operating models for a potential regional EMS outfit. Right now, stakeholders are seeking to determine what overarching entity would oversee the operation. Options on the table include the the hospital district, Big Bend Regional Medical Center, a new nonprofit or a new emergency services district — a taxing, governmental body.
The hospital district-run model would be made possible by SB1526, a bill authored by Senator César Blanco adding a provision to the district’s enabling legislation that would allow the district to “provide emergency medical assistance within the district’s boundaries.”
Allowing the district to provide emergency assistance could help solve some of the complications of maintaining such crucial services in a remote, rural region, said Sen. Blanco.
“When I visit with the families of Far West Texas, I hear about how low population density, great geographic distances, and relative isolation from major population centers make emergency medical services (EMS) expensive and challenging,” said Blanco in a statement to The Big Bend Sentinel. “Access to EMS can mean the difference between life and death – and our families can get proper care when they need it.”
The bill has passed the Senate and will now move to the house for a vote. Newsom said while options are still being explored, the district decided to work with Blanco’s office to get the bill passed this legislative session to expedite the process should the hospital district choose to proceed with the regional EMS initiative. As it stands, said Newsom, the legislation simply opens up an option that still needs to be fully fleshed out.
“I don’t know if the hospital district desires to run EMS,” said Newsom. “Our board would really want to understand the financing and the liabilities before they even thought about running it.”
And while regional EMS talks are tri-county, the BBRHD is bi-county, serving Presidio and Brewster counties through a property tax, meaning Jeff Davis County would need to either enter into the hospital district to capitalize on its new EMS services, should it go that route, or continue to run an independent service. (Jeff Davis county is the only remaining primarily volunteer-run EMS in the area and is currently working on transitioning to a paid service.)
“The way the legislation is written, it would allow us to operate a regional EMS within the district’s boundaries. My interpretation of that is Jeff Davis would need to decide if they wanted to be part of the hospital district,” said Newsom.
“Even if we were to consolidate Brewster County and Presidio County, that’s a win,” Newsom added. “There could be a smaller regionalization, even if we were to just consolidate those two counties. I think that you’re decreasing costs for those respective county residents and providing a better service.”
Jeff Davis County Judge Curtis Evans said, at this time, the county would like to be included in the regional EMS model, but many important details — financial cost, namely — still needed to be worked out.
“It is something we’re going to have to discuss in order for us to be included in this regional EMS service,” said Evans. “We’re still in the baby steps.”
The option to establish an independent nonprofit entity to run a regional EMS, creating interlocal agreements and determining a service area, is also being assessed, said Newsom.
Creating a tri-county emergency services district (ESD), which would be a taxing entity, is another possibility. The ESD could act as a governmental entity and take on all EMS operations, or it could support other organizations through funding. An existing ESD in Southern Brewster County, for example, is a sales tax-based fund that assists Terlingua Fire and EMS, a nonprofit.
Additional legislation that would have created a new taxing entity in the form of a tri-county ESD was withdrawn from this legislative session, said Newsom, in favor of pursuing the option as a voter referendum. ESDs, which can provide EMS and fire services, have the ability to impose both a sales tax and property tax.
But because most communities have already maxed out the legal sales tax — the state’s rate of 6.25% leaves local taxing jurisdictions with 2%, not to exceed 8.25% total — a new ESD would need to be funded through a property tax, explained Newsom. Due to existing property tax burdens, another taxing entity would likely not be met favorably by the public, said Newsom.
A hospital-run EMS solution could have advantages in terms of funding and sustainability, said Newsom. Because the Big Bend Regional Medical Center is classified as a “critical access hospital,” it would be able to receive federal subsidies for running EMS.
“It specifically allows critical access EMS to recuperate costs for Medicare transports,” explained Newsom.
And very few EMS providers in the state take advantage of the funding, said Newsom. The Hamilton County Hospital District, who has been meeting with the local leaders regarding the regional EMS solution, is the only entity in the state utilizing available critical access funding for EMS, and currently serves five counties in its jurisdiction.
When it comes down to it, said Newsom, the combination of the area’s low call volumes, due to smaller populations, and need to have EMS stationed across the expansive Big Bend region for favorable response times, makes the financial viability of EMS difficult.
“The problem is, because our volumes are so low, EMS is always going to need to be subsidized because it will not sustain itself,” said Newsom.
The hospital district is currently collecting financial data from existing tri-county EMS providers on how many patients utilize Medicare, Medicaid, private insurance and private pay to develop a revenue model for a regional EMS entity.
How to equitably fund EMS in each community and how much local control will remain are broader topics of discussion, said Newsom. He argued staffing decisions should be data-driven, based on transportations and population, moving forward, but certain communities may want more support that they will, in turn, need to pay for.
On top of that, there are “all kinds of little idiosyncrasies with all these different areas,” said Newsom. Valentine, for example, is in Jeff Davis County but is covered by Marfa EMS. Big Bend National Park’s EMS staff have been attending meetings, said Newsom, but will not be participating in a regional solution because they are a federal entity.
There is still a lot to work out, said Newsom, and the initiative would take time regardless of the chosen model, and may be approached in phases.
“There could be a multi-year transition to where we’re getting the infrastructure in place to handle the whole region,” said Newsom.
Regardless, alleviating counties and cities from having to fund and run their own EMS services on top of other critical duties would be beneficial, said Newsom.
“All of our cities are struggling with infrastructure issues, staffing and recruiting,” said Newsom. “It allows them to focus on other important things, knowing that there’s a regional operation that’s just focused on providing the best EMS service.”
