New regulations under consideration by the Loudon County commission could limit the number of nonemergency ambulance services operating in the county.
"We're not telling anybody they can't do business in the county, but they have to meet the new regulations," said Mayor Buddy Bradshaw.
According to Tennessee state law, to protect the public health and welfare, any county or city may adopt and enforce reasonable regulations to control the provision of private or nonprofit ambulance service. Regulations in Loudon have not been updated since 194, Bradshaw said.
In addition to rules about equipment, supplies and training, the new regulations could include requiring every ambulance company operating in the county to staff a local office at least 40 hours per week.
Ambulance vehicles would be limited to no more than five years old with no more than 200,000 miles. "We think Loudon citizens deserve the best. We don't want them using a 1985 Country Squire station wagon as an ambulance," he said.
Bradshaw also said he thought the county would get better service with fewer ambulance providers. Too many providers reduces the profitability of all providers and subsequently reduces the quality of service for the citizens, he said.
New regulations, which will be voted on in September, would put the monitoring of any ambulance service operating in the county under the direct supervision of the County Mayor's office. Ambulance companies would have to get a certificate of compliance to operate.
At a recent commission workshop, Chairman Steve Harrelson questioned whether it was a good idea for the county to get involved in regulating ambulance service.
Commissioner Van Shaver said he believes that citizens are capable of deciding which service provider they would like to do business with.
"I'm for the free market system," he said.
Ron Cunningham, a spokesperson for American Medical Response, said it's important that consumers have a choice when making important health care decisions. "You should be able to choose your provider," he said.
Shaver questioned whether the county has the legal right to sign exclusive contracts that might disrupt the ability of other private businesses to operate in the county.
Commissioner Leo Bradshaw, former Loudon County purchasing director, told commissioners it is legal and not unusual for county governments to enter into exclusive contracts with service providers.
According to Shaver, providing exclusivity reduces competition, which can cause an increase in price to the consumer. There is no guarantee quality increases without competition, he said.
Priority Ambulance currently has an exclusive contract for all emergency and nonemergency transport dispatched through the 911 system.
Priority also has exclusive contracts for emergency and nonemergency transport with the city of Loudon and Lenoir City, said Rob Webb vice president of Tennessee Operations. A lot of rural counties have exclusive contracts for both emergency and nonemergency ambulance service, he said.
Webb said he agrees that having too many service providers can reduce the quality of service because the other companies might not be profitable enough to provide quality service.
A lot of rural counties don't generate enough transport business to make it profitable to operate, he said. Nonemergency transports are more profitable because they can be scheduled in advance, requiring fewer resources.
Emergency transports are less profitable. Some of the emergency transports generate no revenue if the patients are indigent or do not pay their bill, yet the contract with the county requires they be transported, Webb said.
Priority, which handles about 100 nonemergency calls a month in Loudon County, might not require any additional resources to take on all the additional nonemergency transports, he said. "We can also pull additional resources from Knox County," he said.
Rural/Metro Ambulance formerly provided emergency transport in Loudon County and currently provides nonemergency transport service. Rural/Metro transports patients from Covenant Health and Fort Loudoun Medical Center.
Rural/Metro filed suit against Lenoir City last year after the city signed the exclusive contract with Priority. The suit was withdrawn when Lenoir City agreed to allow Rural/Metro to continue to work with Covenant.
The November 2014 emergency ambulance service termination agreement between Rural/Metro and the county, the county must still allow Rural/ Metro to provide nonemergency services and is prohibited from taking action to revoke or interfere with that right.
The agreement also stipulates that Rural/Metro comply with Loudon County's regulations governing ambulance service. Rural/Metro declined to comment on the new requirements.
According to a statement from Covenant administrators, Fort Loudoun Medical Center and Covenant Health defer to patients' preference regarding their choice of nonemergency transporter. Fort Loudoun is committed to providing excellent patient care and will work with any ambulance provider chosen by the community's elected officials to accomplish this goal.