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A month ago, Scott County officials decided to investigate making emergency medical services into a county function. It’s a big decision and it’s complicated by the possibility the county’s largest municipality – the City of Davenport – could break away and operate its own service. If that happens, it would change an operating model that’s been in place for four decades. No decisions have been made yet, and officials in the county as well as the City of Bettendorf clearly favor maintaining the one-provider model that’s been in place since the early 1980s. Meanwhile, Bettendorf Mayor Bob Gallagher says he’s worried Davenport hasn’t considered a host of questions about how separate emergency service providers would operate – and that a split could endanger future cooperation between the cities. Davenport Mayor Mike Matson, however, says his city is equipped to take this on. And, he adds, officials there have studied the matter quite carefully. It’s not clear when Davenport will announce its decision, but he says action could be taken “very soon.” At stake for residents is how tens of thousands of yearly emergency dispatch calls countywide are answered. For years, there has been uncertainty about the financial sustainability of Medic EMS, the non-profit entity that has provided emergency services in Scott County since 1982. (Medic is governed by a board that includes representatives of local governments, as well as officials from Genesis Health System and UnityPoint Health.) Government programs like Medicare and Medicaid offer lower reimbursement rates than commercial insurers, and the payor mix is changing. In addition, a range of options to control costs and enhance revenues, such as tax breaks and federal and state programs, are available only to governments – not to non-profits. As a result, stakeholders have long recognized a change is needed. In fiscal year 2023, Medic EMS is projected to lose $1.5 million, as expenses are expected to rise faster than relatively flat revenues. Delayed capital expenditures, increased hiring and higher employee pay are primary reasons for the expected spending increase, according to Medic, as competition for trained emergency personnel has become a major challenge. Medic staff levels are down 20%, even as its calls for service jumped 9-10% in fiscal 2022, Medic’s Executive Director Linda Frederiksen told the QCBJ. With that backdrop, government leaders and Medic have worked to try to find a path forward. Bettendorf and the county want to stick with the single-provider model. “I’ve always believed the whole is better than the sum of its parts,” said Ken Beck, Scott County Board chairman. Meanwhile, Bettendorf’s mayor said that while other communities may feature more than one emergency services provider, the Medic model has proved its worth. And he says Davenport shouldn’t abandon it even if there are financial advantages for it. “I think we (have) a service that is light years better than those services, and to blow that up for a little bit of money seems nearsighted,” Mr. Gallagher said. Davenport Mayor Matson said the city began investigating the possibility of offering its own service in the face of uncertainty over Medic’s future, after a previous plan didn’t work out – and because there was a lack of specific information afterward on how to move ahead. “We had to look at this,” Mr. Matson said. It would have been “irresponsible” for the city not to do so, given discussions about potential changes, he added. Going back at least to 2019, there have been discussions about forming an intergovernmental entity under Iowa Code Chapter 28E to operate emergency services in the county. The idea was to have several area governments govern the operation. Three years ago, Medic officials said the new structure would open the door to new sources of revenue, including federal Ground Emergency Medical Transportation (GEMT) funding – a voluntary program that provides supplemental payments to services to cover the difference between the cost of providing emergency medical transportation and Medicaid’s base payment and other sources of reimbursement. The cost of providing emergency transportation typically runs much higher than what Medicaid pays. However, local officials say that earlier this year, the State of Iowa put the brakes on GEMT funding for an intergovernmental entity, asking that a single local government be responsible instead. Those officials said that the state, which administers Medicaid along with the federal government, was worried an ambulance service operated by more than one government might not get federal approval. Mr. Matson said after the state decision, there was no detailed information about how to proceed, so the city began investigating its own options. Bettendorf officials, however, have said that they believe much of this is prompted by the possibility of increased revenues Davenport could stand to get from federal GEMT funding. Davenport accounts for roughly half of total transports in the county. Mr. Gallagher also said he’s worried the city probably hasn’t considered things such as how transfers will be handled, how two sets of dispatchers will be accommodated and how the two emergency services may overlap. In addition, officials have questioned what would happen with calls for mutual aid and how they would be paid for. Mr. Matson, though, said the city has studied the issue carefully. Davenport already has a lot of trained paramedics, he said, along with infrastructure and funding models. While there would be some capital costs up front, he said the new service can be offered by the city without a tax increase. “We’re continuing to do our research. We’ve done our research. We’re very serious about this,” he said. “We have the ability to do this.” “The long-term looks good for us,” he added. County officials, meanwhile, have raised the possibility they might have to rely on additional property tax dollars to help fund the county’s emergency services operation, though Mr. Beck said he believes it can be done without a tax increase. Already, the county sets aside some funding for Medic if needed. Amidst all this, there are signs that intergovernmental cooperation might be at risk. Mr. Gallagher said Davenport has taken a more “parochial” approach with other cooperative ventures recently, and he suggests splitting off its ambulance service could have ramifications. “It would be much more difficult for me to keep my city council providing money to, for instance, the Quad Cities which spends all of its money in Davenport, not in Bettendorf, to house people who are homeless.” Mr. Matson said Mr. Gallagher’s remarks were “unfortunate.” When this all might come to a head isn’t clear. Mr. Matson has said the Davenport City Council has been briefed all along, and that action could come “very soon.” Scott County staff, meanwhile, is expected to report back to the county board by March, though it could happen sooner than that.