T-R PHOTO BY ROBERT MAHARRY UnityPoint Health-Marshalltown Hospital Administrator and Executive Director of Operations Shari King, left, speaks about the future of EMS services in Marshall County as Marshalltown City Councilors Mark Mitchell, center, and Barry Kell, right, look on during Monday night’s meeting. The council agreed to move forward with a plan to hire a consultant and split the cost evenly between the city, the county and UPH.

At the end of an otherwise short and succinct meeting on Monday night, UnityPoint Health-Marshalltown Hospital Administrator and Executive Director of Operations Shari King addressed the city council about the future of emergency medical services (EMS) in the county and reported that her organization is currently losing approximately $1 million a year providing them.

King introduced herself as a representative of both UPH and an EMS task force that has been assembled within the last year before explaining the difference between the 911 service — which was the topic up for discussion at the meeting — and transfers, which are the responsibility of any hospital to move a patient from location to location as medical need arises.

The current 911 setup includes no funding from any sources other than what it can bill, and in some instances — for example, a patient declines to go to the emergency room after an ambulance arrives — no bill can be issued. Insurance companies often deny reimbursement requests for EMS services.

“Right now, neither the city nor the county provide any funding to UnityPoint Health-Marshalltown for providing this service. The wrinkle here is that I think a lot of our taxpayers think they are paying for this service and that this is something that is already covered as an essential service,” King said.

A handful of smaller communities in Marshall County do have volunteer EMS services, but King said they are “feeling the stress” of dwindling numbers and keeping their members up to date on training. In general, King noted that fewer and fewer individuals are entering the EMT and paramedic fields, and the reimbursement is not covering the cost to deliver the service.

Marshalltown and Marshall County, she added, are “very unusual” in that UPH is the primary provider of 911 ambulance services. County hospitals and Critical Access Hospitals are able to access other sources of public funding such as an EMS tax and reimbursement through Medicare, but UPH-Marshalltown is neither. King estimated that only two or three other services statewide where a hospital is the primary provider of EMS.

According to King, concerns about “EMS deserts” are growing around the state, and she then discussed a law signed by Gov. Kim Reynolds in 2021 allowing for voters in individual counties to designate EMS as an essential service funded by either an income surtax or a property tax levy not to exceed $0.75 per $1,000 of valuation by a 60 percent supermajority. Just to the east, Tama County voters approved such a designation at the polls last November.

King then shared something of a summation of her remarks to that point.

“What really transpired is we were looking at the nature of the service that we’re providing, the challenges we’re having with staffing and the financial loss we’re taking. That’s really what signaled ‘Hey, we have a problem, certainly, in Marshall County.’ We need to work collaboratively to find a solution that will be long-term sustainable because right now, our current model is not sustainable,” she said.

As a result, meetings with stakeholders and elected officials evolved into the development of a task force focused on finding a long-term solution in whatever form it ultimately takes. The current recommendation she brought to the table was hiring a consultant at an approximate cost of $59,000 with the cost split evenly between the city of Marshalltown, Marshall County and UPH.

King opened the floor up for questions, and Councilor Jeff Schneider quickly cut to the chase to ask how much the hospital is currently losing on the 911 services. Her estimate was about $1 million a year. Councilor Greg Nichols wondered about splitting apart the costs for 911 calls and transfers, the latter of which is a requirement for all hospitals to provide, and she said they primarily use billing codes and call data — right now, about 33 to 35 percent of the total volume is estimated to be 911 calls.

In response to another question from Nichols, she projected that UPH was at least at a “barely break even” point for transfers. Councilor Gary Thompson sought clarity on why the ambulance service was losing so much money.

“Medicare, Medicaid, uninsured, refuse to come. We could have a whole other conversation about 911 abuse and when you show up and the patient — somebody else thinks they want help and they don’t,” King said. “So all of those things add up over the months to create that financial loss for us.”

Thompson followed up by asking King what her ideal solution looked like.

“My personal viewpoint — this is Shari talking, nothing else — I think we need a county-run service, and I think we need to really evaluate where do we need to have ambulances stationed and the crews stationed, and how do we do that as a county-run service?” she asked. “That may or may not be possible. I think we really have to consider our excellent volunteer services. Some of them are robust enough, I would say, that maybe they want to be a piece of something or they want to handle their local community, so there’s a lot to balance out in this whole big picture as we look at the volunteer services across the county as well.”

Currently, King said State Center, Gilman, Green Mountain and Liscomb have volunteer EMS services within Marshall County outside of Marshalltown. In response to another question from Thompson, King told him she felt a levy could make the operation self-supporting and also said UPH did not ultimately have to be the provider. It could be run either through the establishment of a public entity or a contract with a private organization, which also led King to point out that there is no actual contract or agreement of any kind in place regarding EMS.

As Thompson noted, UPH could theoretically stop providing the services at any time as it is not under any formal legal obligation to do so.

“We could, (but) we’re not gonna do that,” King said.

Councilor and Mayor Pro Tem Mike Ladehoff expressed optimism about consultants bringing back sustainable options for the future. Nichols inquired about how transfer services would be affected if the provider changed, and King replied that those would still be UPH’s responsibility.

Fellow Councilor Barry Kell asked for input from Fire Chief Christopher Cross on how his department would be affected by any changes to make sure the city didn’t get “18 to 24 months down the road” without a workable solution, but Cross was able to communicate with the council remotely. Ladehoff also clarified that Iowa EMS Consultants would be required to deliver their final report within the next few months, so it would be a fairly quick turnaround.

Nichols, also communicating remotely, asked Cross how EMS becoming a county service would affect the Marshalltown Fire Department (MFD) sending out equipment for calls.

“If the fire department doesn’t have any transport responsibilities or any ambulances within the fire department, we would still, we would intend to handle all 911 calls within the city limits in a similar fashion and a first response type command,” Cross said.

Schneider then motioned to proceed with the course of action outlined in the memo and split the cost of the study evenly with the county and UPH, which was quickly seconded by Nichols. During the public comment period, Jim Shaw began to ask what would happen if something happens to him and 911 is called when a spacey echo reverberated from the sound system.

“That was your answer,” Thompson joked.

Touting her experience in the health insurance field, Leigh Bauder suggested collaborative efforts between UPH and the insurance carriers in a roundtable format. King was not aware of anything of that nature happening but was open to exploring it. Marco Yepez Gomez expressed frustration with the U.S. healthcare system as a whole and took state legislators to task for not providing funds to accommodate the implementation of EMS as an essential service through higher taxes on wealthy individuals.

“Let’s be clear. The discussion is not in our scope. This conversation is for politicians like Kara Warme, David Blom and Kim Reynolds to stop hiding from and actually fund a real solution forward,” he said.

Ultimately, Yepez Gomez said he supported the consultation and putting the EMS levy on a future ballot. The original motion to move forward with the proposal passed by a unanimous 7-0 vote.

In other business, the council:

• Approved the consent agenda as listed.

• Approved the Friends of the Orpheum alcohol license with outdoor service for the Live After 5 events at West End Park on July 3, July 11, July 18 and July 25.

• Approved the city fee schedule for July 1, 2025.

• Approved a contract with Municipal Collections of America Inc. for the collection of unpaid automated traffic enforcement citations.

• Approved the sale of the property at 501 N. 1st Ave. to Troy Cline and the properties at 915 and 919 S. Center St. to Dean Lawthers, along with the third reading of a zoning amendment for 915, 917 and 919 S. Center St. from medium residential to mixed use.

• Approved the third reading of a zoning amendment converting a total of 17 lots from medium density residential to general industrial to accommodate MARSHALLTOWN Company’s expansion project.

• Approved the third reading of an amendment to Chapter 156 of the zoning code pertaining to mini warehouse self-service storage areas by a 6-1 vote with Mark Mitchell opposed.

• Approved the third reading of an amendment to Chapter 156 of the zoning code pertaining to accessory dwelling units, Board of Adjustment procedures and residential building materials.

• Approved the third readings of amendments to the code of ordinances regarding the user charge system for sewers and sewage disposal and exemptions and credits available for stormwater.

• Approved the first reading of an amendment to Chapter 133 of the city code regarding offenses concerning minors.

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Contact Robert Maharry

at 641-753-6611 ext. 255 or

maharry@timesrepublican.com.