Consultant: State inmates subsidize jail; ambulance transfers are loss-making without new payment model

A consultant's financial review presented Tuesday to the Millard County Commission found the county's jail is materially subsidized by contracts to house state inmates and that ambulance interfacility transfers are being subsidized by 9-1-1 calls. Cody Dieter, a consultant with EFG Consulting, told the commissioners his analysis modeled three jail scenarios and two ambulance scenarios and examined staffing, revenue and variable costs over a 10-year period. "The state inmates are subsidizing the jail operations," Dieter said. "Eliminating [state inmates] would require unsafe cuts to jail staffing." Dieter said state inmates comprised roughly 60% of the facility's population over a recent four-year window. Under a status-quo projection the county would continue receiving a mix of state contract revenue and general fund support; dropping state inmates would increase the general-fund subsidy by roughly $10 million over 10 years in Dieter's model unless the county made dramatic staffing cuts. On emergency medical services, Dieter said variable cost per ambulance mile has been about $30; revenue collected per mile from interfacility transfers averaged about $20. "Interfacility transfers are being subsidized by 9-1-1 calls," he said, noting collection rates for billed ambulance charges were low — roughly 43% of billed amounts on average. Dieter offered three options for the county's ambulance transfers: 1) contract directly with the hospital and charge a cost-plus-per-mile rate so the hospital bills insurers; 2) keep the current practice but negotiate a per-mile payment from hospitals to cover the county's shortfall; or 3) stop providing interfacility transfers and require the hospital to arrange alternate transport providers. He recommended negotiating a per-mile rate that covered variable costs and capital replacement (he cited roughly $35 per mile as a break-even figure). Commissioners asked the county and Intermountain Health to get legal guidance before any operational change. Kurt Forsyth, president of Delta and Fillmore Community Hospitals, said he would arrange counsel-to-counsel discussions. "We need to make sure both legal teams agree on who is obligated to pay for or to provide these transfers," Forsyth said. Sheriff Jacobson and other commissioners noted the county has capital and staffing constraints and that any reduction in state inmates could require either more local funding or significant, and potentially unsafe, staffing reductions. Commissioners directed staff to share Dieter's full analysis with the hospital and with county legal counsel and to return with options after the hospital and counsel have reviewed the legal and contractual issues. Ending: The commission did not take formal action on either jail staffing or EMS operations at Tuesday's meeting. Dieter said the report is intended to prompt negotiation and policy choices; commissioners asked staff to pursue follow-up legal review and to schedule future discussion with hospital representatives.