National EMS reports improved response times, outlines costs and new services to Oconee County commissioners

National EMS, the county's contracted ambulance provider, told the Oconee County Board of Commissioners on Tuesday that it met its memorandum-of-agreement response-time target in 2024 and described new clinical protocols, equipment upgrades and the financial pressures that underpin ambulance billing.

John Bridal, vice president of operations for National EMS, said the service received 4,111 calls in Oconee County in 2024 and transported 2,812 patients, a roughly 60% transport rate. Bridal said priority-1 response times — the most urgent calls such as chest pain and severe trauma — averaged 9 minutes and 6 seconds last year and that the service met its goal for those calls 93.3% of the time, exceeding the 90% threshold set in the county's memorandum of agreement (MOU).

The presentation included operational and clinical changes. Bridal said National added 12-lead EKG transmission capability for advanced EMTs and EMTs so lower-level crews can transmit EKGs to hospitals for physician interpretation. He said the service instituted a medication cross-check and introduced a ‘‘care navigator’’ protocol to consult with patients considering refusal of transport. He also described telehealth services available at no cost to Georgia Medicaid recipients.

Bridal described equipment investments and fleet status: National received three new ambulances in 2024 and expected additional deliveries, said it had no ambulances older than eight years assigned to Oconee County, and planned to add three automatic CPR devices (LUCAS) and new stretchers and stair chairs. He said National had refreshed vendor service arrangements so that original equipment manufacturers now service monitors and stretchers.

On quality assurance, Bridal said National employs a full-time quality assurance manager who works with medical director Dr. Kurt Horst of Piedmont Medical Group. He reported 11 STEMI (heart attack) activations, 29 stroke activations and 17 trauma activations in Oconee County in 2024 and said monthly QA reviews helped ‘‘stop several bad outcomes before they've happened.’'

The presentation also explained the provider's finances and billing practices. Bridal said National is privately held and ‘‘financially sound’’; he laid out published billing rates and described why ambulance charges have risen. He said the company bills $47.82 per mile and listed an administrative non-emergent fee of $253. Bridal said the county subsidy — $16,666.66 per month under the current subsidy — covers about $547.94 per day of readiness costs and that a two-ambulance readiness posture costs roughly $7,200 per day.

Commissioners asked about payer mix, billing differences between counties served by National and how deaths or nonemergent pickups are billed. Bridal said Medicare and Medicaid reimburse at lower rates and that payer mix varies by county; he estimated Medicare/Medicaid comprise roughly 55–60% of his calls but said he would provide exact figures to the commission. On non-emergency administrative calls (including some deceased calls), Bridal said the typical administrative fee billed is $253 and that higher charges may apply when advanced interventions occur on scene.

Bridal urged residents to contact National's revenue cycle staff about bills; he said the company offers payment plans and forgiveness in appropriate cases. He also told commissioners National is pursuing state-level changes to require insurers to put ambulance providers in network so bills are paid directly to providers, and that National would seek local elected officials' support for the legislation when it is refiled.

The commission took no formal action on the presentation. Bridal provided printed copies of his presentation on request and left contact information for follow-up.