Finances: Nye ambulance ‘literally running on vapors’

Editor’s note: This is part of a continuing series of stories in the Tonopah Times-Bonanza &Goldfield News, looking at challenges facing rural medicine in the region with the closure last year of Tonopah’s hospital.

Having enough volunteers to staff Nye County’s ambulance service is not the only challenge facing the community as it continues to adjust to the closure of Tonopah’s sole hospital about a year ago.

“Our budget source is on life support,” Nye County Emergency Management Director Vance Payne said during a recent Tonopah workshop visit, saying the ambulance service is “literally running on vapors” financially.

Insurance, Medicare and people being under-insured are among key issues facing the ambulance service, also known as Nye County Emergency Medical Services.

“Nye County ambulance service over the last 13 months has receipted $1.3 million worth of bills,” Payne said. “That is what we billed out. We’ve collected $386,000.”

“Medicare issues, that is what is killing us, probably more than anything else,” Payne said.

Inside the numbers

In Tonopah, 40 percent of all ambulance service calls involve Medicare patients.

“An additional 30 percent of the people are underinsured,” Payne said. “And in the big picture, Medicare is underinsured.”

Along those lines, he noted the challenges faced by Life Guard International/Flying ICU, which is now cutting back recent presence in Tonopah.

“We have a (Tonopah) resident who’s been transported by Life Guard by air six times in the last two months,” Payne said. “Her insurance is through Medicare.”

“The best that they have recovered so far is $1,200 for one of those flights,” Payne said, citing figures from earlier this summer. “It won’t even pay for fuel.”

Billing upturn

As far as Nye County’s ambulance service’s budget status being on “life-support,” Payne said the county has a new electronic system used for billing. That is resulting in a “very tentative plus-side” when it comes to finances, he said.

The new system has sped up the billing process, increasing the chances of the county getting paid the maximum amount for its services.

“Our bills in the past, we were lucky to get them out in two to three weeks,” Payne said. “Anybody that’s in the billing business, if you don’t bill for services within 48 hours of the service delivery, the chances of you collecting the max amount begins to diminish.”

“When you get out outwards of two weeks, it really starts to fail,” he continued. “And you get out past a month, holy cow, you’re only looking at a fraction of the bill you may be able to get.”

With the new system, the return is looking better in the past two months.

“We were looking at going into the hole $30,000 into the new fiscal year, starting July 1,” Payne said. “Literally, the third week in June, we were crunching numbers, and we had to lay off one of the two employees who we had. And by the grace of God, we made it through.”

Payne is now waiting for an auditor’s report in September. “I’m pretty sure we got out of it about $16,000 ahead,” Payne said.

In a normal year, the county ambulance service tries to come into a new budget year with about $250,000.

“You are always are paying your bills, and you’re waiting for money to come in so you need some seed money,” Payne said. “So we are literally running on vapors right now until we get through. But there’s a little light at the end of the tunnel, I hope, with this.”

Building, vehicle costs

Payne also is concerned about the county’s aging fleet of ambulances in addition to fuel and electrical costs for heating and cooling its buildings.

A couple of the buildings are more than 40 years old. One in Carvers costs $1,000 month during the winter just for propane, Payne said.

The last county’s ambulance purchases date back to 2007. “When the money was flush, it was relatively easy to replace one every few years,” Payne said. “Our fleet is not in good shape, guys.”

Contact reporter David Jacobs at


■ A look at how Nevada’s tax structure is affecting funding of the Nye County’s ambulance/medical services.

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