ALTUS - Like most emergency medical service agencies in Oklahoma, Jackson County EMS is having to tighten its belt and monitor well the flow of cash that keeps it alive.

“We're just going to have to take some corrective measures so it doesn't get bad,” said Jackson County EMS Director Dave Stewart, explaining that the local service has recently had to make a “reduction in force” with one supervisor position, modifying the position to an on-call per-diem basis.

Jackson County EMS is not alone in its struggle to make sure expenses are not more than income and to be careful and judicious with the money coming in.

In May of this year initial findings released in a report from the governor's Emergency Medical Services Task Force found a disturbing future for ambulance services statewide unless changes are made.

An Associated Press article following the release of the report notes that 10 ambulance services have recently closed in Wynnewood, Vinita, Kemp, Quapaw, Picher Commerce, Barnsdall, Kremlin, Garber and Wakita. According to state records, the article says, in fiscal year 2006 Medicare was billed $94 million for ambulance runs to assist Oklahoma senior citizens on Medicare, but ambulance companies received only $52 million from the federal government for those patients.

“They're only going to pay what they pay,” Stewart said, adding that about one-third of the local agency's income derives from real estate and ad valorem taxes, which roll in during the first three months of the year, and the other two-thirds comes from collections.

While many EMS firms in Oklahoma have closed their doors, “We're not even close to that,” Stewart said, maintaining nevertheless that frugal thinking in light of Medicare and Medicaid cuts is the prudent course for Jackson County.

Don Sparks, director of Greer County Ambulance Service, said his firm has not experienced a lot of difficulty with Medicare/Medicaid payments, but that's not to say that it couldn't be improved. For example, Sparks said, on a $550 emergency, Medicare pays only $417.

And although mileage rates have nearly doubled recently, he said, it is a constant battle keeping up with the bills and negotiating with the federal agencies to receive the just due.

EMS systems, especially rural systems, must come up with additional funding, said Ron Osterhout, of Altus, president of the Oklahoma State Board of Health. Osterhout represents Ellis, Dewey, Custer, Roger Mills, Beckham, Washita, Kiowa, Greer, Jackson, Harmon and Tillman counties on the state board.

EMS firms, as well as hospitals, are having to serve larger and larger areas, they're not as wealthy, and Medicare and Medicaid are not sufficient, he said.

For example, Osterhout said, some 60 percent to 65 percent of patients of Jackson County Memorial Hospital are either on Medicare or Medicaid or are uninsured. He feels that depopulation in Western Oklahoma, combined with the relatively few large employers who are able to provide medical insurance for their employees, is key to the EMS financial crunch.

In the 1930s, Osterhout points out, Harmon County's population was around 35,000; now it is somewhere around 3,500. And Altus, with its vibrant economy, is better off than most of Western Oklahoma. “You don't have to go too far out of Altus to see that suffering,” he said.