Closing the inpatient hospital at Walla Walla's Veterans Administration Medical Center likely will reduce the city's already ailing ambulance revenues, officials said.
Veterans commonly use the service. The Medical Center pays for runs related to care at its facility. A total of 362 such trips was recorded last year.
That means on average of about once a day, paramedics responded to emergency calls from veterans' homes, took vets from the Wainwright campus to a local private hospital or back, or transferred them for long-distance medical care.
Walla Walla crews frequently travel throughout the Inland Northwest to bring vets to the local government hospital.
Typical cities where vets are picked up include Enterprise, Wallowa, Toppenish, Yakima, the Tri-Cities, Hermiston, Orofino, Lewiston and points in between.
Paramedics also transport the patients to and from Seattle or Portland VA facilities.
``They can provide a good continuum of care within their system,'' said Walla Walla Fire Department Capt.
Jack Pinza, the city's paramedic coordinator.
The calls are of two types _ emergencies or non-emergency transfers.
Each run is calculated as a one-way trip.
In most circumstances when the run is an emergency at a patient's home, the VA Medical Center will pay the ambulance bill only if the patient is taken to the VA. The only exception is if the patient is an apparent stroke victim.
Then the patient may be transported to Walla Walla General Hospital.
Other typical runs include transfers from the VA to General or St. Mary Medical Center for emergency treatment not provided at the VA or for diagnostic procedures such as CT scans or MRIs.
The VA medical center pays the city for each transport in an amount equal to the reimbursement rate paid by Medicare. Amounts depend on such variables as whether the transport is an emergency, and the level of care and supplies required.
Generally the VA is billed about $200 or $300 as a base fee for each one-way run. But then mileage is added, so the total price of each run varies widely, Pinza said.
The fee is considerably lower than the rate paid by non-Medicare or non-Medicaid patients. However, the city can't by law charge the patient the balance even if the patient can afford to pay it.
Last year, the VA paid the city about $200,000, which amounted to about one-sixth of the total yearly ambulance revenue of about $1.3 million.
If the inpatient facilities close, the city could lose much of the VA-related income, Pinza said.
The emergency 911 runs would continue. Also, transfers to the outpatient clinic are possible. And perhaps the ambulance service would transport some patients to other facilities out of town, depending on which hospitals the VA contracts with and for what types of care.
But trips from the VA Medical Center to a local private hospital and back would be gone. ``Also long distance to here more-than-likely would disappear,'' Pinza said.
``Until they have a plan, it's hard to make any kind of prognosis of what it will do,'' Pinza said.
The ambulance service already is reeling from inadequate payments for Medicaid, Medicare and VA patients, which total about 71 percent of ambulance runs.
Officials have predicted a rate hike for the other 29 percent of patients will be necessary because reserves are eroding at a rate of about $13,000 a month and will be depleted by 2008.
But regardless of the potential additional revenue loss to the city, Pinza believes the VA Medical Center provides a valuable service.
``People out there know the attitude and mentality of the vets and they deal with them all the time,'' Pinza said.
In addition, he believes the general economy and well-being of the city have benefited.
``It's filled a real niche,'' Pinza added. ``I'm sure we've got lots of people who've moved to Walla Walla and stayed in Walla Walla because the VA is here.''It's not known specifically how the care would be replaced or the impact on the veterans, Pinza pointed out.
``They don't have a plan.
Their plan is to close the doors and make everything OK,'' he said.