JACKSON -- Managed care, cuts in state and federal reimbursement and shifts in population growth are all factors in ambulance service operations, John Russell says.

Russell, president of Cape County Private Ambulance Service Inc., presented an activity report on the service to Cape Girardeau County commissioners Monday.

County officials have begun working on the 1997 budget, and the proposed contract for subsidizing county ambulance service is $197,000, up from $182,000 for this year.

Commissioners requested the report and will study it before voting on whether to renew the contract.

"Really, I think what we're interested in is how much bang do we get for our buck," said Associate Commissioner Joe Gambill.

Emergency calls made up 75 percent of the ambulance service's 4,233 service trips in 1995, Russell said.

Of that total, 61 percent, or 1,860 trips, were medical emergencies for heart attacks, strokes or other emergencies, and 13 percent, or 568 trips, were auto accidents, he said.

The remaining 25 percent of the trips were for transfers such as a patient being taken from a hospital to a nursing home, Russell said.

Calls for service continue to increase, he said. In 1992, Cape County Private Ambulance made 3,117 trips, and 4,400 trips are projected for 1996.

Decreasing Medicaid and Medicare reimbursement is a problem for ambulance operators just like other health-care providers, Russell said.

Legislators are debating putting ambulance fees on a national fee structure and imposing a seven-year freeze on those fees, he said.

"It gets real tough to project what your operating costs are going to be out that far," he said.

In 1995, the ambulance service had a "write down," or loss of $82,590 for unreimbursed services for Medicaid and Medicare, and another bad-debt write-off of $243,628 for uncompensated care.

Medicaid reimburses $76 per ambulance trip, Russell said. "Frankly, the Medicaid reimbursement does not cover our operating expenses or the payroll on a trip," he said.

Those losses mean costs are shifted to paying and insured customers, he said.

The average trip charge for the first half of 1996 was $276.31, Russell said.

Increasing costs mean the ambulance service is looking at more efficient ways to provide service, he said.

Instead of operating like a fire department and waiting for a call to come in, he said, the ambulance service is "thinking like a police department. We've kind of put the vehicles in the areas where we anticipate the highest likelihood of a call."

Most calls for ambulance service are in Cape Girardeau, he said, but calls for service to Jackson and the Fruitland and northern Cape Girardeau County area are increasing.

A "roving ambulance" is assigned to Jackson for two peak periods daily, he said.

About 70 percent of the calls for service from Jackson occur between 7:30 to 11 a.m. and 2:30 to 8 p.m.

"My guess is that we will eventually move our resources northward" to meet increasing demands for service in the Fruitland area, Russell said.