Washington County EMS Director Kevin Deramus gave an update on the status of EMS operations during his 2022 annual report to county commissioners on Tuesday. 

Washington County EMS Director Kevin Deramus
presents his department's 2022 annual report to
county commissioners on Tuesday.

Much of the report focused on EMS’ aviation division and encouraging trends for the county’s air ambulance agreement with METRO Aviation.  Deramus presented data showing the amount of helicopter flights as continuing to stay on par with early projections, while the financial side maintains a favorable outlook.

Per Deramus, there have been 167 air transports with METRO from June to December.  The most conservative estimate for a year was 300 transports.  Through six months, the air program has accumulated $922,026 in revenue.

Deramus noted that with the county’s ability as a government entity to waive copays for patients, it has prevented $333,406 from being billed to residents who used air medical services.

In addition to the revenue already received, Deramus said the county and METRO believe they are still due an estimated $1,385,312 in air revenue through the Independent Dispute Resolution (IDR) process.  An IDR board determines what an insurance provider pays for services if the company refuses to pay a certain amount.  He said since the county is billing the least in the region and not overcharging providers, it makes it easier to ensure the county is compensated appropriately.

Through six months, the county is looking at $2,307,338 in combined air revenue received and expected, compared to $1,485,219 in costs , including fixed costs of $1,116,435 and non-fixed costs—like fuel—of $368,783.  After county salaries of $350,500 over six months—$701,000 over a full year—are paid, that is still a net profit of $471,619.  Deramus cautioned, however, that the goal is to break even, not make money off of constituents as a government entity.

Update @2:50 p.m. Thursday: KWHI asked Deramus on Thursday if the $1,385,312 is a percentage of what could be owed to the county or if it is the full amount owed. Deramus said that amount is what the county's billing company believes will be received over time as bills make their way through the IDR process, which includes components like contractual write-offs. He said it is not 100 percent of the amount owed, and that “no one expects we will get 100 percent what is owed.”

KWHI also asked what the experience of other companies has been through the process in terms of receiving what they are asking for. Deramus called the process “brand new,” so experience at it “is not something that anyone really has.” He added, “Our billing company told us to expect the 1.3 [million] additional. How long it takes is a whole other question.”

Over the time of the agreement with METRO, the aircraft has maintained an average in-service percentage of 97.7 percent, compared to 77 percent with the county’s previous vendor.

Deramus told the court that a conversation will need to be had about if and how much the county wants to offer its services to other counties, or stick to taking care of the people at home.

While financial data was a large portion of Deramus’ presentation, he stressed that the tangible effect the air medical program has on the lives of people who use the services is far more important.  He cited a recent report from the Texas A&M University Health Science Center that showed per 100,000 people, Washington County’s deaths because of cardiac disease, stroke or trauma are fewer than those of contiguous counties, despite not having facilities in the county to treat those conditions.

Combining the air and ground divisions, Deramus said roughly 82 percent, or $4,620,953, of EMS’ 2022 budget of $5,666,447 is funded by revenue and fees for service.  The other 18 percent, or $1,045,493, comes from tax contributions.  Deramus said on average, the top 200 EMS systems in the nation are funded on a 60-40 split, with the 60 percent being tax income.  Commissioner Kirk Hanath added that the county’s EMS facilities were built using donations or Texas Ambulance Supplemental Payment funding, not tax dollars. 

Hanath reminded the public that the data provided by Deramus is available for anyone to see.  He commended Deramus on the work he has done with the EMS department, saying the team he has put together and the culture he has created is “phenomenal.” 

Commissioner Candice Bullock suggested organizing a public event in the future for residents to learn more about the ins and outs of the EMS program and clear up any misconceptions about how it operates. 

What’s your Reaction?


  1. I get there are some “Negative Nellies” out there, but the simple math that I was taught in my small-town country school shows that the EMS appears to be very well run and appears to be managing its resources pretty well. The majority of the costs seem to be driven by operations which is what drives revenue. From a commonsense perspective, that seems like it is the way it should be. As someone who has had to call an ambulance a few times (never needed the helo; thanks goodness), the professional care and prompt response means everything. I have to say that I am grateful for our EMS service and believe they do a fantastic job. I am also grateful to our various VFD’s and law enforcement. Some of the naysayers really should consider how strong they want our EMS to be when they have a need and must call for an ambulance?

    1. At 5.66 million a year for the EMS why would you not get first class service? This is a 31,000 person county and its costing us like a 500,000 person county. A parable would be a monster truck named Overkill the no one can ever beat wins all the races. The driver owner of Overkill spends million plus each season has the best of the best equipment but only wins a few thousand each race but he is the best of the best but the return in the investment just isn’t there…Overkill. Its unfair to the taxpayers and the other departments in this county. The elected justices of the peace and constables don’t make near the salary alone of the top three EMS employees and its not right. Ever attend a fund raiser for the EMS yep no need.So why do we do this to our VFD? I think we can better distribute the 5.66 million.

  2. WCEMS is a service that is a huge Overkill for a county of 31,000. A 5.66 million dollar budget for an ambulance service per year. So we start in the hole and hope thru billing we might break even but we never do stop gaslighting the people. A ground ambulance is sufficient in most cases because they are well equipped as most ER’s. The air ambulance cost is what close to 170 thousand a month whether it works or not? WCEMS budget needs so serious cuts in funding because it’s Overkill if we are going to overkill something why not the law enforcement and VFD. Not everyone wants a helicopter ride @ 170 grand @ month. Support your local Sheriff and VFD is what we need for this county. Most ambulance service is part of a fire department or hospital district not a stand alone like the WCEMS not sure how that got started but at 5.6 million budget who is putting up the cash? You fix a lot of pot holes with that amount.

    1. Local vfd only get around 32,000$ A year that’s enough to get 7 sets of bunker gear or 3 air packs or 1/4 of a brush truck, the vfd are so underfunded in this county we sometime have to buy there own equipment just to get by

  3. Fact ground service ambulances cost a tenth of the cost of air bus service. So this unelected paramedic is in charge of an annual budget of over 5.5 million who oversees Kevin? Let’s talk about all the uncollected bills for the service. Fact insurance companies fight air bus service as in was it actually necessary,who decides and who is responsible for the cost when it’s not paid? Fact EMS before it does any collections has a potential to cost everyone as in each person in this county 200 bucks. This is outrageous and you Kirk nickel and dime VFD so they have to have fund raising and beg for support. The Sheriff Deputies are limited on calls for home alarms. Tell the whole story about the hidden costs of the uncollected,EMS service please. Have we ever had an EMS fund raiser? Why would we? Fix the roads get rid of Kevin and the Copters are start looking for something else than politics cause you are failing.

    1. And they’re asking for an administrative assistant…more dollars. I’m sure the court will approve that while declining Various Sheriff requests…or Heaven forbid properly fixing roads

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