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Council Nixes Increase in Ambulance Fees

The D.C. Council has rejected Mayor Adrian M. Fenty's plan to double ambulance fees. In a lively legislative meeting yesterday, council members approved an amendment opposing the hike while also voting unanimously for the budget support act of the fiscal 2009 spending plan.

The Fenty administration had estimated that the increase in ambulance fees would generate $7.2 million in revenue. Basic life support transportation would have jumped to $530 from $268 and an advanced life-support trip would have cost $953 instead of the current $471.

The amendment requires the mayor to raise $3.5 million through "vigorous Medicaid and Medicare billing" -- a source of revenue for ambulance services that the city has not been tapping adequately, said Council member Phil Mendelson (D-At Large).

Mendelson had raised concerns that residents would be hit with a 100 percent increase in emergency care and that the mayor had tried to raise the fees without a public hearing and council approval as required by a law. The council approved that law in February.

Any other budget gap will be filled through the budget's operating margin -- a cushion the city can utilize, Council Chairman Vincent C. Gray said.

The mayor will be allowed to establish some type of increase on Oct. 1 if he fails to raise the money through those means. That proposal would go to the council for approval.

By Nikita R Stewart  |  June 4, 2008; 7:00 AM ET
Categories:  Budget  
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It seems that whatever fee schedule is developed should be set to at least cover "costs" for each ambulance call (if an organization can truly determine its costs.) In addition, a fee schedule should be established that at least collects the maximum allowable amounts from third party payors such as private insurance, Medicare, Medicaid, etc.

It is claimed by those opposed to any increases that their constituents will not be able to afford the increases. I bet that a review of the current "private" pay users of EMS will reveal that most of them are not going to pay anything now at the current rates so any rate increase is simply ignored by these folks anyway. Some EMS agencies will reduce EMS charges for those clients that truly have "special" circumstances (just as hospitals will do for their charges where someone has no insurance or social program medical coverage) but most simply have poor collection efforts (maybe due to bad information collected at the time of service?) or simply don't bother to show any real efforts in collecting users fees from those who are not making any attempt to pay their debts. Why not tag-on these unpaid "fees" to their property tax notices, car tag renewal fees, or deduct them from any local income tax rebates that may apply in their locality? That will get the attention of folks who may otherwise attempt to avoid paying a debt they owe to the "taxpayers." If nothing else, they will provide correct information for any health insurance coverage they do have so that can be properly processed. Either way, you get get paid.

EMS is one of the few publically-provided services where one can get service "on credit." Try to bail out someone from jail, get a marriage license, or a copy of a property deed without paying for it at the time of service!

Too many public EMS organizations are financially handicapped by politicians making short-sighted decisions to not raise rates as the call volume typically increases each year, thus creating an even larger shortfall in EMS revenue that results in a larger budget request of taxpayers money each to make up the difference between operating expenses and collected revenue. Most publicly-operated EMS systems never "break even" but each should try to maximize their revenue so the "tax" burden on its citizens and residents is as small as possible.

Posted by: retired EMS Administrator | June 5, 2008 10:05 AM | Report abuse

I don't know what the Council's problem is. Insurance companies will continue to pay for the transport of their members, and those who leech off the system will continue to pay nothing, just as it is now. Do they not realize that it's the system abusers who necessitate fee hikes in the first place?

Besides. EMS can bill anything it wants- Medicare and Medicaid won't change their payments one iota.

Posted by: EMT | June 5, 2008 4:56 PM | Report abuse

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