Headline Animator

Monday, January 22, 2007

Why we bill for EMS

Today I read an interesting article on how Bedford County is going to bill for rides to the hospital (link). Roanoke began billing probably 6 or 8 years ago. But is it that bad in Bedford that they have to start billing now. First of all, let me clear the air about who actually gets billed; the insurance companies. The self-pay, non-insured ambulance "customers" are not billed - well at least not sent to the collection agency.

Why do we bill? The simple answer is that we are trying to capture some of the expense of keeping ambulances staffed, running, and in service with trained personnel.
Why do we have to bill? Because the growing trend of calling the ambulance for everything took a toll on how many ambulances were in service and created a need for more ambulances, more staff, and more wear and tear on the ambulances.

Who calls most frequently? The non-insured to take them to the ER instead of a Family Physician. The mis-informed who think that by riding in an ambulance they will get to be seen first at the ER. The uneducated who do not know that there are Doctors offices who will allow uninsured to be seen and assist them with finding Government supplemental assistance to pay for the visit. Oh and let us not forget the ones who were taught to just call 911.
Who do we collect from? The insurance companies. It is my understanding that we do not come after self-paying people.

Who does it hurt? Well like most insurance paying people, our insurance rates and premiums increase due to the need to cover the costs of Emergency Rooms and Doctors Offices seeing the uninsured. This is a Government problem and it affects all insurance subscribers. The same goes for auto insurance.

What is the answer? Well this leads to an issue that one of our Battalion Chiefs often likes to bring up: EMS Prevention. After all, due to Fire Prevention and education the U.S. was able to see a decline in fires and correct the problem in the 70's and 80's of "America Burning". So why not educate people about EMS and when to call and when not to. The answer is money.

The reason for all the Fire Prevention in the last 80's and 90's continuing to today is because fires, responding to fires, and all the costs a fire department has related to fires is out of pocket. There aren't any funds associated with running fire calls, except the newly established fee for too many false alarms. However, this is only pocket change to running the alarm.

Now that we have seen EMS calls skyrocket, the answer wasn't to educate rather it was to bill for the experience. The flaw is that the very people who call too often aren't the ones saddled with the cost. It is the insured, the ones who rarely call when it isn't an emergency who have to pay. Luckily for them they have insurance, but the premiums, rates, and overall cost of insurance has gone up because of the billing.

Why should we commit to EMS Education? It depends on who you ask. If you ask the responder they will tell you it is a good idea that would decrease call volume, decrease "burnout", decrease response times, increase efficiency, and increase morale. However, if you ask an Administrator (from anywhere) they will more than likely tell you it is not necessary. We are providing a service and recouping the costs associated with responding.

Who cares if the responders are feeling the the affects of running all the nonsense "BS" calls. We are making money people.

Sure there would be costs associated with EMS prevention and education, but imagine the outcome.

Most departments our size are already a step ahead with prioritized dispatching. I know you have heard me say it many times before, it is like beating a dead horse. This doesn't mean that we have to get rid of the BLS calls and give them to Carilion or another 3rd party transport company. This just means that ALS (life threatening) calls would get priority. If we really wanted to make money we would have a fleet of BLS ambulances running around all day long taking people to and from the hospital and doctors offices. That would more than likely necessitate an EMS Division. I am not saying to reemerge as two departments, just divide within the organization. Maybe we can answer some of the other ailments of the EMS system.

But that is a whole other post, probably not one I will do anytime soon.


Anonymous said...

As a resident of Beford Co I know that the number of volunteers has decreased signigicantly over the past few years and that Carilion has had to bring in employees just to make sure calls on the EMS side are covered. I belive the charge for EMS is to start a base so Bedford Co can pay staff other than those from another company

FireFleitz said...

I guess that I used the article to talk about the issue in regards to Roanoke City. It is unfortunate that Bedford County doesn't begin building a paid department with the use of tax dollars and supplement the budget with the EMS funds.

Anonymous said...

It will come...and you will know. Once reticent disciples become oracles of a new age, heralding songs of virture and truth. adversus solem ne loquitor

Anonymous said...

The writing has been on the wall for years and is now coming to fruition. Insurance companies, particularly Medicare, are now starting to deny ambulance transport claims, even those classified as "emergency" or "advanced life support". The greatest reason for denials is a lack of adequate documentation - however, it is just a matter of time before it becomes across the board. The insurance companies, as with all other services in healthcare, will have a negative impact on prehospital care.

Anonymous said...

Well when you educate them not to use 911 unnecessarily, can you teach them that ER's are not family practices? Too much crap ends up in the ER that doesn't need to be there. Want to talk about log jam, visit one of the ER's on a busy night. This education should continue on to the FP's in the valley that rather than see a patient for an issue tell them to go to the ER. Health care in the valley needs a revamp, starting with EMS and going all the way to the top. OH and by the way, I quit volunteering as an EMS when the jurisdiction I was in went fee for service.

Anonymous said...

Agreed - healthcare/medicine needs a total reform. It took the unfortunate turn years ago into a business instead of an art. There is always hope, but I do yearn for the "good ol' days" when care could be provided without prejudice of ability to pay and without the fear of a frivilous lawsuit.