Fire district board considering charging for ambulance aid calls

Sean C. Morgan

Responding to a staff presentation, the Sweet Home Fire and Ambulance District Board of Directors last week asked Fire Chief Dave Barringer to return in November with a detailed proposal to begin charging fees for ambulance responses that don’t result in trips to a hospital.

Most neighboring fire districts charge what are called aid calls, no-trip calls.

SHFAD Administrative Assistant Julie Mayfield researched how other districts handle those calls and presented the results with the SHFAD board during its regular meeting on Oct. 20.

She received information from Klamath Falls, South Lane, Lebanon, Albany, Corvalllis and La Pine. She did not receive information from Sisters. Central Linn County communities receive ambulance coverage from neighboring districts.

“Currently, each of them bill for no-patient trips,” Mayfield said. “We seem to be the only district in this entire area that is not, yet. The consensus is that there is a legitimate cost to the districts and departments for going out and treating a patient.”

The charges by each district vary, Mayfield said, but they tend to handle things similarly.

For example, Mayfield said, they get a call to a diabetic emergency. The medics assess the patient and give him or her D50, administered through an IV. At this point the person has become a patient. They have treated the patient.

The patient feels better, she said, and then declines to go to the hospital. Because medics have used supplies or medications, the district can bill the patient.

“The deciding factor is the difference between assessing an individual and treating them,” Mayfield said. “The moment we begin to treat them, they then become a patient, and that is billable. Usually, if an IV is started or meds are given, then the insurance and patient will receive a bill.”

Medicare and Medicare Advantage won’t cover treatment with no transport, but Oregon Health Plan and Medicaid do, Mayfield said. If a patient has only Medicare, the district would bill Medicare. Once Medicare denies the charge, then the district can charge the patient. Some private insurers will also pay for patient treatment with no transport.

Fire-Med would reduce the bill by half, Mayfield said, and it may be another way to attract more Fire-Med members.

In Lebanon, the district charges $500. In Albany, the charge is $420. South Lane charges half of its base rate, $400.

La Pine has a tiered system for treatment. With advanced life support intervention and treatment, it charges 50 percent of its base rate. For evaluation without advanced treatment, the charge is $125. La Pine also charges different rates for out-of-district patients.

The Sweet Home district responds to numerous motor vehicle collisions, Mayfield said, and she suggested the board consider charging for traffic control, site cleanup and medical assessment to vehicle occupants.

“To not recoup any of the costs associated with the MVAs just isn’t an option any longer,” Mayfield said. “We are seeking your approval to move ahead with this revenue avenue.”

Last year, the district had 1,650 medical calls during which a patient was transported. It had 1,141 medical calls during which the patient was not transported.

Counting crashes, the district had 24 medical transports and 62 without transports.

The district already has billed some patients who call multiple times, Mayfield said. The district charges $250 per call at this time.

Of the 41 percent who are not transported, Fire Cheif Dave Barringer thinks probably half of the calls would become billable, he said, although that’s a rough estimate.

“My suggestion is that we bill no-patient trips,” Barringer said, but the district would only charge if they’re treated. “We either are going to have to do something about the tax base, or we are going to have to do something about revenue. I think it’s fair – even though it’s hard because it’s new – because people are using a service.”

The charge would not be for people who just need an evaluation, a three- or four-lead EKG or a blood pressure reading, for example, Barringer said. It should kick in when medics begin using an IV or have to do a more complicated 12-lead EKG.

Director Don Hopkins asked why the district hasn’t been billing for motor-vehicle collisions when insurance companies are willing to pay on them.

Barringer said that’s what he and his staff are asking.

The main thing, the chief said, is he wanted to get the concept in front of the board and find out if the board was interested in pursuing this as a revenue source.

Board members asked Barringer to go ahead return to the next meeting with specific recommendations for fees and criteria for billing.

“I can give you hard numbers I think would be appropriate, but that’s my opinion,” Barringer said.

In other business, he reported that officials moved apparatus around among the stations to ensure each station has at least 4,000 gallons of water available and meet minimum criteria for consideration in improving ISO ratings, which impact insurance rates for property owners.