In another step toward putting the first county-owned ambulances in Harford County history in service next year, the County Council is considering legislation to set the fees that patients will be billed.
The council held a public hearing Tuesday evening on Bill 17-020, sponsored by Harford County Executive Barry Glassman, that sets fees “equal to the Medicare allowable amount for such transportation,” according to the legislation. No one from the public spoke during the hearing.
The legislation also provides for such charges to increase or decrease in step with applicable Medicare charges fluctuations. If there is no comparable Medicare charge for the service provided, the county’s director of emergency services and treasurer would set the fee.
If the patient transported is not covered by insurance – or the insurance does not cover the service provided, the legislation gives the emergency services director and treasurer authority to waive the charge.
The legislation also states, however, that “the county shall not question an individual about the ability to pay the ambulance service charge at the time the service is requested or provided, or fail to provide said service because of the individual’s perceived or actual inability to pay.”
The legislation also gives the county treasury department authority to adopt rules and regulations both for the collection of charges and procedures for waiving them where applicable.
Setting the ambulance service fees is another step for Glassman’s administration as it moves Harford toward a countywide paid ambulance system – controlled by the county government – and away from what historically has been a service provided strictly by a dozen local privately operated volunteer fire and ambulance organizations.
The council did not vote on the fee legislation Tuesday, but it could act on it as early as the next council meeting Nov. 21.
The county executive laid out his plan for a county takeover of the EMS system in his State of the County message last winter, in which he explained the process would be gradual and would still rely on the volunteer companies — the largest of which already have paid ambulance crews – to provide the bulk of such services in the foreseeable future.
Glassman, who was an active volunteer with the Level Volunteer Fire Company for many years, has said that the county’s fragmented EMS service is not adequate to meet the needs of citizens in an era of evolving high tech – and costly – emergency medicine. He has been particularly concerned about the ability of the local EMS system to respond in a major disaster.
The county executive already has appointed a medical services director for EMS and an emergency standards advisory board to oversee the countywide system.
Last month, the county took delivery of two ambulances for “surge” situations when the other EMS ambulances in the county are out on calls. Fully equipped, the two ambulances cost approximately $650,000, a county government spokesperson said.
The first ambulance is due to go in service Jan. 1 and will be available 24/7, Treasurer Robert Sandless Jr. and County Attorney Melissa Lambert explained during Tuesday’s hearing. All council members attended, except Councilman Joe Woods, a FEMA employee, who has been aiding disaster relief efforts, first in the South and more recently on the West Coast.
Eight people will be hired to staff each surge ambulance, according to Lambert, a bare minimum, she said. It hasn’t been determined when the crew for the second will be hired, but until that is done, the second vehicle will be a backup. Last month, a county spokesperson said the first six months with the single ambulance will serve as a pilot program to determine when and how the second vehicle should be deployed.
Both ambulances will be based at the Harford County government annex on Route 543, the location of the emergency services department. A prefabricated structure is being erected for them, Lambert said.
Lambert said in tying the fees to Medicare reimbursements, the county had talked with the other ambulance service providers and those generally base their fees on Medicare. Some also charge additional fees, she said, but the county will not.
Sandlass said Medicare has a range of fees depending on the level of service provided from about $240 for non-emergency basic life support transport to about $780 for specialty care transport. Most patients will need advanced life support level service which runs about $685, he said.
The county plans to contract with a third party to handle billing – a complicated process, Sandless said, to “maximize the amount of revenue” collected. The billing company will charge 6 percent of what is collected.
Citing situations such as motor vehicle accidents where victims are likely to be younger than Medicare age (65), Councilman Jim McMahan asked: “I’m just wondering when you worked your figures out, actuarially, do you find then that the Medicare charges covers the expenses that you anticipate with this one ambulance?”
Sandlass replied that the service is “not intended to be a [self-sustaining] enterprise fund” and, as such, is “not a service designed necessarily to pay for itself.”
The county considers basing the fees on Medicare reimbursements a “fair and equitable way” to bill people, he added.
McMahan asked if they had consulted with the volunteer companies about how many trips the ambulance would have to make “on average to pay for itself” or how much it would cost a month “to put that ambulance on the road,” but while Sandlass replied with some hypothetical numbers of “a couple of trips” daily, he also reiterated that profitability, or even breaking even, is not the goal.
The county ambulances, he and Lambert said, will be used only in instances where the volunteer fire and EMS companies ambulances aren’t available because they are “overwhelmed” or because of staffing limitations.
“When everything else is on the road, this gets called, so they are...last due,” McMahan said. “So, they will get what’s left over, so I’m just wondering how many trips they will get as a surge ambulance, whether it will pay for itself.”
“I really think the thing to keep in mind, and I think it’s the county’s goal, is that we can make sure an ambulance is arriving in a timely manner to an emergency in a situation when that volunteer ambulance is unable...that there is somebody to make a really timely response and get these people the help they need,” Lambert said.