Wednesday, May 14, 2008

Open forum: Business plan lacking for ambulance fee

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by Marcine D. Goodloe

It is indeed a shame that Patrick Lacefield, the director of the Montgomery County Office of Public Information, is so lacking in providing facts to the public on the county executive’s proposed fee for ambulance service (‘‘Residents will not be charged ambulance fee,” April 30 commentary).

Let’s look at the facts:

Both Medicare and insurance policies have various caps and specific provisions for ambulance coverage as well as restrictions on certain charges they will not cover for ambulance transport. Thus, they have the right to deny certain payments for ambulance fees. We also know that Medicare is struggling to survive and changes can and will be made and ambulance fees could be one of them.

Also, in the Medicare Carrier Manual it states that, ‘‘medical necessity is established when the patient’s condition, at the time of transport, is such that the use of any other method of transportation is contraindicated.” Does that not sound like determinations will be made?

Further, insurance companies can raise their rates they charge our county’s residents especially if all of a sudden thousands of their policy holders are now being charged for a service they never had been charged for previously.

It is also not as simple as a county resident just claiming that they cannot afford to pay the EMS transport fee. There will be numerous forms and supportive documentation required by the billing contractor to prove that fact. That same billing company will be receiving a percentage of the ambulance fee collected from the residents. The fire chief has also requested the hiring of six new county employees to handle the work associated with the ambulance fee as well, which will cost approximately $450,000 for the first year alone. As with all county salaries and benefits those salaries will escalate each year.

The county is also planning to spend approximately $230,000 a year for community outreach to provide information on the new ambulance fee. A law firm that was hired by the county to provide information on the proposed ambulance fee also stated that further legal and consultant fees would be needed as well.

There are many other problems with the proposed ambulance transport fee.

There has been absolutely no business plan presented to answer major questions about the fee, such as what if an ambulance comes and the patient refuses to go and they do not transport, are you still liable for the fee? What if an ambulance responds and provides treatment but does not transport? What if someone else calls for the ambulance and you did not want the service. Who is responsible for the bill? What if you are not at fault in an auto accident, whose insurance will cover the fee, yours or the person who is at fault for the accident? What if the local hospital emergency room is closed to ambulances and you are transported to a hospital further away potentially in another county or the District of Columbia? What impact will that have on the mileage charge to the resident?

Also too much is left up to the determination of the fire chief to make major decisions. Would it not be better to have set decisions that would let you know all of the facts? The residents of the county deserve a business plan to answer all the questions and be a roadmap for the necessary work ahead if the county were to proceed with the ambulance fee.

It is also not true that all neighboring counties charge a fee for ambulance. For example while Mr. Lacefield mentioned that Baltimore city charged, please note that Baltimore County does not charge. Baltimore County, like Montgomery County has an active and robust volunteer fire and rescue service. What was also not mentioned is that Washington County, Ocean City, Worchester County, Wicomico County, Somerset County fire departments do their own direct billing, and that money goes directly to the volunteer fire departments. Other counties such as Calvert County, St. Mary’s County, Anne Arundel County, Hartford County and as mentioned Baltimore County, to name just a few, do NOT charge an ambulance fee.

It is also not factual that the funds will all go directly to fire and rescue budget. The collected fees will follow the usual process of going into the general fund and it will be the County Council’s ongoing budget decision to earmark those funds.

Be aware that while you might think the county fire tax goes to the fire and rescue service that is not the case. All taxes go into the general fund and a portion into a reserve fund that supplements other county departments when necessary.

The ambulance fees will not offset the county property owners still facing an 8 percent to 11 percent increase in property taxes.

Then consider what will truly be the remaining funds available after paying the billing company, six new county employees, and community education for around $230,000 and consultant and legal fees. There are other avenues that need to be explored to ensure fiscal responsibility by the review of changes to many programs that can be made. There really is no proof of exact income as there is no way to tell how many calls will occur or how many of those calls will be subject to billing for ambulance service. There is no assurance that the billing company will not do the same as in other jurisdictions by sending out three or four notices to people before it is determined if they are able or not able to pay.

Mr. Lacefield speaks of other jurisdictions that have fees that do not have any problems. He is obviously not speaking to people in the District of Columbia who have just had their ambulance fees skyrocket from $268 to $530 and $471 to $832 along with $953 charge for advanced life support service and adding on an additional $6.05 per mile fee! The people of D.C. did not have a say in that increase, but you have a say now to help prevent fees from happening.

While we are discussing fees for ambulance service being billed to insurance companies, will fire emergencies be next as there is fire insurance coverage in most homeowners policies? We are starting down a slippery slope when we begin to charge for emergency services, which we believe are a basic function of any government.

Regardless of what anyone writes, including Mr. Lacefield, the volunteer fire and rescue service has conducted surveys in the past where it was clear that there will be many people who will not call 911 for fear of being charged a fee for that service. This disproportionately affects the elderly, the poor and the minorities of our community. Other research confirms our findings that people may hesitate during those critical moments of illnesses or emergencies before calling 911 for fear of incurring a cost.

In Montgomery County we have a robust volunteer fire and rescue service whose operational members take the exact same training as paid personnel. That training runs into the thousands of hours and volunteers do this for no compensation to serve their community and fellow residents. Some of the counties that Mr. Lacefield mentioned as having fees do not have volunteer fire and rescue providers, nor do their volunteers own their stations or apparatus that have been purchased through donations from their communities. In Montgomery County the majority of all fire and rescue stations are owned by the volunteer fire and rescue departments, as are many of the fire and rescue vehicles and equipment.

No one really knows what the ambulance fees will bring or any of the details as there has never been a business plan associated with the fees and the legislation that was presented to the County Council is void of detailed information. A lot of it is ‘‘trust me, you’ll like it.”

The senior task force that is mentioned in Mr. Lacefield’s commentary is a group of seniors who are part of the county’s program for seniors and may not be aware of all of the facts and implications of the proposed fee. They also do not speak for the majority of seniors in our county who, when asked, oppose the fees.

The Montgomery County Volunteer Fire and Rescue Association represents the 19 local volunteer fire and rescue departments and the more than 1,700 volunteer fire and rescue professionals. We were presented several opportunities to accept the fees by the county executive and turned them down each time. One of our volunteer chiefs stated, ‘‘It is the principle of the thing. We are here to serve those in need and will not take or support blood money.”

We are grateful to the County Council that the fees will not go into this budget, but realize the idea will not go away and we will continue to oppose this burden on those residents of the county we serve. When all facts are presented then we know the majority of people will agree with us. Emergency services are a basic tenet of government and are already funded by the tax burden on the residents. Any additional fees are unwise, unwarranted and just plain bad for our county.

Support your volunteer fire and rescue providers by opposing ANY fees for emergency services including charging for ambulance transports.

Marcine D.Goodloe is president of the Montgomery County Volunteer Fire Rescue Association Inc.