Friday, May 17, 2013
What was to be a simple fee update became a matter up for review by the finance committee after Dorchester County Council members looked at the fees the county charges ambulance users.
Council voted 6-1 last week to refer the matter of EMS rates to the finance committee. Councilman David Chinnis, muttering in frustration at the lack of action, voted against.
There were two fees discussed – a mileage fee and a service fee. The mileage fee was to be increased to $9 per mile from $7 per mile, and after the meeting Chinnis said the mileage fee should have been approved.
The service fees, however, took some council members by surprise. Dorchester’s rates were nearly twice as high as the rates charged by Berkeley and Charleston counties.
Councilman Larry Hargett objected to the rates, saying Medicare and Medicaid are going to cut reimbursement rates and private insurance deductibles are going to increase, but the county is trying to raise rates, leaving a larger gap between what’s covered by insurance and what the patient must pay.
“I know who’s going to pay it. The people who can’t afford it. They’re going to pay it,” he said.
EMS Director Doug Warren explained in an email that council has wanted EMS to cover between 75 percent and 85 percent of its costs through user fees.
This year, he projected, the department will have funded 80 percent of its budget through user fees.
Berkeley County, on the other hand, funds one-third of its EMS budget through billing, according to its website.
Dorchester charges $425 for a call that requires basic life support and can be handled by an EMT – for example, bandaging a laceration or administering oxygen.
For an advanced life support level 1 call, which requires a paramedic and could include initiating a peripheral IV line, using an ECG to monitor heartbeats or giving aspirin to a cardiac patient, the county charges $725.
For an advanced life support level 2 call, the county charges $1,085. Such calls usually require additional personnel and can require use of defibrillator, external pacemaker, intubation to help the patient breathe, CPR and multiple drugs. They could also use several doses of pain medication to help the patient cope on a long ride to the hospital, Warren said.
By comparison, Berkeley charges $323, $380, and $555, respectively, for those services.
Its mileage fee is larger, however -- $10 per mile.
Charleston charges $375, $425, and $550 for those services. Its mileage rates differ by area -- $8.50 in the urban areas and $10.25 in the rural areas.
Warren said the Affordable Care Act will reduce the amounts paid for non-emergency ambulance rides.
The service is already enduring 2 percent Medicare cuts because of sequestration, he said.
By law, EMS writes off unpaid balances for Medicaid patients and balances over the out-of-pocket maximum for Medicare patient, he said.
On the other hand, EMS will get at least some payment once more people have insurance of some kind, he said.
Hargett said increasing the mileage fee was a “no-brainer,” but he was concerned about the service fees.
He’s heard complaints about high fees over the years, but seeing a comparison of the three counties was revealing, he said.
It could be that once the committee examines the matter, it decides the fees are justified, he said.
At this point, though, he wants more information.
The county set the current rates in 2002.
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