Due, in large part, to Medicare, Medicaid, and HMO insurance having contractual limits in the amount of money they pay for ambulance service, the North County Fire Protection District is typically reimbursed only 35% to 40% of the actual cost of providing ambulance services to residents throughout North San Diego County. “Nonetheless, we continue to provide the level of emergency services that residents throughout our service area expect and deserve,” said NCFPD Fire Chief, Steve Abbott.
Reimbursement for these emergency services was exacerbated (made worse) in 2015, when the Fallbrook Hospital closed its doors. “Due to this closure, our paramedic ambulances are now forced to travel longer distances to hospitals in neighboring communities.” Chief Abbott explained that in order to adjust to this hospital closure, the District immediately put a third full-time ambulance in to service; thus, placing even greater strain on the Agency’s financial and human resources.
“Fortunately, all of our firefighters are certified paramedics,” Chief Abbott points out; “thus, every time a fire engine is dispatched, there are at least three paramedics on board.” And, the District staffs its ambulances with a minimum of one paramedic and one certified EMT (emergency medical technician). This method of delivery ensures that paramedics arrive on scene as quickly as possible from the closest fire engine, and meet up with an ambulance that can continue advanced life support (ALS) to the hospital. With paramedics on the fire engines as well as ambulances, we create additional depth in our capabilities because the paramedic engine is capable of still providing ALS even when our paramedic ambulances are tied up on calls. “While this increases the cost of transporting patients, it is necessary if we are to provide the high level of care that is needed.” he added.
Speaking to how the District sets its reimbursement rates, Chief Abbott makes note of the fact that California law allows government agencies to base their reimbursement rates on one of two metrics: (i) on actual cost OR (ii) on a regional average. “We choose to employ the latter when calculating reimbursement rates from insurance companies and individuals who use our ambulance services,” he explains, “because this turns out to represent a far greater degree of fairness to our constituents.” The District periodically surveys each agency throughout the region, then adjusts: its reimbursement rate based upon the regional average. He also stresses that when calculating the regional average, the District DOES NOT include the rates being charged by ambulance companies in the private sector. “Adding in the fees charged by firms in the private sector would increase the regional average by as much as 80%,” Chief Abbott explains.
Nonetheless, at the end of the day, the NCFPD finds itself in a fiscal bind. Why? As noted above, the District is typically NOT reimbursed even its cost for providing ambulance services, since the entities that are responsible for reimbursing the District typically have contractual relationships in place with reimbursement rates significantly lower than the actual cost of providing these critical services. Thus, the fire protection District has to absorb the difference.