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Seminole looks at costly 'non transport' ambulance fees

 

Date: November 14, 2016
Source: Orlando Sentinel
Author:  Martin E. Comas

 

InSeminole County, if you call for an ambulance and are treated at the scene — with no trip to the hospital — you'll likely get stuck with a medical bill of up to $800 thatMedicare,Medicaidand many insurers won't pay.

But if you get an ambulance ride to the hospital for the same condition, the cost of the trip likely will be picked up by those insurance programs.

"It doesn't make any sense," County Commisson Chairman John Horan said. In some cases "better [medical] service is given when you treat the person in place, but now we're learning that isn't covered."

On Tuesday, commissioners plan to consider suspending non-transport emergency medical services fees for six months to allow county staff to compile data and evaluate whether the fees are necessary or should be reduced.

The moratorium also will give the county's lobbyists time to urge federal and state lawmakers to change the rules so Medicare and Medicaid will pick up the tab if a patient isn't transported to a hospital after being treated by paramedics.

In some cases taking patients to an emergency room can be costly, inefficient and burdensome to hospitals and emergency medical services staff if the person can be medically treated at the scene by trained paramedics, said Jim Reynolds, director of Seminole County Fire Department.

"Often, emergency departments of hospitals are overloaded," Reynolds said. "The concept is treat patients in place when you can and not overburden hospitals with people that don't necessarily need to be there."

But it's not necessarily cheaper for the patient.

In early 2015, Seminole implemented non-transport EMS fees, which can range from $475 for basic life support — such as bandaging a sprained ankle — to $800 for advanced life support — such as providing insulin to a patient in diabetic shock.

It's part of a growing trend around the country of communities starting community paramedicine programs that allow trained paramedics to treat patients for a variety of medical emergencies if it's not necessary to give them a ride to an emergency room.

Lake and Orange counties transport patients to a hospital in nearly every case, unless the patient refuses. But those counties will not bill patients for services in most non-transport cases.

Jerry Smith, Lake EMS executive director, said treating patients on the scene helps free EMS staff and resources.

"We get a call, we treat them and if we're not driving them to the hospital, then I'm not tying up my [ambulance] truck as long, and I can respond to other calls," he said.

But the drawback, Smith said, is patients end up with a bill.

"Unfortunately, Medicare and Medicaid have not caught up with the trend," he said. "And that's what's hindering us from actually looking at a community paramedicine program because the health-care industry has not developed ways to reimburse the providers."

In the last fiscal year that ended Sept. 30, Seminole EMS staff responded to 27,764 calls. Of those, 7,270 cases were not transported to a hospital.

Seminole has about $240,000 in outstanding bills from patients who were treated by EMS staff but not transported dating back to May 2015. The county has collected roughly $75,000 from patients who weren't taken to the hospital.

"A lot of these folks who need this service, they're seniors," Seminole County Manager Nicole Guillet said. "They're on fixed incomes, and to their credit, they are paying. And sometimes we put them on a payment plan to accommodate them. But we're in a situation where we're doing the right thing. But there's a penalty to that because we're not collecting the fees."

By comparison, Lake responded to 51,037 EMS calls in the last fiscal year. Of those, 12,570 were non-transport cases.

Orange County responded to 80,770 EMS calls including 21,116 cases in which the patient was not transported to a hospital in 2015, the most recent year with available data.

Seminole commissioner Brenda Carey said federal and state legislators should work toward insuring that Medicare and Medicaid pay for the "non-transport" fees. Otherwise, a trip and stay at the hospital can cost several thousand dollars for those federal and state programs and ultimately taxpayers.

"If you're trying to control health-care costs and somebody can be treated in place and not have to be transported to a hospital, then it's in everybody's best interest — the patient, the payers, regardless of who it is," Carey said.