I guess I don’t really think much about ambulance services, but it’s a reasonably significant part of the city’s budget, and the city thinks it may need to charge more for it.
The last time the city raised ambulance fees was in 2002. Currently, ambulance transport costs $415, plus $7.50 per mile, with an average distance traveled of about 5 miles for a total of $452.50.
Under the proposal, that would go up to $800 and $16 a mile, or $880, which city officials said was more in line with other major cities, including Dallas and New York.
But the city only collects about 53 percent of the fees for the more than 140,000 transports the Houston Fire Department completes each year, and has no real mechanism for forcing people to pay. The city does not report non-payment to credit bureaus.
Although the existing ambulance fee brings in $31 million a year, doubling the cost only will bring in an additional $5.5 million because Medicare and Medicaid would continue to reimburse at the same rate they do now.
I don’t want to get too bogged down in the particulars here since this is just an opening bid, and you can be sure there will be plenty of give and take before anything comes to a Council vote, if it ever does. I do think it’s reasonable to take a hard look at ways to improve collections before any prices get raised, but I’ll need more data before I can say more than that. Again, I’m sure we’ll know plenty more before any action gets taken.
I will say this, though. We’ve been demanding that our government officials scrutinize every aspect of their spending to ensure they’re not being wasteful or overpaying for things that should cost less. Well, this is an aspect of that. It’s the government selling an item for less than it could instead of buying an item for more than it should, but the end result is no different. If we want our government to be truly efficient about its resources then it needs to ensure that the funding mechanisms that have been created to support services like ambulances and water are an accurate reflection of their cost. If that means some of those costs will go up, well, that’s how it should be. It’s what we wanted to happen, even if we say we didn’t mean it like that.
Now, the argument that Council Member Jones makes that ambulance services should be free to use and paid for entirely by taxes is fine, though obviously doing that would mean more general revenue is needed to fund it. If that’s the case, then either something else must be cut, and the article mentioned the possibility of layoffs or furloughs for city employees, or some other way to increase revenues must be implemented, which may mean higher taxes. One way or the other, we either admit the possibility that we need to pay more and deal with it, or we ignore it till something breaks. It’s up to us.
This is an issue I care a lot about. It’s not about fees being collected, it’s about unnecessary transports.
The biggest problem we have with the HFD ambulance budget is the fact that approximately 70% of all ambulance calls are for non-emergency trips most EMT I’ve spoken to call “taxicab rides.” In fact, you will probably find a very few regular patients constitute a significant percentage of the total annual trips.
This issue is part of a much larger issue in that we need to find a way to get primary care out of the County ERs. When disadvantaged and indigent citizens need to see a doctor for primary or preventative care but don’t have insurance or transportation, they often call HFD for an ambulance ride and taxpayers absorb the cost when the patient is unable to pay. HFD has to transport if the patient wants them to.
Using current fees as a basis (assuming they directly reflect the actual average cost of a transport), we could save upward of $11 million a year if we were able to reduce the number of taxicab rides by 25% (24,500 transports).
County Judge Ed Emmett is committed to making efforts to change the mission of the Harris County Hospital District to help get primary care out of the ERs, and I think Mayor Parker should put together some folks to help find a way to work with the County and the Feds to make some real progress on this issue.