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Tracy Not Alone in Charging for Medical Emegency Responses

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(Sacramento, CA)
Monday, March 8, 2010
Recently, we told you how the Central Valley city of Tracy will soon start charging residents when its fire department responds to medical emergencies. Officials say the city needs the extra revenue to balance its budget during the recession. But it turns out this practice isn’t unique to Tracy – or even California.  And questions are being raised about whether it’s a good policy – and who gets stuck with the bill.

(sound of a siren from a fire engine)
When you hear this sound coming from a fire engine these days, chances are it’s not heading towards a burning building; it’s responding to a medical emergency. Like this response a few days ago, when we joined a Sacramento Metropolitan Fire District crew for a ridealong: a patient at a nearby Kaiser medical facility needed to get to a hospital; 911 was called; and five minutes later, fire fighters were on the scene.
The patient was a man probably in his sixties, apparently suffering from chest pains. But he was conscious and alert. As the crew wheeled him down the hall on a stretcher, he looked up and said, “Call me a cab – it’s cheaper.”
Fact is, it’s pretty darn expensive to get a ride to the hospital – in some instances, more than a thousand dollars.
Now here’s where the whole Tracy situation comes in: There’s a general consensus that in most cases, the fire fighters tend to arrive first. That means they’re the first ones to treat the patient. Sacramento Metropolitan Fire Captain Roy Cameron says that treatment has become far more sophisticated over his 30 years on the job.
Cameron: “When I started, we were doing CPR on people – no drugs to push onto them, no monitors. It was all just everything by hand. It’s gotten a lot better. A lot more life-saving techniques make a big difference."
What used to be called “basic life support” is now “advanced life support,” or ALS. And the cost has gone up – as have the number of calls, Cameron says.
Cameron: “But to me, if it’s going to save a life, it’s worth a million dollars.  You can’t put a price on it.  It’s gonna enhance our skills; it’s gonna enhance our ability to help.  I don’t think you can put a price on it.”
But some fire departments do exactly that: They charge several hundred dollars for treating medical emergencies.
Sinclair:Typically, what these programs are doing is simply recovering the cost of augmenting the service to the community.”
John Sinclair is the chief of a fire department in Ellensburg, Washington – and the go-to expert on emergency medical services for the International Association of Fire Chiefs. He says it’s easy to forget that ALS is part of the health care system – just like an ambulance ride. Fire departments have to pay for it somehow.
Sinclair:As local communities’ public safety budgets are being squeezed and we look at how we pay for everything, I believe we’re going to see more and more systems that historically may have done it for free, that can no longer do it for free.”
And faced with a choice between dropping ALS or charging a fee, well, Sinclair’s pretty sure Tracy won’t be the last city to start hunting for cash.
But while health insurance almost always covers ambulance rides, it doesn’t always pick up ALS fees. For example, Medi-Cal doesn’t cover them at all.  And Patrick Johnston with the California Association of Health Plans says ALS charges aren’t common, so insurers handle them differently. But if more cities start charging fees…
Johnston: “Then sure, the cost goes to the insurer and that gets passed on in the form of higher premiums to those who purchase the insurance.”
Or insurers could choose to not cover ALS fees at all. Jamie Court with the group Consumer Watchdog says that might make patients think twice before calling 911.
Court:If you need advanced life support, you shouldn’t be worrying about whether to make a call that’s gonna cost you hundreds of dollars.  You should just make that call.  And any barrier to making that call is gonna mean that people aren’t gonna get treated as quickly as they should.”
There aren’t any hard figures on how many fire departments are charging this fee across the country. What we do know is emergency medical systems vary widely. And as one fire fighter puts it, when you’ve seen one EMS system, well,  you’ve seen one EMS system.
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