Tuesday, September 27, 2011

Not particularly surprised

Last week I testified at a City Council meeting, regarding a resolution to increase the rates we charge for Lincoln Fire & Rescue ambulance services.  The rate increase averages about 4.5%, and is based on a formula that increases rates annually in an amount equal to the consumer price index increase, plus 2%.  This method was the recommendation of a committee that studied the ambulance service in Lincoln a few years ago, and acknowledges the reality that medical services are increasing at a rate well beyond the general CPI.

During my testimony, I mentioned that LF&R actually recovers just over half of what we bill.  This seemed to surprise many people, including some of the media.  The Lincoln Journal Star ended up discussing this in their lead editorial yesterday.  It's really pretty straightforward: many people who need an ambulance do not have private health insurance.  The medicare and medicaid rates are well below the billing rate, and many uninsured patients have little ability to pay.  Absent private health insurance, other taxpayers pick up the difference between the bill and the reimbursement rate, or the entire tab in many cases.  This shouldn't shock anyone.  The taxpayers also pay to extinguish your fire when you've put your grill too close to the deck railing, investigate your theft when you've left your garage door standing wide open, and incarcerate the offender if he is caught and convicted.


Anonymous said...

So the question is....why was LFR so excited to get into the ambulance business several years ago, when they chased out a well run ambulance service? Oh, that's right....because it made a lot of firefighters a LOT of money off the taxpayers back. Mandatory staffing levels, overtime shenanigans...you name it, they did it.

Tom Casady said...


Water under the bridge, as it has now been 11 years.

At any rate, I suspect that the landscape has changed in the meantime, with the further squeezing of Medicare and Medicaid rates, and the growing number of people with no insurance, and no payee. Seems to me that the private providers were receiving a substantial City tax subsidy, and still struggling with the emergency side of the EMS business.

We now have two private ambulance companies in Lincoln now that seem to be doing OK, and I suspect that's because they are focusing on non-emergency transports, and are thus handling the portion of the business that can turn a profit: those patients with a payee.

Anonymous said...

When I lived in Hastings back in the early 80s, they privatized their county-run ambulance services, and now, the city/county is taking it back because the private company cannot make the numbers work for the reasons PSD Casady mentions here. Anon 9:01, quit demonizing firefighters for doing their jobs. Do you really want some min-wage person wielding the paddles when you're in cardiac arrest?

FWIW, I hope to never have to use an ambulance; if I'm that bad off, wait a couple minutes, cut out the middleman, and just call Roper's.

Anonymous said...

I had to take a ride on an ambulance for an unfortunate issue I had. Luckily it was not serious. I was very appreciative of the parametics who took care of me and got me to the hospital quickly - and hey they weren't bad to look at either ;)

The only thing that was frustrating was that I called LFR a few days later to find out how much that ride was going to cost me, and the very nice lady who answered said it could be a month or more before I would be billed. I was very surprised it would take that long. I never did get a bill. I assume its because it was submitted to my insurance and insurance must have covered it. I sure hope thats what happened.

Anonymous said...

"Do you really want some min-wage person wielding the paddles when you're in cardiac arrest?"

Since when are private sector EMTs paid only minimum wage? Oh, I see what you did there; set up a straw man then pushed it over.

Anonymous said...

Though I appreciate Director Casady trying to compare tax payers paying for fire service and rescue service there is one point I think he overlooked. Fire service is built into property taxes and is never billed to an individual (assuming it it a legitimate call) while ambulance service is set up to be a billed service. That's the big difference. Our city has used a billing model for ambulance service while fire is an inclusive part of property taxes. Seems to me to be a little bit of a parlor trick taxing for fire service and then slipping a little bit of that money to the rescue side of things while we are not looking. 

Steve said...

There is no free lunch. Get over it.

Nobody, in this day and age, should have to check their bank account before calling 911 for emergency medical service. If police and fire service are provided through tax money, emergency medical care should be, too.

Anonymous said...

When we have a national health care plan (paid for by taxpayers) and everyone has coverage, the reimbursement rates to LFD will be determined by the government and will be certainly less than they are currently. The remaining costs for service will be paid by the taxpayers. If my math is correct, that means 100% will be picked up by the taxpayers.So the only solution is to line up all the millionaires and billionaires in Lincoln and tax them more so the middle class doesn't have a tax increase, thereby keeping both the Republicans and Democrats happy.


Anonymous said...

Tom-Here's a newsflash from Cloweta, Oklahoma, a small town outside of Tulsa. The town is assessing a $250/household charge to cover the cost of fire service. It is not mandatory, however if the trucks have to come to your home and you haven't paid the fee you will be charged $750/hour/truck. Interesting. They are trying to pay for an additional fire station.


Anonymous said...

Eastern Ambulance, and later, Rural Metro Ambulance both received a subsidy paid for by the taxpayer of Lincoln. Both also received an automatic increase just as LFR does as described by Mr Casady. Most services, public or private have a built in escalator clause to try and keep up with rising health care costs. No straw just solid facts.