Fees that Tuolumne County charges to insurance companies and patients for emergency ambulance responses to 911 calls will increase by 50% over the next six months due to operation costs outpacing current rates.
At a public meeting on Tuesday, the county Board of Supervisors approved the increases to the rates of its ambulance services that have been provided through a contract with Manteca District Ambulance since 1987.
The rate increases will go into effect incrementally by 25% on March 1 and another 25% on July 1. It would be the single largest fee hike in the 34 years that the public-private partnership has been in place. They typically respond
Manteca District Ambulance’s contract with the county pays the staffing and operational costs for the equivalent of 5.5 ambulances to run 24 hours a day, seven days of the week, out of four stations throughout the county.
Raising the rates 50% percent is estimated to provide an additional revenue of nearly $1.5 million per year for the county’s Ambulance Enterprise Fund, which currently has an annual budget of about $8.4 million.
The fund is entirely self-sustaining through reimbursement from the patient using the services or their insurance, with none of the money coming out of the county’s General Fund.
Additionally, about $339,000 is provided to the fund annually through a parcel fee approved by voters in Groveland for covering the area.
Revenue in the ambulance fund through Dec. 31 last year is anticipated to be down about 15% from what was expected at the beginning of the year, in part due to decreased 911 calls and out-of-county transports.
County officials believe the COVID-19 pandemic is a “strong contributing factor” to the decreased transportation because of limited bed availability at hospitals in the surrounding area.
The increases will raise the cost per call for Basic Life Support ambulance services from $1,472 to $2,208, Advanced Life Support from $1,905 to $2,858, and paramedic critical care from $2,860 to $4,290, among others.
While the county’s current rate structure is below the average for the state of California, the 50% increase would put the county into the 75th percentile statewide.
Patients with Medicare or Medi-Cal will not be affected by the increases, because those programs pay a fixed amount for ambulance services that are typically far less than the rates. For example, the reimbursement rate for Advanced Life Support through Medicare is $589.
Rates charged to patients and insurers through the county’s contract with Manteca District Ambulance have increased by 203% over the past 30 years, while costs to operate the services have increased 298% in the last 20 years.
The board also approved increasing the rates each July 1 based on the annual adjustment to the consumer price index from inflation.
Bill Caldera, CEO of Manteca District Ambulance, said running ambulances in the county also costs more than other areas in part due to the spread out area that needs to be covered.
“We’re running 8,000 responses a year with 5.5 ambulances for 2,240 square miles,” he said, while the district can respond to about 12,000 calls per year in Manteca with four ambulances.
Caldera also said the board should consider future trends that suggest more the people moving to the county in the coming years are expected to be retirees.
Approximately 80% of the transportation calls in the county last year were from patients of Medicare or Medi-Cal that pay the lower, fixed reimbursement rates. The volume of private insurance calls has also declined over the years, which typically cover the whole cost of what is billed.
County Supervisor Ryan Campbell noted that he believes the cost increases are universal to the medical system throughout the United States.
“Our ability to solve that problem through this process is pretty limited. In fact, we don’t really have any ability to solve that larger issue,” he said, “but I think it’s the right thing to do to maintain mobile medical services in our community.”
Contact Alex MacLean at firstname.lastname@example.org or (209) 768-5175.