CLEARWATER – Pinellas County Commissioners acknowledged Sept. 27 actions by the county administrator that increased ambulance fees by 3.3 percent, effective Oct. 1.
The increase means an additional $17.22 for a first level ambulance ride, bringing the cost to $529.03. It now costs $20.46 more for advanced life support 2 ambulance service, or $640.56. Critical care transport increased by $29.42 to $920.99.
Mileage increased by 39 cents to $12.18 a mile. Waiting time per 30 minutes went up by $1.91 to $59.69 per half hour. Dedicated standby per hour, three-hour minimum, increased to $108.03 per hour, and non-dedicated standby increased by $1.72 to $53.95 an hour.
Mental health transport costs $3.85 more, or $120.66 a ride. The cost to transport a patient who died at the scene remains at $336.06, which is the Medicare emergency rate.
County Administrator Bob LaSala said approval of the rate increases by commissioners was not required. He said he was only bringing it up at the meeting due to the “sensitive nature of the issue.” LaSala is following rules set in a 1989 resolution following recommendations by former county administrator Fred E. Marquis to authorize an automatic increase in ambulance fees, according to the Medical Consumer Price Index for the previous year, until such time that EMS reserves equal the amount set by the board.
In 1989, the commission approved reserves of one-third the EMS budget. The current commission set an EMS reserves target of 25 percent; however, the 2011-2012 budget contains only 22 percent in reserves, thus triggering the automatic increase.
With the exception of Commissioner Norm Roche, no objection was voiced for the increase; however, Commissioners Nancy Bostock and Ken Welch, as well as Roche talked about the lack of notice given to the board and the public that the increase was coming.
Welch said he could "appreciate and understand" the administrator's position, "but we need to get this on the website for the public to help with transparency."
Bostock said she also understood the authority granted by the 1989 resolution, "but it is not on the agenda." She said without notice, the public was unable to express its opinions on the matter. Roche pushed to table action until the matter could be placed on an agenda and given proper notice.
Commission Chair Susan Latvala defended LaSala's actions, saying his announcement "was a courtesy to the board. He has the authority to do it (automatic increase)," she said.
LaSala said increases in ambulance fees let the county to keep its rates competitive and ensure users paid their fair share, reducing the burden on the EMS millage rate, which the board increased by 46 percent on Sept. 15.
Roche questioned LaSala's statement and asked with whom the county was trying to remain competitive. LaSala said the intent was to keep rates competitive with the market and reduce the burden on the taxpayers.
"I felt in this environment it really was not appropriate to just sign this through even though it is allowed and needed," LaSala said. "I could have just signed this and moved along."
Bostock said she thought the 1989 resolution was "prudent" because it allowed for built-in inflation adjustments. Commissioner Karen Seel said she wished she had known about the automatic increase when the board was considering the target amount for reserves.
"We should have known," she said.
Seel also commented that the increase would bring in only an additional $500,000. Maureen Freaney, assistant county administrator, said projections call for an additional $527,000 to be collected with the rate increase.
Roche said ambulance fees should remain as they are “until current issues are resolved,” meaning current plans to try to overhaul the entire EMS system.
Roche’s sentiments were not shared by other commissioners, who voted 6-1, to “acknowledge,” but not necessarily approve, the fee increase.
Pattern of increases
When commissioners approved the 1989 resolution calling for automatic ambulance fee increases tied to reserve levels, they also approved an increase in fees of 8 percent, effective Jan. 1 of that year.
In 2002, commissioners approved an amendment to that resolution to make fee increases effective on Oct. 1 instead of Jan. 1 to coincide with the county’s fiscal year. The action included a rate increase of $25 for basic level ambulance transport, bringing the cost to $397.30.
Another automatic increase of 4.4 percent in fees per the Medical Consumer Price Index occurred in 2004 due to reserves being less than the 33 percent target.
The price was adjusted again in 2007, although there was more than 33 percent EMS reserves, according to a memo from C.T. Kearns, then director of EMS and Fire Administration.
According to Kearns’ memo, the county’s independent billing consultant recommended an increase in advanced life support 2 transports and mileage over 50 miles.
“Medicare pays a higher rate than our current retail rate charged for these transports,” the memo said. “In addition, Medicare pays a higher rate than our current retail rate charged for mileage over 50 miles … with lower rates, we do not receive additional reimbursement (from Medicare), while incurring added cost.”
The board approved increasing ALS-2 transport from $451.60 to $525, and mileage over 50 miles from $6.70 to $10.20.
In 2008, the board again amended its ambulance fees resolution increasing rates by 4.9 percent and adding a rate for patients who died at the scene. The amendment also provided for an automatic fee increases on retail rates when the Medicare rate went up.
Commissioners approved a 10.15 percent increase in ambulance fees on June 10, 2010, effective July 1 of that year, partially because of a budget forecast calling for reserves to fall below 33 percent in fiscal year 2011.
At the time that increase was approved, a first level ambulance transport was $473.73. The regional average, according to the June 15, 2010, agenda information, was $521.82, or 10.5 percent more than the county's rate.
According to the amendment to the resolution, Sunstar’s (the county’s only ambulance service) emergency medical rates remain below the regional average for the Tampa Bay Metropolitan statistical area, which includes Hernando, Hillsborough, Manatee, Pasco, Pinellas, Polk and Sarasota counties.
“The recommended one-time rate increase of 10.15 percent will bring Sunstar rates in line with the regional average,” staff said of the amendment.