Almost a year since Loudoun County began billing for ambulance transports, the money is starting to trickle down to volunteer rescue squads.
The county began sending out bills for ambulance rides for the first time last July. The chief target was insurance companies, Medicaid and Medicare, rather than residents’ wallets. Funding for ambulance services, county staff reasoned, was already built into insurance premiums and federal programs, and was just being left on the table.
Exemptions and exceptions also were built in to the billing for people who couldn’t afford to pay for their transport—nobody would be sent to debt collection, and nobody’s credit rating would be impacted. The anticipated new collections—the program was budgeted to bring in $4.5 million this year, but estimates were reduced to $3.5 million in fiscal year 2017—would cover the program’s administrative costs and the rest would be sent out to help first responders.
But volunteer rescue squads have worried that the billing would do more harm than good by cutting into their fundraising.
“I have had people in the community ask me why they should continue to donate when, if they need 911, they’re going to be charged for it anyways,” said Purcellville Volunteer Rescue Squad President Aaron Kahn. “I just explain how, although the ambulance billing is nice, expenses for running a rescue squad are still extremely high, and every dollar matters.”
He said the key is letting the public know how much the work of a rescue squad costs, even at the two Loudoun stations where all the EMTs and drivers are volunteers.
A new ambulance can cost $200,000, even before it is outfitted with medical equipment and Kahn said volunteer rescue squads must lean on the county more than ever for support.
Now, with two quarters of billing and distribution done, the county has collected $932,445. Of that, $587,022 went back into the county through administrative costs and contributions to the Department of Fire, Rescue and Emergency Management and system infrastructure. The remaining 37 percent went to volunteers.
“At this point we’ve certainly received more than nothing; however, I wouldn’t say it’s made up for all of our financial troubles, or making ends meet,” Kahn said. His squad got a check for the first two quarters of billing for $12,028.
It’s not nothing—but measured against the cost of operating a rescue squad, it can seem like a drop in the bucket.
For billing purposes, the county charges $467 to $770 per ambulance ride (based on the level of service required), plus $11 per mile. In the first quarter of fiscal year 2016, the county calculates it recouped $44.39 per run. In the second quarter, that rose to $184.
Kahn said his Purcellville squad is using the money to purchase a powered cot, as it attempts to avoid patient and provider injury by replacing all its manual cots. One of those powered cots costs about $18,000.
Still, Kahn said, “That is an item we would not be able to afford without the ambulance billing.”
Doug Rambo, treasurer of the Sterling Volunteer Rescue Squad, the county’s other all-volunteer squad, calculated that Sterling volunteers ran about two-thirds of all calls in the county during both quarters from their three stations. In the second quarter, after the county had taken its cut, the Sterling squad got $39.72 per incident. Purcellville took in $41.58 per incident.
Sterling received $106,371 during the first two quarters.
Because of the way the Department of Fire, Rescue and Emergency Management keeps track of its cash, the reimbursements to the stations can lag behind by several months as money is collected, and the second quarter showed dramatically more income than the first. The checks to volunteer rescue squads may continue to climb.
Fire-Rescue Chief Keith Brower said there have been a few glitches rolling out the new system and making sure everyone understands the complex allocation formula, but, overall, the program has helped. “We view this as a system add,” Brower said, adding that in an era of $250,000 ambulances, every little bit of funding helps.
In the first two quarters of fiscal year 2016, the county billed for $3,899,233.50 and received $932,445.81, just under a quarter of what it billed.
The county takes its administrative and contract costs for billing off the top of billing revenue. The county then distributes what revenue is left based on a formula that takes into account who owned the transport vehicle (volunteers or the county), who owned the station that took the call (volunteers or the county), who sent the EMS provider, and who was the first responder—all either a volunteer squad or a professional working for the Department of Fire, Rescue and Emergency Management—in addition to sending 25 percent to county-owned infrastructure such as department-owned buildings.
Even though Sterling ran two-thirds of the calls, Rambo calculates it has been getting about 10 percent of gross revenues.
“More and more, I think we see the county continuing to count on us for the services we provide, but the resources are becoming more difficult to access,” Rambo said.
So far this fiscal year, billing has just broken even with the previous year after a drop in fundraising revenues, he said.
Department of Fire, Rescue and Emergency Management staff members say they’re not overly worried that people will decline an ambulance ride because they’re concerned about getting a bill.
“Absolutely it’s not anything we’ve seen,” said Danielle Brosan, the department’s EMS Cost Recovery Manager. The number of rides to the hospital have stayed steady countywide as the department transitioned to billing.
“If people need to call 911, they’re not concerned about receiving a bill,” Brosan said.
The Purcellville rescue squad has seen a few more people decline ambulance service, Kahn said, but he couldn’t pin that to ambulance billing.
And it’s too early to say whether billing for ambulance rides will test the community’s generosity when it comes to the volunteer rescue squads’ fundraising, he added.
“Our winter fundraising drive did come in lower than last year. But to be honest, I’d want to go a couple more fundraising drives before I tied it to anything,” Kahn said. “Just one fundraising drive being down could be anything.”
“I’ll concede there are transitions at the startup of anything that need to be worked out,” Rambo said. He’s still waiting to see where funding levels off.
“Fortunately or unfortunately, Loudoun has changed a lot, and the day of the volunteer companies being able to support themselves—it’s just over,” Kahn said. “The expenses of running a volunteer company are just far too high for anyone to cover on donations alone. … At this point, the volunteer companies and the county have to work together, because it’s the only way we survive.”