The city of Dayton billed for $18 million in emergency medical services transport charges last year. However, it only collected a fraction of those charges, and the revenue does not come close to covering the cost of operating EMS transport service.
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Last year, the city only collected $4.7 million, most of which was paid by Medicaid and Medicare, city documents show. The city projects its general fund will receive $4.9 million in EMS fees in 2018.
Though Dayton bills insurance companies, Medicaid, Medicare and individuals for emergency medical services, the city has a “soft collection” policy, which means it writes off debt rather than turn it over to a bill collection agency after a certain number of attempts to collect, this newspaper previously reported.
Running ambulances 24/7 that are staffed by qualified personnel and are equipped with life-saving medical devices is not cheap, said Dayton Fire Chief Jeffrey Payne.
Every Dayton Fire Department unit that is deployed carries at least one paramedic, meaning staff can provide advanced life support on nearly every run within eight minutes, Payne said.
The city has many firefighters who are also paramedics who often arrive on scene in a fire apparatus before medical transports do, responding to emergencies when every second and minute matters, he said.
“Ninety percent of the time, we’ll have an ALS intervention within eight minutes of dispatch, which is a tremendous value to the community and a high level of customer service,” he said.
The Dayton Fire Department responds to about 30,000 calls for emergency services each year, resulting in the transportation of more than 22,000 people to local hospital emergency departments, the city said.
The city started charging for emergency medical services in 1994 to generate revenue, according to this newspaper’s archives.
In 1994, paramedic service cost $450 and ambulance service ran $150. Several years later, that increased to $630 for advanced life support involving paramedics and $290 for basic life support.
Today, Dayton’s EMS transport charges range from $512 for basic life support to $1,075 for serious medical intervention (advanced life support level 2).
There is also a charge of $11.78 per “loaded” mile, and the average trip is 3 miles, the city said.
More than two-thirds of the fire department’s transports involved advanced life support level 1 treatment, city documents show. Basic life support accounted for the lion’s share of the rest of the transports. Level 1 EMS charges are $870.
Basic life support services include checking the patient’s vitals, the administration of oxygen and a standard assessment on the way to the hospital, officials said.
Advanced life support generally involves paramedic care and can include the use of cardiac monitors, IVs and other inventions involving life-saving measures and medication.
The Dayton Fire Department provides emergency medical services to citizens and visitors across the city using its 11 medical vehicles.
Dayton staff also provide mutual aid to neighboring communities, and on any given day, between zero to 10 EMS transports from outside agencies come into Dayton to respond to emergencies.
According to Chief Payne, EMS is not cheap because of the costs of the vehicles ($200,000+), the salaries of paramedics and EMTs and equipment. Monitors can cost $40,000 or more. Cots and lift systems can cost $50,000.
The city on average buys one new medic transport per year, because crews go on a lot of runs and put a lot of miles on the vehicles, causing a lot of wear and tear, Payne said.
The city says it is seeking a third-party administrator to oversee its EMS billing and collection that will provide top-notch customer service and helps “maximize revenue.”
Communities have different policies regarding EMS charges.
The city of Kettering only sends ambulance bills to third-party payers if the patients live or work in the city. Kettering only bills city residents who receive transport if they are insured or have Medicare coverage.
Uninsured Kettering residents are not billed. Non-residents who require an ambulance are billed, even if they lack health insurance coverage.
Since 2001, Brookville has been able to bill customers for EMS. The city's fire department charges the Medicare-suggest rates, plus mileage, to the patient's insurance carrier. Patients transported to the hospital in Harrison Twp. Fire Department ambulances are billed by an outside billing agency.
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