Several years ago I had the opportunity to chair a work group to identify any issues that could be barriers to the successful implementation of a cost recovery process for ambulance service from insurance and Medicare. We used a stakeholder input process and listed issues and vetted them out to identify solutions. There were no problems that we identified that we couldn’t find a reasonable solution or adopt a best practice used in other jurisdictions. Those opposed to the ambulance service cost recovery then are the same ones opposed now and each time it has been promoted for implementation. They deny that things have changed and now it is important to find other ways to fund services.
In the 1920s and 30s the fire response system was evolving in Montgomery County and the communities and leaders were focused solely of fire protection. It was a unique community who had emergency ambulance service at that time. Montgomery County was unique in that we did have it. It became an expectation. However that expectation was most frequently an afterthought when it came to funding it. It has never been funded to the level required. I repeat, never has been funded to the level required.
When a tax system was set up in Montgomery County to acquire funding for fire protection it never envisioned the complexity of health care in the future when setting an appropriate mechanism to keep up with growth and increased service demand. That funding mechanism is a separate fire tax on your assessable property value. It is called a Fire Tax not a Fire and Emergency Medical Response Tax. Ambulance and paramedic service is part of a community’s health care system but in Montgomery County it just happens to be delivered by the Fire and Rescue Service.
Montgomery County enjoys the benefit of excellent medical facilities that provide care to our aging population, an aging population that is increase with a surge from the baby boomer generation. In fact Montgomery County has touted itself a good place to grow old. But as the attracted aging population grows so does the demand on ambulance service. Many of these specific communities and facilities to house and care for the aging population are in dense clusters throughout the County and have become significant service demands for transport to the dispersed hospitals. These facilities account for thousands of calls for service by our ambulances and use a tremendous amount of County tax supported materials, personnel, fuel, etc. By the way, these are big business and they charge their residents (our patients) dearly for their services. But they do not include in that charge for services a funding mechanism for their increased use of ambulances. This demand on services was never imagined and has never been funded to match the purpose or demand. The budget for ambulance and medical supplies has seen little if any increase in years and the cost of equipment and the need for new technology has gone up further eating into these funds. Everyone of those patients have some sort of health care insurance that pays for each of the links in the chain of their care, except one, the treatment by EMTs and Paramedics and the transport of the patient to the hospital. The recovery of those costs is not requested from Montgomery County of insurance and Medicare. This type of institutional demand on emergency service was not planned or anticipated and the unrecovered cost of the ambulance service simply remains with the insurance company while the precious little funding to provide emergency ambulance service supplements these businesses.
Why doesn’t Montgomery County recover those costs of service like so many other jurisdictions? The answer is because there isn’t the will to recognize that things have changed and we deny that it has. Nearly all of the jurisdictions in the Metropolitan Washington and Baltimore areas recover the cost of ambulance service from insurance and Medicare as a standard practice. Furthermore, beyond the suburban areas most of the rural counties in Maryland and Virginia also recover ambulance cost from the insurance companies. In the past the County could absorb the loss of this funding source but with considerably less revenue to pay for services it will soon be necessary to cut service down to the level of the funding. To repeat, this will mean to cut emergency services down to the new level we are being funded at. This makes no sense as Montgomery County continues to grow. Population growth always means an increased demand on emergency services. As a recently retired manager and strategic planner for Montgomery Fire and Rescue Service I can tell you that we are still behind in providing adequate service coverage to match the national standards. Yes I said that we are behind and have a deficit in providing services to the national standard for emergency coverage. If the County is forced to cut more fire and ambulance services as was done already this year we will be even further in the hole. We cannot let that happen.
Vote yes for Question A on the Montgomery County Ballot on November 2, 2010. QUESTION A authorizes Montgomery County to get reimbursed by insurance companies, Medicare and Medicaid for the cost of ambulance service.
On November 2nd, your vote FOR QUESTION A can help keep taxes down by billing the insurance industry for the cost of our local ambulance service. IT WON’T COST YOU A PENNY.
Mike Love
Tags: ambulance service, cost recovery, EMT, Fire and Rescue Service, Fire Protection, Maryland, Montgomery County, Paramedic
October 22, 2010 at 1:32 pm |
I’m having a hard time reconciling some of the rhetoric with the language of the bill itself.
According to the bill, 100% of the revenues generated will be placed into the General Fund, and will not be used to fund ambulance services. Therefore, how can it be claimed that a lack of said funding needs to result in a cut of ambulance/medic services during this same year? The letter of the law says that funding to the fire/rescue service should remain completely unchanged in the first year if it is passed. It certainly shouldn’t lead to any job losses or cuts in service.
From the second year, 100% of the funds raised are to SUPPLEMENT and not SUPPLANT existing funding to the fire/rescue service. If the currently budgeted funds pay for the currently provided services, it would stand to reason that additional funding should allow new services.
Looking at the argument that the fire tax does not cover the actual costs, then I would expect that part of the current funding level is taken from other sources. That may be the case. However, if the bill specifically states that current funding levels are not to be affected, and the new revenues are in addition, it would seem that this does will not actually release those funds to be used elsewhere.
I’m not stating a position on the vote itself, but am having a hard time reconciling the statements being made on the effect of it not passing with the actual text of the bill.
October 22, 2010 at 6:37 pm |
The big issue for the current budget year FY 2011 is that after the County Council passed the cost recovery bill for ambulance reimbursement the County Execs budget included the funding it would produce for the county’s budget. I am not sure exactly, but there was around $14 million budgeted with the plan to use ambulance reimbursement. If that is then reversed by the referendum you have to make that large chunk up out of the whole county budget. It affects all departments critically as they have cut to the bone already. If the change that is talked about by Governor Candidate Ehrlich to move teacher pensions to the counties that will be disastrous. As I am no longer with MCFRS I can’t say what the plan is in regard to supplement and supplant. Several years ago we emphasized that we did not want to pursue the ambulance reimbursement if it meant supplanting existing budgeted funds, only if it could fund the needed gaps that I talked about in the blog.
Thanks for your comments.
Mike
October 22, 2010 at 9:02 pm |
Thank you for the response.
I agree with the fact that they budgeted on having the $14m, but it strikes me as being almost punitive or political in nature that if they don’t get the revenue from the fee, they are going to cut that from the fire/rescue budget rather than trimming across the board.
Furthermore, if the revenue after the first year is intended to supplement all existing fire/rescue funding, does that not imply that even if the fee is voted down, they lose the justification not to return ALL cut funds to the fire/rescue budget after that first year?
What does it say about the intended uses for the ambulance fee revenues after the first year if they don’t commit now to restoring all cut fire/rescue funding after the first year?
As I said originally, I’m not even stating my opinions on the fee itself. I just have some serious concerns that the arguments used by the county to support it just don’t seem to hold water.
If the ~$14m is only supposed to go into the General Fund for one year, shouldn’t they be able to clearly identify temporary programs that were funded by this increase in revenue that they can cut, thus not needing to touch the fire/rescue budget? If they don’t have any such temporary programs, where do they plan to get the $14m needed for these programs in 2012 – or will we hear in a year that they regrettably are not able to devote the ambulance fee funding to the fire/rescue service due to the “continued economic downtown”?