Ambulance fee may nearly quintuple City Fire Department proposes $475 per trip

July 03, 1996|By Peter Hermann | Peter Hermann,SUN STAFF

The Baltimore Fire Department is proposing to more than quadruple the fee it charges to transport patients to hospitals, hoping the extra money will pay for new ambulances and faster service.

The proposal would raise the $100 transport fee, established seven years ago, to $475. It is backed by Fire Chief Herman Williams Jr., the Board of Fire Commissioners and the union representing firefighters, and is expected to be presented to the Board of Estimates next week.

Hampered by an increased number of emergency calls and inadequate staffing that forced some firehouses to close on a rotating basis, fire union officials say more money is needed to maintain an adequate level of care.

"An increase is so long overdue it's pathetic," said Bill Taylor, president of the Firefighters Union, Local 734. "They absolutely need help by virtue of more medics."

Such fees are common in major cities, such as New York, Philadelphia and Washington, but relatively rare in Maryland. An informal poll found only one jurisdiction other than Baltimore that charges for an ambulance ride: $100 in Prince George's County.

City Councilwoman Agnes B. Welch, a 4th District Democrat and a member of a committee evaluating the ambulance service, said the $100 fee should rise, but she is not convinced it needs to be so high. She said the major problem is the Fire Department's inability to collect the money it is owed. Only 16 percent of the people transported actually pay the ambulance bill.

"It's a big problem," Welch said. "And what do you do with people who can't pay?"

Battalion Chief Hector L. Torres, a Fire Department spokesman, said paramedics are using hand-held keypads to input patient information, enabling faster and more efficient billing -- in some cases, directly to insurance companies.

But many city patients aren't insured. And Medicaid, used by 30 percent of those transported by city ambulances, refuses to pay the fee because it's a taxpayer-provided service. Torres said the department considers that money lost.

The ambulance service's budget was about $9 million in 1995, including $950,000 collected through the $100 fees. But the city's 18 medic units took 69,317 people to hospitals that year. If everyone had paid, the Fire Department would have received $6.9 million from fees alone.

Torres said the money generated by the increase would be used to buy more ambulances, which cost $100,000 each. Despite a decline in city population, emergency ambulance runs have increased to 118,000 from 100,000 since 1989. That year also was the last time the city's ambulance fleet increased, from 16 to 18.

Mayor Kurt L. Schmoke, a Board of Estimates member, said through his spokesman that he will give "very careful consideration to the recommendation. I'm sure that this increase will generate enough money to make significant improvements in the Fire Department."

The Fire Department runs what is supposed to be an emergency service, yet officials acknowledge that on many calls, an ambulance is not needed. Medic 7 at the Oldtown station was the busiest in the nation last year, going on 9,000 emergency calls.

Because ambulances are spread thin, fire engines routinely are dispatched on routine medic calls because they can arrive faster. And the department recently closed some fire stations on rotating basis because firefighters -- up to 30 a day -- had to be transferred to ambulances because of staffing shortages.

Torres said the $475 cost is in line with the national average and is on par with what private ambulance services -- which are barred from responding to many types of emergencies -- charge.

The private companies, Torres said, "are charging the same kinds of prices for doing nothing more than transporting a patient from one hospital to another."

City ambulances in San Diego charge $492 plus $6.50 a mile. Idaho Falls, Idaho, charges $280 for a ride and extra for oxygen or drugs. Oklahoma City charges $720. Washington charges $163 for basic life support service and $280 for advanced service.

Fire departments in Baltimore, Anne Arundel and Howard counties do not charge, though they have discussed the topic. "I think it's on the horizon because costs are going up," said Baltimore County Capt. Bruce Conrad. "We're going from a tax-based system to a user-based system."

DTC Officials acknowledged that many city residents cannot afford to pay for ambulance service, and they said the city will not aggressively go after them to pay. But all agreed that more than 16 percent of the patients or their insurance companies can afford the cost.

Bill Kraft, the chief executive officer of Advanced Care Ambulance, a private company, said it is unfair to compare his service with the city's because his company offers customized care, while Baltimore specializes in emergency service. He said that cities are in a tough predicament, in that "there is a large contingent of individuals who will never pay. What Baltimore City is obviously trying to do is offset the tax base for their system to survive."

Pub Date: 7/03/96

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