HomeMy WebLinkAboutI. A. EMERGENCY MEDICAL SERVICES (EMS) SUSTAINABLE FUNDING OPTIONS 11262024Virginia Beach Emergency Medical
Services
EMS Revenue Recovery
•Provide background information related to how we have arrived to this point
•Provide an overview of EMS billing basics and present study findings
•Define compassionate billing and address potential concerns
•Present the perspective of the volunteer rescue squads through the Rescue
Council
•Discuss next steps and answer any questions
Overview
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•Rescue Squad funding has historically been sourced from fundraising and
city contributions.
•In the last several years the rescue squads have seen their expenses increase 40% or
greater.
•Fundraising revenues have mostly remained flat.
•Operating expenses for the Department of Emergency Medical Services
have been provided through the General Fund.
•These operating expenses have more than doubled in the last five years.
•Rescue Council commissioned a feasibility study of EMS billing as a
potential funding source to help pay for expenses.
Background
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•The Centers for Medicare and Medicaid Services (CMS) provide a ‘reimbursement’ to EMS agencies for ambulance transport if billed.
•Health insurance plans provide a benefit for ambulance transportation.
•Patient payer mix is typically identified as: Medicare, Medicaid, Commercial Insurance or Private Pay.
•Charges are based on the level of care provided and transport mileage to the receiving facility.
•State Statute provides for the authority and framework for a local government to conduct EMS billing.
•This can be done in partnership with, and on behalf of, the locality’s participating rescue squads.
EMS Billing Basics
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•AP Triton Consultants are industry leaders providing innovative solutions for Public
Safety agencies.
•During the study it became very clear that:
•The City is served by passionate group of dedicated volunteers and career providers.
•Department of EMS and Rescue Council leadership are working together to improve the
system.
•The volunteer rescue squads are challenged to fund ambulances, equipment and supplies.
•Increased funding is necessary to avoid impacts to service-delivery.
EMS Billing Study
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•Available payer mix information for Virginia Beach indicates the following for
patients transported by Va. Beach EMS:
•Medicare – 50%
•Medicaid – 21%
•Commercial Insurance – 12%
•Private Pay – 17%
•The system conducts ~40,000 ambulance transports each year.
•All other Hampton Road cities conduct EMS billing.
EMS Billing Study
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•The ambulance fees for eight (8) other Hampton Roads cities were considered.
•Fees for basic life support (BLS) transports range from $425 to $700.
•Fees for advanced life support (ALS 1) range from $551 to $850.
•Fees for advanced life support (ALS 2) range from $750 to $975.
•The median rates of these cities were used for analysis in this study:
•BLS - $583
•ALS 1 – $701
•ALS 2 - $887
Regional Ambulance Fees
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•Transports broken down by type (BLS, ALS 1, etc.) and quantity.
•Charges for transports were calculated utilizing payer mix estimations and median regional rates.
•ONLY third-party payers were considered; uninsured or self-pay were not.
•Customary payer adjustments were applied with industry standards.
•With the preceding factors considered, it is feasible to expect the following:
•$14.5million net proceeds in first full year.
•Increased projections to $17million over a five-year period.
EMS Billing Estimation(s)
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•EMS billing will not be a consideration when providing patient care.
•No patient will ever be denied services; every patient will receive the same level of exceptional care.
•Billing laws require a ‘reasonable and customary’ effort to collect fees.
•Generally, results in three (3) subsequent invoices (30, 60, 120 days) for payment.
•Municipalities can elect not to charge residents of that locality any copays, deductible fees or other uncovered fees.
•Non-residents would require the ‘reasonable and customary’ effort.
•Council can elect policy to write-off any outstanding debt and never pursue ‘collections’.
Compassionate EMS Billing
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•Rescue Council is a democratic representative group of the ten (10)
volunteer rescue squads and Marine Rescue Team.
•Rescue Council serves the following functions in City Code (Sec. 2-424)
•Advisory Board to the EMS Chief on department policy matters; and
•Provide recommendations to the City Manager on related EMS matters.
•The consideration of EMS billing as a revenue source was a Rescue
Council initiative.
Rescue Council Perspective(s)
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•EMS billing revenue can be a source to pay for new and replacement ambulances, operating supplies, equipment and rescue squad infrastructure.
•EMS billing can provide ‘relief’ so squad personnel can concentrate on efforts, programs and initiatives to ensure sustainability, vitality and service to the community.
•Each of the ten (10) rescue squads have indicated support of the development of an EMS billing program.
Rescue Council Perspective(s)
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•Rescue Council approved a position statement endorsing the
development of EMS billing, with the following considerations:
•There should be a collaborative Memorandum of Understanding (MOU) establishing the
governance of a system-wide EMS billing program.
•All EMS billing revenue should be reinvested to the volunteer rescue squads and Dept.
of EMS operations through a restricted special revenue fund.
•The administration of EMS billing be transparent and include Rescue Council in the fund
accountability process.
•Appropriate public awareness and community education should be conducted by the
City.
Rescue Council Perspective(s)
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•It will take six (6) to nine (9) months to initiate EMS billing if/when approved.
•Process to partner with third-party billing company
•Establishment of related policies and infrastructure
•Application process for provider ID number(s) and billing credentials
•Staff can include compassionate EMS billing as part of FY2026 budget process.
•Includes authorizing ordinance(s), fee schedule and MOU with Rescue Council
•Council will be asked to consider a Resolution authorizing staff to proceed with preparations for implementation on December 10, 2024.
•EMS and Communications can develop, and make available, public information and education leading up to consideration.
Next Steps
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•It is feasible to establish a compassionate EMS billing program. Municipalities billing for EMS is the ‘norm’, not the ‘exception’.
•The success of such a program is contingent on a transparent and inclusive partnership between the City and rescue squads.
•EMS billing policy can ensure that residents are not billed for any uninsured or out-of-pocket expenses.
•Funds from EMS billing can be useful to fund pharmaceuticals, purchase ambulances and equipment, provide medical supplies, fund volunteer recruitment and retention initiatives, ensure rescue squad vitality, etc.
Summary
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Questions?
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