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Controller: Better Fee Collection Can Fix Philadelphia EMS

PHILADELPHIA -- Philadelphia could finance a solution to an acute shortage of ambulances and eliminate fatal delays in response times with a more aggressive collection policy for ambulance fees, City Controller Alan Butkovitz said yesterday.

Butkovitz said the city could generate $15 million a year with a list of improvements, including increasing emergency medical service rates, changing the city's agreement with Independence Blue Cross to assure higher reimbursement rates, and adding incentives to improve performance of the city's bill-collecting company.

"Lives are in the balance," Butkovitz said. "This is not just money we want to put in the stock market."

Blue Cross pays the city the same rate paid by Medicare and Medicaid -- either $338 or $401, depending on the services rendered, out of the $505 the city charges, according to an audit of the Fire Department released yesterday. The difference is written off.

Butkovitz recommended that the city put the bill-collection contract out to bid. That contract has been held for 18 years by Affiliated Computer Systems, Butkovitz said.

Affiliated spokesman Andy Wilson yesterday said the contract is bid out every five years, and ACS last won the contract in 2006 when no other contractors submitted bids. Wilson said the city has not had an increase in EMS fees since 2004, yet ACS increased collections.

"ACS's rate of return in the city of Philadelphia is consistent with programs in other major metropolitan areas where citizens rely on Medicaid or are uninsured," Wilson said. "Because of the work performed by ACS on this competitively bid contract, the rate of recovery for EMS services has increased by 25 percent since the city last raised fees."

Spokeswoman Liz Williams said the company had yet to read the controller's report.

"This is the first we have heard about issues with this contract," Williams said. "As always, we stand ready to discuss any concerns with the city."

"Because of the work performed by ACS on this competitively bid contract, the rate of recovery for EMS services has increased by 25 percent since the city last raised fees," according to a statement from ASC. "Since ACS began providing this service, we have been able to provide the city almost a quarter of a billion dollars in additional revenue."

Butkovitz reported in December that the city's ambulances met the industry standard of response time of under nine minutes less than 60 percent of the time in 2006. That figure fell from 77 percent four years earlier.

The city operates 28 full-time ambulances, Butkovitz said, when 20 more are needed. The $15 million in savings he forecast would pay for those vehicles, he said.

His point was underscored on New Year's Day, when Deborah Payne, 55, of Northeast Philadelphia, died while waiting 101 minutes for an ambulance. Councilwoman Joan L. Krajewski has asked for hearings to investigate the problem, but agreed to hold off pending a meeting with Mayor Nutter.

Contact staff writer Jeff Shields at 215-854-4565 or jshields@phillynews.com.

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