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North Carolina County EMS Fee Criticized

DURHAM - A springtime decision by county officials to raise ambulance fees is drawing flak from a recent patient who said he was "flabbergasted" by the expense.

Danny Johnson mistakenly directed his complaint to City Council members, who have no role in setting Emergency Medical Services fees. He said EMS told him that the city set the rate.

But county officials, apprised of Johnson's unhappiness, quickly owned up to their role in the decision.

EMS Director Skip Kirkwood said his staff will work with Johnson "in whatever way is necessary to get his bill paid by any or all of his eligible insurance providers."

Johnson was unhappy at being charged $660 plus $30 in mileage fees for a trip to the Durham VA Medical Center for treatment of severe stomach pain.

The fee corresponded with what EMS charges for a trip requiring a degree of "advanced life support," namely examination by a paramedic. It's the middle level of the three primary charges EMS levies for ambulance service.

A trip that requires no examination or treatment of a patient carries a $575 fee, while one where a patient needs "multiple drugs and intervention" costs $685. The service also has a $10-a-mile mileage charge.

County Commissioners, as part of deliberations this spring on their government's fiscal 2013-14 budget, agreed to raise the three service fees by $50 each, and to increase the mileage rate by $1.

The increases were the county's first since 2008, Budget & Management Services Director Pam Meyer said.

Meyer and Deputy County Manager Lee Worsley said Durham County officials compare their EMS rates to what nearby and peer counties charge before deciding on increases.

"The commissioners ask us to do that across all the fees where we have discretion" in setting them, Meyer said, adding that the county doesn't raise EMS charges every year.

The fees cover about 68 percent of EMS' costs, Kirkwood said.

EMS, according to the county's 2013-14 budget, is an $8.8 million-a-year operation.

It receives $2.2 million in subsidies each year from the Duke University Health System as part of the lease that allows the system to run Duke Regional Hospital.

Patient fees and Medicaid subsidies cover the balance of EMS' expenses. "We get no state money" other than what it puts in to Medicaid, Kirkwood said.

Meyer said Medicaid in 2013-14 will likely account for about $525,000 in revenues.

She and Kirkwood also noted that EMS is a 24/7 operation with significant fixed costs, mainly on the personnel side.

"Most people do not understand that the cost of providing emergency medical services is not just the time in which the ambulance is in contact with a patient, treating and transporting," Kirkwood said. "Most of the cost involves having the EMS system available, ready to respond when called."

The department's expenses have risen by 27.3 percent since fiscal 2009-10, the biggest jump coming in the last year or so as it has absorbed ambulance services previously operated by a trio of volunteer fire departments.

Had they raised fees annually instead of all at once, the commissioners would have needed to increase the levy Johnson paid by about 1.6 percent a year to get it from $610 in 2008 to the $660 it is today.

Inflation in that time averaged about 1.3 percent a year.



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