Call it the fire department equivalent of tolling.
Faced with the steadily rising costs of health care and personnel, and repeated calls from partners to limit their annual increases in contributions, Eastside Fire & Rescue is considering charging citizens for various fire services, from ambulance rides to car crash responses.
Sammamish officials have pushed the department to see what it would take to draft a budget with a zero-percent increase next year. EFR Deputy Chief of Operations Jeff Griffin said the administration is dedicated to trying for that, but said it may be a choice between staff or program cuts, or new revenue from fees.
The plans are still in the theoretical stages now, but will be presented as alternatives as the administration puts together its 2011 budget. Griffin told the board at its Aug. 12 meeting that many other local agencies, including Bellevue and Kirkland, were considering a fee-for-service model, which gives districts a more stable revenue source that doesn't fluctuate like property tax receipts.
"The balance between what a society wants and what it is willing to pay for is delicate," Griffin said.
He also highlighted the fairness issue. Currently, whether or not a patient gets a free ride to the hospital with EFR or pays approximately $700 for one with a private company is dependent on how many units are staffed near where they live and the severity of the injury. This naturally means that rural residents near Carnation or North Bend are more likely to be charged for their ride than residents in more dense areas, like Issaquah or Sammamish.
Maureen McCarry, Issaquah representative on the EFR board of directors, said she has yet to read Griffin's report, but she has concerns about potential new costs.
While she said would like to see more revenue for EFR, she said she worries that people might not call EFR during an emergency if they didn't think they could afford the trip to the hospital.
"With health care, it's a concern of mine that many people might choose not to call," McCarry said.
About 35 percent of patients in the area are transported by EFR, while private companies handle 65 percent. Griffin said that ratio would not change under the fee program; the agency would just recoup some of its costs and time spent carting people into hospitals in Bellevue or Seattle. Griffin said admitting a patient to Overtake Hospital Medical Center in Bellevue takes a unit out of commission for an hour and a half on average.
If the fee program were approved, the board would have to determine what to charge, whether it would bill patients itself or forgo approximately 15 percent of the revenues to pay an outside company to do billing. The board would also have to consider how hard to go after those who don't pay -- would it send them to collection agencies or forgive the debt?
All of those factors would affect how much EFR would make from the program annually, but Griffin estimated it could net the agency between $262,000 and $367,000. At the end of 2009, the district passed a budget that took approximately $300,000 from reserve funds and still had a $241,000 hole, which was made up by union employees forgoing wage increases and finding a cheaper health insurance plan.
At least one board member, Chairman Ron Pedee, said he is philosophically opposed to the idea. Pedee spoke at length against the proposal, calling it a "double billing" of taxpayers who have already funded the services with their tax dollars.
"Our job is to do the most good for the most people with the resources the public has provided for us," he said. "It seems improper to charge them again for a service we feel is prudent given that they've already paid for it.
"Do we need the money? You bet," he said. "But it's disingenuous for public agencies to be grubbing around for fees they can tack on when the public has specifically said they don't want that."
Pedee disagreed with the idea that charging patients for services would somehow make the system fairer. He suggested that if the aim was truly to make the system more equitable, the agency should consider getting out of the transport business completely, focusing local units on first response while letting the private companies handle transports.
"Fairness on a call-to-call basis is impossible," he said. "It's possible for me to experience response time 'X' and my neighbor to experience response time 'XX.'"
King County medical directors are against districts charging for rides as well, Griffin said. The group feels that the fee would be double-dipping taxpayers who already pay money through then-Medic One levy that is routed to individual districts for ambulance service -- about $1.3 million dollars a year of a budget of more than $20 million.
The hospital administrators also fear that the elderly or those on fixed incomes might shy away from seeking medical attention, because they could not afford it and the fee would put pressure on emergency medical technicians to consider economic factors in their care.
Griffin downplayed suggestions that EMTs would have an economic incentive to transport people instead of giving them over to private services, saying that district policy still requires that departments prioritize keeping units in their regular areas over transports.
In its contract with private ambulance service American Medical Response, "it states that in the event of an emergency, we could have 25 additional ambulance trips into our area within an hour," Griffin said. "We don't want to lose that capacity. We have no interest in driving the private companies out of business."