Fire district can't allow revenue to go untapped

“Declining Medicare reimbursement from the federal government, combined with an increasing Medicare patient load, have driven up the cost of providing ambulance service in the last few years.

“The loss of money has prompted concern from local officials, who note that communities across the country are facing the same problem. Officials have chosen to continue providing service despite financial losses, though, seeing it as one of the basic services of local government.”

A passage from Scott Unger’s comprehensive Aug. 22 “Critical condition” story?

It certainly could have been, but it actually comes from a Nicole Montesano story from May 10, 2007. And ambulance reimbursement was by no means a new issue then.

As a 2006 Montesano story explains, “But in 2001, Medicare began gradually lowering its reimbursement rates over a five-year period, using a complicated formula. Over the period, local shortfalls grew annually, hitting $539,483 last year. And that quickly began to prove too large to readily make up.”

Those Medicare cuts have never been made up. And now, more are in the offing.

Reed Godfrey, chief of the newly formed McMinnville Fire District, told Unger a 3% rural rate boost is set to expire next month and ballooning federal debt could trigger a 2% sequestration cut on top of that.

Unfortunately, Medicare and Medicaid recipients account for more than 85% of local ambulance calls, compared to just 12% for the privately insured and 3% for the uninsured. Typically, costs average $2,500 and federal reimbursement $426 on local runs, leading to already massive losses that continue to grow at an alarming rate.

Then Chief Jay Lilly noted in the 2007 story that when he started out in the 1970s, “We had oxygen and a Band-Aid. There were two things we did. We put oxygen on them and we went real fast to the hospital.”

But that long ago morphed into a lengthy list of advanced life support services. It’s saving lives, but at a steep price — one the federal government has consistently refused to pay.

An aging population is filling vastly more care center beds, serving to further widen the chasm between cost and reimbursement for providers. The new district is collecting $8.4 million a year in tax revenue, and seeing ambulance service subsidies eat up almost half of it.

Godfrey said ambulances cost about $400,000 each. He said they rack up about 80,000 miles a year, so must be replaced on a regular basis

That doesn’t even count the cost of staff, fuel, maintenance and equipment. “You could show up with two robots in the ambulance, and you’re going to lose money,” Godfrey said.

Clearly, that’s not sustainable. But sadly, the woes don’t end there. They go on to include:

n Almost 1,800 out-of-district runs last year, accounting for 20% of the district total. That means the district’s McMinnville-area taxpayers are subsidizing service to Yamhill, Carlton, Lafayette, Dayton, Amity and rural points between.

n Failure of outlying cities to cover the cost of supplies used on such runs, even though the MFD is allowed to bill them and does so. Godfrey noted, “I’m giving those medical supplies away for free. I’m like Santa Claus.”

n Calls to transport patients to Portland hospitals. They take ambulances out of service for extended periods, but generate nothing more than one-way mileage reimbursement, which is minimal.

n Little in the way of reimbursement under the state’s Ground Emergency Medical Transportation program, launched in 2017. Godfrey terms the GEMT program unreliable and inefficient.

Anemic Medicare and Medicaid reimbursement serves to shift the EMS burden from the user to the local taxpayer. Lack of reimbursement for out-of-district emergency runs, supplies used on those runs, transport runs to Portland hospitals and costs billed to GEMT serve to shift it even more dramatically to the local taxpayer, and even more unfairly.

We see little prospect for the district to tap either local taxpayers or the federal government for additional revenue. However, we see plenty of room for the district to demand a better deal from the state, county, Portland medical community and outlying cities for the free benefits they are reaping.

McMinnville retiree Jerry Hubbard, a longtime fire district leader in the Bend area, makes a persuasive case on that score in a letter published in today’s edition. He calls for the district to take a tougher stand on behalf of its taxpaying constituents, and we echo him on that.

It would by no means make the district whole. It would, however, represent a meaningful first step in the right direction.

The district isn’t legally required to offer ambulance service, only fire service. But no one wants to see it come to that.