Calls for emergency medical assistance within the city of Pasco have gone up 81 percent since 2007.
In the same period, the total hours that paramedics are out of service and unavailable for other calls has increased 83 percent as they spend more time taking patients to the hospital in Richland.
Yet, the Pasco Fire Department’s overall staffing level has stayed fairly constant as the city’s population continues to grow.
Fire Chief Bob Gear says now is the time for the city to focus on opening a fourth station or adding more staff.
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City council members listened to a presentation at a recent workshop geared at helping them understand Pasco’s ambulance utility and how it operates. The utility receives a general fund contribution of at least $420,000 a year, with the rest of the revenue coming from transport charges and a $7.75 monthly fee paid by residents.
But last year, the write-offs for unpaid charges exceeded revenues with the department only collecting 47 percent of what was billed, Gear said. It is ideal to be in the 50 percent to 60 percent range, he said.
The city is going to do a cost-of-service study to look at how overall fire and ambulance services should be provided and funded in Pasco because budget expenditures have gone up the same as call volume.
The review will include the current ambulance transport fee of $700 for a resident and $1,050 for others with an $11-per-mile charge, along with the monthly assessment. Different alternatives will be given to council members in coming months, including the possibility of raising costs.
Already, Pasco homeowners are facing a 5- to 10-percent bump in insurance premiums in the next year when the department’s protection class is downgraded because of the impact ambulance services have on staffing in case of a building fire.
The department had 4,725 calls in 2014 and, of those, 3,659 were for emergency medical services. That breaks down to an average 12.6 calls a day with 10 of them medical, and 24 percent of all calls are not billable. In 2007, the city had 2,018 medical calls out of 2,536 total.
Calls cover not only homes and businesses but people passing through Pasco, including on the surrounding highways. There are 12 personnel on duty for a 24-hour shift, and a minimum four respond to a medical call with the number increasing to six for a vehicle crash and eight if occupants are trapped, the chief said.
Last year, there were 1,500 times that Pasco units were tied up with at least two or more calls at the same time.
Paramedics in 2014 were out of service while handling patients for a total 2,772 hours compared with 1,512 hours in 2007. Gear said that essentially means the department is down two people for a third of each day.
In large part, that is because Pasco ambulances made nearly 1,400 trips across the river to Kadlec Regional Medical Center last year, a couple hundred more than were done in 2013 and well above the approximate 300 trips in 2007. Kadlec already was the hospital for trauma cases, and about five years ago was designated by the state as the Tri-City’s stroke and cardiac centers, he said.
In comparison, the medics made a little more than 1,100 runs to Pasco’s Lourdes Medical Center in 2014 and 200 to Trios Health in Kennewick.
The ambulance fleet drove a total 63,117 miles in 2014, a number that has wavered over the years but is 37 percent above the 46,081 miles in 2007. Almost 19,000 of that was billed as transport mileage.
The Pasco Fire Department has 17 firefighter/paramedics working under the ambulance utility. The utility also covers a captain who oversees the program as the medical services officer, and half the salaries of the chief and the department secretary who handles billing.
The utility is about 34 percent of the department’s overall budget, with the majority for fire suppression, yet 80 percent of the calls generate around medical needs, Gear said.
A person who receives some kind of medical care on scene, like an EKG or treatment with a nebulizer, but chooses not go to a hospital will be billed $250. Patients do have the right to refuse care, but Gear said 99.9 percent go to one of the three Tri-City hospitals.
Twenty-seven percent of the people who go in ambulances are state Medicaid patients, 46 percent are on federal and about 10 percent are uninsured. However, Medicaid only reimburses Pasco for $168 of the $700 tab and $5.08 a mile, and Medicare pays $431 and $7.16 a mile.
Gear said on average they only collect $393 for each billable medical call. His department cannot bill patients for the rest of the money, so they have to write off the difference along with a good number of the uninsured bills which never get paid.
The city has raised the transport rate a few times through the years, but the Medicaid/Medicare reimbursement remains the same so another increase would just mean the department is out more money, he said.
“We certainly have an issue with what we’re collecting vs what we’re writing off,” Gear told the council.
A bill is before the state Legislature this session that would require the state to bring the Medicaid rate up to the Medicare rate for ambulance billing, which Gear said would help Pasco’s numbers considerably.
Kennewick reported 6 percent of patients with Medicaid, 48 percent with Medicare and 3 percent with no insurance. And Richland had 12 percent on Medicaid, 54 percent on Medicare and 2 percent uninsured. Both cities collected about $200,000 to $400,000 above the amount they had to write off in 2014.
While Pasco residents pay $7.75 a month for the ambulance utility, Richland residents are charged $7.82 and Kennewick’s is set at $6.67. Aberdeen’s utility is as high as $21.85 a month, with Bridgeport on the low end at $3.
Councilman Al Yenney said Pasco needs to eliminate some of the write offs and believes the city should be looking at a monthly utility rate more in line with Hoquiam’s $11.83 or th $11.10 in Moses Lake.
“I really don’t like to raise utility taxes,” Yenney added, “but I think this is one area that we’re going to have to raise because the city cannot afford to go this direction that we have been.”