Supes OK ambulance rate hike

By Chris Daley

Democrat staff writer

Non-residents who need an ambulance in El Dorado County are going to have to pay a $200 fee for the service. Currently the rate is $25 for non-residents who accounted for just over 10 percent of ambulance users on the Western Slope last year. In South Lake Tahoe, however, non-residents make up more than 40 percent of calls.

The Public Health Division of the countys Health Services Department recommended the fee increase as part of a larger package of ambulance service fee adjustments that took effect June 1. The Board of Supervisors voted unanimously to approve the request.

Compared to regional fire department-based ambulance services, El Dorado Countys rates were nearly 10 percent lower for Advanced Life Support services. ALS is designated at Level 1 or Level 2. The first applies to an emergency transfer to a hospital or air ambulance. Level 2 includes administration of at least three different medications or at least one procedure such as defibrillation or endotracheal intubation. Since 2008, the cost for Level 1 service had been $1,003. Level 2 was set at $1,085 for residents. As proposed, those rates went up to $1,114 and $1,174, respectively non-residents will pay the added $200.

Medicare and Medi-Cal account for just under 62 percent of all payments for ambulance services in the county, according to the county Health Department. Medicare, at 46.9 percent, represents the single largest payer. Other insurance pays 29 percent, while private payers make up the balance of about 9 percent.

Health Services Director Neda West delivered the ambulance rate review to the board at a special meeting May 24 following a presentation titled Two Year Achievement Report detailing emergency calls for medical aid. Both presentations drew heavily on data gathered by the Citygate Associates consulting group.

Fire Chiefs Brian Veerkamp and Greg Schwab, along with Marty Hackett, executive director of the Joint Powers Authority for the county, compiled and presented information on the number of calls for emergency aid and the time it took from first contact to arrival on-scene. The data represent calendar years 2008 and 2009.

There were 13,405 calls for medical aid throughout the county in 2009, down slightly from 13,472 the previous year, the report noted. The JPA also showed results from a 17-month study of response times within a matrix of four geographic/demographic zones: Urban; Semi-Rural; Rural; and Wilderness.

Citygate noted in its report that for both the Tahoe Basin and the countys Western Slope the response time performance … comes very close to meeting best practice for the suburban and rural areas covered.

Response in urban areas averaged 11 minutes; in semi-rural areas, 16 minutes; rural areas were calculated at 24 minutes for an average response time. Wilderness or remote regions averaged 90 minutes per response from dispatch to arrival on the scene.

Hackett explained during a phone interview this week that response times can be calculated in different ways, one of which is a census track that sets standards for the different areas based on geography, environmental and road conditions, population density and any other factors affecting access.

The fire-based ambulance service is coordinated through the Cal-Fire Emergency Command Center in Camino. In his report to the board, he noted that in 2009, the Camino center took a total of 104,459 calls and dispatched 27,315 incidents. Serving both El Dorado and Amador counties, the center dispatched an average of 75 calls per day. El Dorado accounted for an average of 37 medical aid calls every day.

Hackett is especially proud of how his teams handled the big snow storm last Dec. 7-8. His presentation noted that the Camino office fielded 1,386 calls resulting in 528 responses for fire, emergency medical services or hazardous materials issues. During that 48-hour period, there were up to 18 Medic units on duty, nine continuously.

He cited the fire-based model as significantly more comprehensive than a traditional ambulance-only service would be.

Fire-based emergency medical services is the hallmark of our system, he said. Our people are trained to work in all conditions and environments, some of which are pretty extreme. During the storm, they had to hike in to houses through snow and downed trees. We bring Advanced Life Support to where the patient is, and we can also help out with fires or whatever other emergency may arise. They really are multi-talented.

E-mail Chris Daley at cdaley@mtdemocrat.net or call (530) 344-5063.