Every year, more people call for a Durango Fire Protection District ambulance, and every year the district faces more ambulance bills that were not fully paid.
Emergency medical calls make up the bulk of the emergencies the district responds to – about 3,700 out of 5,000 calls in 2016. Emergency calls also account for a growing percentage of the total number of calls each year. In 2012, emergency medical calls accounted for 60 percent of all calls; in 2016, they accounted for about 70 percent, according to district data.
By call volume, the district’s EMS system is the seventh busiest in the state, said Scott Sholes, the district’s Emergency Medical Services chief.
While call volume is projected to continue to rise, the district’s revenue is expected to fall.
The decline is caused, in part, by the 1982 Gallagher Amendment, which requires the state to lower the assessment rate for homes when residential values increase faster than nonresidential property values.
To meet the growing demand for services, fire district members, including city residents, will be asked to increase their property taxes by 2.5 mills on the November ballot.
The fire district covers 325 square miles in central La Plata County and along U.S. Highway 550, stretching north into a small part of San Juan County and south to the New Mexico border.
The city contracts with the fire district for services, and the city needs additional revenue to generate the $1.37 million needed to pay its share of the mill increase.
The public revenue will help fill the gap left by Medicaid and Medicare reimbursements that do not cover the full cost of ambulance service.
Last year, about $1.4 million was unpaid by Medicaid and Medicare, Sholes said.
The new property tax increase would also help pay for fire trucks, new stations, training and additional staff needed to help handle the increased call volume.
Calls grow, reimbursements lagNo single factor is driving the uptick in calls, but population growth, more visitors and an increasingly active population are likely contributors, Sholes said.
“It’s part of what’s going on in this community. It’s a very active community. It’s a good place to retire,” he said.
While an aging population could be a small part of increased demand, Sholes said there has not been significantly more older patients calling for care.
But it is not the growth in call volume alone that is causing the problem for the district, it is the lack of full payment for services.
About 25 percent of the time, medics care for patients who are not transported to the hospital, and the vast majority of the time, the district cannot charge for those services, Sholes said. The services that EMS can charge for are largely tied to transportation, a standard set by the federal government.
There are a few exceptions to the rule. For example, if a patient needs to be put on a heart monitor or treated for a diabetic emergency in the field, the district could charge for those services, he said.
Even if ambulance staff take a patient to the hospital, the district is likely not going to receive full payment.
An average bill for EMS services is about $1,080. The exact amount is determined by the care a patient receives and the distance traveled, Sholes said.
The district may not see full payment from those who have private insurance because they may have high deductibles they cannot afford or they may be unable to pay the balance of their bill.
For low-income patients, the district offers payment plans and will provide matching grant funds for the district’s internal budget. But that has become far less common after the expansion of Medicaid in 2014, when far more people started to qualify and sign up for it, Sholes said. More than 20 percent of the district’s patients are on Medicaid.
Medicare reimburses the district for about 45 percent of what it costs to provide services, and Medicaid reimburses the district for about less than 20 percent of cost.
The Emergency Medical Services Association of Colorado has been lobbying the Colorado Legislature to increase its Medicaid reimbursement, and a 9 percent increase went into effect in July 1, said Tim Dienst, chairman of the advocacy committee for the association. The association plans to continue to lobby for increased reimbursement, but it is tough because there are so many competing priorities for state funding, he said.
“People want parks. People want roads ... They think about the things they use every day. They don’t think about the things they might need,” he said.
Privatizaton not a solution
Despite the Medicare and Medicaid shortfalls, if the EMS system was separated from the fire department and privatized or run as a separate public agency, it would be a step backward, Durango Fire Chief Hal Doughty said.
“Neither one of those systems will work without the other one in place, for the current size and structure that we’ve got,” he said.
All of the staff members with Durango Fire are cross-trained to work as firefighters and paramedics, which provides important flexibility within the system. If the systems were separated, it wouldn’t leave adequate staff for fire or emergency services, he said.
If a private EMS company were brought in, it is also likely it would provide fewer ambulances and less experienced staff and only be willing to cover calls in Durango city limits, where the majority of calls happen, he said.
“I don’t think our community wants a lower quality of care and a lower number of units, at a higher price,” Doughty said.