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View Full Version : Combination vol/paid depts.


JimSpoor
12-19-2003, 11:14
Currently my squad is suffering through some growing pains and I was wondering if anyone else has experienced the same?

We are a 100% volunteer BLS ambulance that is looking at upgrading to ALS. Our closest ALS mutual aid is usually at least 20 to 30 minutes away, if it is available at all. Many times we scoop and run to the small, rural, local hospital because we can get there before ALS can get to us. The squad has recognized for years that this is not a good solution. We have finally bitten the bullet and decided to hire paramedics to provide the squad with ALS capabilities. The plan is to have a chief paramedic to oversee the ALS operations as well as cover shifts. We would then have two full time and 10-15 per diem paramedics to cover the shifts. That would give us one paramedic with an ALS fly car for immediate response on each shift. The rest of the system would remain the same. Day calls would be an all page for the crew to pick up the ambulance and respond to the call. Nights and Weekends the duty crew (vol. BLS) would respond along with the ALS fly car.

To fund this we have gone to the town and requested the formation of a tax district to fund the ALS operations, (not the squad as a whole.) After several months of meetings, discussions, community meetings, etc. the vote is set for 12/22. It is anybody's guess whether it will pass or not. I can't believe that anyone would vote against this when it will only cost the average homeowner a $20-$30 increase in their annual property taxes.

Sorry for being long winded but I needed to paint the picture. The point is we squad members are now facing two new problems. We are in disagreement with a sizable chunk of the local population and in addtion some are worried about us vs. them with the paid ALS guys. Anybody else work or volunteer in a combined aency? Who else has struggled through the creation of a tax district? Thoughts or comments?

Sandles2Sidearm
12-19-2003, 13:09
you could recommend that the community members buy transport insurance to fund your operations, those that do not purchase the insurance run the risk of being charged for calls for service and ALS care provided. A charge could also be submitted for transport/mileage.

In Newport Beach, this is the status quo as the Fire Service also provides BLS and ALS transport, private ambulance is second or third in...

Also 50/50 rigs are common in our area, you have to pay more for a medic than you do for an EMT-B, so you can split the rig and lower your costs. A Basic as an operator and a medic for ALS level calls. I guess it all depends on call volume, but if you you are still running a volunteer rig, I think it safe to assume you are not running 24 calls a day.

JimSpoor
12-19-2003, 14:56
We ran 1200 calls last year so 24 a day would be a little high. We will probably be a little above 1200 this year. We do bill and use a billing company to "soft bill" our patients. Although there is some legalese it basiclly means that we accept whatever the insurance pays and eat the rest.
Your insurance or subscription idea has merit but you start running into problems quickly under COBRA. It has been interpreted to be either over-charging or offering discounts to certain members, facilities, etc. I thnk your subscription revenue has to be within 10% either way of what you would have gained from billing or some such non-sense. I let the CPAs and lawyers worry about that.
We want to provide our communities a more prompt response at a higher level of care. A tax district seems the only way to do this, at least at the present.

Sgt Jack
12-20-2003, 02:27
Just a thought...Is it possible to try "Balance Billing" your patients or is that not possible due to regulations..Not sure that would cover all your costs either... How many communites does your squad service?..and your current ALS provider are they another call squad..hospital based or private company?...

unit83
12-26-2003, 18:42
:idea: We have a similar sized dept and have been billing thru a contract company for about 3 years. They do a good job and we went to a paid crew 12 hours per day about 2 years ago. We are now considering 24 hours per day paid. We have not touched or requetsted any additional tax funds. and we buy a new rig every two years.