If the Colusa County Board of Supervisors anticipated better news about the ambulance situation before AP Triton’s valuation study, they didn’t get what they were hoping for.
Scott Clough, principal of AP Triton Consulting, confirmed last week what Sierra-Sacramento Valley EMS Agency said previously: the volume and kind of transports in Colusa County do not support the cost of providing ambulance services.
“From a transport to revenue perspective, the system is financially unsustainable at the current volume,” Clough said.
Over the last few years, Enloe Medical Center provided one 24-hour ambulance operating in Colusa County and one 12-hour ambulance, until they could no longer afford to subsidize the services, and cut the part-time unit.
The primary problem for the provider is that the majority of patients in Colusa County the ambulance transports are on Medi-Cal or Medicare, which have far lower reimbursement rates than private insurance.
According to the report, the single Enloe ambulance makes about 1,014 transports per year, of which 51.6 percent are Medicare reimbursements, which pay $589 per transport, with a small share of cost passed to the patient. Medi-Cal’s reimbursement is only $174 per transport, with no share of the cost required by the patient. Combined, they account for 78 percent of the total transports, Clough said.
Because this population group, and the coverage they receive, has a cap on the benefit that does not cover the actual cost of the system, it means even an increase to the rates would not generate an increase in the revenue, the report states.
Blue Cross and Blue Shield reimburse at $3,152 and $4,112, respectively, per transport, but they, along with other commercial insurances, account for only 9 percent of total transports.
“As costs increase and revenue decreased, the operator was forced to reduce the total daily coverage (in Colusa County) to a single 24-hour unit,” Clough said.
While Clough said this was a necessity from a financial standpoint, he believes it created a dangerous scenario for the community at large. In some situations, back up ambulances are pulled from out of the area when the single ambulance was in use, resulting in longer wait times for patients, he said.
Clough believes that sustainability of an ambulance service in Colusa County will have to be found in a combination of factors, including modifications to the system rates, aggressive billing and collection practices for patient share of costs, and a system redesign that will help provide for increased federal reimbursements.
“It is the opinion of this consulting firm that the potential for a Fee-for-Service-based emergency ambulance provider to meet the demands of the system, along with generating a profit, will be a significant challenge,” the report states. “Thus, the overall goal may be better focused on meeting costs with the end result of breaking even as the new baseline. This may be best achieved through innovative approaches, such as more cost effective deployment models, greater community involvement (tax assessment), alternative funding solutions, public education, and cost sharing on a multi-county regional approach that brings a greater economy of scale. The positive aspects of this approach will be that Colusa will be able to create a more stable system, but in the long term may be better positioned to deal with future changes in health care and transitional financial changes that take place, such as the current COVID-19 crisis.”
County officials said they would continue meeting with local fire chiefs on a solution to the ambulance crisis, which may include the addition of Basic Life Support ambulances to handle non-life threatening transportation.
Colusa Fire Department already has a basic life support ambulance, and Maxwell Fire Protection District is in the process of outfitting a basic life support ambulance.
While officials said BLS units will help relive some of the transportation issues, decisions will ultimately have to be made to create a taxpayer-supported, government operated ambulance service, which would ultimately generate the greatest leverage for federal funding. ■