Ambulance fees alarm riders

This story is full of fail on many levels. It shows that neither BCBS nor many patients, not  “passengers” as the reporter describes them don’t understand what EMS is or what it does. Nor does anyone mention that EMS, even though we who are in it think of it as the center of the medical universe, is really a small part of medicine. That’s especially so when it comes to how  much EMS costs.

She couldn’t believe it.

A week after a doctor’s appointment turned into an emergency room visit, the Brookline interior designer was holding a $990 bill from Cataldo Ambulance — for a one-minute ride from Beth Israel Deaconess Medical Center’s east campus to its west campus.

“I could have walked,” the woman told the Pulse. “But I wasn’t given a choice. I was told, ‘You have to go to the emergency room, and here’s an ambulance.’ ”

Lady, you’re right, but you’re wrong. In a rational world, if you really had an “emergency” then you probably should have gone by ambulance, but if you didn’t you should have walked. Without knowing what your “emergency” was, there is no way to tell. However, if you were allowed to walk and suffered any injury at all, even if it was totally unrelated to your “emergency”, then you would be all teary eyed on TV and this same Boston Herald would have the typical “sad” picture of you as your lawyer told the clueless reporter about how you should never have been allowed to walk. So, whoever it was at the Beth Israel that decided you needed to go over to their emergency department was protecting themselves and the institution from exposure to liability. Don’t like it? Neither do I. Here’s what I suggest you do, call your state and federal elected representatives and demand tort reform. After you pay the bill, that is.

In March, Blue Cross made good on a long-running threat and told ambulance companies to either accept their reimbursement rates, or charge what they want and chase the passengers for the money.

Uh, MS McConville, this is an ambulance service, not Yellow Cab. Which means that the white van with the orange stripe has to meet the state regulations for design, construction, type and quantities of equipment, training of the EMTs or paramedics, and of course the insurance and operating costs. I used to be friendly with a gentleman that ran a small municipal service. He told me that when he was doing his cost analysis for his annual budget requests one year, he determined that every time one of his three ALS ambulances rolled out the door, it cost over $1,000.00 dollars. That was whether they transported or not, saw a patient or not, or got canceled while they were responding. I don’t think that costs have gone down over the years. In addition to the cost of the ambulance, anywhere from $80,000.00 to over $200,000.00, plus radios, registration and insurance costs, equipment costs (cardiac monitors cost about $25,000.00), and of course the princely salary the EMTs and medics are paid. Don’t forget that they have to be housed in garages, need fuel and maintenance, and a dispatch center. Back when I did that sort of stuff, we used to figure that for every mile on the odometer there was the equivalent of two more miles in wear and tear from idling between calls and the harsh environment in which they operate.

Ambulance companies “are charging outlandish fees simply because they can,” Blue Cross Senior Director Michael T. Caljouw told state lawmakers last month. “They know that private insurers are legally required to pay all fees for emergency services — no matter how high.”

They are charging “outlandish” fees because that’s what it takes to run a full service 24 hour a day all year round EMS system, public or private. They are in business to make a profit and even though BCBS is a “not for profit” you guys are in business to make an “operating surplus”. It’s much the same as when emergency departments charge “outlandish” fees for services. Emergency services are damned expensive to provide. That’s what hospitals have been saying for years, that’s part of why there is a health care financing crisis in this country. Not only do hospitals have to charge for their costs in keeping an emergency department open 24 hours year round, they have to charge because of the higher litigation costs they incur keeping those places open. Oh, and they have to make up for all of the uncompensated care that state and federal laws require them to provide. My advice is the same to you as it is to the patient.

“And we lose money every time a gangbanger gets shot at 3 a.m. We can spend, between manpower and equipment, over $1,000 getting him to the ER, and we never get paid for that.”

And they lose money every time they transport an indigent with no health insurance or a driver with no insurance or an illegal immigrant with no insurance. That goes more so for municipal services because they don’t have the (relatively) lucrative transfers, dialysis runs, and “returns” that the private sectors do. If the private companies lose $1,000.00 when they transport that shooting patient to the emergency department, how much do you think that the hospitals lose for treating that patient, including emergency department fees, operating room costs, surgical ICU costs, and everything else? I’d guess that if the patient survives the first day or so, the costs end up being around $50,000.00. How much do you think it costs to have an operating room and team available 24 hours a day? If you are one of those people who think that we shouldn’t do that and the ORs should be closed at night, who do you think is going to take care of you when you roll the Volvo over at midnight coming home from the wine and cheese party?

For those of you who think that this is all about evil for profit medical services at any level, I’ll point you to the cost studies of countries like Great Britain where the health care is “free”. Of course, those EMS guys get guaranteed breaks too, but that’s a different story.

This story is about far more than an allegedly greedy ambulance service and greedy insurance company. It raises fundamental questions about funding of health care, tort reform, and just what level of medical care we want to provide in this country.

Not that I expect our so called political leaders to answer those questions.