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Frederick County mulls ambulance fee proposal

By Joe Beck -- jbeck@nvdaily.com

Frederick County soon could join Warren and Shenandoah counties in charging for ambulances fees under a proposal working its way toward the board of supervisors.

County residents heard details of the plan Wednesday night during an informational meeting at the Star Tannery Volunteer Fire and Rescue Company.

Round Hill Fire Chief Chester Lauck led the 12 people in the audience through a Power Point presentation in which he repeatedly declared that county residents would pay nothing for ambulance service if the program -- dubbed "revenue recovery'' -- is approved.

Lauck said all the costs would be borne through Medicare, Medicaid or independent insurance companies. Fire and rescue companies would write off expenses left over from uninsured or underinsured patients they aided, Lauck said. Billing would be handled by a company contracted to send the paperwork to each patient's insurer.

No new taxes would be necessary and increases in insurance premiums would be "highly unlikely" as a result of the program, he said.

"The bottom line is that there would be no out-of-pocket expenses," Lauck told the audience, adding "all the money is in your insurance plan."

Lauck said the ambulance fees will help the county and volunteer fire departments cope with sharply rising costs for fire trucks and ambulances needed to replace a fleet of aging vehicles. He also cited other equipment, training classes and electricity, fuel and other daily operating items that could be paid for through the fees.

The ambulance fees could also allow for the hiring of up to six firefighters and paramedics, he said. More personnel means faster response times and better service for residents, Lauck added.

Lauck said projections for how much money could be obtained from government and private insurers is hard to estimate, but he cited Winchester's revenue recovery rate of 70 percent as one example.

The extra money would be divided evenly between county and volunteer companies, the only feature of the plan to draw an objection from a member of the audience.

Shawn Graber, who identified himself as a Star Tannery resident and 12-year veteran of firefighting and ambulance services elsewhere in Northern Virginia, called for the county to receive 80 percent of the money. Graber said the county should receive more money to allow for the hiring of more than six firefighters, a number he deemed woefully inadequate.

"We need people in the station, boots on the ground," Graber said.

He said data he had obtained from Frederick County showed average response times for Star Tannery of more than 14 minutes in 2010 and more than 15 minutes in 2011, both well above professional standards.

Graber said Star Tannery is the only fire and rescue company in the county without a career member on staff.

Lauck said little about Graber's criticism after the meeting.

"I have to be open to everyone's opinion," he said.

Kenny Monkman, EMS billing technician with Shenandoah County's Department of Fire and Rescue, said his department instituted a revenue recovery program in February that divides up ambulance fees according to mileage and whichever company sends an ambulance on a call. The money is further divided up based on the composition of the crew, he said.

For example, the county would receive all the money reserved for a crew if all the members are career paramedics, he said. A crew that combined volunteer and career paramedics would divide the money among the companies represented up to a maximum of three companies, he said.

Chief Richard E. Mabie of Warren County Fire and Rescue Services said all ambulance fee revenue is administered by his agency and distributed among the volunteer companies to pay for various goods and services as needed.

Additional informational meetings on Frederick County's proposal are planned for 7 p.m. Oct.1 at the Greenwood Volunteer Fire and Rescue Company, 809 Greenwood Road and at 7 p.m. Oct. 9 at the Gainesboro Volunteer Fire and Rescue Company, 221 Gainesboro Road.

Each of the county's fire and rescue companies will vote on the proposal in October, and results will be counted at their association meeting later in the month, Lauck said. The results will be sent to the Board of Supervisors who may vote on the plan around Jan. 1, Lauck said. If approved, the proposal could take effect by July 1, 2013, he said.


It's idiotic thinking to say "there is no out of pocket expenses" BS Who the heck do you think pays for the insurance? Insurance rates are based on coverage items. Thanks for being as stupid as Shenandoah County.

Aw, I'm sure you could have included "warren" and "other counties" on the comment of "thanks for being as stupid as" . You know what AW you live in a county that is crazy about Growth, so you may as well move out of it to be happy.

As for me, I'm so glad I live in shenandoah county, and glad I don't live in frederick county.

"Billing would be handled by a company contracted to send the paperwork to each patient's insurer."

I'm SURE whatever company is contracted to do the paperwork ISN'T going to do if for FREE SO there is OUT-OF-POCKET costs to the taxpayers!!!!! If it was done IN-HOUSE by someone ALREADY on payroll, THEN there would be NO ADDITIONAL costs.

OR do they think we are idiots?

So you are glad you live in Shenandoah County were the only things allowed to grow are your taxes and the county government?

How many new jobs were created with the new County courthouse and the new administration building? Both were built illegally against the Virginia Constitution. Under the Constitution the county is not allowed to contract a capital debt without voter approval. Were they on your ballot for approval?

Then they used a loop hole in the law to get a new jail in another county who will get any new jobs from the building.

Let me guess, you will vote a straight Republicant ballot because you ARE AGAINST BIG GOVERNMENT and against ANY JOB GROWTH. But you LOVE big taxes. The three things Shenandoah county's government are EXPERTS at creating.

Yes, John they think the county residents are idiots. Be careful or you will get a shiny new courthouse, county administration building and jail if you are not careful.

If you want to be considered a first class idiot move over to Shenandoah County were you can get all these things as well as a reappraisal of your real estate during the worst down turn in the economy since the depression, that in my case was almost a $60,000. Yep, I'm an idiot, the real estate market hit bottom but my 50+ year old house with no improvements just became 60K more valuable?!?!

Yep, if you want to be a true idiot move on over to the county that only allows the government and taxes to grow. If I could be lucky enough to give my house away in Shenandoah's BOOMING real estate market I would be gone.

And the sad part is all the idiot republicants over here in this county think it's all Obama's fault.

ANYONE who would vote for this is the idiot. Is there ANYONE who doesn't understand that the cost of their insurance would not go up? It is high time we started getting some return for our taxes as is. Most of us get NOTHING of consequence. All I ever see is some LEO sitting along the side of the road trying to catch some one going over 25MPH-- Pass this and donations will drop more than the revenue collected. You might expect to die of an heart attack, or bleed to death while they try and find out if you have insurance. I for one will keep my donations and hope for the best. Just like the meals tax that was supposed to just stick it to visitors. However, we get stuck with it tear round. Maybe the County should rethink it's spending.
JRW, Frederick County, VA

The people who are complaining about this are the first ones to complain when it takes an ambulance to long to show up. This money is going to help ease the need for fundrainsing by the volunteers and allow them to focus more on what they are supposed to do and respond to emergencies. Its going to help put more people in the stations so when you call for help, someone shows up. Instead of raising taxes across the board, this effects the people who utilize the service. This is utilized not only in our area but across the country and it has not detered anyone from calling for help. If you call 911 now, you get a LARGE bill from the hospital and they do not practice soft billing. The EMS agency sees nothing from the transport even they they have used fuel, supplies, manpower, and put wear and tear on there equiment. The cost for the billing company comes straight from the money collected so there is no use of tax dollars to institute this. I agree there is a lot of wasteful spending at the local level, however, when it comes to public safety, the money should be there.

I thought local and property taxes are supposed to go to support the 'services' of the county? If there isn't enough tax revenue around to support the county, maybe the county is spending to much.
I live within my means (salary). Why doesn't the county?

This might be a silly question:
But how did the county 'survive' for the past 50, 40, 30, or even 20 years WITHOUT having to do this type of thing?
As people moved into the county, tax revenue should have increased proportionately the same as services required. Unless the county gov't grew more than it needed too, NO?

This is one of those “good things” that has spilled out of the “savings” from the Affordable Care Act, even though Northern Virginia is so full of Tea Party and Doubting Thomas’s that the mud throwing defies all of the goods sense. It may be one of the few goods things that we have seen come out of the past three years of standoff between the Political parties but in short it is working. The counties and all of us should want to implement this simply because on the surface it appears to be a win-win brings in more qualified 1st responder jobs to the emergency services that serves and protects all of us. That doesn’t mean the counties should not watch things carefully, keep tight with the Medicare – Medicaid organizations and the medical providers. We have been so blessed in Frederick County with our medical care programs for seniors and the reductions in costs throughout the spectrum of services. The difference in the mechanisms of the Obama administration is that the Medicare savings is moved to support the Medicaid programs and the caps imposed on the providers to provide 85% of earnings in actual health care for their patients is paying off. And of course the prescription for senior is in itself a good deal – my household saves over $450/month and enables all our kids and grandchildren coverage. So like the politics or not for us in Northern Virginia things are working and if the opponents of this ambulance idea just want to shut things down than that is as tragic as this whole political climate has become. To hurt the country because you don’t like the color or perception of the President is foolhardy – I have lots of disagreements with his politics but he is still my President and stand tall to that, served my time in wars, got my butt shot off, and with a little help now and then made it to the Shenandoah, which is one step from Heaven. Now as concerned citizens of all persuasions – let’s make it better step by good step and push out political leaders to think straight and act accordingly.

I've seen stories concerning this type of services:
Medicare Fraud Alert: Ambulance Companies Falsely Billing for Non-Emergency Transport

Last year, the federal budget took a hit of $60 billion. The same thing happened the year before that — all of it lost through Medicare and Medicaid fraud and abuse, according to the U.S. Department of Health and Human Services and the U.S. Department of Justice.

If you only knew the true facts of the Act and the true costs, you might be shocked. HHS released a report recently and the true savings aren't that much.

On September 6th the Institute of Medicine (IOM) released a report stating that the U.S. healthcare system wastes $750 billion a year through unnecessary care, outdated paperwork, fraud and other wasteful practices. The report recommends a major overhaul to the way doctors and specialists communicate to prevent misdiagnoses and to ensure that breakthroughs in medical technology are adopted more rapidly.
Source: http://www.iom.edu/Reports/2012/Best-Care-at-Lower-Cost-The-Path-to-Continuously-Learning-Health-Care-in-America.aspx

Report: About 30 cents of every health care dollar wasted; US can cut costs without rationing.

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