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EMS studying subscription services

Tuesday, June 3, 2008 by Mark Richardson

When there is a medical emergency, it is good to know that Austin-Travis County has one of the highest rated Emergency Medical Services in the country.  However, shock may set in a few weeks later when the bill arrives for the ambulance. The cost can run to more than $1,200.


City officials are now looking into a plan that could help cut the cost of a 911 call down to a small amount and perhaps even nothing. It is called Subscription EMS, a program that has caught on in many other states, including California and along the East Coast.


The basis of the program is that a customer can pay a subscription fee (most programs claim that it is not insurance) that will guarantee that EMS will accept whatever the client’s insurance company reimburses for service. There are a number of variations, and the annuals fee can range from $35 on up to $100 and higher.


John Ralston, assistant director of administration and finance for ATCEMS, briefed the Public Safety Task Force Monday on what the city is considering as a way to improve the cash flow of the EMS, while offering potential clients a way to cut costs.


Under the subscription plan, “When a client pays a fee, if they need an ambulance and a fee is generated, EMS will accept whatever insurance pays as payment in full,” he said. “This type of program has been in place and successful in a number of areas around the country.”


Ralston used the example of the East Texas Medical Center in Tyler, which serves a large area of East Texas. He said that hospital’s program brings in about $950,000 a year.


“There is a 1 to 2 percent utilization rate in their program,” he said. “The means the program keeps almost all of the money.”


Ralston said his research showed a common annual fee of between $35 and $60 to subscribe to the program.  He said there are several pros and cons to the program.


“Of course, it’s part of a new revenue stream for the department,” Ralston said. “It can also be a big help for people on a fixed income. There are some potential problems though with service expectations. Some people may feel the subscription entitles them to call EMS for anything, and that can generate a lot of non-emergency calls.”


Task force members had several questions: Does the fee cover an entire family or just the individual? Can you exclude habitual EMS users? Are helicopter ambulance calls included?


Ralston said ATCEMS currently collects about 50 percent of the EMS fees it bills, but he said the collection rate is much higher for those individuals who have insurance.


“Our current policy is to collect beyond what a client’s private insurance will pay,” he said. “We are not allowed to collect on Medicare or Medicaid accounts,” beyond what the federal government pays.


Ralston promised to have answers to the task force members’ question and a more developed plan by the group’s July meeting.

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