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LAFD Emergency Medical Services – Values, Billing and Receipts

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VOICES-Before there was an LAFD Emergency Medical Services (LAFD-EMS), ambulance personnel would give “First Aid” and take patients to the City’s Receiving Hospitals.  In the early 1970s, this “scoop and run” service was transformed as Paramedical services began to deliver specific and sophisticated medical care at the scene.  They would clean wounds, stabilize fractures, give intravenous medications and perform Cardio-Pulmonary Resuscitation (CPR).  Two levels of expertise produced two new sets of qualified and certified medical professionals; Paramedicals and Emergency Medical Technicians (EMTs).

Now, the LAFD-EMS has a staff of over 1,000; about 300 of whom are qualified Parameds.  Most of the rest are Emergency Medical Technicians.  They answer over 80% of the LAFD Dispatch’s Incident/Response calls, annually.  In FY2013, these calls resulted in dispatching over 350,000 ambulance trips and over 211,00 patient transports.  In FY2014, these calls resulted in dispatching 430,630 ambulance trips and 216,702 patient transports using 41 Basic Life Support (BLS) and 93 Advanced Life Support (ALS) ambulances.  All of these numbers continue to increase by about 5%, year after year.

The LAFD-EMS staff evaluate and stabilize the patients at the scene. They work in close association with Emergency Room Physicians in the local public and private hospitals; becoming extensions of those Emergency Rooms in the field. 
The City of Los Angeles can take justifiable pride in the fact that the concepts and methods or the Parameds started here and that our LAFD-EMS continues to be the best example and primary model for similar programs all across the country and the world.

ECONOMICS

The value of the LAFD-EMS to the health and safety of the people of the City is beyond measure.  The LAFD-EMS is firmly established as part of the LAFD but, practically, the LAFD-EMS is an expensive, extra activity.   It had an budget of $ 169 million in FY2014-2015 and a budget of $ 189,879,313 proposed for FY2015-2016. 

However, Public Health services are supposed to be the financial responsibility of the State of California and are supposed to be delivered by County facilities.  That is why we have five County Hospitals serving the City of Los Angeles. 

These authorities are very complex, very political and very intransigent.  Most of the funds for these Public Health services come from the Federal Government as it determines the rates it will pay for Medi-Care and Medi-Cal services.  It is not certain how the Affordable Care Act (“Obamacare”), which will provide health care insurance to many more Californians, will effect the people of the City of Los Angeles and its ambulance/medical services.. 

The County of Los Angeles operates an emergency medical system but doesn’t have its own ambulances.  The County contracts with four private ambulance companies to serve seven County areas, all of which are outside the City of Los Angeles.  Other cities including Burbank and Chicago bill patients who receive medical care.  The City of San Francisco bills for medical care and for ambulance transports but it is a special case; the City of San Francisco and the County of San Francisco occupy the same land mass.

The LAFD is fully aware that it is “good medicine” to provide essential medical services first and then consider billing and receiving payment, later.  Still, running the LAFD-EMS has real  costs.  The LAFD-EMS had an budget of $ 169 million in FY2014-2015 and a proposed budget of $ 189,879,313 for FY2015-2016.   The LAFD-EMS provides over $ 80 million worth of medical care but it only bills for its ambulance transports.      

This article focuses on the values, costs and collections of the LAFD-EMS.  The LAFD-EMS ambulance services were among the three largest sources of unreimbursed collectibles in the City.  In FY2011-2012, the “new” Inspector General for Collections reported that 316,866 incident/responses and 192,737 ambulance transports produced billable charges of $ 234 million but collections were only $ 68 million; a $ 166 million short-fall.  Although the City’s cost for each transport is over $ 1,400, the City was paid only $ 352 for each transport.  The LAFD-EMS experience emphasizes why it is so important to create an effective, Collections Systems under a permanent Inspector General for Collections.

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I believe that:

  • The LAFD should gather and publicize more data defining the populations served by the LAFD-EMS; focusing on medically indigent, self-paying, private insurance paying, Medi-Care covered and Medi-Cal covered people.  They should use these data to devise humane and appropriate charges (policies) for each group. 
  • The City Council should resurrect, review and reconsider for approval the 2006 Council File (#06-3126) which speaks of adapting the (insurance-like) plan of the City of Burbank … a $ 48 per year per household fee to cover the costs of EMS services.  
  • The City review and take appropriate action with County, State and Federal authorities to clarify and rectify the legal, moral and financial responsibilities for the LAFD-EMS. 
  • The City should gather, define and approve policies to establish the direct and indirect costs (salaries, equipment cost & maintenance, administration and operating expenses) so that the City can charge and recover these expenses, when feasible and when appropriate.
  • The City should diligently pursue the implementations of State Assembly Bill (AB678), which is an attempt to equalize (raise) Medi-Cal payments to match Medi-Care rates. This could increase revenue to the City by $ 12 million, per year.


On April 21, 2015, the Controller published an audit of the LAFD-EMS recommending very similar actions to those above,  The Neighborhood Council Budget Advocates have made similar recommendations for the last three years.

Now, it is time to put these ideas into action.

 

(Daniel Wiseman is a long-time Neighborhood activist and an occasional contributor to CityWatch.  He has served as an NC Budget Advocate.  The views expressed here are his own.)

-cw

 

 

 

CityWatch

Vol 13 Issue 35

Pub: Apr 28, 2015

 

 

 

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