Palo Alto mulls new fees for emergency medical services

City considers charging for services that don't require ambulance transport

Riding in an ambulance during a medical emergency is rarely a pleasant experience.

Neither is receiving the bill afterwards, which in Palo Alto can top $1,700.

But for the city's Fire Department, which provides paramedic services, charging customers for medical response is in some ways an all-or-nothing proposition: They either transport the victim to a local hospital and charge the requisite fees (which vary based on miles traveled, services rendered and other factors) or they don't transport them anywhere and do not charge them anything. In the existing system, the reimbursement model is based exclusively on transporting patients. Even if paramedics render aid and use medical supplies, they have no ways of charging for these services.

That, however, may soon change.

On Tuesday night, the City Council Finance Committee discussed a proposal to create a "treat and no transport fee" that would address situations in which someone receives medical care from the city but does need to be taken to the hospital. The committee authorized a request from Fire Chief Eric Nickel to begin conducting community outreach about this proposed fee.

One of the goals of the new fee is cost recovery. Currently, the city sends a fire engine or a ladder truck to all emergency medical calls, which now make up an overwhelming majority of total calls, according to city data. The vehicles, manned by emergency medical technicians and paramedics, often arrive before the ambulance and provide immediate emergency treatment. Yet the cost to deploy these employees and render the service has no recovery mechanism in the current municipal fee schedule.

In his presentation, Nickel said the department wants to be in a position where it can offer services to residents who don't need to go to the hospital and charge them a different fee from the ones that get transported. The new "treat but not transfer" fee would likely be in the range of $375 to $450, Nickel said.

He noted that in many cases, the fees that the city charges patients for transport are reimbursed by insurance companies. By contrast, the city cannot receive any reimbursement for services that don't require a hospital visit. The cost of these services is swallowed entirely by the city and, hence, by the taxpayers.

"I personally feel the taxpayer should not be subsidizing the insurance carriers if we do not attempt to recover the cost of our service," Nickel said.

The department is also considering situations in which fees should not apply at all, he said.

"If someone gets into accident, someone else calls 911, and if the person is not hurt and doesn't want treatment, we'd have a process to waive those fees," Nickel said.

The proposal comes at a time when medical calls are on the rise, a trend that is expected to continue as the large baby boomer generation gets older. According to the city's 2013 performance report, the department received 4,712 calls in the medical/rescue category in fiscal year 2013, up from 4,484 in 2012 (by contrast, the city received 150 calls relating to fire in 2013). The department made 3,523 ambulance transports in fiscal year 2013, up from 3,220 the prior year.

In the vast majority of the cases (91 percent), a Palo Alto responder arrives within eight minutes of the call, compared to the 12 minutes it takes for ambulances elsewhere in Santa Clara County. Residents have been generally happy with the services, with 93 percent ranking them "good" or "excellent" in a recent Citizen Survey.

Nickels said Monday that in addition to helping recover costs, the new fee would align with the department's objective of providing more services that do not require hospital visits. It would also be consistent with provisions of the federal Affordable Care Act, also known as Obamacare. The act provides incentives for preventative care and alternate treatment options, particularly those that reduce costs, according to a report from the Fire Department.

"We want to not take them to a hospital," Nickel said. "We want them to stay home and be independent. If we can do that, like we've done with fire prevention, we all win."

The four-member council committee unanimously backed Nickel's request to begin doing outreach, though Councilwoman Karen Holman acknowledged she has "mixed feelings" about the cost-recovery argument. She said she was particularly concerned about low-income residents who may have a hard time paying the fees.

"The last thing you need (in that situation) is to get dragged into a small-claims court and get harassing letters," Holman said. "We want to be a compassionate community."


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Posted by senor blogger
a resident of Palo Verde
on May 8, 2014 at 8:59 am

We don't have firemen anymore, we have ambulance drivers that get paid over $200,000 per year.
Its time to outsource emergency response to Paramedics as other cities (including Santa Clara County) have done.
This will let the Fire Dept. fight fires as they are trained to do. This will also let us find out how many firemen we really need in this city.

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Posted by Wayne Martin
a resident of Fairmeadow
on May 8, 2014 at 9:37 am

> Nickels said Monday that in addition to helping recover costs,

The Fire Department has been receiving at least $26M a year as base funding from the yearly budgeting cycle. Where does this money go? If this a "freebee" because Fire Firefighters have a guanteed job, whether they work or not?

Every knows that the number of actual fire-related callouts has dropped to about 2%-3% of the total calls-for-service. This is pretty much a national phenomenon, based on ever-better fire codes, use of sprinklers, and less smoking in bed. So--what are we paying $26M to the FD for?

(Oh, and this 26M generally doesn't cover any capital costs.) Keeping in mind that FFs are now about the highest paid employees in local government--maybe it's past time to consider merging fire departments, and other local public safety units, to look at seriously reducing costs.

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Posted by Josh
a resident of Another Palo Alto neighborhood
on May 8, 2014 at 10:13 am

I thought our local taxes cover this service? Real hard to get behind this when our Firefighters are making $100k to 200k per year in base salary and overtime.

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Posted by Kate
a resident of Duveneck/St. Francis
on May 8, 2014 at 10:20 am

The City is planning a 7% raise for its employees, and it has the gaul to raise fees like the one proposed because this will hurt seniors especially. Another way to drive seniors out of town. There are accidents, illnesses that can be treated and the victim/patient not sent to the hospital.The cost of an ambulance right now is outrageous anyway. It is only 1/6 (that's one-sixth) of a mile from the Palo Alto Clinic Urgent Care to the Stanford ER, and the cost is about $1,500. The charge is by-the-mile plus medical services. So listen up, fellow residents, don't get sick, hurt, or old. What will employees and council members be charged? Come to think about it - what are they charged NOW?

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Posted by A resident
a resident of Duveneck/St. Francis
on May 8, 2014 at 11:02 am

Am I the only one feeling that we are double-charged?

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Posted by CrescentParkAnon.
a resident of Crescent Park
on May 8, 2014 at 11:10 am

Why is the only thing our city council can do competently is figure out ways to raise the prices and create fees to take our money, while at the same time lowering service and any expectation that our local city government might do something FOR its residents?

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Posted by Need a Recall
a resident of Old Palo Alto
on May 8, 2014 at 11:17 am

Wow. We're flush with tax revenue, which goes to employee raises and to hire more bureaucrats (which further digs the pension hole for our children).

Then they want to raise taxes to pay for neglected infrastructure.

Then they want to raise fees to "recover costs"

Then they want to "change" the Utility Users Tax to try to tax our cell phone usage.

The incumbents need to be voted out in favor of residentialist realists, preferably with some common sense regarding money. This would typically be a hard requirement, but given that this current council has absolutely zero fiscal sense, its impossible to go down.

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Posted by Barbara
a resident of Downtown North
on May 8, 2014 at 11:32 am

NO, do NOT outsource our emergency services. What's with Senor Blogger? Paramedics and emergency techs provide an important service. They are close by and vital to our community. Forget about how much they make. . .they earn their money.

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Posted by AGREE
a resident of College Terrace
on May 8, 2014 at 11:45 am

I agree Barbara.

It is very easy to sit back and complain about everything the city does...but wait until your family member is suffering from a heart attack or your house is burning down. Do you want to wait an additional 4 minutes to have emergency services arrive from out of the area?

We need to have people nearby and trained...and are YOU willing to run into a burning building to save someone you don't know? Takes a brave, well trained person to do that...and they're worth their salary to do that.

Think twice before you outsource we've done with so many jobs in this country.

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Posted by bob
a resident of Charleston Gardens
on May 8, 2014 at 11:53 am

Firemen make to much money now, This would mean they would have nothing to do but collect money for every thing they would do. Say NO to this bad idea.

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Posted by Realistic
a resident of Adobe-Meadow
on May 8, 2014 at 11:54 am

Firefighters don't run into burning buildings anymore. They show up with six people at any medical call and drive ambulance runs.

Yes, they fight the odd fire, but it is so rare and much safer these days that the job of firefighter is statistically much safer than farmer, construction worker, machinist, or any other much lower paying blue collar job, and only slightly more hazardous than being a cashier or accountant.

Outsourcing is fine. Service will not suffer if part of the outsourcing requirement is that responders be based throughout the city, as they are now. 100,000 dollar firefighters will do the job just as well as 200,000, and the huge savings could be applied with much greater effect elsewhere (more police, underground utilities, etc.)

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Posted by Old an
a resident of Old Palo Alto
on May 8, 2014 at 11:57 am

Our taxes will cover only the City Manegement expenses, which is......
Mr Nickel, you have left out an important potential fee!

A 911 call. Responding officer and/or firemen must SWIPE a credit card before doing their city tax funded jobs, fee should be charged for every person in the home,

Initiate a new slogan "no pay up front , No Service"

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Posted by Jim
a resident of Downtown North
on May 8, 2014 at 12:29 pm

I don't know why people keep blaming the firefighters. My mother lives alone near me, and she had a stroke a couple months ago in her apartment. She wasn't able to answer the door when the fire trucks arrived, so the firemen had to break down the door with special tools. I was told later that ambulances are not trained in that type of activity. I for one, am happy to have the fire dept, as it seems they can do a lot of things that the ambulances cant do. They do A LOT more than just fight fires.

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Posted by Alphonso
a resident of Los Altos Hills
on May 8, 2014 at 12:40 pm

Collecting fees for emergency services is a good idea because it helps subsidize the fire department. The rest of Santa Clara county outsources ambulance service to Rural Metro - slower service, less qualified people, less money going back to the cities to cover the fire programs and higher fees to the patients they serve. Furthermore the fees being collected are covered by most medical insurance policies.
If you are worried about saving money don't call for an ambulance unless you really need it.

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Posted by JerryL
a resident of Adobe-Meadow
on May 8, 2014 at 1:53 pm

My wife is alive today because PA Firefighters got there when they did
and the resuscitation prep work was done when the ambulance arrived
several minutes later. If they had wanted to charge me $450 I would
not have complained.

But, at the same time, I recall that her ambulance fee was mostly taken care
of by insurance. If the "no transport" fee is too high, people will want to
start submitting the bills to their insurance company. Then the PAFD will
start getting deluged with paper work imposed by the Insurance Industry. So, if the city is not careful, the net gain from charging the fee could be wiped out by the extra administration. So yes to the fee but keep em manageable by the average Palo Altan please.

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Posted by jerry99
a resident of Barron Park
on May 8, 2014 at 3:51 pm

Use the SURPLUS money that is burning a hole in the City Council's pocket to pay for any Fire dept. paramedic and ambulance service. The city should not charge individuals for this except for those that use this service.

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Posted by Legal????
a resident of Crescent Park
on May 8, 2014 at 6:10 pm

This sounds like double taxation. As a former attorney, I am relatively certain that this is not legal under Clifornia law.

Unless, of course, something big has changed in the two years since I retired. However, since I still keep a hand in and receive the appropriate publications, I should think I would have heard of it or read of it if this law had been repealed.

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Posted by Greed Kills
a resident of Community Center
on May 8, 2014 at 10:40 pm

We already pay for emergency services with our tax dollars, and we have for a long time. It is wonderful that fires are much less of a threat due to technology and owner vigilance, and yet I would not want to outsource or diminish our fire department in any way - when we need them we NEED them!

With fires being less prevalent, I don't see that as a statistic that warrants charging for non-fire emergencies. If the overall PERCENTAGE of medical-related calls have increased, but the OVERALL number of calls have not (or perhaps decreased), then there is absolutely no reason to start charging residents for a service that is already paid for by tax dollars!

I love the PAFD - they also responded to our home once and were fantastic in their response time and diligence. I would not want to jeopardize the reliable service by outsourcing.

I just don't quite understand what our tax dollars are paying for if we have to pay-per-use for the services they already provide. So all of our tax dollars pay for a stand-by team in the rare event there is an actual fire?

I agree this is a proposal that hurts our seniors (who have paid taxes for decades for a service they most likely never needed), and seems to represent double-dipping - note there is no proposal to add services we don't already pay for through taxes, just one to start charging for those same services.

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Posted by Cid Young
a resident of another community
on May 9, 2014 at 3:17 pm

How are "taxes" paying for Fire Protection Services? Are property owners the only ones paying the tax? Then, renters are not being "double charged" are they? Is the Revenue from local sales tax funding the local fire department? Then the tax liability is being spread more evenly through-out the community. Here on the Coastside property-owners are assessed via a parcel tax. However, before they were recently recalled, the Fire Board Directors were taxing residents of Montara and Moss Beach about $117.00 per parcel, while the Property owners in the 2 cities to the South (El Granada and Half Moon Bay) IN THE SAME DISTRICT were only assessed $35.00 per parcel (depending on building type or vacant land etc. (WRONG WRONG WRONG). Especially when the majority of local medical emergency calls were from a senior 55+ community located in Half Moon Bay. Once we voted the Three Directors being recalled out, the Newly Elected Directors did the right thing and charged everyone in the District the same parcel tax ($35.00) District-wide. We also contract services through CALFIRE, so we pay less for unfunded liabilities in retirement benefits. (Being a Statewide Agency, the State of California handles that for their own employees. In other words, the local municipality is not paying for some cushy benefit package.

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Posted by Buster
a resident of Crescent Park
on May 9, 2014 at 9:29 pm

Definitely double-charging. Why limit double-charging to the Fire Department? Why not bill us a fee each time the meter reader comes for utilities, or the street sweeper? We already pay for these services, but why not charge us twice? Why not charge us an admission fee if we attend a City Council meeting or a public hearing?

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Posted by Henry
a resident of Downtown North
on May 9, 2014 at 10:55 pm

@ Buster - They should charge residents to vote here too!

Then the new slogan could be "No representation without double taxation."

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Posted by Silly
a resident of Embarcadero Oaks/Leland
on May 12, 2014 at 12:18 pm

Definitely double taxation.

Two different drivers ran into our PARKED car in broad daylight in two different occasions and with all the ambulances, cop cars, fire engines, motorcycle cops you would have thought we were in the middle of some invasion. Each time there were more than 20 cops, firemen and ambulance personnel!!

All for fender benders! The rudeness of the cops and ambulance drivers was extra when my husband walked outside in his bathrobe to DARE to ask for the drivers' insurance information.

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Posted by Silly is as silly does
a resident of Professorville
on May 12, 2014 at 8:31 pm

[Post removed.]

 +   Like this comment
Posted by Senior citizen
a resident of Community Center
on May 12, 2014 at 9:29 pm

Am I the only one feeling that we are double-charged? I couldn't agree more with the writer who made this comment!!

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