Patient charges for ambulance rides will rise by 9 percent in San Diego beginning Wednesday and an additional 15 percent on Jan. 1, following the City Council's unanimous approval of an amendment to the city's contract with its paramedic contractor.
Base rates charged by American Medical Response range from $1,631 to $2,154, depending on the level of care required by an emergency call. The new range will be $2,022 to $2,671.
The rates for basic care are already the highest in the county and will remain so. For advanced life-saving needs, the new rates will be just a little over the county median.
"When a constituent calls 911, they need to be assured that an ambulance is going to show up," Councilman Mark Kersey said.
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Tom Wagner, AMR's western region chief executive, said the increases will not directly hit most consumers since 57 percent of the transported patients are covered by Medicare or MediCal, and others have their bills paid by insurance companies. The company also has a program to help indigent patients with their bills, he said.
According to Wagner, AMR — which pays the city $10.7 million annually — expects to lose $7.2 million in its San Diego operations under terms of a contract signed in 2011, with the company being squeezed by pressures affecting paramedic services nationwide.
Stewart Gary, with the Folsom-based consultancy firm Citygate Associates, said the portion of transported patients covered by Medicare and MediCal just a few years ago was 30 percent, and now it has nearly doubled. Medicare reimburses ambulance services $430 while MediCal provides $135, amounts he said do not come close to the cost of responding to a call.
Additionally, medics are seeing an increasing amount of patients who are not experiencing an actual medical emergency, though they might need to see a doctor sometime during the day, Gary said. He said about 28 percent of calls do not result in transports to a hospital.
Triaging 911 calls is "a crisis in the U.S.," according to Gary.
San Diego Fire-Rescue Chief Brian Fennessy told the council members that his agency is looking at ways to improve the triaging system.
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The amendments to the contract passed by the City Council also reduce the number of geographic zones used to track response times from eight to four. Before this year, AMR had trouble meeting response time benchmarks and had to pay penalties, but Gary argued that the eight zones did not properly reflect operational realities.
The city plans to take the ambulance contract out to a full bidding process next year, and a completely new deal with AMR or some other company could take effect in 2019.
