County may get contract for ambulances

The ambulance might be the same, but a ride to the hospital for Spokane County residents could cost up to twice as much as it does for Spokane city residents.

Even before recent acknowledgments by American Medical Response that it overbilled patients in Spokane by $320,000, fire officials outside the city have been considering a countywide ambulance contract that would bring down the cost of ambulance service. It also would hold AMR accountable for standards on how it conducts business.

“We have no control or regulation over them,” said Spokane Valley Fire Chief Mike Thompson.

Currently his department has an eight-page contract with the company that covers things like the type of ambulances it uses and the amount of equipment it must have available at a given time. Unlike Spokane’s ambulance contract, it does not charge the company for its monopoly ambulance provider status or set the rates it charges.

Jileyne McDowell was charged about $1,000 for a nine-mile ambulance trip between the fire station on Hastings Road north of Spokane and Sacred Heart Medical Center.

She had walked to the fire station to have her blood pressure checked, something she did regularly while living in Bellingham. Firefighters concerned about her condition advised her to go to the hospital, and AMR provided a nitro pill and the transportation.

“It was definitely not an emergency type of situation,” she said.

If she had been picked up 1.5 miles south of there inside the Spokane city limits, the cost would have been closer to $360 or $500 plus additional charges.

McDowell didn’t have health insurance. She called the company to object to the amount she was charged, and AMR agreed to reduce it to $669.

When she heard about the refunds given to Spokane patients she initially thought the rate might have been wrong, but it turns out that is likely the standard charge for where she was picked up.

An AMR spokesman was not able to provide specific rates in Spokane County. According to the company’s Web site, “Rates are determined by many factors such as the cost of providing the service and other economic forces in the community.”

Thompson said one Valley firefighter was charged $940.20 for an ambulance trip that was not work-related. The rate for advanced life support was $690.90 plus $13.65 per mile and additional charges.

Valley fire hasn’t received many complaints about AMR’s billing practices, he said, but officials hope a countywide contract would reduce the rates. “That’s one of the reasons we are in the process to put in an agreement,” Thompson said.

Additionally, when every county fire district and the Spokane Fire Department draw up different contracts, the result can be two jurisdictions competing for the same resources, said District No. 9 Fire Chief Bob Anderson.

Different contract language also can result in service being more expensive in some areas than others. His district borders the cities of Spokane and Spokane Valley, and sometimes the rules governing ambulance service can differ based on what side of the street a patient is on.

In years past, the ambulance contracts have come up for renewal at different times. A more global approach to setting things like maximum response times in urban and rural areas could end up improving the service countywide, he said.

“Hopefully it will be a win-win deal,” Anderson said.

Any requirements placed on AMR will recognize that the company will have to make a profit to stay here, Thompson said.

“We don’t want to control it so tightly it puts them out of business,” he said.

One of the contracts they are looking at as a model is from Clark County.

Clark County EMS District No. 2 collects $19.50 from ambulance companies each time they transport someone. Part of that pays for two people who monitor the service and make sure it complies with the contract. The district also charges ambulance providers when they don’t meet preset services levels, and historically it has brought in $35,000 to $40,000 in fines in year, said EMS manager Doug Smith-Lee.

The contract specifies that trips should cost $674.07 on average plus up to $10.45 per mile with a maximum charge of $914.81, he said.

If a countywide contract is signed here, it would likely cover Deer Park Ambulance and small ambulance providers in south Spokane County as well as AMR.

The nonprofit ambulance service out of Deer Park is run by volunteers and charges $525 for basic life support, $575 for advanced life support and $15 per mile.

In its 2003 agreement, Spokane negotiated rates lower than those charged elsewhere in the county. Base charges there are $358 for basic life support and $494 for advanced.

The recent refunds stem from the company billing patients at the advanced life support rate when basic life support was provided.