Affordable Care Act ‘devastating’ for ambulance service
March 25, 2015
Minden, Nev. — Calling the impact of the Affordable Health Care Act on East Fork Fire District's ambulance service "devastating," Chief Tod Carlini laid out the district's budget for commissioners on Tuesday.
"Since its enactment, we've had a $500,000 loss in ambulance revenue," Carlini said. "Affordable health care is somewhat of an unfunded mandate impacting many health care providers."
The district compensated by dissolving the East Fork Paramedic District, which will take effect on July 1.
The duties of the paramedic district will be taken over by the fire district. The move saved the district enough money to balance the budget this year, but it will face a challenge as more people enroll in the program.
According to Carlini, the mandatory loss estimated for 2015-16 will be $2.33 million, which is more than the $2.2 million total collection loss the district had this fiscal year. Of that only $667,000 was actual bad debt. The rest was the result of government and contractual losses.
"If you're experiencing this, what's happening throughout the country," Commissioner Nancy McDermid said. "What do you hear about how you're going to solve this. We can't continue this way, or we're going to bankrupt systems."
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Carlini said that there's hope a change in how the state works with Medicaid will help offset some of the costs.
The district anticipates a 4 percent decrease in its total budget from $13.95 million this year to $13.43 million for next fiscal year.
In addition to the ongoing ambulance write-offs, Carlini said it's difficult to tell what will happen with over-time, since that's dependent on what happens during fire season.
During this fiscal year, in addition to the Clear Creek fire, the district responded to summer flash floods and wind storms that caused substantial damage in December and February.
Carlini said the district intends to continue to do its own billing.
He said they looked at private billing, and found that it cost more than the district was able to do on its own.
"We also get person to person contact with the people we serve," he said. "With our demographic, we have a lot of older people who like to come in. We send them out with batteries for smoke detectors, and information."
Carlini said that the district is projecting an increase in calls for service to 6,000 for 2015. Calls jumped in 2014, from 5,452 to 5,847. He said the district saw a 7.2 percent jump in calls which can partially be attributed to the increase in the number of people who are insured under the Affordable Health Care Act. The majority of the increase in calls were for emergency medical service responses.
The district's daily shift strength has remained stable at 19 per day over the last seven years. Seven career staff members are based in Minden-Gardnerville, with four in the Gardnerville Ranchos, four in northern Douglas County and four in south county.
The ratio of volunteers qualified for fire attack are 39 to 45 in support roles. Carlini said a dozen new volunteers are participating in the district's firefighter academy.
He said that 85 percent of the district was able to maintain an ISO protection class 3, which has saved residents and businesses an estimated $18 million on their fire insurance since 2005.
Carlini said that equates to $112-235 a year for homeowners.
"That's better than any tax reduction you could afford to give people," he said.
He said that when people receive their tax bills there will be a large increase in the East Fork Fire District's share, due to the absorption of the paramedic district. In order to ensure that residents know what's happening, he may seek to have the paramedic district listed as 0.
The paramedic district collects 15.92 cents per $100 assessed valuation, while the fire district collects 32.82 cents.