East Pierce EMS sees increase in calls, raises transport fees

When residents of East Pierce Fire and Rescue think of their local fire department, they may think of large red trucks, long yellow hoses and athletic men and women wearing full face masks and oxygen tanks while fighting a house fire.

In truth, this is only a small part of East Pierce. Of all the calls made to the fire district in 2014, 74 percent of them requested not firefighters, but the district’s emergency medical services.

Assistant Chief Russ McCallion presented the EMS 2014 performance and analysis report to the fire commissioners June 16.

Although the report was filled with positive news of increased CPR survival rates and low per capita call volume, McCallion said he predicted call volume to continue to increase during the next few years.

In order to keep up with the aging baby-boomer generation, McCallion urged the commissioners to pass Resolution 774 to increase EMS transport fees.

The resolution passed unanimously and is being implemented July 1.

Call volume analysis

According to McCallion, approximately 7,000 calls were made to EMS in 2014, or roughly 19 calls per day.

This is a 9 percent increase from 2013.

McCallion said call volume will continue to increase in the future for several reasons.

“Many of us fit in the Baby Boomer generation profile,” McCallion said during his presentation. “Ten thousand people every day are turning 65. People over the age of 65 use EMS at a rate four times higher than people younger than 65. So that has an influence on our call volume.”

McCallion also said a shortage of nearly 130,000 physicians in the U.S. will affect call volume because more people will turn to EMS when they find it difficult to access the health care system.

Call volume will also increase as more senior living facilities and memory care facilities are built within East Pierce’s district, McCallion said.

“People in assisted living centers and memory care centers use 911 services at a disproportionate rate than people who are healthier and live on their own,” McCallion said. “All this is going to drive up call volume.”

McCallion predicted that by the end of the decade, if not sooner, East Pierce will have to re-examine EMS staffing levels to continue to provide effective services in the district and give EMS crews reasonable workloads.

Although call volume is increasing, East Pierce EMS call volume is well below the area average.

According to McCallion, East Pierce EMS received 78 calls per 1,000 people in 2014.

The area average, which combines West Pierce EMS, Central Pierce EMS, Graham Fire, South Kitsap and Lacey Fire District No. 3 service calls, is 86 calls per 1,000 people.

Survival rates

Over the last four years, East Pierce EMS has seen a large increase in patients surviving CPR and defibrillation after suffering heart failure.

Between 2006 and 2010, the survival rate for patients who needed defibrillation was 10 percent.

For the last four years, EMS has increased the survival rate to 40 percent.

“Mind you, these are small numbers,” McCallion said in a later interview. “We average about eight to ten of these patients a year.”

From 2011 to 2014, EMS attempted 170 resuscitations of various types. Of those, 16 patients left the hospital alive.

Transporting patients

In 2014, EMS transported nearly 5,000 patients to nearby medical facilities, McCallion reported, which averages nearly 14 people a day.

“That is an increase over two years of 16 percent,” McCallion said. “That rate of increase is not sustainable and will impact our operation.”

McCallion also said 73 percent of all EMS calls result in transporting a patient,

86 percent of all transported patients are district residents and 65 percent of patients are transported to Good Samaritan Hospital in Puyallup.

In total, East Pierce EMS billed $5.2 million in 2014, but only collected $2.3 million, a collection rate of 44 percent, which McCallion said was average.

The average EMS bill, according to McCallion, is around $1,050, but EMS only collects around $460.

This is because Medicare and Medicaid, which is the insurance of 73 percent of East Pierce EMS patients, pays East Pierce a flat rate for every bill East Pierce sends them, no matter the amount.

Increased transportation fees

Effective July 1, EMS transportation fees for all patients will be increasing, but this doesn’t mean patients will have to pay more.

The new milage fee, which affects all EMS patients, will increase from $19.50 per mile to $22 per mile.

Basic Life Support services, which includes CPR, defibrillation, AEDs and a limited amount of medication, will now cost $850 instead of $700.

Approximately 29 percent of East Pierce EMS patients receive only Basic Life Support services when being transported by East Pierce.

The cost of Advanced Life Support Services 1 fees, which includes making surgical airways, uncollapsing lungs and administering a larger list of medication, will increase from $925 to $1050.

Around 67 percent of EMS patients receive Advance Life Support Services 1.

Finally, Advanced Life Support Services 2 fees, which includes large doses of medication and more intense life-saving techniques and materials, will increase from $975 to $1150.

Only 4 percent of East Pierce EMS patients receive Advance Life Support Services 2.

With the 14 percent jump in fees per patient transport, McCallion estimates the average EMS transportation bill will increase from $1,050 to $1,090.

However, this will not affect the 73 percent of East Pierce EMS patients who have Medicare and Medicaid.

Additionally, this will not affect the 27 percent of East Pierce residents who have private insurance either, McCallion said, because East Pierce has a policy of not collecting co-pay, or “out of pocket” costs, from residents.

“The only patients who might have to open up a checkbook and pay more would be the non-resident portion of that 27 percent,” McCallion said.

Roughly one in seven patients who fall under that 27 percent are not residents in the district, which totals to between 130 and 180 patients a year that this service fee hike may effect.

“Still, I think our rates are quite reasonable when compared to private ambulances, and the fact that we haven’t raised the rates since October 2012 and the non-salary costs of EMS are skyrocketing,” McCallion said.

For example, IV bags, which are commonly used by EMS everywhere, have increased from 50 cents to $1 per bag to as much as $20 per bag in the last two years, McCallion said during his presentation.

The new rates is estimated to increase new revenue to East Pierce by $80,000, which will go to resupplying and training EMS staff.

Reach Ray Still at rstill@courierherald.com or 360-825-2555 ext. 5058. Follow him on Twitter @rayscottstill for more news, pictures and local events.