Calexico ambulance fee increase proposed
CALEXICO — The Calexico City Council has scheduled public hearings on Wednesday to discuss and possibly approve proposed rate increases for its ambulance and solid waste services, as well as changes to its water and sewer rate structure.
The proposed changes are the result of a series of rate studies recently commissioned by the city that determined some of the current fees did not adequately cover current and projected operational expenses.
Ambulance services fees have not been amended since 1992, resulting in annual operational deficits of about $3.7 million in fiscal year 2017-18, said Todd Burton, a consultant with Temecula-based Willdan Financial Services, which conducted the rate studies.
“They are about four times lower than our neighboring agencies as well as comparable state agencies,” Burton said during the council’s June 6 meeting. “It’s extremely low and well overdue.”
The proposed ambulance rate increases would also allow for the city to hire additional Fire Department personnel to adequately staff another ambulance unit, bringing the number of units available around the clock from one to two.
“We’re looking at potentially double and triple in revenue collected with the additional staff and ambulances in circulation,” Burton had said.
The current rate structure also does not adequately charge for varying levels of ambulance and paramedic services, further resulting in lost revenue, he said.
Ambulance services made up more than 80 percent of the nearly 5,000 calls the Calexico Fire Department had received so far this fiscal year.
Departmental staffing shortages resulted in only about a third of those calls for service resulting in transportation of patients, further resulting in the loss of potential revenue.
Ambulance services are broken into six billing categories:
• Advanced life support level 1 emergency
• Advanced life support level 1
• Advanced life support level 2
• Basic life support
• Basic life support emergency
• Against medical advice
The vast majority of calls for ambulance services were designated as advanced life support level 1 emergency, which currently cost patients $449. If approved, the new rate for such services would rise to $1,410.
The proposed rate increase also would raise the cost of ALS level 1 and ALS level 2 services from their current rate of $449 to $1,368 and $1,431, respectively.
The “against medical advice” category corresponds with a subject’s denial of any medical attention by responding CFD paramedics.
The current fee structure does not charge patients who sign an AMA form. Under the proposed rate hike, the fee would be $442.
The fact that the city and department had gone so long without an ambulance rate increase appeared to frustrate several council members, who indicated early support for the proposed changes during their June 6 meeting.
“It’s just very unfortunate that it took 26 years to get this done,” said Councilman Armando Real.
Mayor Maritza Hurtado expressed disappointment that the city’s third-party medical billing provider had failed to notify the city of its relatively low ambulance fees, resulting in both the city and the billing agency losing out on potential revenue.
Councilman Jesus Eduardo Escobar had also asked Burton whether the city’s ambulance service reimbursement rate of about 50 percent vastly exceeded the rates of other comparable cities.
Escobar also had asked how the city could “aggressively pursue” non-payment for services rendered.
Although Burton had said that some larger cities may see a reimbursement rate of about 60 to 70 percent, their operations are often also subsidized by general fund monies.
“You’re really not far off the mark,” he said. In response to a question from Councilman Lewis Pacheco about the hiring of additional Fire Department personnel, City Manager David Dale had told those present at the June 6 meeting the city has already begun advertising the open positions.
“If this doesn’t pass, of course we won’t hire anybody,” Dale had said, referring to the proposed fee hike that would go into effect immediately upon its passage.
The Fire Department’s ambulance program had recently been the target of a potential shut down and personnel layoffs in connection to a budget shortfall. Ultimately, the Calexico Firefighters Association and the city came to a contract agreement that closed the budget gap.
State law mandates the city cannot charge more for its services than the actual cost of providing and maintaining such services.
In regards to its proposed water and sewer rate changes, the city would do away with its monthly minimum charge for water of about $44 for a residential unit and in its place would adopt a monthly fixed charge of $17.24 plus $1.99 for every cubic foot of water used.
If approved, the new water rate schedule would go into effect July 1, and also rise 4.5 percent annually over the following four years.
Similarly, the current monthly sewer rate of about $38 would rise to about $44, with similar increases of 4.5 percent over the two following years and hikes of 2 percent in fiscal years 2021-22 and 2022-23.
The proposed solid waste rate changes include an increase from the current $18.60 monthly rate to $19.35 for a residence.
The 2.7 percent consumer price index adjustment also would be retroactive to Jan. 1, if approved.